Visual Outcomes and Safety of a Refractive Corneal Inlay for Presbyopia: One-Year Results.

PURPOSE: To determine the visual outcomes and safety 12 months after implantation of the Presbia Flexivue Microlens refractive corneal inlay. METHODS: In this prospective, non-randomized trial, 22 patients with a mean age of 52.54 ± 2.86 years were implanted with the Flexivue Microlens refractive corneal inlay in the non-dominant eye at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Corrected near, intermediate, and distance (CNVA, CIVA, and CDVA) visual acuity and uncorrected near, intermediate, and distance (UNVA, UIVA, and UDVA) visual acuity, manifest refraction, subjective quality of vision, endothelial cell count, and contrast sensitivity were measured 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. RESULTS: For binocular CDVA, no patient lost two or more lines and 30% lost only one line at the 12-month visit. In the eye that had surgery, 85% of the patients lost two or more lines of UDVA, which was statistically significant. Sixty-five percent of the patients gained one or more lines in binocular UIVA, and 80% achieved 20/40 or better in DCIVA. UNVA showed a statistically significant improvement, with 90% of the patients achieving 20/40 or better 12 months after implantation. A total of 85% gained two or more lines in binocular UNVA. CONCLUSIONS: This refractive corneal inlay showed an improvement in binocular UNVA, UIVA, CNVA, and CIVA, whereas binocular CDVA and UDVA were not statistically affected. [J Refract Surg. 2024;40(1):e1-e9.].

Anterior eye parameters and lens thickness measured by an intraoperative OCT and a swept-source OCT: comparison of hyperopic, emmetropic and myopic eyes.

PURPOSE: To evaluate if anterior chamber depth (ACD) and lens thickness (LT) measured by two different devices are affected by different eye lengths. METHODS: ACD and LT of 251 eyes (44 hyperopic, 60 myopic, 147 emmetropic) of 173 patients received with an iOCT-guided femtosecond laser-assisted lens surgery (FLACS) and the IOL Master 700 were compared. RESULTS: ACD measured with the IOL Master 700 was -0.026 ± 0.125 mm smaller (p = 0.001) than that with the iOCT for all eye-groups (hyperopic: p = 0.601, emmetropic: p = 0.003; myopic: p = 0.094). However, differences in all groups were not clinically relevant. LT measurements (all eyes: -0.0642 ± 0.0504 mm) shows a statistically significant difference in all evaluated groups (p < 0.001). Only myopic eyes showed a clinically relevant difference in LT. CONCLUSION: The two devices show no clinically relevant differences in the eye-length groups (myopic, emmetropic, and hyperopic) for all ACD measurements. LT data shows a clinically relevant difference only for the group of myopic eyes.

Recurrent Keratoconus: Corneal Transplants for Keratoconus Develop Tomographic Ectatic Changes.

PURPOSE: The purpose of this study was to evaluate postoperative Scheimpflug imaging changes during the first 5 years after penetrating keratoplasty (PK) in patients with keratoconus (KC). METHODS: This retrospective, interventional case series includes 31 eyes of 31 patients who underwent their first PK with a history of KC. Postoperative Scheimpflug imaging was performed 3 months after the removal of the last suture (baseline) and then repeated 3 and 5 years after the PK. Demographic data, donor and host trephination diameter, and Scheimpflug imaging (Pentacam HR, Oculus, Germany) parameters indicative of ectasia were analyzed to evaluate postoperative graft changes that occur after PK. RESULTS: The maximal keratometry (Kmax) progressed significantly between baseline (53.5 ± 6.1 D) and postoperative year 3 and year 5 [56.5 ± 6.1 diopter (D) and 58.8 ± 7.9 D, P < 0.001]. Significant changes were also observed for the anterior best fit sphere and posterior best fit sphere ( P < 0.001 for 3 and 5 years compared with baseline). Kmax increased by at least 2 Ds for 74.2% of patients and up to 7 Ds or more for 25.8% of the patients. A significant inverse correlation was observed for host trephine size and progression of Kmax (r = -0.52, P = 0.01), which indicated that larger host trephination size was associated with a smaller increase in postoperative Kmax. CONCLUSIONS: Tomographic graft changes indicative of ectasia were observed within 3 to 5 years after PK in patients with KC. These changes were observed more frequently and sooner after corneal transplants than previously reported.

