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?

Refractive results of photorefractive keratectomy comparing trans-PRK and PTK-PRK for correction of myopia and myopic astigmatism.

PURPOSE: To compare refractive outcomes after transepithelial photorefractive keratectomy (tPRK) and combined phototherapeutic keratectomy (PTK-PRK) procedure using two different excimer laser platforms for correction of myopia and myopic astigmatism. METHODS: In this retrospective multicenter study, we compared the results of two different PRK methods. The first group received a tPRK treatment with the Amaris750 excimer laser (Schwind eye-tech solutions). The second group received a combined PTK-PRK treatment with the MEL90 excimer laser (Carl Zeiss). Only healthy eyes with no previous surgery and a spherical equivalent (SE) of -1 to -8 diopters (D) were included. Preoperative spherical equivalent (SE), age, and sex were matched among the two groups. All treatments were performed by the same surgeon in different clinics. This study was approved by the local Ethics Committee (No. 2022-1980). RESULTS: We included 154 eyes of 86 patients in our study. There was no difference in predictability of SE between the two groups. Efficacy and safety indices were equally high in both groups. Similarly, no significant differences were seen in change of higher order aberrations (HOA) between the two groups (p > 0.05). No complications occurred. CONCLUSION: Both investigated methods provide safe and effective refractive results. The combination of PTK with PRK may be a suitable option to the already used one-step tPRK for the correction of myopia.

Comparison of toric intraocular lens alignment between femtosecond laser-assisted capsular marking and digital marking.

PURPOSE: To compare the accuracy of toric intraocular lens (IOL) alignment between femtosecond laser-assisted capsular marking and digital marking. SETTING: Ruhr University Eye Clinic, Bochum, Germany. DESIGN: Prospective clinical trial. METHODS: In this study, 28 eyes of 23 patients, who underwent femtosecond laser-assisted cataract surgery with implantation of a toric IOL, were included. Intraoperatively, both femtosecond laser-assisted capsular marking and digital marking were applied simultaneously and compared in every case. The toric IOL was aligned to the capsular markings. Postoperatively, the axis of the capsular markings and toric IOL alignment was examined. Visual acuity and refractive outcomes were evaluated. RESULTS: Both alignment methods were performed without intraoperative complications in all cases. 25 eyes were included in the final analysis. Misalignment was significantly lower with femtosecond laser-assisted capsular marking than with digital marking (1.71 ± 1.25 degrees vs 2.64 ± 1.70 degrees, P = .016). Deviation from the target axis of the toric IOL was 1.62 ± 1.24 degrees 4 to 6 weeks postoperatively. Postoperative uncorrected distance visual acuity was 0.14 ± 0.13 logMAR, and residual astigmatism was 0.3 ± 0.23 diopter (D) with an astigmatism ≤0.5 D in 93% of eyes. CONCLUSIONS: Both methods showed excellent results for the alignment of toric IOLs. However, femtosecond laser-assisted capsular marking was significantly more precise than digital marking and showed good refractive results. In addition, capsular marking offers the possibility to avoid parallax error and evaluating postoperative IOL rotation.

[Analysis of distribution characteristics and influencing factors of chord µ in young myopia].

Objective: To explore and analyze the distribution characteristics of chord µ related parameters, as well as the pupil center's relative position to the coaxial corneal light reflex on the corneal surface, and the influencing factors in young myopia. Methods: This was a cross-sectional study. A total of 761 myopic patients (761 eyes) were collected from March 2021 to December 2021 in the Refractive Surgery Center of Tianjin Eye Hospital, including 388 males and 373 females, with an average age of (24±6) years. The relationship between age, sex, diopter, anterior and posterior corneal surface parameters, and chord µ related parameters was analyzed, including the x and y absolute values of the pupil center, chord µ length, and angle. The normality of the data was tested using the Kolmogorov-Smirnov test, and the influencing factors of chord µ were analyzed through Pearson and Spearman correlation analysis. Results: The equivalent spherical degree and chord µ length were (-5.47±1.66) D and (0.178±0.095) mm, respectively. The chord µ length followed an approximately normal distribution. The chord µ length of 266 eyes (35%) was distributed in the range of 0.120 to 0.200 mm, while the chord µ length of 479 eyes (63%) was<0.200 mm, and the chord µ length of 620 eyes (81%) was<0.260 mm. The chord µ angle distribution accounted for the largest proportion in the superior nasal quadrant (45.6%), followed by the superior temporal quadrant (34.3%), the inferior temporal quadrant (10.1%), and the inferior nasal quadrant (10.0%). High myopia (r=0.11, P=0.002) and high astigmatism (r=0.08, P=0.023) were associated with an increase in chord µ length. The higher the degree of myopia, the smaller the chord µ angle (r=-0.09, P=0.019). The larger the ISV (r=0.09, P=0.017), IVA (r=0.08, P=0.025), and IHD (r=0.08, P=0.039) on the anterior surface of the cornea, the longer the chord µ length. The higher the astigmatism of the posterior corneal surface, the greater the absolute value of the Y coordinate of the pupil center (r=0.07, P=0.044), and the longer the chord µ length (r=0.08, P=0.035), and the smaller the chord µ angle (r=-0.08, P=0.032). Conclusions: The chord µ length of young myopic individuals in China followed an approximately normal distribution, with the majority located in the superior nasal and superior temporal quadrants. High myopia, high astigmatism, and irregular corneal shape are the main factors related to an increase in chord µ length.

