Comparing clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis for myopia.

BACKGROUND: To compare clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis (LASIK). METHODS: A retrospective study included patients who underwent bilateral cataract surgery and PanOptix trifocal intraocular lens (IOLs) implantation. Patients were grouped: Group A for patients with history of LASIK and Group B for patients without history of LASIK. Postoperative outcome measures comprised distance, intermediate, and near visual acuity, manifest refraction, defocus curve, contrast sensitivity, visual quality, patient satisfaction, and the rate of spectacle independence. RESULTS: A total of 288 eyes (144 patients) were included: 132 eyes in Group A and 156 eyes in Group B. At 6 months post-surgery, patients of both groups achieved a continuous satisfying visual acuity from 33 cm to distance. 73% of eyes in Group A and 75% of eyes in Group B were within ± 0.50 D of emmetropia (P > 0.05). The percentages of eyes within ± 1.00 D of emmetropia were 98% for Group A and 96% for Group B (P > 0.05). The total scores of satisfaction were 52.58 ± 3.46 for Group A and 53.23 ± 3.46 for Group B (P > 0.05). Most of patients (98% for Group A, 99% for Group B) were able to be spectacle independence for daily living. 53% of patients in Group A and 51% in Group B experiencd mild to moderate negative visual symptoms, which made it a little or moderate difficult to drive at night. CONCLUSIONS: Cataract patients with and without history of LASIK could safely undergo implantation of the PanOptix IOLs, which results in precise refractive outcomes and satisfactory visual acuity. Although contrast sensitivity decreased and some negative visual symptoms were observed, patients' satisfaction was generally high due to the high rate of spectacles independence. There were no statistically significant differences between the study groups.

Optimization of Ray-Tracing-Guided LASIK Outcomes: A Prospective Comparative Study of ZZ InnovEyes Strategy versus Automated Strategy.

Purpose: To evaluate the effectiveness of Zhang and Zheng's InnovEyes (ZZ InnovEyes) strategy for optimizing outcomes of ray-tracing-guided laser in situ keratomileusis (LASIK) compared to the standard automated strategy. Methods: A total of 38 patients (71 eyes) undergoing therapeutic refractive surgery at Hangzhou MSK Eye Hospital were randomly assigned to the ZZ InnovEyes and automated groups using double-masked randomization. The study assessed visual acuity, refractive outcomes, and higher-order aberrations preoperatively and at 1-day, 2-week, 1-month, and 3-month follow-ups. Statistical analysis was done with Microsoft Excel and SPSS 19.0. Results: The exposure and control groups comprised 36 and 35 eyes, respectively. The ZZ InnovEyes group demonstrated significant advantages in manifest refraction spherical equivalent (MRSE) correction compared to the automated approach group (0.13 ± 0.30 D vs 0.62 ± 0.40 D, p < 0.001), achieving 97.22% uncorrected distance visual acuity (UDVA) of 20/16 or better compared to 85.71% in the automated group at the 3-month follow-up (p = 0.08), and achieving 50.00% UDVA of 20/12.5 or better compared to 28.57% in the automated group at the 3-month follow-up (p = 0.06). Loss lines from preoperative corrected distance visual acuity to postoperative UDVA were lower in the ZZ InnovEyes group (0.00%) than the automated group (8.57%; p = 0.07). Both groups exhibited similar astigmatism corrections and higher-order aberrations. Conclusion: The ZZ InnovEyes strategy, which incorporates manifest and wavefront refraction for ray-tracing-guided LASIK, demonstrated superior MRSE correction and potential advantages in visual acuity outcomes compared to the standard automated strategy. This study highlights the need for ongoing optimization and research in refractive surgery. Clinical Trial Registration Number: ChiCTR2300078709.

A Comparative Study of the Effect of Femtosecond Laser-Assisted Cataract Surgery on Corneal Astigmatism in Post-LASIK Eyes and Virgin Eyes.