Self-rated quality of vision and optical phenomena intensity of diffractive presbyopia-correcting IOLs: EDoF, trifocal vs panfocal.

PURPOSE: To investigate the self-rated quality of vision (SQV) and optical phenomena intensity of 3 diffractive multifocal intraocular lenses (mIOLs). SETTING: Department of Ophthalmology, Goethe University Frankfurt, Germany. DESIGN: Prospective comparative case series. METHODS: Patients who had bilateral implantation of a diffractive extended depth-of-focus (EDoF), trifocal, or panfocal mIOL were assessed. Outcome parameters were SQV, symptom intensity of optical phenomena under 3 lighting conditions, quality of everyday lifestyle activities, spectacle independence (SI), and contrast sensitivity (CS). RESULTS: The study comprised 108 eyes. The 3 lenses provided good total SQV under all lighting conditions. EDoF patients reported a slightly better total SQV (EDoF: 9.8 ± 6.67, trifocal: 22.2 ± 7.09, panfocal: 19.6 ± 16.25 visual analog scale, P = .041). A similar percentage of patients reported the presence of optical phenomena with no difference between mIOLs ( P > .05). EDoF, trifocal, and panfocal patients rated symptom intensity of optical phenomena mild to moderate under all lighting conditions; however, EDoF patients reported a lower symptom intensity of halos ( P < .05). Reported quality of everyday lifestyle activities and CS were comparable ( P < .05). All panfocal and trifocal patients (100%) achieved complete SI, whereas almost half (44%) of the EDoF patients used reading spectacles. CONCLUSIONS: Diffractive EDoF, trifocal, and panfocal mIOLs provided good total SQV with mild to moderate intensity of optical phenomena under all lighting conditions. EDoF patients experienced the same percentage of optical phenomena but reported a weaker symptom intensity of halos and better night-driving ability. EDoF patients would all choose the same IOL, although a significant number of them needed reading spectacles, indicating that SI is not the main factor that determines patient selection of IOLs.

Visual and patient-reported factors leading to satisfaction after implantation of diffractive extended depth-of-focus and trifocal intraocular lenses.

PURPOSE: To evaluate factors that influence postoperative satisfaction in patients with diffractive extended depth-of-focus (EDoF) and multifocal intraocular lenses (mIOLs). SETTING: Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany. DESIGN: Observational case study. METHODS: Patients were evaluated after implantation of a diffractive EDoF (Symfony, AT LARA) or trifocal/quadrifocal (AT LISAtri, Panoptix) 3 months postoperatively. A subjective refraction was performed, uncorrected and corrected visual acuities were tested for distance (UDVA, CDVA), intermediate (at 60 cm and 80 cm, UIVA, DCIVA), and near (at 40 cm, UNVA, DCNVA). A test for contrast sensitivity was performed, and the patients filled 2 different questionnaires on daily activities and optical phenomena. Parameters with a potential correlation to the postoperative overall satisfaction were investigated. RESULTS: 94 patients with a mean age of 66 ± 19 years were included. Patients with a better UDVA and UIVA at 60 cm were more likely to choose the same IOL again. The intensity of subjective optical phenomena and the visual quality at different tasks of daily living influenced overall satisfaction. UIVA at 80 cm, UNVA, and corrected visual acuity demonstrated no significant influence on patient satisfaction. The uncorrected visual acuity at specific distances had a direct impact on the subjective visual quality regarding the task performed at those distances. CONCLUSIONS: For patients with diffractive EDoF and tri-/quadrifocal IOLs, the UDVA and UIVA at 60 cm seem to be more important than the UNVA and UIVA at 80 cm. Subjective visual quality and optical phenomena influence patient satisfaction, as well.