Evaluation of long-term clinical outcomes after toric implantable collamer lens implantation.

PURPOSE: To evaluate the long-term (8-10 years) outcomes of toric implantable collamer lens (TICL) surgery. SETTING: Nagoya Eye Clinic, Nagoya, Aichi, Japan. DESIGN: Retrospective observational study. METHODS: Patients who underwent TICL surgery from 2005 to 2009 to correct myopia and myopic astigmatism were enrolled. The safety, efficacy, predictability, astigmatism correction efficacy, and complications were evaluated using preoperative, 1-year postoperative, and final examination data. RESULTS: 133 eyes of 77 patients were included. At the final visit, the mean uncorrected and corrected visual acuities were -0.01 ± 0.2 and -0.17 ± 0.05, respectively. The mean safety and efficacy indices were 0.91 ± 0.26 and 0.68 ± 0.21, respectively. The manifest astigmatism was -0.45 ± 0.43 diopters (D). The mean corneal astigmatism change from 1 year postoperatively to the final visit was 0.40 ± 0.26 D. Of the 38 eyes with a change in corneal astigmatism ≥0.5 D, 30 eyes (78.9%) changed to against-the-rule (ATR) astigmatism, 1 (2.6%) changed to oblique astigmatism, and 7 (18.4%) changed to with-the-rule (WTR) astigmatism. The mean manifest astigmatism change from 1 year postoperatively to the final visit was 0.43 ± 0.52 D. Of the 60 eyes with a change in manifest astigmatism ≥0.5 D, 25 (41.7%) changed to ATR astigmatism, 18 (30.0%) changed to oblique astigmatism, and 17 (28.3%) changed to WTR astigmatism. During follow-up, 8 (6.0%) of 133 eyes developed anterior subcapsular cataracts, among which 4 (3.0%) underwent TICL removal and phacoemulsification and aspiration. No vision-threatening complications occurred. CONCLUSIONS: TICL surgery showed good long-term astigmatism-correcting effects, although the long-term uncorrected visual acuity decreased. The procedure was effective in correcting myopia and astigmatism.

Extensive misalignment of plate-haptic rotationally asymmetric multifocal toric intraocular lens.

PURPOSE: Plate-haptic rotationally asymmetric multifocal toric intraocular lenses (IOL) (Lentis Comfort Toric) occasionally rotate extensively after surgery. We conducted the current study to investigate the incidence of extensive misalignment of this IOL and its association with clinical parameters. STUDY DESIGN: Retrospective case series. SUBJECTS AND METHODS: Data were collected from patients who had undergone phacoemulsification and implantation of a plate-haptic multifocal toric IOL. RESULTS: Among 332 eyes, extensive misalignment of toric IOLs ≥ 45º occurred in 3.3% (11 eyes). The amount of misalignment in eyes with extensive misalignment was 81.6 ± 22.9º, while in those without extensive misalignment, it was 3.0 ± 2.7º. The eyes with extensive misalignment showed significantly greater axial length (p < 0.001), larger corneal diameter (p = 0.034), and flatter corneas (p = 0.044) than those without extensive misalignment. Repositioning surgery to correct toric IOL misorientation was conducted in 9 eyes between 7 and 28 days after cataract surgery. In 2 eyes, repositioning surgery was carried out twice. CONCLUSIONS: In majority of cases plate-haptic multifocal toric IOLs showed satisfactory rotational stability, but extensive misalignment ≥ 45º occurred in 3.3% of cases.