Purpose: To evaluate and compare the effect of femtosecond laser-assisted cataract surgery on corneal astigmatism in post-LASIK eyes and virgin eyes. Patients and Methods: Patients who underwent femtosecond laser-assisted cataract surgery were included in the study and categorized into two groups: Group A, consisting of patients with post-LASIK eyes, and Group B, consisting of patients with virgin eyes. Visual acuity, corneal astigmatism, and surgically induced astigmatism (SIA) were evaluated. Additionally, the correlation between SIA and preoperative corneal astigmatism, mean corneal curvature, and central corneal thickness was also analyzed. Results: A total of 168 eyes were enrolled in this study, with 62 eyes in Group A and 106 eyes in Group B. Significant differences in corneal astigmatism and SIA were observed between the two groups in the early postoperative period following cataract surgery (P<0.05). However, there was no significant difference at 6 months postoperatively (P>0.05). Corneal astigmatism demonstrated an against-The-rule shift in both groups postoperatively. No significant correlation was identified between SIA and preoperative corneal astigmatism, corneal curvature or corneal thickness. Additionally, there was no significant difference observed between the two groups in terms of uncorrected distance visual acuity (UDVA) at 6 months postoperatively. Conclusion: The effect of femtosecond laser-assisted cataract surgery on corneal astigmatism in post-LASIK eyes and virgin eyes was different in the early postoperative period. However, there was no significant difference at 6 months postoperatively. The post-LASIK eyes exhibited a delayed recovery compared to the virgin eyes.

Fitting-Shape-based Strategy for Topography-guided LASIK: A Prospective Study.

PURPOSE: To assess and compare the visual acuity and refractive outcomes of topography-guided laser in situ keratomileusis (LASIK) based on the fitting-shape-based refractive compensated and Phorcides software strategies. METHODS: Consecutive patients who underwent topography-guided LASIK were included in this study. Through double-masked simple randomization, patients were assigned to the Zhang & Zheng Auto-compensate Refraction (ZZ AR) group (the fitting-shape-based refractive compensated strategy using the ZZ AR calculator was used) or the Phorcides group (the topography analysis algorithm in Phorcides software [Phorcides LLC] was used). Only one eye per patient with binocular correction was randomly enrolled. The preoperative and postoperative visual acuities and refraction were analyzed at the 6-month follow-up visit. RESULTS: The ZZ AR and Phorcides groups comprised 156 and 147 eyes, respectively. At the 6-month postoperative follow-up visit, the median (range) absolute residual cylindrical refraction was 0.35 (1.01) and 0.47 (1.63) diopters (D) for the ZZ AR and Phorcides groups, respectively (P < .001). The percentages of patients with residual cylindrical power within 0.25 D were 29.49% and 13.61% for the ZZ AR and Phorcides groups, respectively (P = .001). Based on the percentages of patients with residual cylindrical powers within 0.50 and 1.00 D, the ZZ AR group showed better outcomes (P = .02 and .01). The percentage of patients with visual acuity better than 20/16 was significantly higher for the ZZ AR group than for the Phorcides group (P = .03). CONCLUSIONS: The fitting-shape-based refractive compensated strategy for topography-guided LASIK procedures can better optimize the visual acuity and astigmatic refraction than the Phorcides software strategy. [J Refract Surg. 2024;40(5):e336-e343.].

Visual Outcomes and Patient Satisfaction of Trifocal or Trifocal Toric IOLs in Chinese Cataract Patients: Focus on Near Vision at 33 cm.

Purpose: To examine the visual outcomes, particularly at 33 cm, and assess patient satisfaction following the implantation of a diffractive trifocal intraocular lens (IOL) and its toric variant. Patients and Methods: This prospective single-arm observational study involved 45 Chinese patients (90 eyes) underwent bilateral cataract surgery and PanOptix or PanOptix toric intraocular lenses (IOLs) implantation. Postoperatively, visual acuity was evaluated at various distances, including 40 cm and 33 cm, for both monocular and binocular outcomes. Patient satisfaction was evaluated using the VF-14 questionnaire. Results: 72 eyes underwent PanOptix IOLs implantation, and 18 eyes received PanOptix toric IOLs. At 3-month postoperative mark, the mean monocular UDVA, UIVA, and UNVA at 40 cm and 33 cm were -0.02±0.09, 0.00±0.07, 0.02±0.07, and 0.07±0.14 logMAR, respectively, with proportions of visual acuity exceeding 0.1 logMAR were 96.7%, 96.7%, 94.4%, and 74.4%, respectively. The mean binocular UDVA, UIVA, and UNVA at 40 cm and 33 cm were -0.05±0.06, -0.03±0.05, 0.00±0.05, and 0.04±0.07 logMAR, respectively, with proportions of visual acuity exceeding 0.1 logMAR were 97.8%, 100.0%, 100.0%, and 91.1%, respectively. When the near point shifted from 40cm to 33cm, some patients showed a decline for UDVA, but the average reduction was less than one line. The overall VF-14 questionnaire score was 4.02±4.19. Conclusion: PanOptix can provide Chinese patients with a full range of satisfying visual acuity, near to 33cm. Though the visual acuity of some patients at 33 cm did not match the level at 40 cm, the gap of one line may not carry clinical significant.