Cost-effectiveness analysis of preloaded versus non-preloaded Descemet membrane endothelial keratoplasty for the treatment of Fuchs endothelial corneal dystrophy in an academic centre.

AIMS: To determine the cost-effectiveness of preloaded Descemet membrane endothelial keratoplasty (pDMEK) versus non-preloaded DMEK (n-pDMEK) for the treatment of Fuchs endothelial corneal dystrophy (FECD). METHODS: From a societal and healthcare perspective, this retrospective cost-effectiveness analysis analysed a cohort of 58 patients with FECD receiving pDMEK (n=38) or n-pDMEK (n=30) from 2016 to 2018 in the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA. Exclusion criteria were previous ocular surgeries (other than uncomplicated cataract surgery), including other keratoplasty procedures, ocular pathological conditions as glaucoma, amblyopia, laser treatments, or any retinal or corneal disease. The main outcome parameters were the incremental cost-utility ratio (ICUR) and net monetary benefit (NMB). RESULTS: pDMEK was less costly compared with n-pDMEK (healthcare: $13 886 vs $15 329; societal: $20 805 vs $22 262), with a slighter greater utility (QALY 0.6682 vs QALY 0.6640) over a time horizon of 15 years. pDMEK offered a slightly higher clinical effectiveness (+0.0042 QALY/patient) at a lower cost (healthcare: -$1444 per patient; societal: -$1457 per patient) in improving visual acuity in this cohort of patients with FECD. pDMEK achieved a favourable ICUR and NMB compared with n-pDMEK. Based on sensitivity analyses performed, the economic model was robust. CONCLUSIONS: From the societal and healthcare perspective, pDMEK was less costly and generated comparable utility values relative to n-pDMEK. Therefore, pDMEK appears to be cost-effective and cost saving with respect to n-pDMEK. Further long-term follow-up data are needed to confirm these findings.

Intraoperative OCT vs Scheimpflug and swept-source OCT measurements for anterior eye parameters.

PURPOSE: To compare agreement of anterior segment parameter measurements using an intraoperative optical coherence tomography (iOCT) of a femtosecond laser (LenSx) during interface docking to the eye with preoperative Scheimpflug tomography (Pentacam AXL) and swept-source optical coherence tomography (SS-OCT) (IOLMaster 700). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Retrospective study. METHODS: Anterior segment measurements were performed in mydriasis prior to surgery using Scheimpflug tomography and SS-OCT. Postoperatively, iOCT images were analyzed using a modification of the FIJI image-processing program. Outcome measures included external anterior chamber depth (ACD), central corneal thickness (CCT), and central lens thickness (LT). RESULTS: 95 eyes of 66 patients who underwent planned OCT guided femtosecond laser-assisted lens surgery were included. The ACD measured with the iOCT was -0.011 ± 0.126 mm smaller (P = .389) than that with the SS-OCT and -0.059 ± 0.185 mm than with the Scheimpflug tomography (P = .003). The SS-OCT measured a -0.047 ± 0.146 mm smaller ACD than the Scheimpflug tomography (P = .002). The measurements of CCT using the iOCT and the Scheimpflug tomography (-0.705 ± 20.837 µm, P = .742) and the LT measurements using SS-OCT and iOCT (-0.050 ± 0.089 mm, P < .001) showed no clinically relevant difference. Only the ACD between the iOCT and the Scheimpflug tomography showed a clinically relevant difference. CONCLUSIONS: The comparison of the anterior segment parameters of iOCT with SS-OCT showed no clinically relevant differences regarding the ACD and the LT. However, Scheimpflug tomography vs iOCT measured a small clinically relevant difference for ACD. The iOCT showed no clinically relevant differences in anterior segment parameters compared with the SS-OCT. A small clinically relevant difference for ACD was found in comparison with that of a Scheimpflug device.