Implanting toric implantable collamer lens displays better astigmatism correction than implantable collamer lens combined with manually limbal relaxing incision.

BACKGROUND: This retrospective study aimed to compare the outcomes of toric implantable collamer lens (TICL) surgery with those of implantable collamer lens (ICL) implantation combined with limbal relaxing incision (LRI) in patients with low myopia and astigmatism. METHODS: A total of 40 eyes of 28 patients who underwent TICL implantation and 40 eyes of 27 patients who underwent ICL implantation combined with manually LRI between 2021 and 2022 were included. Primary outcomes were manifest sphere and cylinder, intraocular pressure, visual acuity, and astigmatism parameters at 1 day, 1 week, and 1, 3, and 6 months postoperatively. RESULTS: The two surgeries showed comparable effects on manifest sphere and cylinder, intraocular pressure, and visual acuity (all p > 0.1). Surgery-induced astigmatism (SIA) was maintained as stable in the TICL group (1.73 to 1.68, p = 0.420), but was significantly reduced in the ICL/LRI group (1.74 to 1.17, p = 0.001) from preoperative to postoperative 6 months. The TICL group displayed significantly higher SIA and correction index at postoperative 1, 3, and 6 months than the ICL/LRI group (at 6 months: SIA, 1.68 (1.26, 1.96) vs., 1.17 (1.00, 1.64), p = 0.010; CI: 0.98 (0.78, 1.25) vs. 0.80 (0.61, 1.04), p = 0.018). No complications occurred during follow-up. CONCLUSIONS: The effects of ICL/LRI are comparable to those of TICL in correcting myopia. TICL implantation displays better astigmatism correction than ICL/LRI.

Impact of Thermal Pulsation System Therapy on Pre-Operative Intraocular Lens Calculations before Cataract Surgery in Patients with Meibomian Gland Disfunction.

In patients with eye surface disorders such as dry eye syndrome or Meibomian gland dysfunction (MGD) it is necessary to improve the tear film condition in order to obtain visual system measurements before cataract surgery. The aim of the project was to analyze the Thermal Pulsation System (TPS) impact on the visual system parameters used in cataract surgery qualification. The study included six patients (11 eyes) with MGD diagnosis. All patients were treated with TPS. The obtained results were compared and used to calculate the power and type of the intraocular lens (IOL). As a treatment result, the power of astigmatism has changed in 64% of the eyes. Planned surgical treatment type has changed in 27% of cases. TPS also affected the cylinder axis in three eyes, which was 27% of cases. Based on the calculations, power of the recommended IOL has changed in five eyes (46%). Stabilization of visual system parameters after TPS allowed to improve the accuracy of the results. It also ensured the proper astigmatism treating method during cataract surgery and allowed selection of the proper IOL power and type.

Visual performance and rotational stability of a multifocal toric intraocular lens in myopic eyes.

OBJECTIVE: This study aimed to evaluate the visual performance and rotational stability of the multifocal toric intraocular lens in myopes. METHODS: This prospective, observational study included patients with an axial length of ≥24.5 mm and regular corneal astigmatism of >1 diopter who underwent phacoemulsification cataract surgery and implantation of a multifocal toric intraocular lens (AT LISA toric 909M). The visual acuity, defocus curves, residual astigmatism, rotational stability, higher-order aberrations (HOAs), modulation transfer function (MTF), spectacle dependence and patient satisfaction were evaluated 3 months after surgery. RESULTS: Forty-three eyes from 30 patients were enrolled in this study. Postoperatively, uncorrected distance and near visual acuities (logMAR) were 0.09 ± 0.08 (standard deviation, SD) and 0.14 ± 0.08, respectively. The defocus curve analysis provided a bimodal curve showing two peaks of maximum vision at 0.0 D and at -3.0 D defocus level. The multifocal toric intraocular lens showed excellent rotational stability; the mean rotation was 4.02 ± 2.49 (SD) degrees at 3 months postoperatively. Refractive predictability was excellent with a mean spherical equivalent of 0.19 ± 0.37 (SD) diopters (D) and a mean refractive cylinder of -0.34 ± 0.39 (SD) D. CONCLUSIONS: The diffractive multifocal toric intraocular lens, AT LISA toric 909M, provided effective distance and near visual acuities in myopic eyes. It was a predictable and effective device with good rotational stability for the correction of preexisting astigmatism during cataract surgery. In this study, more than 80% of patients achieved spectacle independence.

