Enhanced morphological assessment based on interocular asymmetry analysis for keratoconus detection.

PURPOSE: To clarify the interocular asymmetry of corneal morphological descriptors and evaluate its discriminant ability of keratoconus (KC). METHODS: This retrospective study recruited 344 normal participants and 290 KC patients, randomized to training and validation datasets. Interocular correlation and agreement were evaluated on 44 corneal morphological descriptors derived from Schiempflug tomography. Logistic regression models were constructed using binocular data and of which diagnostic performance was evaluated using the area under receiver operating characteristics curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). RESULTS: Interocular agreement of corneal descriptors is better in the normal than in KC except for dimensions of cornea and anterior chamber. The interocular asymmetry increases along with the severity of KC. Interocular asymmetry in maximum anterior keratometry, mean anterior keratometry and higher-order aberrations of anterior surface show high AUC above 0.950. Binocular logistic regression index reaches an AUC of 0.963 with high specificity (95.2%) and brings gain to monocular parameters in distinguishing the normal eyes from KC (NRI = 0.080 (0.042 ~ 0.118), P < 0.001) and IDI = 0.071 (0.049 ~ 0.092), P < 0.001). Interocular asymmetry benefits even more in subclinical keratoconus (SKC) detection reflected by NRI (0.4784 (0.2703-0.6865), P < 0.001) and IDI (0.2680 (0.1495-0.3866), P < 0.001) measures. CONCLUSION: Interocular asymmetry is a well-characterized feature of KC and related to the severity. It is feasible to apply the interocular asymmetry in diagnosis of KC and SKC as a replenishment of monocular parameters and in progression tracking.

Comparison of visual quality after Q value-guided FS-LASIK and SMILE for correction of myopia with age-related accommodation deficiency.

PURPOSE: To investigate differences in objective and subjective visual quality 12 months following Q value-guided (Custom-Q) femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) versus small incision lenticule extraction (SMILE) for correction of low-to-moderate myopia and compensate for age-related accommodation deficiency. METHODS: Clinical data of 45 patients were analyzed, of whom 23 were treated with FS-LASIK and 22 with SMILE. At the 12-month follow-up, the distance, intermediate, and near visual acuities; objective and subjective refractions; Q factor; corneal higher-order aberrations (HOAs); defocus curve; contrast sensitivity; stereopsis and a subjective visual quality questionnaire were evaluated. RESULTS: At 12 months postoperatively, the two groups had comparable binocular uncorrected distance and intermediate visual acuities (UDVA, UINA). A slightly better uncorrected near visual acuity (UNVA) was observed in the FS-LASIK group (P < 0.05), but patients reported equivalent near vision satisfaction and spectacle independence. Total HOAs and coma increased significantly in all treated eyes (P < 0.05). The Q value and spherical aberration (SA) became more positive, but the shifts were significant only in the SMILE group and the dominant eyes of the FS-LASIK group (P < 0.05). Binocular contrast sensitivity was better in the FS-LASIK group. No significant differences in visual disturbances were found between groups. CONCLUSION: For myopic patients with mild age-related accommodation deficiency, both FS-LASIK with Custom-Q protocol and SMILE could provide good efficacy, safety, predictability, and high patient satisfaction. The Custom-Q protocol could better preserve the original prolate shape of the cornea and achieve superior visual quality compared to SMILE. KEY MESSAGES: What is known Both femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE) have been widely applied in young myopic patients, with comparable efficacy and safety. Studies evaluating the clinical outcomes of FS-LASIK and SMILE in treating myopia with age-related accommodation insufficiency are lacking. What is new For myopic patients with mild age-related accommodation deficiency, both FS-LASIK with Custom-Q protocol and SMILE could provide good efficacy, safety, predictability, and high patient satisfaction. The Custom-Q protocol could better preserve the original prolate shape of the cornea and achieve superior visual quality compared to SMILE.

Full range of vision and visual quality after mini-monovision FS-LASIK in high myopic patients with presbyopia.

