Suboptimal visual outcome after femto-LASIK ablation in a high myopic patient.

A 28-year-old nurse had an aberration-free femto-laser in situ keratomileusis (LASIK) performed for her myopia of -6.25 -0.50 × 096 and -6.75 -0.50 × 175 in the right and left eye, respectively. Corrected distance visual acuity (CDVA) preoperatively was 20/16. Preoperatively, there were no abnormalities on Scheimpflug imaging, and a pachymetry of 585 µm was measured in both eyes. Flap thickness was 115 µm. The patient was quite nervous during the surgery. Since the surgery, her uncorrected distance visual acuity (UDVA) and CDVA are suboptimal at 20/30 and 20/20 in the right eye, and 20/20 and 20/16 in the left eye. 3 months postoperatively, there is a stable manifest refraction of +0.25 -1.25 × 030 and +0.25 -0.00 × 0. The keratometric astigmatism in the Scheimpflug imaging is 1.2 diopter (D) × 114 and 0.4 D × 78 in the right and left eyes, respectively (FIgures 1 and 2). Thinnest pachymetry is 505 µm and 464 µm in the right and left eye, respectively. Her wavefront analysis shows refraction in a 6 mm zone of -0.99 -1.22 × 32 and -0.91 -0.36 × 136. The cycloplegic refraction is 1.25 -1.00 × 023 and +1.00 -0.25 × 006 (Figures 3 and 4). What is the cause of the suboptimal visual outcome in this case? What would be your treatment strategy to improve visual outcome?

Peripheral Vision in Patients Following Intraocular Lens Implantation: A Systematic Review and Meta-Analysis.

PURPOSE: To update the literature on peripheral optics and vision following intraocular lens (IOLs) implantation. METHODS: We investigated how current IOLs influence peripheral visual function, peripheral optical quality, and visual perception and performance, in patients following cataract surgery. Peripheral vision is described as vision outside the central foveal region of the eye (beyond 4-5° of eccentricity). We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Embase, and gray literature for relevant references. Randomized controlled trials and observational studies were eligible for inclusion. Finally, 47 studies with a total of 5963 participants were eligible for this review, of which 15 were included in the meta-analysis. RESULTS: Regarding visual fields, the meta-analysis showed that the pooled estimate of mean deviation (MD) measured with perimetry tests (standard automated perimetry [SAP], short-wavelength automated perimetry [SWAP], and frequency doubling technology [FDT]) appears to be lower than the mean of healthy age-matched controls, regardless of IOL design. Results for pooled estimate show that localized defects (pattern standard deviation [PSD]) were higher than those in the healthy age-matched controls for FDT. We also collected evidence demonstrating that pseudophakia increases peripheral astigmatism and a myopic shift from 20° onward, leading to decreased peripheral image quality compared with that in phakic eyes. Patient-reported outcomes on peripheral vision showed a pooled score estimate of 95.19, indicating high satisfaction, and for the Steps & Stairs questions, a pooled score estimate at 0.23, indicating no to little difficulty seeing steps and stairs. CONCLUSIONS: Peripheral image quality is degraded in eyes after cataract surgery. Nevertheless, whether this degradation leads to impaired visual function in the periphery requires further investigation.

Ten-year outcomes of pseudophakic mini-monovision correction of hyperopic presbyopia.

