Wavefront-guided excimer laser vision correction after multifocal IOL implantation.

PURPOSE: To investigate the use of wavefront-guided LASIK after multifocal intraocular lens (IOL) implantation to correct residual ametropia and higher order aberrations. METHODS: In a prospective, nonrandomized case series, wavefront-guided LASIK was performed in 27 eyes (19 patients) after multifocal IOL implantation (Tecnis diffractive IOL, n = 20; ReSTOR diffractive IOL, n = 4; ReZoom refractive IOL, n = 3) using the VISX STAR S4 IR excimer laser. Visual acuity, manifest refraction, and wavefront error were examined pre- and 3 months postoperatively. RESULTS: In the Tecnis group, results before (after) LASIK were: sphere +1.06 +/- 0.77 diopters (D) (-0.03 +/- 0.28 D; P = .0001), cylinder -1.13 +/- 0.73 D (-0.14 +/- 0.25 D; P = .00004), distance uncorrected visual acuity (UCVA) 20/45 +/- 0.09 (20/29 +/- 0.16; P = .00004), near UCVA 20/30 +/- 0.24 (20/25 +/- 0.16; P = .001), and higher order aberrations (4-mm pupil) 0.14 +/- 0.05 microm (0.18 +/-0.03 microm; P = .02). Distance and near best spectacle-corrected visual acuity (BSCVA) did not change. In the ReSTOR group, results before (after) LASIK were: sphere +0.75 +/- 0.56 D (+0.13 +/- 0.22 D), cylinder -1.50 +/- 0.47 D (-0.13 +/- 0.22 D), distance UCVA 20/40 +/- 0.07 (20/26 +/- 0.07), near UCVA 20/44 +/- 0.05 (20/25 +/- 0.0), and higher order aberrations (4-mm pupil) 0.14 +/- 0.03 microm (0.20 +/- 0.02 microm). Distance and near BSCVA did not change. In the ReZoom group, results before (after) LASIK were: sphere +0.08 +/- 1.20 D (0.00 D), cylinder -0.83 +/- 0.120 D (0.00 D), distance UCVA 20/40 +/- 0 (20/25 +/- 0), near UCVA 20/60 +/- 0.09 (20/150 +/- 0.18), and higher order aberrations (4-mm pupil) 0.43 +/- 0.04 microm (0.39 +/- 0.03 microm). Patients lost one line of distance BSCVA and two lines of near BSCVA. CONCLUSIONS: Wavefront-guided LASIK is safe and effective in diffractive multifocal IOLs to correct residual refractive error, but higher order aberrations did not improve. It is not recommended in refractive multifocal IOLs, as these cannot be measured reliably with current wavefront sensors.

Intravitreal bevacizumab for retinopathy of prematurity: refractive error results.

PURPOSE: To evaluate refractive error in infants who underwent intravitreal bevacizumab injection for treatment of threshold retinopathy of prematurity (ROP). DESIGN: Retrospective nonrandomized interventional comparative study. METHODS: The study group included all infants who consecutively received a single intravitreal bevacizumab (0.375 mg or 0.625 mg) injection for therapy of threshold ROP in fundus zone I or zone II. The control group included infants who had previously undergone retinal argon laser therapy of ROP. The follow-up examination included refractometry under cycloplegic conditions. RESULTS: The study group included 12 children (23 eyes; mean birth weight: 622 ± 153 g; gestational age: 25.2 ± 1.6 weeks) and the control group included 13 children (26 eyes; birth weight: 717 ± 197 g; gestational age: 25.3 ± 1.8 weeks). Both groups did not differ significantly in birth age and weight and follow-up. At the end of follow-up at 11.4 ± 2.3 months after birth, refractive error was less myopic in the study group than in the control group (-1.04 ± 4.24 diopters [median: 0 diopters] vs -4.41 ± 5.50 diopters [median: -5.50 diopters]; P = .02). Prevalence of moderate myopia (17% ± 8% vs 54% ± 10%; P = .02; OR: 0.18 [95% CI: 0.05, 0.68]) and high myopia (9% ± 6% vs 42% ± 10%; P = .01; OR: 0.13 [95% CI: 0.03, 0.67]) was significantly lower in the bevacizumab group. Refractive astigmatism was significantly lower in the study group (-1.0 ± 1.04 diopters vs 1.82 ± 1.41 diopters; P = .03). In multivariate analysis, myopic refractive error and astigmatism were significantly associated with laser therapy vs bevacizumab therapy (P = .04 and P = .02, respectively). CONCLUSIONS: In a 1-year follow-up, a single intravitreal bevacizumab injection as compared to conventional retinal laser coagulation was helpful for therapy of ROP and led to less myopization and less astigmatism.