BACKGROUND: To evaluate clinical outcomes and visual quality 3 months after mini-monovision (spherical equivalent [SE] between - 0.25 D and - 0.50 D) femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for correction of high myopia in patients with presbyopia. METHODS: Patients who had mini-monovision FS-LASIK for high myopia (SE < -6.0 D) and aged between 40 and 50 years were included. At the 3-month postoperative visit, we evaluated full range of visual acuity; defocus curve; optical quality; accommodation function, contrast sensitivity and stereopsis. Binocular tests were done twice, once in mini-monovision condition and once with the residual myopia in the non-dominant eye corrected. Subjective visual quality was evaluated with questionnaire postoperatively with mini-monovision correction. RESULTS: Clinical data of 31 cases were analyzed. The average patient age was 42.58 ± 3.06 years. At the 3-month follow-up, the mean uncorrected binocular visual acuity at distance, intermediate, and near was - 0.11 ± 0.07, -0.06 ± 0.10, and 0.04 ± 0.11 logMAR separately. In comparison, patients with binocular full distance correction achieved better uncorrected distance visual acuity (UDVA), and they achieved superior uncorrected near visual acuity (UNVA, P = 0.04) with mini-monovision correction. FS-LASIK induced significant increases in higher-order aberrations (HOAs) (P < 0.001). For accommodative function, only the negative relative accommodation (NRA) improved significantly after surgery (P < 0.001). A slight decrease in contrast sensitivity was observed at low spatial frequency with mini-monovision correction (P < 0.05). Questionnaire demonstrated high satisfaction with near vision and visual quality. CONCLUSION: FS-LASIK with mini-monovision (SE between - 0.25 D and - 0.50 D) appeared to be safe and effective in treating high myopia combined with presbyopia to get satisfying visual quality at distant and at near.

Clinical outcomes after topography-guided FS-LASIK for myopia with nonastigmatic eyes.

BACKGROUND: To analyze the clinical outcomes after topography-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) with Phorcides Analytic Engine (PAE) algorithm or Custom-Q FS-LASIK for myopia with nonastigmatic eyes. METHODS: In this retrospective study, a total of 90 eyes with myopia without manifest astigmatism (82 patients) were included. All surgeries were performed by topography-guided FS-LASIK planned with a PAE algorithm (42 eyes) or Custom-Q system (48 eyes). Refractive, visual outcomes and corneal aberrations were compared between the two groups. RESULTS: At 6 months postoperatively, the postoperative uncorrected distance visual acuity (UDVA) was 20/20 or better in 42 eyes (100%) in the PAE compared with 44 eyes (92%) in Custom-Q (P = .120). The postoperative UDVA of 20/16 or better was measured in 92% of eyes in the PAE group and 81% of eyes in the Custom Q group (P = .320). Postoperative corrected distance visual acuity, manifest refractive spherical equivalent and refractive astigmatism were similar between the two groups (P > .05). The postoperative optical path difference (OPD) and Strehl ratio (SR) were significantly better in the PAE group compared with the Custom Q group. CONCLUSIONS: Topography-guided FS-LASIK with PAE algorithm or Custom Q demonstrated similar refractive efficacy and predictability. PAE for the patients with zero manifest astigmatism demonstrated better results in correcting corneal aberrations.

Differences in anterior chamber depth in keratoconus patients with binocular very asymmetry ectasia.

BACKGROUND: To evaluate the difference in anterior chamber depth (ACD) between two eyes among keratoconus patients with binocular very asymmetric ectasia (VAE) and to explore the influencing factors. METHODS: The corneal curvature and ACD in both eyes of patients with VAE were measured by Sirius (version 3.2, CSO, Italy) at the following points: corneal vertex, maximum curvature (apex), and the 1.5 mm, 2.5 mm, and 3.5 mm superior-, inferior-, nasal-, temporal-paracentral from center. The mean pupil power (MPP) and corneal morphology parameters were also measured. Correlations between ACD and curvature and morphology parameters were analyzed by linear regression. RESULTS: 172 eyes of 86 patients (9 to 45 years) were classified into the VAE-N (n = 86) group and the VAE-E group (n = 86) based on the corneal morphology. The central (3.32 ± 0.27 mm versus 3.43 ± 0.29 mm, P < 0.001) and paracentral ACDs increased significantly in the VAE-E group, and the corneal morphology parameters were also significantly higher. The central ACD was significantly correlated with the MPP (r = 0.465), KVf/b (Keratoconus Vertex front/back) (r = 0.306, r = 0.327), and BCVf/b (Baiocchi Calossi Versaci front/back) (r = 0.356, r = 0.416). Linear regression showed good relationships between △ACD and △MPP (R2 = 0.429) and △KVf/b (R2 = 0.504, R2 = 0.536). CONCLUSIONS: The ACD was larger in the VAE-E group. The difference in ACD between the VAE-E and VAE-N groups was significantly correlated with corneal curvature and the extent of corneal elevation, indicating the influences of both the corneal magnification effect and corneal ectasia on ACD.