Rotational stability and refractive outcomes of the DFT/DATx15 toric, extended depth of focus intraocular lens.

PURPOSE: To quantitatively assess postoperative rotational stability and visual acuity with the DFT/DATx15 extended depth of focus (EDOF) toric intraocular lens (IOL). METHODS: In this prospective case series, thirty-five patients with a calculated IOL power between + 15.0 D and + 25.0 D, corneal astigmatism between 0.75 D and 2.25 D, and no significant ocular pathology underwent cataract surgery. Primary outcome was rotational stability of the IOL at 1 month post-operatively. Secondary outcomes included residual refractive astigmatism, absolute residual astigmatism prediction error, and monocular distance and intermediate visual acuities. RESULTS: Mean absolute postoperative IOL rotation was 1.1 ± 0.2 degrees, with no rotation of more than 3 degrees at the final visit. Monocular mean best spectacle-corrected distance visual acuity (BSCDVA) improved from logMAR 0.27 ± 0.030 to 0.078 ± 0.017 (P < .001). Monocular uncorrected distance visual acuity (UCDVA) improved from 0.93 ± 0.096 to 0.18 ± 0.022 (P < .001). Best spectacle-corrected intermediate visual acuity (DSCIVA) was 0.17 ± 0.025, and uncorrected intermediate visual acuity (UCIVA) was 0.27 ± 0.040. Residual regular astigmatic refractive error was 0.21 ± 0.047 D. CONCLUSIONS: The toric DFT/DATx15 EDOF lens showed excellent rotational stability and effective and predictable correction of astigmatism. Its refractive outcomes and safety profile were similar to those identified in prior studies of the non-toric DFT/DAT015 EDOF IOL. A small difference in monocular BSCDVA, of uncertain clinical significance, was found when comparing these outcomes with prior DFT/DAT015 data. The trial was retrospectively registered on November 5, 2021 (TRN ​​NCT05119127).

In cataract surgery, the natural lens of the eye is replaced with an artificial lens implant. In many cases, the patient's glasses prescription in the operated eye can be reduced or eliminated through careful choice of a lens implant. There are many types of lens implants available. Toric lens implants are used to reduce one component of the glasses prescription, called regular astigmatism (or often just "astigmatism"). To maintain the full astigmatism-reducing effect of the toric lens, the lens implant must not rotate significantly within the eye after the surgery. The DFT/DATx15 (Vivity™) is a relatively new type of lens implant designed to offer patients good spectacle-free vision at far distances and improved glasses-free vision at arm's length ("intermediate") compared to a more traditional lens implant that is designed to maximize spectacle-free distance vision only. This study reports one surgeon's experience with measuring the amount of rotation of DFT/DATx15 lenses after surgery. This study also assessed the ability of the DFT/DATx15 to reduce regular astigmatism and improve glasses-free vision at far and intermediate distances. The results show that this lens did not rotate significantly within the eye and was effective at reducing the regular astigmatism as intended.

Amblyopic astigmatism characteristics and surgical outcomes in younger children with severe congenital ptosis after frontalis suspension surgery.

BACKGROUND: To examine the astigmatism characteristics and surgical outcomes in patients with unilateral severe congenital ptosis following frontalis suspension surgery. METHODS: We included 53 congenital ptosis patients who underwent frontalis suspension surgery in Hunan Children's Hospital. Each patient underwent a refractive examination before and after surgery to assess astigmatism. We also evaluated the effects and complications associated with the procedure. RESULTS: Degree of astigmatism in ptotic and fellow eyes was - 1.45 ± 0.59 D and - 0.66 ± 0.51 D before surgery. Ratio of severe astigmatism in ptotic and fellow eyes was 51.3 and 12.8%. The fellow eyes presented with with-the-rule astigmatism (WR; 71.8%) and against-the-rule astigmatism (AR; 20.5%) types, with no cases of oblique astigmatism (OA). Ptotic eyes demonstrated higher frequencies of AR (59.0%) and OA (10.2%) than did fellow eyes. Furthermore, the former showed increased astigmatism, followed by a gradual decrease at the 6-month, before significantly decreasing at the 1-year postoperatively. The ratio of postoperative AR and OA astigmatism cases in ptotic eyes decreased to 35.9 and 7.7% 1 month postoperatively. However, there was a postoperative increase in the WR ratio from 30.8 to 56.4% after 1 month. Kaplan-Meier survival analysis showed a success rate of 81.4% at 6 months and 62.9% at 12 months which was influenced by the following complications: suture reaction, epithelial keratopathy, infection and granuloma, lid lag, and recurrence. CONCLUSION: Monocular congenital ptosis could develop severe astigmatism and higher frequency of AR or OA, early surgery may ameliorate astigmatic amblyopia.