PURPOSE: To evaluate long-term efficacy, safety, and spectacle independence after the treatment of hyperopic presbyopia with pseudophakic mini-monovision using standard monofocal intraocular lenses (IOLs) after bilateral cataract surgery. SETTING: Private practice in Barcelona, Spain. DESIGN: Retrospective, noncomparative case series. METHODS: Patients with hyperopic presbyopia underwent bilateral cataract surgery with pseudophakic mini-monovision using standard monofocal IOLs between 2008 and 2018. Main outcomes analyzed were uncorrected distance visual acuity (UDVA), uncorrected near distance visual acuity (UNVA), and rates of spectacle independence at postoperative day 1 (POD1), months 1, 6 and 12, and at 5 and 10 years (Y10) postoperatively. RESULTS: The study enrolled 463 patients. Both UDVA and UNVA significantly improved postoperatively ( P < .05). The mean binocular UDVA improved from 0.47 ± 0.3 logMAR preoperatively to 0.096 ± 0.14 at POD1 to 0.16 ± 0.2 at Y10 ( P = .0033). The binocular UNVA was 0.05 logMAR at Y10, whereas in preoperative visits, all patients needed spectacles. The mean UDVA for the dominant eye ≤0.20 logMAR was achieved in 84.29% at the Y10. Self-reported and measured complete spectacle independence for near vision was achieved in 79.61% of patients at POD1 and 71.92% at Y10 postoperatively. For distance, respectively, in 86.29% of patients at POD1 and 78.43% at Y10. The achieved results were stable. No serious events were reported, as well as no photic phenomena. CONCLUSIONS: Pseudophakic mini-monovision in hyperopic presbyopes is a safe, effective, and low-cost approach for the long-term correction of presbyopia. It significantly reduces spectacle dependence and fulfils patients' expectations after bilateral cataract surgery.

Photorefractive keratectomy after DMEK for corneal decompensation by phakic IOL.

PURPOSE: To provide the first description of photorefractive keratectomy (PRK) for the correction of mild residual refractive error after Descemet membrane endothelial keratoplasty (DMEK). METHODS: Case report. RESULTS: A 45 year-old woman presenting with phakic intraocular lens (PIOL)-related corneal decompensation underwent staged DMEK surgery following PIOL explantation and cataract surgery. Eighteen months after DMEK, uncorrected distance visual acuity (UDVA) was 20/60 and best-corrected visual acuity (BCVA) was 20/22, with a stable refraction. The patient requested refractive surgery to decrease spectacle dependance, and wavefront-optimized PRK was performed. At last follow-up observation thirty-three months after PRK (54 months after DMEK surgery), UDVA was 20/20, the cornea remained clear without signs of rejection or endothelial failure, and the endothelial cell loss rate was not accelerated after PRK. CONCLUSION: Since long-term visual and refractive stability can be expected after DMEK, PRK may be a particular safe and effective approach for the correction of mild residual refractive errors after DMEK. However, we consider that surgeons must exercise caution when considering keratorefractive surgery in these eyes due to postoperative changes in corneal curvature and thickness, and further studies are encouraged.

DMEK for the treatment of interface fluid syndrome secondary to failed DSAEK graft: A case report and review of the literature.

Purpose: To report a case of Descemet membrane endothelial keratoplasty (DMEK) for the management of post-laser in situ keratomileusis (LASIK) interface fluid syndrome (IFS) secondary to failed Descemet stripping automated endothelial keratoplasty (DSAEK) graft, and to provide a literature review on endothelial keratoplasty (EK) for this indication. Observations: A 52-year-old patient presented with LASIK interface fluid accumulation and a non-functioning primary DSAEK graft. Past ophthalmic history was relevant for: (1) phakic intraocular lens (PIOL) implantation with later refinement by LASIK; (2) combined PIOL explantation and refractive lens exchange due to accelerated endothelial cell loss (ECL); (3) primary DSAEK due to corneal decompensation.A secondary EK graft (DMEK) was performed, and the patient was prospectively followed for 6 months (M6). DMEK surgery was uneventful, without postoperative graft detachment. Corneal clearing and resolution of interface fluid accumulation occurred during the first postoperative month. Best-corrected visual acuity (BCVA) improved from 20/800 Snellen to 20/25 Snellen at 3-month follow-up, remaining stable at M6. Due to a persistent rise in intraocular pressure (IOP), the patient underwent uneventful non-penetrating deep sclerectomy 2 months after DMEK, with controlled IOP and without accelerated ECL. Conclusions and Importance: DMEK is feasible, effective, and safe in the management of IFS in cases where corneal endothelial failure plays a major role, even in complex eyes with previous EK grafts. Aggressive postoperative IOP control is warranted to decrease the risk of interface fluid recurrence and damage to the optic nerve. Studies with larger patient numbers are encouraged to ascertain the role of EK for this indication.