Impact of Topical 0.05% Cyclosporine A Eye Drops on Post-Femtosecond-Assisted Laser In Situ Keratomileusis Ocular Surface Recovery: A Randomized Clinical Trial.

OBJECTIVES: To investigate the effect of topical 0.05% cyclosporine A (CsA) eye drops as an adjunct to conventional therapy in maintaining post-femtosecond-assisted laser in situ keratomileusis (FS-LASIK) ocular surface stability. METHODS: Sixty-six patients (eyes) undergoing FS-LASIK were randomized into 2 groups: 33 patients (eyes) in group I (conventional treatment group) and 33 patients (eyes) in group II (CsA group). Conventional treatments include topical levofloxacin, fluorometholone, and artificial tears. Group II received topical 0.05% CsA eye drops twice daily for three months in addition to conventional treatment. Ocular Surface Disease Index (OSDI), numerical rating scale (NRS), tear break-up time (TBUT), Schirmer I test (SIt), corneal fluorescein staining (CFS), conjunctival lissamine green (LG) staining, corneal sensitivity, and corneal nerve morphology were measured. In addition, tear inflammatory cytokine levels were measured using the Luminex assay. Follow-up was performed preoperatively and 1 and 3 months postoperatively. RESULTS: In the CsA group, OSDI, TBUT, LG, corneal sensitivity, and corneal nerve fiber total branch density recovered better than in the conventional treatment group. As for tear inflammatory cytokines, interferon (INF) -γ, interleukin (IL)-10, and IL-6 levels were significantly higher in the conventional treatment group as compared with the CsA group. In addition, no significant differences in NRS, SIt, and CFS scores were observed between the two groups. CONCLUSION: In conclusion, 0.05% CsA eye drops is a useful adjunct to conventional treatment for restoring the ocular surface stability after corneal refractive surgery and is more potent in sustaining anti-inflammatory effects.

Comparison of objective and subjective visual quality after flapless laser vision correction for mild to moderate myopia: SMILE vs PRK.

PURPOSE: To investigate the differences in surgical results and the objective and subjective quality of vision (QoV) of patients after small incision lenticule extraction (SMILE) versus alcohol-assisted photorefractive keratectomy (PRK). METHODS: Medical records of patients treated with SMILE and PRK were retrospectively examined. Visual quality, biometric parameters, Strehl ratio (SR), and corneal higher-order aberrations (HOAs) within a 6.0 mm area were recorded. The effective optical zone (EOZ) and decentration were measured using a tangential pre-post operation difference map. Subjective QoV and operation satisfaction were evaluated 6 months postoperatively using the Quality of Vision questionnaire. RESULTS: The study comprised 100 eyes treated with SMILE (preoperative mean spherical equivalent (SE), - 4.52 ± 0.81 dioptres (D)) and 69 eyes with PRK (mean SE, - 4.21 ± 1.25 D). Six months postoperatively, the EOZ reduction was significantly larger in the PRK group (P < 0.001). Decentrations were comparable between the groups. Regarding visual symptoms, monocular diplopia was more common following PRK (P = 0.02), and 98 (98.00%) SMILE-treated and 67 (97.10%) PRK-treated patients were satisfied with the QoV. Both groups demonstrated significant increases in total HOAs, coma, and spherical aberration (SA) at 6 months postoperatively compared to preoperatively (P < 0.001); these values were significantly higher in the PRK (P < 0.05) compared to the SMILE group. SR increased significantly only in the PRK group (P < 0.05). CONCLUSION: Although EOZ was more consistent with anticipated treatment and HOAs were fewer in SMILE, high patient-reported satisfaction and good corneal optical quality were achieved in both groups, indicating that both SMILE and alcohol-assisted PRK are excellent options for mild to moderate myopia correction.