Safety and efficacy of low-energy small incision lenticule extraction for the correction of myopia and myopic astigmatism: A retrospective analysis.

Purpose: To determine the safety and efficacy of low-energy settings in small incision lenticule extraction (SMILE) for correcting myopia and myopic astigmatism. Methods: We included patients aged ≥18 years with the myopia of -0.5 to -10 D and myopic astigmatism of -0.5 to -5 Dcyl in this retrospective case series performed at a private eye hospital in South India. All patients had preoperative best-corrected visual acuity of LogMar 0.0 ± 0, with stable refraction for 1 year and normal corneal topography. Ocular surface disease and other pathology cases were excluded. The repetition rate of the laser was 500 kHz, and the pulse energy was 110 nJ. The lenticule diameter was set at 6.5 mm, cap diameter was 7.20 mm, and intended cap thickness was 110-130 µ. The spot distance was 4.5 µm. All patients were evaluated immediately postoperation and on postoperative days 1, 8, and 30. Results: Overall, 541 eyes were included. The mean patient age was 25.03 ± 4.1 years. The mean spherical error was -3.76 ± 1.84 Ds. The mean cylinder was -1.24 ± 0.91. The mean spherical equivalent of refraction was -4.22 ±1.94 D. The logMAR on postoperative day 1 was 0.0 ± 0. The mean spherical equivalent at 1 month was 0.28 ± 1.06 D. There was no loss of Snellen's lines after the procedure. The mean spherical equivalent of refraction to the target was 95% within ± 0.50 D. The postoperative astigmatism was within 0.5 Dycl. No intraoperative complications of SMILE including retained lenticule fragments, tears of incision, or improper dissection occurred. Conclusion: Low-energy settings in SMILE are safe and effective in correcting myopia and myopic astigmatism including high cylinders (>3 Dcyl).

EVO/EVO+ Visian Implantable Collamer Lenses for the correction of myopia and myopia with astigmatism.

INTRODUCTION: Intraocular lens implantation in phakic eyes for the correction of refractive error is currently a widespread procedure. The EVO and EVO+ Visian Implantable Collamer Lenses (ICL) are two of the most prevalent lenses implanted. They incorporate a central orifice to avoid the need for iridotomy. The main difference between both ICL is the higher optical diameter zone provided by the EVO+, allowing a better quality of vision at night. This review aims to provide an overview of the current ICL models available for correcting myopia and myopic astigmatism. AREAS COVERED: During the last decade, more than 100 scientific papers analyzing the performance of EVO and EVO+ lenses have been published. This review describes the objective visual performance achieved with the implantation of central hole ICL lenses and the subjective perception of the patients implanted with these lenses. In addition, the safety and the potential complications associated with undergoing an EVO and EVO+ ICL implantation have been addressed. EXPERT OPINION: Refractive surgeons and candidates to undergo ICL implantation should be aware of the excellent safety and visual outcomes provided by the implantation of central hole ICL lenses. However, future research could address minor issues currently not resolved.

Distribution and Clinical Characteristics of Periorbital Infantile Hemangiomas.

Background: Periorbital infantile hemangiomas (POIHs) are associated with a high incidence of visual complications. Objective(s): To analyze the sites of predilection of POIHs and to determine whether certain sites require earlier intervention due to their higher rate of visual complications. Methods: A retrospective case series study was conducted on patients from two tertiary care centers for 25 years. The location of POIHs was determined from clinical photographs, medical records, and radiological studies. The presence or absence of anisometropic astigmatism (anisoastigmatism) and amblyopia was recorded. Data were analyzed using a chi-square test. Results: There were 486 patients, of which 302 patients had ophthalmology evaluations and 245 patients had refractive error data. At presentation, 10% of patients already had amblyopia and 44% had anisoastigmatism. Medial eyelid lesions had the highest risk of developing anisoastigmatism (anisoastigmatism correlates with eyelid position, p = 0.0001). Segmental and upper medial lesions had the highest risk of amblyopia at initial evaluation. Conclusion: The site of POIH is an important indicator for developing clinically significant anisoastigmatism and amblyopia, underlining the need for early ophthalmologic assessment and management.

