Topographic and surgical risk factors for high postoperative residual astigmatism after small incision lenticule extraction in patients with different degrees of myopia: a retrospective cohort study.

BACKGROUND: To evaluate the possible topographic and surgical risk factors for high postoperative residual astigmatism in patients who undergo small-incision lenticule extraction (SMILE) surgery and have different myopia degrees. METHODS: A retrospective cohort study was conducted, and patients who underwent SMILE surgery were enrolled. A total of 80 and 150 eyes from 40 to 75 individuals, respectively, were selected as the low myopia and high myopia groups. The demographic data, visual acuity, refraction, topographic parameters and surgical settings were recorded. Multiple linear regression with interaction tests were performed to survey the risk factors for high postoperative residual astigmatism in each group. RESULTS: Five (6.25%) and 9 (6.00%) eyes presented with high postoperative residual astigmatism in the low myopia and high myopia groups, respectively, but these differences were not significant (P = 0.569). A steep corneal curvature was correlated with a greater risk of high postoperative residual astigmatism in the low myopia group (P = 0.015), while a higher degree of cycloplegic cylinder power, steeper corneal curvature, greater topographic cylinder power, smaller optic zone and longer incision length were associated with a high rate of postoperative residual astigmatism in the high myopia group (all P < 0.05). In addition, the interaction effects of cycloplegic and topographic cylinder power and longer incision length on the incidence of high postoperative residual astigmatism development were more evident in the high myopia group than in the low myopia group (all P < 0.05). CONCLUSIONS: A steep corneal curvature correlates with a high risk of high postoperative residual astigmatism after SMILE surgery, and a higher degree of cycloplegic and topographic cylinder and longer incision are associated with high postoperative residual astigmatism in individuals with high myopia.

Clinical manifestations of central retinal artery occlusion in eyes of proliferative diabetic retinopathy with previous vitrectomy and panretinal photocoagulation.

PURPOSE: To report the clinical characteristics of central retinal artery occlusion in eyes of proliferative diabetic retinopathy with previous vitrectomy and panretinal photocoagulation. METHODS: Retrospective case series. RESULTS: Twelve eyes in 12 patients (4 women and 8 men) with a mean age of 55.3 ± 6.2 years of age were included in this study. All patients had successful previous surgery for complications of proliferative diabetic retinopathy and complete panretinal photocoagulation performed. All patients had sudden visual deterioration and fluorescein angiography confirmed central retinal artery occlusion. Prominent cherry-red spot was noted in only two eyes. The other eyes either had less prominent or incomplete, or invisible cherry-red spots. Sequential optical coherence tomography in 7 of the 12 eyes showed increased optical reflectivity at inner retinal layer in 6 of the 7 eyes. Rubeosis iridis developed later in six eyes and neovascular glaucoma in four eyes. Vision worsening was noted in five eyes, improved in three eyes, and stable in four eyes after an averaged follow-up of 4 months. CONCLUSION: Less typical cherry-red spots, higher possibility of rubeosis despite previous complete panretinal photocoagulation, are the characteristic features of central retinal artery occlusion in patients with proliferative diabetic retinopathy with previous vitrectomy.

Topographic and Surgical Risk Factors for Early Myopic Regression between Small Incision Lenticule Extraction and Laser In Situ Keratomileusis.

Our objective was to evaluate the topographic and surgical factors of early myopic regression between laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE). A retrospective case-control study was conducted, and 368 and 92 eyes were enrolled in the LASIK and SMILE groups via propensity score matching (PSM). Visual acuity, refractive status, axial length, and topographic/surgical parameters were collected. Multiple linear regression was applied to the yield coefficient and the 95% confidence interval (CI) of the parameters. The cumulative incidence of early myopic regression was higher in the LASIK group (p < 0.001). In the SMILE group, a lower central corneal thickness (CCT) thinnest value and a higher corneal cylinder associated with early myopic regression were observed; meanwhile, in the LASIK group, a lower CCT thinnest value, a higher steep corneal curvature, a larger optic zone, and a lower flap thickness related to early myopic regression were observed (all p < 0.05). In the SMILE group, a higher CCT difference correlated with early myopic regression was observed compared to the LASIK group (p = 0.030), and higher steep corneal curvature and lower cap/flap thickness (both p < 0.05) correlated with early myopic regression were observed in the LASIK group compared to the SMILE group. In conclusion, CCT differences significantly influence early myopic regression in the SMILE group; meanwhile, corneal curvature and flap thickness affect early myopic regression principally in the LASIK group.