Nondiffractive wavefront-shaping extended depth-of-focus intraocular lens: visual performance and patient-reported outcomes.

PURPOSE: To evaluate visual performance and patient-reported outcomes after bilateral implantation of a new nondiffractive wavefront-shaping extended depth-of-focus (EDoF) intraocular lens (IOL). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Prospective, single-arm, single-center study. METHODS: Patient population: 16 patients (32 eyes) who received bilateral implantation of a nondiffractive wavefront-shaping EDoF IOL (AcrySof IQ Vivity) were included. Target refraction in both eyes was emmetropia. Observation procedure: Monocular and binocular uncorrected (UCVA) and distance-corrected (DCVA) visual acuity (VA), refractive outcome, defocus curve, and contrast sensitivity (CS) were evaluated 3 months after surgery with a questionnaire on optical phenomena and spectacle independence. Main outcome measure: 3-month postoperative monocular and binocular UCVA and CDVA (logMAR), defocus curve, CS, and quality of vision (QoV) questionnaire results. RESULTS: 16 patients with 32 eyes were included. Mean spherical equivalent was -0.16 ± 0.37 diopters (D) 3 months postoperatively. Binocular uncorrected distance VA at distance, intermediate, and near was 0.01 ± 0.05 logMAR at 4 m, 0.05 ± 0.05 logMAR at 80 cm, 0.07 ± 0.06 logMAR at 66 cm, and 0.25 ± 0.11 logMAR at 40 cm, respectively. Despite some minor optical phenomena, 88% of patients would choose the same lens. 63% of patients reported no optical phenomena at all. CS was 1.25 ± 0.41 logCS (photopic), 0.96 ± 0.24 logCS (mesopic), and 0.93 ± 0.24 (mesopic + glare). CONCLUSIONS: This nondiffractive wavefront-shaping EDoF IOL provides good VA at far and intermediate distance and functional near VA. It showed good QoV and CS and high spectacle independence for distance and intermediate vision with significantly less optical phenomena than with other EDoF or multifocal IOLs.

Impact of Pseudoexfoliative Syndrome on Effective Lens Position, Anterior Chamber Depth Changes, and Visual Outcome After Cataract Surgery.

PURPOSE: To compare the effective lens position (ELP), anterior chamber depth (ACD) changes, and visual outcomes in patients with and without pseudoexfoliation syndrome (PEX) after cataract surgery. DESIGN: Prospective, randomized, fellow-eye controlled clinical case series. METHODS: This prospective comparative case series enrolled 56 eyes of 56 consecutive patients with (n = 28) or without PEX (n = 28) and clinically significant cataract who underwent standard phacoemulsification and were implanted with single-piece acrylic posterior chamber intraocular lenses (IOLs). The primary outcome parameters were the ACD referring to the distance between the corneal anterior surface and the lens anterior surface, which is an indicator of the postoperative axial position of the IOL (the so-called ELP) and distance corrected visual acuity (DCVA). RESULTS: Before surgery, the ACD was 2.54 ± 0.42 mm in the PEX group and 2.53 ± 0.38 mm in the control group (p = 0.941). Postoperatively, the ACD was 4.29 ± 0.71 mm in the PEX group and 4.33 ± 0.72 mm in the normal group, respectively (p = 0.533). There was no significant difference in ACD changes between groups (PEX group: 1.75 ± 0.74 mm, control group: 1.81 ± 0.61 mm, p = 0.806) and DCVA pre- (p = 0.469) and postoperatively (PEX group: 0.11 ± 0.13 logMAR, control group: 0.09 ± 0.17 logMAR, p = 0.245) between groups. CONCLUSION: Preoperative and postoperative ACD, as an indicator of ELP, between PEX eyes and healthy eyes after cataract surgery showed no significant difference. Phacoemulsification induced similar changes in eyes with PEX compared to healthy eyes.