Liposomal Ozonated Oil in Ocular Infections: A Review of Preclinical and Clinical Studies, Focusing on Its Antiseptic and Regenerative Properties.

Ozonated oil has shown antimicrobial, anti-inflammatory and regenerative properties that make it useful in the prevention of infectious diseases and also as an adjuvant in wound-healing management. This review brings together most aspects of the use of liposomal ozonated oil for ocular infections and regeneration of the ocular surface. A search was performed in PubMed, Medline, Web of Science and Cochrane Library for studies published by June 2021. Search terms were combined to sort out papers on the properties and use of ozonated oil in ocular infections. A total of 25 publications were selected for this review on the composition, mechanism of action, restorative action, and preclinical and clinical studies of liposomal ozonated oil focused on ocular infections. In patients with complicated corneal pathology, liposomal ozonated oil has been found to restore corneal ulcers and improve keratitis. In patients with ocular pathologies involving inflammation and infections, liposomal ozonated oil has been found to improve and almost completely restore the signs of vernal, granulomatous and even adenoviral conjunctivitis. Liposomal ozonated oil has also been found to be effective in reducing ocular microbial flora. In conclusion, liposomal ozonated oil has an antiseptic and regenerative effect on corneoconjunctival tissues. It has demonstrated efficacy and safety profile for its use in ocular infections and can be considered as a suitable supportive strategy both alone and combined with other antimicrobial agents.

Long-term efficacy and safety profiles after posterior chamber phakic intraocular lens implantation in eyes with more than 10 years of follow-up.

PURPOSE: To evaluate long-term efficacy, safety, predictability, and stability of a posterior chamber phakic intraocular lens (Visian implantable collamer lens [ICL]) in eyes with ≥10 years of follow-up. SETTING: Instituto de Microcirugía Ocular, Barcelona, Spain. DESIGN: Retrospective study. METHODS: Eyes undergoing ICL implantation from 2008 to 2011 with ≥10 years of follow-up were included. Variables analyzed were preoperative, 1-month, 1-year, 5-year, and last follow-up uncorrected distance (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, spherical equivalent (SE), endothelial cell count (ECC), and intraocular pressure (IOP). Descriptive statistics were performed and results reported following the Standard for Reporting Refractive Surgery Outcomes. RESULTS: 45 eyes (26 patients) were analyzed; the mean follow-up 11.35 ± 1.30 years. The mean preoperative SE was -10.06 ± 3.40 diopters (D) and the mean preoperative cylinder -1.55 ± 1.45 D. At the last follow-up, efficacy and safety indices were 0.79 and 1.12, respectively. In total, 32 eyes (71%) achieved an UDVA of ≥20/40. 22 eyes (49%) gained ≥1 line of CDVA, and 2 eyes (4%) lost ≥2 lines of CDVA. At the final follow-up, 19 eyes (42%) and 29 eyes (64%) were within ±0.50 D and ±1.00 D of attempted SE correction, respectively. 31 eyes (69%) had ≤1.00 D of postoperative astigmatism, and 29 eyes (74%) were within ±15 degrees from the intended correction axis. At the last visit, a statistically significant myopic progression of -0.75 ± 1.20 D was observed ( P = .01). ECC loss at the last follow-up was 9.85 ± 11.35%. IOP remained stable. There were no intraoperative complications. 3 eyes (7%) developed cataract after 10 years. CONCLUSIONS: The long-term results demonstrated that ICL was effective, predictable, stable, and safe.

Coexistence of Meesmann Corneal Dystrophy and a Pseudo-Unilateral Lattice Corneal Dystrophy in a Patient With a Novel Pathogenic Variant in the Keratin K3 Gene: A Case Report.