Long Term Evaluation of Surgically Induced Astigmatism and Corneal Higher-Order Aberrations After 2.2 Mm Clear Corneal Incisions in Femtosecond Laser-Assisted Cataract Surgery: Temporal versus Superior Approach.

Purpose: To assess long term changes of the surgically induced astigmatism (SIA) and corneal higher-order aberrations (HOAs) after 2.2 mm clear corneal incisions (CCIs) in femtosecond laser-assisted cataract surgery and compare them between 2 types of CCIs: temporal and superior approach. Patients and Methods: Patients received the temporal CCIs (Group A) or the superior CCIs (Group B). Outcome measures included visual acuity, manifest refraction, corneal astigmatism, SIA, flattening effect, and corneal HOAs. Correlation between postoperative corneal HOA and SIA at each follow-up were analysed. Results: This study assessed data from 106 eyes, of which 64 in Group A and 42 in Group B. The two groups had similar postoperative visual acuity of distance, intermediate and near (all P > 0.05). SIA and corneal HOAs were significantly lower in Group A than Group B in the early postoperative period, while there was no significant difference in the late postoperative period. At 6 months after surgery, the arithmetic mean of SIA over corneal 4mm zone was 0.33 ± 0.19D for temporal incision, and 0.37 ± 0.25D for superior incision. For Group A, the correlations of HOAs and SIA persisted from 1 week to 6 months after surgery. For Group B, the changes in corneal HOAs were significantly related to the SIA at 1 week and 1 month postoperatively. Conclusion: This study suggested the consistency of increasing and recovering process of corneal HOAs and SIA after surgery. Compared to the superior incisions, temporal incisions might induce quicker corneal recovery and less change in SIA and corneal HOAs.

Low-Cost Photoelectric Flow Rate Sensors Based on a Flexible Planar Curved Beam Structure for Clinical Treatments.

In clinical treatments, reliable flow rate measurements ensure accurate drug delivery during infusions, precise gas delivery during artificial ventilations, etc., thereby reducing patient morbidity and mortality. However, precise flow rate sensors are costly, so medical devices with limited budgets choose cheaper but unsatisfactory flow rate measurement approaches, leading to increased medical risks. Here, a photoelectric flow rate sensor based on a flexible planar curved beam structure (FPCBS) is proposed. The FPCBS ensures low out-of-plane stiffness of the sensitive sheet and allows large deformation in the elastic range, enabling the flow rate sensor to measure the flow rate with high sensitivity over a wide range. Meanwhile, the flow rate sensor can be mass-produced using mature materials and manufacturing technology at less than $5 each. The flow rate sensors are integrated into a commercial infusion pump to measure drug infusion and a home ventilator to monitor respiration. The results are comparable to those measured by a commercial flow rate sensor, demonstrating the applicability of the sensor. Considering its proven outstanding performance at low cost, the flow rate sensor shows great potential in clinical treatment, medical diagnosis, and other medical fields.

Defocus Curve and Satisfaction of Patients with Presbyopia After LASIK Using the Differential Modulation of Binocular Longitudinal Spherical Aberration.