Influence of overnight orthokeratology on tear film and meibomian glands in myopic children: a prospective study.

BACKGROUND: Orthokeratology lenses, which are worn overnight, are recommended for reducing myopia progression. They lie on the cornea and can influence the ocular surface by temporarily reshaping the corneal surface through a reverse geometry design. This study investigated the effect of overnight orthokeratology lenses on tear film stability and meibomian gland status in children aged 8-15 years. METHODS: This prospective, self-controlled study included 33 children with monocular myopia who were prescribed orthokeratology lenses for at least one year. The experimental group (ortho-k group) comprised 33 myopic eyes. The control group comprised the emmetropic eyes of the same participants. Tear film stability and meibomian gland status were measured using a Keratograph 5M (Oculus, Wetzlar, Germany). Paired t-tests and Wilcoxon signed-rank tests were used to compare the data between the two groups. RESULTS: At the one-year visit, the non-invasive first tear film break-up time (NIBUTf) values were 6.15 ± 2.56 s and 6.18 ± 2.61 s in the experimental and control groups, respectively. The lower tear meniscus height was 18.74 ± 0.05 µm and 18.65 ± 0.04 µm in these groups, respectively. No significant difference was observed in loss of meibomian glands or non-invasive average tear film break-up time between the experimental and control groups using Wilcoxon signed-rank tests. CONCLUSIONS: The stability of the tear film and meibomian gland status were not significantly affected by wearing orthokeratology lenses overnight, indicating that continuous use of orthokeratology lenses for 12 months has a minimal effect on the ocular surface. This finding can help guide the clinical management of tear film quality with respect to the use of orthokeratology contact lenses.

Subjective patient-reported visual quality after small-incision lenticule extraction and its correlation to the objective one.

PURPOSE: The purpose of the study was to characterize the subjective visual quality and satisfaction following small-incision lenticule extraction (SMILE) and to identify its influential factors. SETTING: Peking University Third Hospital, Beijing, China. DESIGN: This was a retrospective observational study. METHODS: Patients who had simultaneous binocular SMILE for myopia and myopic astigmatism were included 6 months postoperatively, and the patient-reported outcome questionnaire was employed for the assessment of visual quality in real-life situations. Examinations with SIRIUS combined corneal topography and tomography were performed including the parameters of Strehl ratio (SR), corneal higher-order aberrations (HOAs) within 6.0-mm area, kappa angel, and thinnest corneal thickness. Decentration and effective optical zone (EOZ) were measured based on a tangential pre-post-operation difference map. Binary logistic regression analysis was performed for predictors of patient-reported visual quality. RESULTS: Clinical data from 97 cases were analyzed retrospectively. Overall satisfaction was 96.91% (94/97). Fluctuation in vision and glare is the most frequent and dominant visual symptoms. SR value increased non-significantly compared with preoperative (P> 0.05). A statistically significant (P < 0.05) increase in total HOAs, spherical aberration, and coma was noted. SR and HOAs were not correlated with the degree of visual symptoms (P > 0.05). No objective parameter was found to be associated with patient-reported visual quality after SMILE (P> 0.05). CONCLUSION: The high patient-reported satisfaction confirmed the ideal effect on visual quality following SMILE in real-life situations, though some objective optical performances were not satisfying. It is very tolerant toward patients' conditions and mild deviations, and this study did not find factors affecting visual performances.

A prospective randomized self-controlled study of LASIK combined with accelerated cross-linking for high myopia in Chinese: 24-month follow-up.