Combining primary and sulcus piggyback IOLs for the correction of a spherical-cylindrical defect in an eye with abnormal cornea.

INTRODUCTION: Piggyback IntraOcular Lenses (IOLs), or supplementary secondary implant lenses, have been developed to provide a sufficient dioptric power in eyes with high refractive defects, which are not fully correctable after cataract surgery with single IOL in the range of powers available. These lenses can also be used for the correction of refractive errors that occurred for a wrong choice of the IOL power after cataract surgery. CASE DESCRIPTION: We report the case of a complete refractive success obtained in a patient with an abnormal cornea, with a central stable ectasia, with thinning, high myopic astigmatism and cataract, obtained with the implant of a primary posterior chamber IOL at the time of cataract surgery and a subsequent implant of a secondary piggyback, sulcus-based customized toric IOL (Camellens FIL 622-2 Toric Monofocal IOL, Soleko, Rome, Italy). CONCLUSIONS: This brief report demonstrates the utility of combining primary and piggyback IOLs implant for the correction of a complex spherical-cylindrical refractive defect in a case of abnormal cornea and cataract.

Predictors of Femtosecond Laser-Assisted Arcuate Keratotomy Efficacy for Astigmatism Correction in Cataract Surgery.

PURPOSE: To evaluate the predictors related to the efficacy of epithelium- and Bowman membrane-penetrating femtosecond laser-assisted arcuate keratotomy (FSAK) in the treatment of preoperative astigmatism in patients with cataracts and to clarify the predictive role of the incision-to-limbus distance. METHODS: This retrospective study included patients who underwent femtosecond laser-assisted cataract surgery combined with FSAK using the LenSX platform (Alcon Laboratories, Inc) at Beijing Aier-Intech Eye Hospital from March 2017 to December 2021. The Lenstar LS900 (Haag-Streit, Inc) was used to measure the horizontal corneal diameter, and ImageJ software (National Institutes of Health) was used to measure the vertical corneal diameter and incision-to-limbus distance. Finally, the measured values were converted. Changes in corneal astigmatism before and 3 months after surgery were analyzed using Alpins vector analysis. Correlation analysis and regression analysis were used to evaluate the factors associated with surgically induced astigmatism (SIA) in preoperative ocular biometric parameters. RESULTS: The study included 94 eyes of 94 patients. The mean target induced astigmatism was 1.36 ± 0.44 diopters (D), SIA was 0.82 ± 0.43 D, and mean difference vector was 0.70 ± 0.40 D. Pearson correlation analysis and univariate regression analysis showed that preoperative corneal astigmatism, arcuate keratotomy arc length, incision-to-limbus distance, and astigmatism type were significant predictors of SIA. Multiple variable regression analysis included parameters such as age, arcuate keratotomy arc length, and incision-to-limbus distance and established a multiple regression model of SIA (all P < .01). CONCLUSIONS: The incision-to-limbus distance was a significant independent predictor of SIA, and inclusion of this parameter may further improve the accuracy of the nomogram. [J Refract Surg. 2022;38(8):480-486.].

Long-term outcomes of cataract surgery with toric intraocular lens implantation by the type of preoperative astigmatism.

Surgical outcomes of toric intraocular lens (IOL) implantation for 8 years after surgery were analyzed. Data were retrospectively collected in 176 eyes of 176 patients before and 1 month, 1, 3, 5, and 8 years after phacoemulsification and implantation of a toric IOL. Preoperative corneal and postoperative manifest astigmatism was analyzed by converting to power vector notations; horizontal/vertical (J0) and oblique (J45) astigmatism components. Toric IOL implantation significantly reduced pre-existing astigmatism by decreasing J0 in eyes with preoperative with-the-rule (WTR) astigmatism, increasing J0 in eyes with against-the-rule (ATR) astigmatism, and correcting J45 in eyes with oblique astigmatism. After surgery, the eyes with preoperative ATR astigmatism showed a significant ATR astigmatic shift, and J0 at 5 and 8 years was significantly smaller than that at 1 month postoperatively. Uncorrected distance visual acuity was also significantly worse at 5 and 8 years than at 1 month postoperatively. In eyes with WTR and oblique astigmatism, the effects of toric IOLs on astigmatism and visual acuity were sustained for 8 years. The long-term astigmatism-correcting effects did not differ among the models of toric IOL used in this study, SN6AT3-8 (Alcon Laboratories). In eyes with preoperative ATR astigmatism, astigmatism-correcting effects of toric IOLs decreased at 5 years and later postoperatively, indicating that overcorrection may be considered at the time of cataract surgery. In eyes with WTR and oblique astigmatism, the effects of toric IOLs were maintained throughout the 8-year follow-up period.