Refraction and topographic risk factors for early myopic regression after small-incision lenticule extraction surgery.

We sought to evaluate the topographic risk factors for early myopic regression after small-incision lenticule extraction (SMILE). A retrospective case‒control study was conducted, and individuals who underwent SMILE surgery were enrolled. Among them, 406 and 14 eyes were categorized into the nonregression and regression groups, respectively. The preoperative and postoperative parameters in the two groups were collected, including spherical refraction (SE), axial length (AXL) and topographic data. A generalized linear model was adopted to analyze the difference in each parameter between the two groups. After 6 months, UCVA decreased in the regression group, and SE increased in the regression group (both P < 0.05). The increase in the CCT at the thinnest point (P = 0.044), flat corneal curvature (P = 0.012) and TCRP (P = 0.001) were significantly greater in the regression group. Regarding the risk factors for myopic regression, preoperative SE, preoperative sphere power, preoperative AXL, preoperative flat corneal curvature, preoperative SA, early postoperative SE, early postoperative sphere power, early postoperative AXL and early postoperative CCT difference were significantly greater in the regression group (all P < 0.05). The SE, sphere power, AXL, preoperative flat corneal curvature, preoperative SA, and postoperative CCT difference correlate with early myopic regression after SMILE.

The Association Between Ocular Residual Astigmatism and the Efficacy of Astigmatism Correction Via Small Incision Lenticule Extraction (SMILE).

INTRODUCTION: Astigmatism correction after small-incision lenticule extraction (SMILE) surgery is affected by several factors, including ocular residual astigmatism (ORA), which accounts for the vector difference between refractive and corneal astigmatism. Previous studies revealed the relationship between ORA and astigmatism correction after laser-assisted in situ keratomileusis (LASIK). However, in SMILE surgery, no comprehensive study exploring the link between these two variables has been performed. We have therefore assessed the association between ORA and astigmatism correction after SMILE. METHODS: This was a retrospective, single-centered study. Patients with myopia or myopic astigmatism who underwent SMILE surgery using the 500-kHz Visumax laser platform and were followed up for at least 3 months were included. Patients' demographic and clinical characteristics, such as visual acuity, refractive status and corneal tomography, were recorded. ORA was calculated using Alpins Statistical System for Ophthalmic Refractive Surgery Techniques (ASSORT) Ocular Residual Astigmatism calculator. RESULTS: A total of 888 eyes (408 eyes from males and 480 eyes from females) from 444 patients (mean age [standard deviation] 32.4 ± 7.1 years) were included in our study. Mean (± SD) preoperative sphere and cylinder were - 5.45 ± 1.98 (range - 10.00-0.00) diopter (D) and - 0.89 ± 0.70 (range - 4.00-0.00) D, respectively. Calculated mean ORA was 0.68 ± 0.35 (range 0.07-3.53) D. Postoperative logMAR uncorrected visual acuity was 0.03 ± 0.31. Mean postoperative sphere and cylinder were - 0.10 ± 0.56 (range - 1.5 to 1.0) D and - 0.51 ± 0.37 (- 1.5 to 0.0) D, respectively. The Pearson correlation test revealed preoperative sphere, steep keratometry (steep-K) and ORA were statistically correlated with the amplitude of astigmatism correction (P < 0.001), and the generalized estimating equations analysis showed that ORA was negatively correlated with the amplitude of astigmatism correction (P < 0.001). CONCLUSION: The results of our study suggest that preoperative higher ORA may be associated with a lower magnitude of astigmatism correction after SMILE surgery in patients with all levels of astigmatism preoperative. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05604872. Registered 3 November 2022-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT05604872.