Purpose: To investigate the visual acuity and satisfaction of patients after Zhang & Zheng's corneal laser-enhanced accommodation refraction Q (ZZ-CLEAR-Q) surgery utilizing differential modulation of binocular longitudinal spherical aberration and determine its clinical significance. Patients and Methods: This prospective observational study enrolled a consecutive cohort of patients with presbyopia who underwent ZZ-CLEAR-Q surgery between December 2020 and January 2023. The study assessed visual acuity, distance-corrected defocus curve, satisfaction, Q factor, manifest spherical equivalent, and primary spherical aberration, among others, at 3 months postoperatively. Additionally, the study conducted a binocular comparison to analyze the clinical significance of setting the different longitudinal spherical aberrations. Results: A total of 232 eyes of 116 patients were included. The binocular uncorrected distance visual acuity was 20/20 for all patients. At 3 months postoperatively, the binocular uncorrected near visual acuity was Jaeger 1 for 96% of the patients and Jaeger 2 for 100% of the patients. Furthermore, 93.1% of the patients expressed satisfaction. The monocular distance-corrected defocus curve revealed that the dominant eyes had significantly better visual acuity at 0 D (P<0.001), while the non-dominant eyes had significantly better visual acuity across various defocus levels except 0 and -0.50 D (All P<0.05). At 3 months, there were no significant differences between the expected and achieved manifest spherical equivalents, corneal Q factor values, and ocular primary spherical aberration values of both groups. Conclusion: Patients with presbyopia who underwent ZZ-CLEAR-Q surgery were likely to achieve normal uncorrected visual acuity and be satisfied. The increased depth of field has clinical significance for assisting near vision.

Comparison Over Time of Vault in Chinese Eyes Receiving Implantable Contact Lenses With or Without a Central Hole.

PURPOSE: To compare the longitudinal vault changes after implantation of a posterior chamber phakic intraocular lens (pIOL) (Visian implantable contact lens) with (ICL V4c) and without (ICL V4) a central artificial hole for moderate to high myopia in Chinese eyes. DESIGN: Retrospective case series. METHODS: This study comprised 78 eyes implanted with the ICL V4c model and 82 eyes implanted with the ICL V4 model at our department by the same surgeon. The time course of the postoperative pIOL vault changes was quantitatively assessed using ultrasound biomicroscopy over 6 months. RESULTS: There was a trend toward a decrease in all measures of central vault, peripheral vault, and the endothelium-anterior pIOL distance for both central hole pIOL and conventional pIOL over time, although the variance was not statistically significant (all P > .05). There were no significant between-group differences in the amount of the pIOL central vault, peripheral vault, or the endothelium-anterior pIOL distance at any time point after surgery (all P > .05). CONCLUSIONS: The time course of the central hole pIOL vault changes is essentially equivalent to that of the conventional pIOL vault, suggesting that the presence of the central hole did not significantly affect the pIOL position.

Posterior chamber collagen copolymer phakic intraocular lens with a central hole for moderate-to-high myopia: First experience in China.

The purpose of this article is to evaluate the clinical outcomes of a posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens V4c) for the correction of moderate to high myopia in Chinese eyes.The article is designed as a retrospective case series.This study included the first consecutive eyes that had implantation of a new pIOL design with a central hole, at our department by the same surgeon. The safety, efficacy, predictability, stability, and adverse events of the surgery were evaluated over 6 months.The study enrolled 63 eyes (32 patients). The mean spherical equivalent decreased from -12.81 ±â€Š3.11 diopters (D) preoperatively to -0.05 ±â€Š0.27 D 6 months postoperatively; 96.8% of eyes were within ±0.50 D of the target and 100% of eyes were within ±1.00 D. All eyes had a decimal uncorrected distance visual acuity of 0.5 (20/40) or better at every follow-up visit. The safety and efficacy indices were 1.42 ±â€Š0.34 and 1.11 ±â€Š0.19, respectively. Postoperatively, the intraocular pressure (IOP) remained stable over time. No significant rises in IOP (including pupillary block) and no secondary cataract were found. After 6 months, the mean vault was 505.2 ±â€Š258.9 µm (range 120-990 µm), and the mean endothelial cell loss was 2.0%.Implantation of the pIOL was safe, effective, predictable, and stable in the correction of moderate-to-high myopia in Han Chinese patients, even without peripheral iridectomy.

Long-term ultrasound biomicroscopy observation of position changes of a copolymer posterior chamber phakic intraocular lens.