Increased Corneal Endothelial Cell Migration in Fuchs Endothelial Corneal Dystrophy: A Live Cell Imaging Study.

Purpose: To investigate if corneal endothelial cells (CECs) in Fuchs endothelial corneal dystrophy (FECD) have altered cellular migration compared with normal controls. Design: Comparative analysis. Materials: Descemet's membrane and CECs derived from patients with FECD undergoing endothelial keratoplasty or normal cadaveric donors. Methods: Ex vivo specimens were used for live cell imaging and generation of immortalized cell lines. Live imaging was performed on FECD and normal CECs and on ex vivo specimens transfected with green fluorescent protein. Migration speeds were determined as a function of cellular density using automated cell tracking. Ex vivo specimens were classified as either FECD or normal low cell density (nonconfluent) or high cell density (confluent). Scratch assay was performed on CECs seeded at high confluence to determine migration speed. Genetic analysis from blood samples or CECs was performed to detect a CTG repeat expansion in the TCF4 gene. Main Outcome Measures: Mean cell migration speed. Results: Fuchs endothelial corneal dystrophy CECs in low cell density areas displayed increased mean speed (0.391 ± 0.005 µm/minute vs. 0.364 ± 0.005 µm/minute; P < 0.001) and mean maximum speed (0.961 ± 0.010 µm/minute vs. 0.787 ± 0.011 µm/minute; P < 0.001) compared with normal CECs, and increased mean maximum speed (0.778 ± 0.014 µm/minute vs. 0.680 ± 0.011 µm/minute; P < 0.001) in high cell density areas ex vivo. Similarly, FECD CECs displayed increased mean speed compared with normal CECs (1.958 ± 0.020 µm/minute vs. 2.227 ± 0.021 µm/minute vs. 1.567 ± 0.019 µm/minute; P < 0.001) under nonconfluent conditions in vitro. Moreover, FECD CECs also displayed increased mean speed compared with normal CECs under high confluent conditions as detected by scratch assay (37.2 ± 1.1% vs. 44.3 ± 4.1% vs. 70.7 ± 5.2%; P < 0.001). Morphologic analysis showed that FECD CECs displayed an increased fibroblastic phenotype as detected by filamentous-actin labeling. Conclusions: Fuchs endothelial corneal dystrophy CECs demonstrated increased migration speed compared with normal CECs. Further investigation into the mechanisms of heightened cell migration in FECD is needed and may provide insight into its pathogenesis, as well as having implications on descemetorhexis without endothelial keratoplasty.

Fuchs endothelial corneal dystrophy: The vicious cycle of Fuchs pathogenesis.

Fuchs endothelial corneal dystrophy (FECD) is the most common primary corneal endothelial dystrophy and the leading indication for corneal transplantation worldwide. FECD is characterized by the progressive decline of corneal endothelial cells (CECs) and the formation of extracellular matrix (ECM) excrescences in Descemet's membrane (DM), called guttae, that lead to corneal edema and loss of vision. FECD typically manifests in the fifth decades of life and has a greater incidence in women. FECD is a complex and heterogeneous genetic disease where interaction between genetic and environmental factors results in cellular apoptosis and aberrant ECM deposition. In this review, we will discuss a complex interplay of genetic, epigenetic, and exogenous factors in inciting oxidative stress, auto(mito)phagy, unfolded protein response, and mitochondrial dysfunction during CEC degeneration. Specifically, we explore the factors that influence cellular fate to undergo apoptosis, senescence, and endothelial-to-mesenchymal transition. These findings will highlight the importance of abnormal CEC-DM interactions in triggering the vicious cycle of FECD pathogenesis. We will also review clinical characteristics, diagnostic tools, and current medical and surgical management options for FECD patients. These new paradigms in FECD pathogenesis present an opportunity to develop novel therapeutics for the treatment of FECD.