Higher-Order Aberrations of Topography-Guided LASIK and Wavefront-Optimized LASIK in High- and Low-Myopic Eyes: A Non-Randomized Controlled Trial.

We aimed to investigate high-order aberration (HOA) change between topography-guided (TG) and wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) in patients with different degrees of myopia. A non-randomized clinical trial was conducted, in which 40 eyes of 20 patients aged 20-50 years old were included. Participants received TG-LASIK in one eye and WFO-LASIK on the alternate eye. Corneal topography and HOAs including coma, trefoil, spherical aberration (SA), and contrast sensitivity (CS) were collected. Moreover, a quality of vision (QoV) questionnaire was completed by each participant. Non-parametric tests were used to infer the difference in HOAs and CS between the TG-LASIK and WFO-LASIK groups, and subgroup analyses stratified by myopia degree were performed. The high-myopia patients with TG-LASIK showed more coma and SA compared to low-myopia individuals (all 95% CI lower limits > 0), and subjects who received WFO-LASIK exhibited more SA in high-myopia status (both 95% CI lower limits > 0). The TG-LASIK group showed lower postoperative trefoil compared to the WFO-LASIK group in the high-myopia population (mean difference: -0.1267, 95% CI: -0.24 to -0.01). The TG-LASIK group yielded less surgically induced haze, better clarity at night, and better total quality scores (all p < 0.05). In conclusion, TG-LASIK might yield less postoperative trefoil in high-myopia patients and higher QoV in the general population compared to the WFO-LASIK procedure.

Difference in Quality of Vision Outcome among Extended Depth of Focus, Bifocal, and Monofocal Intraocular Lens Implantation.

We aimed to compare the postoperative quality of vision among patients who received extended depth of focus (EDOF), bifocal, and monofocal intraocular lens (IOL) implantation. A retrospective study was conducted, and 87 patients who underwent cataract surgery were enrolled. Patients were categorized into different groups according to IOL design, with 24, 29, and 34 individuals constituting bifocal, EDOF, and monofocal groups. Preoperative and postoperative visual acuity (VA), biometry data, refractive status, contrast sensitivity (CS), higher-order aberrations (HOAs), and a quality of vision questionnaire that consisted of 11 questions were obtained 1 month postoperatively. The Kruskal−Wallis test and Pearson's chi-square test were applied for statistical analyses. The postoperative CDVA was better in the EDOF group than in the bifocal group (p = 0.043), and the residual cylinder was lower in the EDOF groups than in the other two groups (both p < 0.05). The CS was worse in the EDOF group than in the other two groups (all p < 0.05), while the spherical aberration and trefoil were lower in the EDOF group than in the bifocal group (both p < 0.05). In terms of the quality of vision, the scores were better in the monofocal group than in the EDOF group in seven items (all p < 0.05), and the quality of vision in the bifocal group was better than in the EDOF group in small print reading (p = 0.042). In addition, the incidence of glare was lower in the monofocal group than in the other two groups (p < 0.001), while the spectacle dependence ratio was significantly higher in the monofocal group compared to the other two groups (p < 0.001). In conclusion, the general quality of vision was better in the monofocal group compared to the bifocal and EDOF groups, while the spectacle dependence ratio was significantly higher in the monofocal group than in the other two groups.

Utilizing intraoperative aberrometry and digital eye tracking to develop a novel nomogram for manual astigmatic keratotomy to effectively decrease mild astigmatism during cataract surgery.

