Risk factors for intraocular pressure elevation during the early period post cataract surgery.

PURPOSE: To assess the risk factors for intraocular pressure (IOP) elevation during the early period post cataract surgery. STUDY DESIGN: Retrospective study. METHODS: This study involved 1587 eyes that underwent cataract surgery at the Baptist Eye Institute, Kyoto, Japan between April 2020 and May 2021. In all subjects, risk factors for early postoperative IOP elevation (i.e., an increase of IOP of 10 mmHg or more at 1-day postoperative compared with that at baseline, or a postoperative IOP of 28 mmHg or more) were analyzed by multivariate logistic regression analysis. RESULTS: Of the 1587 treated eyes in this study, 100 (6.3%) experienced early-postoperative IOP elevation. Of those 100 eyes, 78.0% were men, 27.0% had an axial length (AL) of ≥ 26.5 mm, 23.0% had a history of glaucoma treatment, 11.0% had poor mydriasis and 10.0% had intraoperative floppy iris syndrome (IFIS). Multivariate analysis findings revealed that male [odds ratio (OR) 4.36; 95% confidence interval (CI) 2.63-7.23; P < 0.001], AL of ≥ 26.5 mm (3.11; 1.83-5.30; P < 0.001), a history of glaucoma treatment (2.83; 1.63-4.91; P < 0.001), poorly mydriasis (2.63; 1.16-6.01; P = 0.02), IFIS (4.37; 1.78-10.74; P = 0.001) and baseline high IOP (1.09; 1.01-1.18; P = 0.03) were associated with increased IOP during the early period post cataract surgery. CONCLUSIONS: The findings in this study reveal that male sex, high myopia, a history of glaucoma treatment, poor mydriasis, IFIS and baseline high IOP are risk factors for IOP elevation during the early period post cataract surgery.

Long-term course of contrast sensitivity in eyes after laser-assisted in-situ keratomileusis for myopia.

PURPOSE: To evaluate the long-term contrast sensitivity (CS) after laser in-situ keratomileusis (LASIK) for myopia. METHODS: This retrospective, single-center, cohort study involved 190 eyes of 95 patients who underwent bilateral LASIK between January 2001 and October 2007. This study includes patients who underwent CS and higher-order aberration (HOA) measurements in a five-year postoperative period. For all enrolled patients, visual acuity, refractive error (RE) in diopters (D), CS at 3-, 6-, 12-, and 18-cycles per degree (cpd), and HOA in a 4 mm area of the dilated pupil were measured before surgery and 6 months, 1 year, and 5 years after it. RESULTS: The mean RE measured before the surgery and after 6 months, 1 year, and 5 years after was -6.08 ± 2.50D, -0.26 ± 0.65D, -0.28 ± 0.65D, and -0.48 ± 0.80D, respectively. There were no clinically significant changes between preoperative results and the measures taken 6 months, 1 year, and 5 years after surgery. The slight increase in HOA had little effect on CS over the mid to long-term postoperative period. CONCLUSION: Our findings show that CS does not clinically change post LASIK. Although we were unable to identify the specific mechanism, we theorize that after LASIK there is a possibility for the compensation of HOA.

Myopia progression over a 4-year period after laser-assisted refractive surgery in patients in their 20s and 30s.

PURPOSE: To investigate the increase in refractive error (RE) and axial length (AL) in myopia patients in their 20s and 30s after laser-assisted in situ keratomileusis (LASIK) or epipolis-LASIK (epi-LASIK). STUDY DESIGN: Retrospective cohort study. METHODS: This retrospective study involved 280 eyes of 140 myopia patients who underwent LASIK or epi-LASIK at the Baptist Eye Institute, Kyoto, Japan and who were followed for more than 5 years postoperatively. The patients were divided into 2 groups according to age: group A (age range, 20-29 years) and group B (age range, 30-39 years). In all patients, the RE and AL were measured at 1, 2, 3, 4, and 5 years postoperatively, and the 2 groups were compared in terms of each surgical method. RESULTS: The patients' mean age at surgery was 30.6 ± 4.9 years. No significant difference was found between the 2 groups in terms of the preoperative mean spherical equivalent (SE) or AL. In the LASIK group, the mean changes in SE during the 4 years of study in groups A and B were + 0.054 ± 0.256 D and + 0.052 ± 0.327 D, respectively (P = .93, NS), and the postoperative increases in AL were 0.059 ± 0.134 mm and 0.027 ± 0.133 mm, respectively (P = .08, NS). In the epi-LASIK group, the mean change in SE during the 4 years of study in groups A and B were -0.438 ± 0.207 D and -0.259 ± 0.454 D, respectively (P = .41, NS), and the postoperative increases in AL were 0.124 ± 0.141 mm and 0.094 ± 0.166 mm, respectively (P = .46, NS). CONCLUSION: Our findings showed no significant difference in myopia progression in patients in their 20s and 30s during a 4-year period after either LASIK or epi-LASIK.

Patient-reported vision-related quality of life after laser in situ keratomileusis, surface ablation, and phakic intraocular lens: The 5.5-year follow-up study.