One-Year Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty Versus Non-Preloaded Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To compare the one-year outcomes of preloaded Descemet membrane endothelial keratoplasty (pDMEK) and non-preloaded DMEK (n-pDMEK) in patients with Fuchs endothelial corneal dystrophy (FECD). METHODS: This retrospective comparative cohort study consecutively included 68 eyes with Fuchs endothelial corneal dystrophy who underwent either pDMEK (n = 38) or n-pDMEK (n = 30) performed by cornea fellows with an experienced surgeon between 2016 and 2018 at the Massachusetts Eye and Ear Infirmary. Exclusion criteria were previous surgery (other than uncomplicated cataract surgery) and any documented evidence of macular or other corneal diseases. Corrected distance visual acuity (CDVA), central corneal thickness, intraocular pressure, patient characteristics, postprocessing endothelial cell count, donor graft data, and complications were compared. RESULTS: CDVA showed similar results for pDMEK (0.12 ± 0.11 logarithm of the minimal angle of resolution [LogMAR]) and n-pDMEK (0.13 ± 0.13 LogMAR) (P = 0.827). Sixty-six percent of the pDMEK eyes and 57% of the n-pDMEK eyes achieved a VA of ≥0.1 LogMAR, and 95% and 97%, respectively, achieved a CDVA ≥0.3 LogMAR. The preoperative central corneal thickness of pDMEK and n-pDMEK (644 ± 62.2 µm, 660.5 ± 56.2 µm) decreased significantly after surgery (525.1 ± 43.6 µm, 526.5 ± 45.2 µm, P < 0.001), with no difference between groups (P = 0.840). The postprocessing endothelial cell count did not differ between pDMEK (2959.2 ± 182.9 cells/mm2) and n-pDMEK (2939.3 ± 278.7 cells/mm2) (P = 0.484). Complication rates were comparable with just the rebubbling performed in a minor procedure room showing a lower rate for pDMEK (13.16%) compared with n-pDMEK (33.33%) (P < 0.045). CONCLUSIONS: One-year clinical outcomes were similar between pDMEK and n-pDMEK procedures, rendering eye bank-prepared pDMEK tissues a useful tool in the treatment of endothelial dysfunction.

Presbyopia Correction in Astigmatic Eyes Using a Toric Trifocal Intraocular Lens With Quadrifocal Technology.

PURPOSE: To evaluate the visual performance after bilateral implantation of a toric diffractive aspheric multifocal intraocular lens (IOL) with a +2.17 diopters (D) (60 cm) intermediate and a +3.25 D (40 cm) addition (add) power. METHODS: This prospective single-arm study was conducted at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Twenty-five patients (50 eyes) received bilateral implantation of the toric PanOptix IOL (AcrySof IQ PanOptix; Alcon Research LLC) before enrollment. Exclusion criteria were previous ocular surgeries excluding lens surgery and ocular pathologies or corneal abnormalities. Examination at 3 months postoperatively included manifest refraction; monocular and binocular uncorrected distance (UDVA) and distance-corrected (DCVA) visual acuity at 4 m and 80, 60, and 40 cm; and slit-lamp examination. At 3 months postoperatively, monocular and binocular defocus, binocular contrast sensitivity under photopic and mesopic conditions, and optical phenomena, and spectacle independence were evaluated. RESULTS: Mean refractive spherical equivalent was 0.12 ± 0.380 D and mean refractive cylinder was -0.21 ± 0.237 D at 3 months postoperatively. A significant decrease in refractive cylinder was observed postoperatively (P < .05), with 98% showing a postoperative astigmatism below 0.75 D. Monocular UDVA was better than 0.14 logMAR in all distances. Binocular defocus curve showed peaks at 0.00 D (-0.09 logMAR) and -1.50 and -2.00 D (-0.02 and 0.00 logMAR). The worst values between far (4 m) and near (40 cm) distance were 0.04 logMAR at -1.00 D. Despite some optical phenomena, 92% of patients would choose the same IOL again and recommend it to others. CONCLUSIONS: The visual performance of the toric PanOptix IOL showed good visual acuity at all distances; more than 90% achieved a decrease of refractive cylinder below 0.75 D, high patient satisfaction despite some optical phenomena, and high spectacle independence 3 months postoperatively. [J Refract Surg. 2020;36(10):638-644.].