PURPOSE: The purpose of the study is to develop a novel nomogram and validate with a retrospective comparative study for manual astigmatic keratotomy (MAK) with the assistance of intraoperative aberrometry (Optiwave Refractive Analysis [ORA]) and digital eye tracking (VERION) in mild astigmatic correction enhancement. SETTING: The study was conducted in Honolulu, Hawaii. DESIGN: This was a single-surgeon comparative study with retrospective data collection. METHODS: Sixty consecutive adult cataract surgery cases with regular astigmatism of 1.25 D or less were included for study from April 2016 to April 2017. VERION was used preoperatively in all cases. MAK was performed before phacoemulsification according to the surgeon's own nomogram. ORA then was utilized to obtain the axis and remaining cylinder power after phacoemulsification and intraocular lens implant implantation. MAK extension was performed for eyes with 1 D or more of remaining cylinder. Extensions were carried out slowly and slightly until the amount of cylinder was 1½ D or less under ORA. The mean degrees of extension plus the original MAK plan were calculated to develop the new nomogram. Sixty consecutive similar cases by the same surgeon using the surgeon's nomogram without using ORA/VERION for enhancement were reviewed from April 2015 to April 2016 for comparison. All patients included in this study signed the consent form. RESULTS: Using Alpins vector analysis for comparison, the proportion of patients with cylinder <0.5 D 3 months postoperatively was 87% in the ORA/VERION group compared to 70% in the non-ORA/VERION group (P < 0.05). Better than 20/25 best-corrected visual acuity was achieved more in the ORA/VERION group compared to non-ORA/VERION group. CONCLUSIONS: This novel nomogram developed by the surgeon may have better outcomes than the old surgeon's own nomogram. Further prospective control study is needed to validate the efficacy. If validated, those surgeons who do not have ORA/VERION can hopefully use this nomogram with greater success.

Negative Mantoux test in a patient with definite pulmonary and ocular tuberculosis.

The case is reported of a patient with pulmonary and ocular tuberculosis presenting with blurred vision in both eyes. A 27-year-old well-nourished male nursing-home resident with a previous history of traumatic intracerebral hemorrhage was brought to the ophthalmological clinic due to progressively blurred vision. His best-corrected visual acuity was 20/400 in the right eye with only light perception in the left eye. Fundus examinations revealed retinal segmental periphlebitis and hemorrhagic retinitis in the right eye and dense vitreous hemorrhage in the left eye. The Mantoux test was negative; however, the results of an interferon gamma release assay were positive. Ocular tuberculosis was suspected. Although he had never had any respiratory symptoms, his chest radiograph and computed tomography scan showed a multiple centrilobular glandular and ground-glass appearance with air-space consoli dations and atelectasis in both lower lobes. Pulmonary tuberculosis was confirmed by a positive acid-fast stain of a bronchial alveolar lavage sample. A GEN-PROBE amplified Mycobacterium tuberculosis direct test of the vitreous fluids was also positive. Ocular tuberculosis was confirmed. After treatment for tuberculosis and vitrectomies, his final best-corrected visual acuity improved to 20/30 in the right eye and 20/200 in the left eye. Ocular tuberculosis is rarely reported as the primary presentation of systemic tuberculosis in young patients. A negative Mantoux test may lead to misdiagnosis and delayed treatment. Doctors should become more familiar with the manifestations of systemic tuberculosis and use advanced diagnostic tools in cases of clinical suspicion.

Pituitary apoplexy in a teenager--case report.

BACKGROUND: Pituitary apoplexy is a rare clinical emergency which results from hemorrhage or infarction in the pituitary gland. PATIENT: We present a 14-year-old girl with pituitary apoplexy and review the literature. RESULTS: Our patient experienced blurred vision, nausea, and headache. Her best-corrected visual acuity was 20/200 and 20/20. Confrontation test visual field testing revealed bitemporal hemianopsia. Brain imaging demonstrated a suprasellar mass. The microscopic endonasal transsphenoidal approach only found 5-10 mL brownish fluid-like material. Pathology confirmed no malignancy. Pituitary apoplexy was diagnosed. Her nausea and headache gradually improved. Six months after operation, her best-corrected visual acuity had improved to 20/30 and 20/20. CONCLUSIONS: Although pituitary apoplexy is rare in pediatric patients, prompt evaluation including detailed ophthalmic examination, biochemical evaluation, endocrine workup, and image study are very important.