To evaluate the long-term efficacy of refractive surgery of all cases in a single center via the use of a patient-reported outcome (PRO) refractive status questionnaire using descriptive statistics. This study was prospective, single-center, cohort study that involved 1422 patients who underwent refractive surgery (laser in situ keratomileusis, surface ablation, and phakic intraocular lens) at Baptist Eye Institute, Kyoto, Japan. The patients were asked to answer the Refractive Status and Vision Profile (RSVP) questionnaire before the surgery after 6 months (n = 1133 patients) and after 5.5 years (n = 232 patients). During the same period, examination by slit-lamp biomicroscopy and visual acuity tests were performed. Moreover, the patients were asked to rate their satisfaction with the surgery 6 months and 5.5 years after it. We examined overall RSVP scale (S), 8 RSVP subscales, rate of satisfaction with surgical outcome, slit-lamp biomicroscopy findings, and refractive error. The mean preoperative S was 36, yet that score significantly improved to 19 at 6 postoperative months postoperatively (P < .01), and basically remained the same (i.e., 20) throughout the 5.5-year postoperative period. During the 5-year follow-up period, mean refractive error became slightly myopic (0.3 D). No change in the rate of satisfaction was observed at both 6 months and 5.5 years postoperative period. The findings of this study help to clarify long-term PRO quality of vision (QOV) postrefractive surgery in a single center, and show that minor change in refractive error during 5 years postoperative period had no influence on the mean RSVP scores among outpatients. Nearly all patients reported short-term improvement of QOV, which continued throughout the long-term follow-up period.

Clinical outcomes and time to recurrence of phototherapeutic keratectomy in Japan.

To assess the indications, outcomes and time to recurrence of phototherapeutic keratectomy (PTK) for anterior corneal pathology.This study involved 714 eyes of 477 consecutive patients (mean age: 66.0 ±â€Š15.2 years; range: 6-101 years) who underwent PTK as the initial surgical intervention for an anterior corneal pathology. In case of each patient, the cornea treated by PTK, followed up by slit-lamp examination and corrected distance visual acuity (CDVA) testing. Main outcome measures included Slit-lamp findings (1), CDVA (2), patients' complaints (3).The mean follow-up period was 44.0 ±â€Š38.8 months (range: 1-156 months).We treated 376 granular corneal dystrophy (GCD) eyes, 238 band keratopathy (BK) eyes, 23 epithelium attachment disorder eyes, 16 gelatinous drop-like corneal dystrophy (GDLD) eyes, 13 lattice corneal dystrophy (LCD) eyes, and 48 eyes with other corneal diseases. The CDVA significantly improved from LogMAR 0.65 ±â€Š0.61 pre PTK to LogMAR 0.26 ±â€Š0.39 post PTK. A 2 or more lines increase of CDVA was observed in GCD eyes (67.8%), BK eyes (49.2%), epithelium attachment disorder eyes (57.1%), GDLD eyes (87.5%), LCD eyes (76.9%), and other corneal disease eyes (60.4%). The recurrence of BK was rare. GCD recurred slowly. Epithelium attachment disorder eyes remitted simultaneously, and recurred comparatively faster.PTK was proved to be a successful therapy for all 6 corneal disease categories. Disease recurrence after PTK differed among the diseases, and surgeons should recognize the different rates of disease recurrence after PTK surgery.

Multiple Linear Regression Analysis of the Impact of Corneal Epithelial Thickness on Refractive Error Post Corneal Refractive Surgery.

PURPOSE: To evaluate the influence of corneal epithelial thickness (CET) on the deviation from the targeted refraction (refractive error [RE]) post corneal refractive surgery. DESIGN: Retrospective, single-center, cross-sectional study. METHODS: This study involved 211 eyes of 211 patients who previously underwent laser-assisted in situ keratomileusis (LASIK) or epipolis LASIK for the correction of myopia and myopic astigmatism from August 2000 to May 2014 at the Baptist Eye Institute, Kyoto, Japan, and who subsequently underwent examination of CET via optical coherence tomography imaging of 17 zones (central: n = 1 zone, paracentral: n = 8 zones, and midperipheral: n = 8 zones) within a 6.0-mm-diameter area of the central cornea from April 2014 to February 2015. The relationship between CET and RE was evaluated using Spearman coefficient in 5 parameters: CET in the (1) central, (2) paracentral, and (3) midperipheral zones, and the difference between the (4) central and paracentral zones and the (5) central and midperipheral zones. The influence of CET on RE was evaluated in the CET parameter that showed a significant correlation with RE using multiple liner regression analysis. RESULTS: The correlation coefficient with RE was (1) -0.238 (P < .01), (2) -0.172 (P < .05), (3) -0.002 (P = .98), (4) -0.186 (P < .01), and (5) -0.266 (P < .01), respectively. Multiple liner regression analysis revealed that the difference of mean CET between the central and midperipheral zones had a significant influence on RE (ß coefficient = -0.028, P < .01). CONCLUSIONS: The difference between CET at the central and midperipheral zones may play a role in the final RE post corneal refractive surgery.

[Patient-reported Outcomes after Laser In Situ Keratomileusis Surgery].

PURPOSE: To evaluate patient-reported quality of vision before and after laser in situ keratomileusis (LASIK) surgery. SUBJECTS AND METHODS: This study involved 140 patients who underwent LASIK surgery at Baptist Eye Clinic, Kyoto, Japan. Each patient was asked to respond to the Refractive Status and Vision Profile (RSVP) questionnaire prior to surgery and at 6-months and 5.5-years postoperative. In each patient, we defined the eye with better uncorrected visual acuity (VA) or with less refractive error as the better eye, and the other eye as the worse eye. RESULTS: Even in the worse eyes, the percentage of eyes with an uncorrected VA of decimal 0.5 or greater was 93.5% at 6-months and 88.6% at 5.5-ears postoperative. The mean preoperative total RSVP score was 37.1, yet that score significantly improved at 6-months postoperative (p< 0 .001) and remained the same throughout the 5.5-year follow-up period. CCONCLUSION The patient-reported quality of vi-ion post LASIK surgery was improved and remained improved throughout the 5.5-year follow-up period.