Near visual acuity and patient-reported outcomes in presbyopic patients after bilateral multifocal aspheric laser in situ keratomileusis excimer laser surgery.

PURPOSE: To determine improvement of near visual acuity by bilateral multifocal aspheric laser in situ keratomileusis (LASIK) treatments in presbyopic patients. SETTING: Goethe-University, Frankfurt, Germany. DESIGN: Prospective, nonrandomized trial. METHODS: Thirty presbyopic patients underwent LASIK treatment with a multifocal aspheric ablation profile using an excimer laser (PresbyMAX). The first 15 patients received a multifocal aspheric ablation profile combined with micromonovision. For the consecutive 15 patients, less depth of focus was included on the distance eye (hybrid). Outcome parameters were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected and distance-corrected intermediate visual acuities, uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA); manifest refraction spherical equivalent; subjective quality of vision; and spectacle independence. RESULTS: The data of 29 patients were analyzed and showed that binocular CDVA changed from -0.16 ± 0.10 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.05 ± 0.20 logMAR UDVA and -0.06 ± 0.14 logMAR CDVA (P = .000, P = .001) 1 year postoperatively. Near visual acuity improved from 0.47 ± 0.13 logMAR (DCNVA) and 0.48 ± 0.26 logMAR (UNVA) to 0.19 ± 0.19 logMAR (DCNVA, P < .001) and 0.05 ± 0.15 logMAR (UNVA, P < .001). The hybrid and the µ-monovision group did not differ statistically except for a better DCNVA in the µ-monovision patients (0.21 ± 0.15 logMAR vs 0.34 ± 0.17 logMAR, P = .034). Of the hybrid and µ-monovision patients, 21 (72%) and 12 (41%) had a binocular CDVA and UDVA of 20/20 or better, 8 patients (28%) lost 1 line, 3 (10%) lost 2 lines, 4 (14%) lost 3 lines, and 2 (7%) lost 4 lines of CDVA. CONCLUSIONS: The PresbyMAX laser seemed to satisfy most of the patients, although they experienced a loss of CDVA. The gain of near visual acuity and therefore reported less need of spectacles seemed to compensate for this loss.

Comparison of Femto-LASIK With Combined Accelerated Cross-linking to Femto-LASIK in High Myopic Eyes: A Prospective Randomized Trial.

PURPOSE: To evaluate the safety and efficacy of femtosecond (fs) laser-assisted in situ keratomileusis (LASIK) combined with accelerated corneal cross-linking (LASIK Xtra) compared to conventional fs-LASIK (convLASIK) in high myopic patients. DESIGN: Prospective, randomized, fellow-eye controlled clinical trial. METHODS: Setting: Department of Ophthalmology, Goethe University, Frankfurt/Germany. StudyPopulation: Twenty-six patients with high myopia and/or myopic astigmatism received randomized treatment with LASIK Xtra (30 mW/cm2, 90 seconds with continuous ultraviolet-A) in 1 eye and convLASIK in the other eye. MainOutcomeMeasures: Uncorrected distance visual acuity (UDVA), best spectacle-corrected VA (BSCVA), manifest refractive spherical equivalent (MRSE), endothelial cell count (ECC), and corneal thickness. RESULTS: The UDVA improved from 1.26 ± 0.13 logMAR preoperative to -0.02 ± 0.15logMAR in LASIK Xtra eyes and from 1.27 ± 0.12 logMAR to 0.01 ± 0.15 logMAR in the convLASIK eyes (P > .05). The MRSE changed from -7.35 ± 1.15 diopters (D) and -7.5 ± 1.12 D to -0.17 ± 0.43 D and -0.25 ± 0.46 D, respectively. There was no significant difference in outcomes between both groups during the 12 months follow-up except for the convLASIK eyes' showing slightly better BSCVA after 1 week (P < .05). ConvLASIK eyes revealed a nonsignificant trend toward myopic regression from 3 to 12 months postoperative with a change in MRSE of -0.15 D compared to -0.1 D in LASIK Xtra eyes. Topography showed stability of corneal curvature with no signs of keratectasia in both groups at 12 months. CONCLUSION: While apparently safe, LASIK Xtra showed no advantages over conventional LASIK. At 12 months, both groups showed no difference regarding UDVA and refractive stability, and no signs of keratectasia.