PURPOSE: This study aims to clinically and genetically report a case of coexisting Meesmann corneal dystrophy (MECD) and pseudo-unilateral lattice corneal dystrophy (LCD). METHODS: Clinical characterization was supported by a complete ophthalmological evaluation, including visual acuity measurement and slit-lamp examination. Molecular diagnosis was performed by whole-exome sequencing analyzing the gelsolin, keratin K3 (KRT3), keratin K12, and transforming growth factor-beta-induced genes. RESULTS: A 57-year-old woman presented with recurrent corneal erosions over 17 years and visual impairment in both eyes. Ophthalmological evaluation revealed multiple central tiny cysts in the epithelium of both eyes and lattice linear lesions only in the right cornea. In both eyes, a corneal posterior crocodile shagreen degeneration could also be observed. These findings were compatible with a MECD and a unilateral LCD. Molecular analysis identified the novel heterozygous nucleotide substitution c.1492G>A (amino acid change p.Glu498Lys) in the KRT3 gene, in cosegregation with the MECD familial phenotype. However, no genetic evidence supported the unique LCD phenotype observed in the patient. CONCLUSIONS: To the best of our knowledge, this is the first report of a pseudo-unilateral LCD in a patient with coexistent MECD. Moreover, the genetic analysis showed a novel mutation in the previously MECD-associated gene KRT3.

Near-infrared transmitting occlusive intraocular lens implantation for intractable diplopia: Report of two cases.

OBJECTIVE: The objective of this article is to report two cases of black occlusive intraocular lens and implantation for treating intractable diplopia. CASE DESCRIPTIONS: Two patients with intractable diplopia after orbitofacial, trauma, and surgical removal of pituitary adenoma failed to conservative management. After uneventful cataract, phacoemulsification, a black intraocular lens was implanted in every case. In both cases, a complete degree of satisfaction was achieved, with no symptoms of diplopia, and no complications have been observed in their follow-up. The use of optical coherence tomography has been possible in both cases to assess the macula and optic nerve, since a fundoscopy is not possible in such cases. CONCLUSION: Implantation of a near-infrared transmitting occlusive intraocular lens for treating intractable diplopia provided a complete resolution of symptoms without eliminating the possibility of examining macula and optic nerve using optical coherence tomography.

Phase IV clinical study to evaluate the effects of an intracameral combined mydriatic and anesthetic agent and standard topical mydriatics and anesthetics on the ocular surface after cataract surgery.

PURPOSE: To compare intracameral and topical mydriatics and anesthetics in cataract surgery. SETTING: Institute of Ocular Microsurgery, Barcelona, Spain. DESIGN: Phase IV, open-label, randomized, single-center study. METHODS: Patients were randomized in a 1:1 ratio to receive intracameral mydriatic-anesthetic (Mydrane/Fydrane) and anesthetic eyedrops or control (topical eyedrops only). The other treatment was administered for the second cataract surgery. Assessments were performed at presurgery and immediately postsurgery, at 12 to 36 hours postsurgery (day 1), and 7 days postsurgery. The primary endpoint was the change from baseline in corneal/conjunctival surface staining. The secondary endpoints included assessments of epithelial alterations, point-spread function, ocular surface disease index, conjunctival hyperemia, vision breakup time, ocular symptoms/signs, adverse events (AEs), corrected distance visual acuity, intraocular pressure, patient/investigator satisfaction, and procedure time. RESULTS: A total of 50 patients undergoing sequential cataract surgery in both eyes were included. Baseline assessments were similar in each group. The difference between Fydrane and control groups for the change from baseline at day 1 in corneal and conjunctival surface staining was not statistically significant. For Fydrane, postoperative epithelial alterations were fewer at day 1 (P < .005), folliculopapillary reaction was less frequent (P < .05), some ocular symptoms were less frequent and milder (P < .05), length of procedure was shorter (P < .001), and patient and investigator satisfaction were better (P < .05). There were few AEs in both groups. CONCLUSIONS: Fydrane reduced ocular surface damage by decreasing corneal epithelial and conjunctival toxicity with faster recovery of surface integrity compared with topical eyedrops, improved patient and investigator satisfaction, and reduced procedure time.

Safety and efficacy of a standardized intracameral combination of mydriatics and anesthetic for cataract surgery in type-2 diabetic patients.