BACKGROUND: To assess the visual and refractive outcomes of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) concurrent with accelerated cross-linking (LASIK Xtra) compared with conventional FS-LASIK (convLASIK) for high myopia in Chinese individuals. METHODS: In this prospective, randomized, fellow-eye comparison study, 25 patients with high myopia were treated randomly with LASIK Xtra in one eye and convLASIK in the other. A 24-month follow-up was conducted, and the main outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE) and corneal tomography. RESULTS: The UDVA was 0.09 ± 0.15 logMAR in the LASIK Xtra group, which was significantly worse than that in the convLASIK group 1 day postoperatively (P = .001), but the difference became nonsignificant from 1 week after surgery. The efficacy index was 0.88 ± 0.18 in the LASIK Xtra eyes and 0.99 ± 0.13 in the convLASIK eyes at 24 months (P = .028). Throughout the follow-up period, a slight myopic shift in the MRSE and keratometry values were observed in both groups without significant intergroup differences. The coefficient of determination was 0.9982 in the LASIK Xtra eyes and 0.9987 in the convLASIK eyes. The corneal density was significantly higher, and demarcation lines were visible in the first 6 months in LASIK Xtra eyes, but both signs of cross-linking gradually disappeared during follow-up. No severe complications were detected in either group. CONCLUSIONS: LASIK Xtra showed comparable safety and predictability with convLASIK for high myopia in Chinese, but lower efficacy and no greater stability was observed up to 24-month follow-up.

Topography-guided corneal surface laser ablation combined with simultaneous accelerated corneal collagen cross-linking for treatment of keratoconus.

BACKGROUND: to study the outcomes of topography-guided customized excimer laser subepithelial ablation combined with accelerated CXL for progressive keratoconus. METHODS: Thirty-one eyes of 30 patients with progressive keratoconus were included in this prospective study. Topography-guided excimer laser ablation without refractive correction was performed. Simultaneous accelerated collagen cross-linking with ultraviolet light of 30 mW/cm2 for 4 min was followed. Uncorrected distance visual acuity (UCVA), manifest refraction, corrected distance visual acuity (CDVA), tomograghy were examined at postoperative 1, 6, and 12 months. RESULTS: UDVA improved slightly after surgery (P > 0.05). BSCDVA improved significantly from 0.32 ± 0.20 logMAR to 0.15 ± 0.14 logMAR at postoperative 12 months (P < 0.05). During 12-month follow-ups, there were no significant differences in manifest refraction and corneal keratometry except for maximal keratometry value of the anterior surface (Kapex), which decreased significantly from 57.23 ± 5.09D to 53.13 ± 4.47D (P < 0.05). Even though the thinnest corneal thickness decreased from 465 ± 24 µm to 414 ± 35 µm (P < 0.05), curvature asymmetry index front (SIf), keratoconus vertex front (KVf) and Baiocchi Calossi Versaci index front (BCVf) decreased significantly till postoperative 12 months (P < 0.05). Corneal higher-order aberrations and coma also decreased significantly till 12 months after surgery (P < 0.05). CONCLUSIONS: Topography-guided surface ablation without refractive correction combined with simultaneous accelerated collagen cross-linking provided good stability in refraction and corneal curvature, and also showed significant improvement in BSCDVA, corneal regularity and corneal optical quality.

The possible causes for tomography suspect Keratoconus in a Chinese cohort.

BACKGROUND: To explore the possible causes of tomography suspect keratoconus (TSK) marked by Tomography in screening keratoconus in a Chinese cohort, and the reasonable range of corneal horizontal diameter and thickness for decreasing the proportion of TSK. METHODS: Nested case-control study from a single center prospective cohort. All subjects were selected from the Peking University Third Hospital Ectasia Cornea Disease Cohort Project database, which included myopic patients seeking corneal refractive surgical corrections since 2013. Demographic information, basic eye examination, and auxiliary equipment examination including refraction, IOL-master, Pentacam, Sirius, and Topolyzer were recorded. In this study, all cases were classified into two groups: TSK group and normal control (NC) group, and all of them were followed up at least 2 years. The former is consisted of those whose screening examinations of tomography are abnormal, the latter is those whose screening examinations are normal. All of them have already been followed up at least 2 years without abnormalities after excimer laser corneal refractive surgeries. Unpaired t tests and Chi-square tests were used to compare the differences of indices from the tomography between the two groups. RESULTS: Of 183 TSK eyes (109 patients) and 160 NC eyes (83 patients), the mean age is 28.0 and 26.3 years old respectively. The corneal horizontal diameter is 11.5-11.8 mm in TSK group and 11.8-12.0 mm in NC group. The central corneal thickness is nearly 520 µm in the former and 550 µm in the latter. For Sirius, the TSK ratio of indices of SIf and SIb is 41.5 and 39.9% respectively in TSK group. For Pentacam, the TSK ratio of index IHD is 59.0% and "final D" is 72.7%. CONCLUSIONS: Corneal horizontal diameter and central corneal thickness have great influences on the results of corneal tomography in detecting the suspect keratoconus.