A Rare Cause Of High Astigmatism In Pseudophakia.

We present a case of a 65-year-old Pakistani woman who underwent an uneventful standard left phacoemulsification with posterior chamber intra-ocular lens placement for a mature senile cataract. She was observed to develop post-operative astigmatism secondary to a tilted intra-ocular lens and required repeat surgical intervention to correct the malposition. Per-operatively, the lens was found to be defective with a fixed bend at the haptic-optic junction which necessitated the need for an intra-ocular lens exchange procedure that restored adequate vision. The study highlighted defects in the structural integrity of intra-ocular lenses as an important differential to consider in such cases, and established lens replacement as a successful intervention to improve visual outcome.

Long-term ophthalmological outcomes in patients with anterior plagiocephaly managed with a fronto-orbital advancement procedure.

BACKGROUND: Anterior plagiocephaly results from early fusion of a unilateral coronal cranial suture, which affects 1/10,000 infants at birth and can be associated with ophthalmological complications. The study aimed to evaluate the frequency of oculomotor disorders and refractive errors in children with non-syndromic anterior plagiocephaly. METHODS: Patients with anterior plagiocephaly undergoing surgery using a fronto-orbital advancement technique were included in this retrospective study between 2011 and 2017. The following data were collected: cycloplegic refraction in diopters (D), best-corrected visual acuity, manifest strabismus in primary position, ocular motility, head tilt in primary position, slit-lamp and fundus examination. The refractive errors were determined by autorefraction after cycloplegia with cyclopentolate. RESULTS: Among the sixteen patients included, hyperopia >2.5D was found in 10 patients, astigmatism >1D in 10 patients and anisometropia >1D in 7 patients. Astigmatism was contralateral to the synostosis in 7 cases. In total, significant refractive errors were found in 92.9%. Amblyopia was found in 33.3% patients. Strabismus was found in 11 patients, most frequently combined horizontal and vertical, of which 4 required strabismus surgery. The most frequent vertical deviation was ipsilateral hypertropia in 54.5%. We found superior oblique muscle limitation in 3 patients. Optic disc pallor was found in 2 patients. CONCLUSION: In the years following fronto-orbital advancement for non-syndromic anterior plagiocephaly, refractive errors and oculomotor disorders are frequently encountered, mainly contralateral astigmatism and strabismus with both horizontal deviation and ispilateral hypertropia.

Correction of pre-existing astigmatism with phacoemulsification using toric intraocular lens versus spherical intraocular lens and wave front guided surface ablation.

BACKGROUND: This study aimed to evaluate toric intraocular lens to correct of pre-existing astigmatism at the time of phacoemulsification compared to using of spherical intraocular lens followed by wavefront guided surface ablation. RESULTS: The patients were classified into three groups: Group A with 20 eyes of 19 patients having phacoemulsification with spherical intraocular lens only as a control group, group B with 20 eyes of 14 patients had phacoemulsification with toric intraocular lens and group C with 20 eyes of 16 patients had phacoemulsification with spherical intraocular lens and wavefront guided PRK three months later. Comparison pre-operative data for all groups showed no statistically significant difference regarding UCVA, BCVA, MRSE, and refractive astigmatism (P>0.05). Post operatively, there was a statistically significant difference for UCVA, BCVA, MRSE, and refractive astigmatism for group A compared to group B (P<0.05) and group A compared to group C but there was no statistically significant difference for group B compared to C regarding all these parameters (P>0.05). CONCLUSION: In this study, we found similar effects for both techniques in astigmatism corrected groups while both differed from the control group that was not corrected. Correcting preexisting astigmatism during cataract surgery should be in mind in every case to improve visual outcomes. Longer period of follow up are required to evaluate stability of these techniques and possibility of regression.