PURPOSE: To evaluate longitudinal changes in Implantable Collamer Lens phakic intraocular lens (pIOL) position after implantation. SETTING: Department of Ophthalmology, Zhejiang University, Hangzhou, China. DESIGN: Retrospective case series. METHODS: Myopic eyes that had pIOL implantation with a follow-up of at least 24 months were evaluated. Ultrasound biomicroscopy examinations were performed at each visit. RESULTS: The study enrolled 62 eyes (31 patients; 22 women, 9 men) ranging in age from 21 to 46 years. The manifest spherical equivalent ranged from -8.25 to -18.75 diopters. A significant increase (mean 36 µm±50 [SD]) in the endothelium-anterior pIOL distance occurred between 1 month and 3 months (P=.000); afterward, the distance decreased slowly (P>.05). The largest decrease (mean 47±17 µm) in central vault occurred between 1 month and 3 months (P=.009). The largest decrease (mean 21±14 µm) in peripheral vault occurred between 1 month and 3 months (P=.000). CONCLUSIONS: A significant increase in the endothelium-anterior pIOL distance occurred from 1 month to 3 months postoperatively, after which a slight decrease occurred over time. Central vault and peripheral vault had a tendency to decrease over time. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Solitary infantile myofibromatosis in the bones of the upper extremities: Two rare cases and a review of the literature.

Infantile myofibromatosis (IM) is the most common fibrous tumor of infancy. IM may arise in a solitary or multicentric form, with similar histopathological findings, however, the clinical features and prognoses may vary. The solitary form tends to occur predominantly in males and is typically observed in the dermis, subcutis or deep soft tissues. The reported incidence of solitary osseous myofibromatosis is rare. Furthermore, the majority of solitary IM cases of the bone occur in the craniofacial bones, while the occurrence of solitary osseous myofibromatosis on the extremities has been sporadically reported. The present study describes two cases of solitary IM involving the bones of the upper extremities in females who were over two years old. The cases show unusual symptom presentation and the tumor origin is in a rarely observed location. The study discusses the clinical, radiological and pathological features, in addition to the previously described etiology, prognosis and treatment options for this condition.

[Selection of the posterior chamber phakic intraocular lens length].

OBJECTIVE: To evaluate the efficacy, safety and clinical value of calculating the posterior chamber phakic intraocular lens (ICL) length according to the corneal horizontal diameter. METHODS: This was a retrospective study. A Staar Visian implantable contact lens (ICL) was implanted in 32 patients (64 eyes) with high myopia in the Department of Ophthalmology, the First Affiliated Hospital, College of Medicine, Zhejiang University between November 15, 2005 and January 15, 2011. The lens length was calculated according to the corneal horizontal diameter measured by Orbscan II. Patients were followed up postoperatively at 1 day, 1 week, 1, 3, 6 and 12 months and every 6 months thereafter. The evaluations included visual acuity, manifest refraction, applanation tonometry, endothelial cell count, slit-lamp microscopy to detect cataract, and UBM to assess the degree of ICL tilt and distances between the corneal endothelium, the ICL, and the crystalline lens. All of the preoperative and 12-month follow-up observations were analyzed using SPSS 16.0 software. RESULTS: No anterior subcapsular cataracts were found in any of the eyes after surgery. Pigmentary dispersion was observed on the anterior and posterior surface of the ICL, but the difference was not statistically significant (χ(2) = 2.24, P = 0.13). The intraocular pressure changed from (15.67 ± 3.23) mm Hg (1 mm Hg = 0.133 kPa) to (15.78 ± 3.23) mm Hg, but the difference was not significant (t = 0.24, P = 0.38). The corneal endothelium-lens (central section) distance measured by UBM postoperatively was (2.97 ± 0.25) mm and the corneal endothelium-ICL (central section) distance was (2.24 ± 0.27) mm; the difference between them was statistically significant (t = 15.77, P < 0.01). The degree of ICL tilt measured by UBM was 1.20° ± 1.05 °. The percentage of eyes with a trabecular-iris angle (TIA) greater than 30°, between 21° and 30°, between 11°and 20°, and smaller than 10° were 29.1%, 50.0%, 11.6%, and 9.3%, respectively. The angle opening distance at 500 micron (AOD500) measured by UBM postoperatively was (0.32 ± 0.15) mm. The contact distance between the iris and the ICL measured by UBM postoperatively was (0.85 ± 0.46) mm and the ICL-lens central distance was (0.47 ± 0.25) mm. The Pearson's correlation coefficients between the ICL-lens central distance and the corneal horizontal diameter, sulcus diameter, anterior chamber depth(ACD) and ICL length were 0.11, 0.16, 0.04 and 0.19, respectively; none were statistically significant. The ICL-lens peripheral distance measured by UBM postoperatively was (0.25 ± 0.20) mm. CONCLUSION: Selecting the length of the ICL according to the corneal horizontal diameter is appropriate, and assures the safety, effectiveness and predictability of ICL implantation.