Application of a scheimpflug-based biomechanical analyser and tomography in the early detection of subclinical keratoconus in chinese patients.

BACKGROUND: In vivo corneal biomechanics evaluation has been used to help screen early keratoconus in recent years. This study is to evaluate the value of a Scheimpflug-based biomechanical analyser combined with tomography in detecting subclinical keratoconus by distinguishing normal eyes from frank keratoconus (KC) and forme frusta keratoconus (FFKC) eyes in Chinese patients. METHODS: Study design: diagnostic test. This study included 31 bilateral frank keratoconus patients, 27 unilateral clinically manifesting keratoconus patients with very asymmetric eyes, and 79 control subjects with normal corneas. Corneal morphological and biomechanical parameters were measured using a Pentacam HR and a Corvis ST (OCULUS, Wetzlar, Germany). The diagnostic ability of computed parameters reflecting corneal biomechanical and morphological traits [including the Belin-Ambrósio deviation index (BAD_D), the Corvis biomechanical index (CBI) and the tomographic and biomechanical index (TBI)] was determined using receiver operating characteristic (ROC) curve analysis and compared by the DeLong test. Additionally, the area under the curve (AUC), the best cut-off values, and the Youden index for each parameter were reported. A novel corneal stiffness parameter, the stress-strain index (SSI), was also compared between KC, FFKC and normal eyes. RESULTS: Every morphological and biomechanical index analysed in this study was significantly different among KC, FFKC and normal eyes (P = 0.000). The TBI was most valuable in detecting subclinical keratoconus (FFKC eyes), with an AUC of 0.928 (P = 0.000), and both forms of corneal ectasia (FFKC and frank KC eyes), with an AUC of 0.966 (P = 0.000). The sensitivity and specificity of the TBI was 97.5 and 77.8 % in detecting FFKC and 97.5 and 89.7 % in detecting any KC, respectively, with a cut-off value of 0.375. The morphological index BAD_D and the biomechanical index CBI were also very useful in distinguishing eyes with any KC from normal eyes, with AUCs of 0.965 and 0.934, respectively. The SSI was significantly different between KC, FFKC and normal eyes (P = 0.000), indicating an independent decrease in corneal stiffness in KC eyes. CONCLUSIONS: The combination of a Scheimpflug-based biomechanical analyser and tomography could increase the accuracy in detecting subclinical keratoconus in Chinese patients. The TBI was the most valuable index for detecting subclinical keratoconus, with a high sensitivity and specificity. Evaluation of corneal biomechanical properties in refractive surgery candidates could be helpful for recognizing potential keratoconic eyes and increasing surgical safety.

Effect of Orthokeratology on Axial Length Elongation in Anisomyopic Children.

SIGNIFICANCE: Anisomyopia is a natural experimental paradigm that compares dose response between fellow eyes. This study is the first to explore whether orthokeratology (ortho-k) has a dose-response effect on axial length growth and reduces the interocular difference in axial length in anisomyopic children. PURPOSE: The purpose of this study was to compare the effect of ortho-k on axial length elongation between the fellow eyes of anisomyopic children. METHODS: In this retrospective study, 49 anisomyopic children who wore ortho-k lenses were assigned to the anisomyopic ortho-k group. Based on the one-to-one match principle (same age and proximate spherical equivalent), high-isomyopic and low-isomyopic groups each enrolled 49 isomyopic children who wore ortho-k lenses with spherical equivalent similar to that of the more myopic eye and the less myopic eye in the anisomyopic ortho-k group, respectively. Forty-nine anisomyopic children who wore spectacles were enrolled in the anisomyopic spectacle group. At baseline and at 1- and 2-year visits, axial length was measured. Axial length elongation and interocular difference in axial length were compared. RESULTS: In the anisomyopic ortho-k group, the less myopic eyes exhibited more axial length elongation than did the more myopic eyes during 1- and 2-year treatment periods (P < .01). However, there was no significant difference in axial length elongation between the fellow eyes in the isomyopic groups and anisomyopic spectacle group. At the 2-year visit, the interocular difference in axial length of children in the anisomyopic ortho-k group significantly decreased from 0.72 ± 0.34 to 0.56 ± 0.38 mm (P < .05). In contrast, ortho-k lens-wearing isomyopic children or spectacle-wearing anisomyopic children did not show a significant change in interocular difference in axial length. CONCLUSIONS: Orthokeratology could reduce the amount of anisomyopia in children primarily through stronger myopia control in the more myopic eye.

