Femtosecond laser assisted cataract surgery in a cataract patient with low vaulted ICL following LASIK: a case report.

BACKGROUND: Apart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management. CASE PRESENTATION: A 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 µm and 200 µm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 µm in the right eye and 83 µm in the left eye. Considering the patient's history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0. CONCLUSIONS: Our report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully.

Prevalence of refractive error among Chinese preschool children: The Changsha children eye study.

Purpose: We aimed to investigate the refractive status and prevalence of refractive error, as well as its characteristics in Chinese preschool children aged 1-6 years old. Methods: A population-based cross-sectional study-Changsha Children Eye Study (CCES) was conducted. The prevalence of refractive errors among children aged 1-6 years old from 18 community health service centers was surveyed. A handheld child vision screener, Suowei, was used for examination. Results: A total of 43,105 preschool children were included. The mean spherical equivalent (SE) was 0.42 ± 1.05 D for the right eyes. The mean astigmatism (diopter of cylinder, DC) was -0.83 ± 1.02 D for the right eyes. The magnitude of refractive error was lower in older children, indicating the ongoing of the emmetropization during the 1-6-year-old children. The prevalence of myopia (SE ≤ -1.00 D), hyperopia (SE ≥ +2.00 D) and astigmatism (DC ≥1.50 D) was 2.94, 13.8 and 17.6%, respectively. The prevalence of myopia decreased with the increase of age between the six age groups (P < 0.001). The prevalence of hyperopia was lower in 5-6 years old, whereas, the prevalence of myopia was slightly higher at this period of time. With-the-rule (WTR) astigmatism (+ cylinder axis 90° ± 15°) was the most prevalent type of astigmatism than against-the-rule (ATR) astigmatism (+ cylinder axis 180° ± 15°) and oblique (OBL) astigmatism (X 2 = 209.5, P < 0.001). The binary logistic regression model showed that older age and suffering astigmatism were independently associated with the development of myopia. In addition, there was no significant gender difference in the prevalence of myopia, emmetropia, and hyperopia. Conclusions: Our population-based cross-sectional study investigated the prevalence of myopia, hyperopia, and astigmatism in preschool children aged 1-6 years old. The distribution of the refractive error was disperse in the younger group and gradually turned more centralized in older group. Similar to hyperopia, with age increased, the prevalence of myopia was lower in preschool children younger than 5 years old and then slightly increased at 5-6 years, which may indicate an early sign of myopia in school-age children. Therefore, we emphasize that more attention should be given to the children at this age.

Longitudinal Changes in Refractive Error Among Preschool Children Aged 1-6 Years: The Changsha Children Eye Study.

Purpose: To investigate the longitudinal changes in refractive error of preschool children and explore the factors related to these changes and the timing of intervention. Methods: The refractive data of preschool children aged 1-6 years were collected from 16 community Health Service Centers in Changsha during April 2016 to July 2019 for the retrospective cohort study. The refractive data of each participant was measured with a hand-held vision screener without cycloplegia. A follow-up for all the included participants was performed. The spherical equivalent change was calculated, subsequently, an analysis of risk factors related to the change was performed. Results: Four thousand nine hundred twenty-one cases were included in the study with the follow-up for 1-2 years. The refractive status was found smoothly changed in 67.8% of children. The overall initial SE was 0.62 ± 1.13 D, and the average SE change was -0.20 ± 1.23 D per year. However, profound myopic shift was observed in 32.2% of children. The change of SE in 3-year-old group is most overt. The proportions of 1-6 years old who showed moderate and severe myopic shift (SE change ≥-1.00 D) were 21.6, 18.9, 28.2, 25.5, 13.4, and 10%, respectively. At the first visit, the younger children with greater hyperopic state exhibited more noticeable myopic shift, no significant difference was found in gender. Conclusion: The shift from hyperopia to myopia in preschool children is smooth, with -0.20D change on average per year. We suggest that an optometry screening should start at 3-year-old to track children's refractive status. We recommend that preschool children whose SE changes more than -1.00 D per year go to the ophthalmology department for further examination. Our study also found that at the first visit, the younger the child is and the more positive initial SE is, the degree of shift of myopia is greater.

A GAN-based deep enhancer for quality enhancement of retinal images photographed by a handheld fundus camera.

Objective: Due to limited imaging conditions, the quality of fundus images is often unsatisfactory, especially for images photographed by handheld fundus cameras. Here, we have developed an automated method based on combining two mirror-symmetric generative adversarial networks (GANs) for image enhancement. Methods: A total of 1047 retinal images were included. The raw images were enhanced by a GAN-based deep enhancer and another methods based on luminosity and contrast adjustment. All raw images and enhanced images were anonymously assessed and classified into 6 levels of quality classification by three experienced ophthalmologists. The quality classification and quality change of images were compared. In addition, image-detailed reading results for the number of dubiously pathological fundi were also compared. Results: After GAN enhancement, 42.9% of images increased their quality, 37.5% remained stable, and 19.6% decreased. After excluding the images at the highest level (level 0) before enhancement, a large number (75.6%) of images showed an increase in quality classification, and only a minority (9.3%) showed a decrease. The GAN-enhanced method was superior for quality improvement over a luminosity and contrast adjustment method (P＜0.001). In terms of image reading results, the consistency rate fluctuated from 86.6% to 95.6%, and for the specific disease subtypes, both discrepancy number and discrepancy rate were less than 15 and 15%, for two ophthalmologists. Conclusions: Learning the style of high-quality retinal images based on the proposed deep enhancer may be an effective way to improve the quality of retinal images photographed by handheld fundus cameras.