BACKGROUND: Cataract surgery in diabetics is more technically challenging due to a number of factors including poor intraoperative pupil dilation and a higher risk of vision threatening complications. This study evaluates the safety and efficacy of an intracameral combination of 2 mydriatics and 1 anesthetic (ICMA, Mydrane) for cataract surgery in patients with well-controlled type-2 diabetes. METHODS: Post-hoc subgroup analysis of a phase 3 randomized study, comparing ICMA to a conventional topical regimen. Data were collected from 68 centers in Europe and Algeria. Only well-controlled type-2 diabetics, free of pre-proliferative retinopathy, were included. The results for non-diabetics are also reported. The primary efficacy variable was successful capsulorhexis without additional mydriatic treatment. Postoperative safety included adverse events, endothelial cell density and vision. RESULTS: Among 591 randomized patients, 57 (9.6%) had controlled type 2 diabetes [24 (42.1%) in the ICMA Group and 33 (57.9%) in the Topical Group; intention-to-treat (ITT) set]. Among diabetics, capsulorhexis was successfully performed without additional mydriatics in 24 (96.0%; modified-ITT set) patients in the ICMA Group and 26 (89.7%) in the Topical Group. These proportions were similar in non-diabetics. No diabetic patient [1 (0.5%) non-diabetics] in the ICMA Group had a significant decrease in pupil size (≥3 mm) intraoperatively compared to 4 (16.0%; modified-ITT set) diabetics [16 (7.3%) non-diabetics] in the Topical group. Ocular AE among diabetics occurred in 2 (8.0%; Safety set) patients in the ICMA Group and 5 (16.7%) in the Topical Group. Endothelial cell density at 1 month postoperatively was similar between groups in diabetics (P = 0.627) and non-diabetics (P = 0.368). CONCLUSIONS: ICMA is effective and can be safely used in patients with well-controlled diabetes, with potential advantages compared to a topical regimen including reduced systemic risk, better corneal integrity and reduced risk of ocular complications. TRIAL REGISTRATION: The trial was registered at (reference # NCT02101359) on April 2, 2014.

Comparative study of penetrating keratoplasty and vitreoretinal surgery with Eckardt temporary keratoprosthesis in ocular trauma versus non-trauma patients.

PURPOSE: To evaluate the effectiveness of temporary keratoprosthesis combined with vitreoretinal surgery and penetrating keratoplasty in patients with or without trauma. METHODS: This retrospective study included 49 eyes in 49 non-trauma patients and 51 eyes in 48 ocular trauma patients who underwent penetrating keratoplasty and vitreoretinal surgery with Eckardt temporary keratoprosthesis between 2009 and 2016, with a follow-up of at least 12 months. Study variables included previous corneal, glaucoma, or retinal surgeries; various intraoperative surgical maneuvers; lens status; vitreoretinal and corneal pathology; functional outcomes; anatomical retinal reattachment; graft clarity; and need for glaucoma surgery or treatment. RESULTS: The mean age was 56 years in the non-trauma group and 42 years in the ocular trauma group. A total of 45% of the non-trauma cases and 24% of the ocular trauma cases had a single functional eye. Pseudophakic and aphakic keratopathy was diagnosed in 41% of the non-trauma group and corneal laceration in 65% of the ocular trauma group. In the ocular trauma group, injuries were open globe injury in 78%, closed globe injury in 12%, and intraocular foreign body in 10%. Retinal detachment with proliferative vitreoretinopathy was present in 39% of patients in the non-trauma group and in 35% of the ocular trauma group. Improvement or stability of visual acuity was higher among ocular trauma patients (86%) than in non-trauma patients (78%). The rate of clear corneal grafts was 49% in both groups. Retinal attachment was achieved in 90% and 78% of patients in the non-trauma and ocular trauma groups, respectively. The use of retinotomy had a positive influence on the final attached retina (p = 0.016). The placement of a scleral buckle significantly increased the risk of glaucoma (p = 0.004). Poor functional outcome was related to persistent retinal detachment (10% versus 16% in the non-trauma and ocular trauma groups, respectively), phthisis (25% versus 12%), hypotony (33% versus 18%), corneal graft end failure (51% in both groups), and secondary glaucoma (18% versus 24%). CONCLUSION: In patients with both vitreoretinal and corneal pathology, the use of Eckardt temporary keratoprosthesis combined with vitreoretinal surgery and penetrating keratoplasty resulted in improvement of visual acuity, particularly in the groups of ocular trauma and monocular patients. The high rate of retinal reattachment and the low rate of graft rejection was probably related to the use of new vitreoretinal techniques, including retinotomy in selected patients.