High incidence of rainbow glare after femtosecond laser assisted-LASIK using the upgraded FS200 femtosecond laser.

BACKGROUND: To compare the incidence of rainbow glare (RG) after femtosecond laser assisted-LASIK (FS-LASIK) using the upgraded FS200 femtosecond laser with different flap cut parameter settings. METHODS: A consecutive series of 129 patients (255 eyes) who underwent FS-LASIK for correcting myopia and/or astigmatism using upgraded WaveLight FS200 femtosecond laser with the original settings was included in group A. Another consecutive series of 129 patients (255 eyes) who underwent FS-LASIK using upgraded WaveLight FS200 femtosecond laser with flap cut parameter settings changed (decreased pulse energy, spot and line separation) was included in group B. The incidence and fading time of RG, confocal microscopic image and postoperative clinical results were compared between the two groups. RESULTS: There were no differences between the two groups in age, baseline refraction, excimer laser ablation depth, postoperative uncorrected visual acuity and refraction. The incidence rate of RG in group A (35/255, 13.73%) was significantly higher than that in group B (4/255, 1.57%) (P < 0.05). The median fading time was 3 months in group A and 1 month in group B (P > 0.05).The confocal microscopic images showed wider laser spot spacing in group A than group B. The incidence of RG was significantly correlated with age and grouping (P < 0.05). CONCLUSIONS: The upgraded FS200 femtosecond laser with original flap cut parameter settings could increase the incidence of RG. The narrower grating size and lower pulse energy could ameliorate this side effect.

[Clinical analysis of complications of LASIK using the WaveLight FS200 femtosecond laser].

OBJECTIVE: To explore the incidence of intraoperative and early postoperative complications associated with the WaveLight FS200 femtosecond laser-assisted flap creation in LASIK surgery. METHODS: A consecutive series of 400 patients (786 eyes) who underwent LASIK using the WaveLight FS200 femtosecond laser from March 2011 to December 2012 were included in this retrospective study. Intraoperative and early postoperative complications were described and analyzed. RESULTS: The intraoperative complications included suction loss (two eyes, 0.25%), incomplete flap creation (one eye, 0.13%), severe opaque bubble layers (three eyes, 0.38%), anterior chamber gas bubbles (eight eyes, 1.02%), skip lines (12 eyes, 1.53%), and corneal epithelial defects (eight eyes, 1.02%). The early postoperative complications included canal bleeding (eight eyes, 1.02%), diffuse lamellar keratitis (23 eyes, 2.93%), haze (six eyes, 0.76% ), and flap dislocation (one eye, 0.13% ). CONCLUSIONS: Intraoperative and early postoperative complications of LASIK using the WaveLight FS200 were relatively mild. All patients could obtain satisfactory clinical results with proper treatment.

[Efficacy observation of 0.1% bromfenac sodium eye drops on relieving the post-LASEK irritative symptoms].

OBJECTIVE: To observe the efficacy of bromfenac sodium eye drops on relieving the irritative symptoms after LASEK surgery. METHODS: Sixty-four people who had received LASEK surgery were randomly divided into two groups, observing the right eye for each group. group A was given 0.1% bromfenac sodium eye drops twice a day in three days before surgery and one day after surgery; group B was given 0.5% ketorolac tromethamine (acular) eye drops four times a day in three days before surgery and on day after surgery. In the 1(st), 3(rd), 5(th) and 7(th) day after surgery, irritative symptoms grade, duration of irritation, time for corneal epithelial healing, and uncorrected visual acuity were observed and compared between the two groups. RESULTS: 0.1% no discomfort in group A with bromfenac sodium eye drops was observed while 0.5% ketorolac tromethamine eye drops caused tingling, burning discomfort that lasted for 2-3 seconds in 16 of the 28 subjects (87.5%). No significant difference was observed between the irritation grades of group A and B (Z = -1.625, P = 0.104); the duration of irritative symptom was significantly shorter in group A than that in group B (Z = -2.895, P = 0.004) . No significant difference was observed between the time of healing and visual acuity recovery of the two groups. CONCLUSION: 0.1% bromfenac sodium eye drops can effectively relieve the post-LASEK irritative symptoms, and it is better tolerated than 0.5% ketorolac tromethamine eye drops.