Combined intracorneal ring segments and iris-fixated phakic intraocular lens for keratoconus refractive and visual improvement.

PURPOSE: To evaluate the efficacy and safety of keratoconus refractive and visual improvement by combined intracorneal ring segments (ICRS; Intacs/Intacs SK, Addition Technology Inc., Des Moines, IL) and phakic intraocular lens (PIOL; Artisan/Artiflex Toric IOL, Ophtec BV, Groningen, Holland) implantation. METHODS: This study comprised patients who had ICRS implantation followed by PIOL implantation 6 or more months later for the correction of keratoconus. Over a 12-month follow-up after PIOL implantation, the main outcome measures were uncorrected and corrected distance visual acuity (UDVA and CDVA), spherical equivalent refraction, and central endothelial cell density. Efficacy and safety indexes were calculated. RESULTS: The study included 21 eyes of 16 patients. The mean UDVA 12 months after ICRS and PIOL implantation increased from 2.0 ± 0 to 0.25 ± 0.22 logMAR (Snellen 20/2000 to 20/35) (P < .001). The mean CDVA increased from 0.31 ± 0.13 to 0.13 ± 0.13 log-MAR (Snellen 20/40 to 20/25) (P = .039). Predictability of refractive results was good, with spherical equivalent refraction within ±0.50 diopter of the attempted correction in 13 eyes (61.9%) and within ±1.00 diopter in 19 eyes (90.5%). Mean central endothelial cell density decreased from 2,513 ± 245 cells/mm(2) preoperatively to 2,312 ± 263 cells/mm(2) (P = .402). The efficacy index was 1.06 and the safety index was 1.40. CONCLUSIONS: Keratoconus visual and refractive improvement by the sequential implantation of Intacs ICRS and Artisan/Artiflex Toric IOL is a safe and predictable procedure.

Endophthalmitis prophylaxis in cataract surgery: overview of current practice patterns in 9 European countries.

Data on practice patterns for prophylaxis against infectious postoperative endophthalmitis (IPOE) during cataract surgery in 9 European countries were searched in national registers and reviews of published surveys. Summary reports assessed each nation's IPOE rates, nonantibiotic prophylactic routines, topical and intracameral antibiotic use, and coherence to the European Society of Cataract & Refractive Surgeons (ESCRS) 2007 guidelines. Although the reliability and completeness of available data vary between countries, the results show that IPOE rates differ significantly. Asepsis routines with povidone-iodine and postoperative topical antibiotics are generally adopted. Use of preoperative and perioperative topical antibiotics as well as intracameral cefuroxime varies widely between and within countries. Five years after publication of the ESCRS guidelines, there is no consensus on intracameral cefuroxime use. Major obstacles include legal barriers or persisting controversy about the scientific rationale for systematic intracameral cefuroxime use in some countries and, until recently, lack of a commercially available preparation.

Intrastromal corneal ring segment implantation for irregular astigmatism after laser in situ keratomileusis.

UNLABELLED: We describe the case of a 56-year-old man with a previously decentered laser in situ keratomileusis ablation in his right eye that induced associated vision-threatening problems. After intrastromal corneal ring segment implantation, both topography and visual acuity significantly improved. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

The Boston Type I keratoprosthesis: an assessment of its efficacy and safety.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy and safety of the Boston Type I keratoprosthesis. PATIENTS AND METHODS: Twelve patients who underwent surgery with implantation of the Boston Type I keratoprosthesis were monitored. The following parameters were considered: diagnosis, comorbidity, previous surgery, preoperative and postoperative visual acuity, complications, and keratoprosthetic retention. RESULTS: The follow-up period ranged from 6 to 42 months (mean: 23 months). The mean number of previous keratoplasties was 2.0. The percentage of patients whose best-corrected visual acuity improved was 83.3%, and 16.7% maintained their previous vision. No patient had preoperative visual acuity better than 0.05. Patients with glaucoma comorbidity had the most limited final postoperative vision. Four eyes presented limited corneal melt. In another two eyes, corneal stromal bleeding led to a vitreous hemorrhage that was completely resolved after some weeks. No endophthalmitis or extrusion of the device occurred. CONCLUSION: The Boston Type I keratoprosthesis has a visual rehabilitation potential in cases of complicated corneal blindness, where the prognosis of a conventional keratoplasty is considered poor. Anatomical retention may be favorable in the medium term.

Phakic intraocular lenses: part 2: results and complications.

The second part of a review of phakic intraocular lenses (pIOLs) addresses results and complications with current pIOL models. Phakic IOLs demonstrate reversibility, high optical quality, potential gain in visual acuity in myopic patients due to retinal magnification; correction is not limited by corneal thickness or topography. With proper anatomical conditions, pIOLs also show good results in hyperopic patients. Toric pIOL designs enable spherocylindrical correction. Complications are rare and primarily related to pIOL position and type. The main complications of angle-supported anterior chamber pIOLs are glare and halos, pupil ovalization, and corneal endothelial cell loss; of iris-fixated anterior chamber pIOLs, chronic subclinical inflammation, corneal endothelial cell loss, and dislocation or pupillary block glaucoma; and of posterior chamber pIOLs, anterior subcapsular cataract formation, pigment dispersion, and luxation or pupillary block glaucoma. No causative relationship between pIOL implantation (of any pIOL type) and retinal detachment has been established.

Phakic intraocular lenses part 1: historical overview, current models, selection criteria, and surgical techniques.

In this 2-part overview, the current status of phakic intraocular lens (pIOL) surgery to correct refractive errors is reviewed. Three types of pIOLs, categorized by their intraocular position, are included: angle-supported anterior chamber, iris-fixated anterior chamber, and posterior chamber (usually fixated in the ciliary sulcus). Part 1 reviews the main models of each pIOL type, the selection criteria, and the surgical techniques, with emphasis on currently available pIOLs. Bioptics, adjustable refractive surgery, and enhancements are addressed, and applications of the new anterior segment imaging techniques are reviewed.

Visian toric implantable collamer lens for correction of compound myopic astigmatism.

PURPOSE: To assess the safety, efficacy, predictability, and stability of a toric posterior chamber phakic intraocular lens for the correction of myopia with astigmatism. METHODS: A non-randomized, retrospective analysis of 63 eyes of 36 patients with a minimum follow-up of 6 months was performed. The STAAR Toric Implantable Collamer Lens (TICL) was implanted under topical anesthesia through a 3-mm temporal clear corneal incision. Mean preoperative spherical equivalent refraction was -10.71+/-3.55 diopters (D). Median preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25, with a mean sphere of -8.78 D (range: -2.50 to -16.50 D) and mean cylinder of 3.60 D (range: 1.25 to 7.00 D). Postoperative parameters were analyzed at different time points, and vector analysis was performed to calculate surgically induced astigmatism. RESULTS: Fifty-nine (93.6%) eyes had a spherical equivalent refraction within +/-1.00 D and 52 (82.5%) eyes were within +/-0.50 D of emmetropia. Median postoperative uncorrected visual acuity was 20/25 and BSCVA was 20/20. Preoperative keratometric astigmatism was 1.99@178.2 vs 1.82@178.6 postoperative keratometric astigmatism, most likely due to the surgical incision. Preoperative refractive astigmatism was 2.17@93 whereas postoperatively it reduced to 0.38@99.6. No eye lost 2 or more lines of Snellen BSCVA. Twenty-two (34.9%) eyes gained 2 or more Snellen lines of vision. Preoperatively, 45 (71.4%) eyes had a BSCVA of 20/30 or better, whereas 60 (95.2%) eyes were within this range of BSCVA after surgery. The TICL demonstrated good rotational stability in this study. CONCLUSIONS: Implantation of the STAAR TICL was an effective, predictable, and safe method for correction of high myopia and myopic astigmatism as shown in this retrospective observational series.