Visual Quality Assessment After FS-LASIK Using Customized Aspheric Ablation Profile for Age-Related Accommodation Deficiency Compensation.

PURPOSE: To evaluate clinical outcomes and visual quality 12 months after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) performed with the Custom-Q algorithm for correction of myopia with or without astigmatism and compensate for age-related accommodation deficiency. METHODS: Patients who had Custom-Q FS-LASIK for myopia and myopic astigmatism with age-related accommodation deficiency were included in this retrospective study. Distance, intermediate, and near visual acuities, objective and subjective refractions, Q-factor, corneal higher order aberrations (HOAs), accommodation function, defocus curve, contrast sensitivity, and a subjective questionnaire assessing visual quality were evaluated 12 months postoperatively. RESULTS: Clinical data of 43 cases were analyzed. The mean age was 42.02 ± 1.85 years (range: 40 to 48 years). At the 12-month follow-up visit, there were 43 (100%), 42 (97%), and 33 (77%) patients who achieved a binocular uncorrected distance, intermediate, and near visual acuity, respectively, better than 20/20 separately. Defocus curves revealed better distance vision in the dominant eyes, and the nondominant eyes performed better at intermediate and near vergence (P < .001). The Q-value and corneal spherical aberration coefficient were more positive in the dominant eyes than those in the nondominant eyes (P < .001). The accommodative amplitude and relative accommodation improved binocularly (P < .001). The questionnaire demonstrated high patient satisfaction with near vision, and no one reported having severe visual disturbance. CONCLUSIONS: For myopic patients with age-related accommodation deficiency, the Custom-Q algorithm proved to be an effective way to achieve acceptable near vision without compromising distance vision. [J Refract Surg. 2024;40(4):e245-e252.].

Topography-guided photorefractive keratectomy combined with accelerated corneal collagen cross-linking versus cross-linking alone for progressive keratoconus: a long-term prospective cohort study.

Purpose: To comprehensively compare the long-term outcome of the combined topography guided photorefractive keratectomy (TG-PRK) with accelerated corneal cross-linking (ACXL) and ACXL alone in eyes with progressive keratoconus. The analysis focused on the changes in the detailed corneal aberrometric values. Methods: This single-center, prospective cohort study included 28 patients (30 eyes) of the TG-PRK plus ACXL group and 14 patients (15 eyes) of the ACXL alone group. The mean duration of the follow-up was 44 ± 10.18 months (ranged from 31 to 65 months). The preoperative data and the postoperative measurement data at the last follow-up visit, including demographic data, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, corneal topography, pachymetry, aberrometry and densitometry were analyzed. Results: The CDVA significantly improved in the TG-PRK plus ACXL group at the last follow-up visit (p = 0.006), while no significant improvement was found in the ACXL alone group (p = 0.432). The maximal keratometry of the anterior corneal surface (Kmax) of both groups significantly decreased at the last follow-up visit (p < 0.05). Compared with the ACXL alone group, the Kmax of the TG-PRK plus ACXL group showed a greater decline (p = 0.008). The total corneal aberrations, the corneal lower-order aberrations (LOAs), the corneal higher order aberrations (HOAs), the vertical coma and the spherical aberration (SA) at the 4.0 mm and 6.0 mm zone of the TG-PRK plus ACXL group significantly decreased at the last follow-up visit (all p < 0.05). The declines of the total corneal aberrations, the corneal LOAs, the corneal HOAs and the vertical coma at the 4.0 mm and 6.0 mm zone of the TG-PRK plus ACXL group were significantly higher than those in the ACXL alone group (p < 0.001). Conclusion: Compared with ACXL alone, combined TG-PRK with ACXL procedure had a significantly higher reduction in the corneal HOAs and better CDVA, while providing a similar long-term stability and safety. For progressive keratoconus patients with adequate corneal thickness, the combined procedure might be a recommended treatment option.