Tomographic analysis of anterior and posterior surgically induced astigmatism after 2.2 mm temporal clear corneal incisions in femtosecond laser-assisted cataract surgery.

PURPOSE: To evaluate surgically induced astigmatism (SIA) of temporal clear corneal incisions (CCIs) on anterior and posterior corneal curvature after femtosecond laser-assisted cataract surgery (FLACS) using Scheimpflug tomographic measurements. SETTING: Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany. DESIGN: Prospective interventional case series. METHODS: This study enrolled patients who underwent FLACS from June 2013 to July 2014. All eyes were measured with a Pentacam HR preoperatively and at 1 month and 3 months postoperatively, had preoperative total corneal refractive power (TCRP) astigmatism (CATCRP) of 0.50 diopters (D) or less, and received a temporal 2.2 mm incision at 0 degrees and 180 degrees. Vector analysis, using the Holladay-Cravy-Koch formula and the Alpins method, determined astigmatic changes in anterior corneal astigmatism (CAant), posterior corneal astigmatism (CApost), and CATCRP. Student t and Wilcoxon tests were performed. A P value less than 0.05 was considered statistically significant. RESULTS: This study comprised 53 eyes of 38 patients. At 3 months postoperatively, the CAant, CApost, and CATCRP were significantly higher compared with the preoperative values (P = .015, P = .007, P = .008, respectively); however, CApost and CATCRP were significantly lower compared with the limit of 0.50 D (P < .001, P = .01, respectively), whereas CAant was not (P = .11). The mean SIA of CAant, CApost, and CATCRP was 0.25 D ± 0.15 (SD), 0.16 ± 0.11 D, and 0.28 ± 0.17 D, respectively. The angle of error was high (-1.98 ± 52.95 degrees, 1.64 ± 51.27 degrees, and -1.72 ± 48.79 degrees, respectively). CONCLUSION: Femtosecond laser temporal CCIs induce minimal astigmatism in CAant, CApost, and CATCRP, but can be evaluated statistically as astigmatically neutral.

Defocus curves of 4 presbyopia-correcting IOL designs: Diffractive panfocal, diffractive trifocal, segmental refractive, and extended-depth-of-focus.

PURPOSE: To evaluate the defocus curves of 4 presbyopia-correcting intraocular lenses (IOLs). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Prospective case series. METHODS: Patients included in the study had bilateral surgery with implantation of diffractive panfocal, diffractive trifocal, segmental refractive (SegRef), or extended-depth-of-focus (EDOF) presbyopia-correcting IOLs. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected intermediate and near visual acuities, distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuities, defocus curve, and spectacle independence were measured. RESULTS: The UDVA and CDVA were not significantly different between groups (P > .05); however, the EDOF group had worse near CDVA (P < .001). The trifocal and EDOF groups showed better DCIVA than the panfocal and SegRef group at 80 cm (P < .001); the EDOF and panfocal groups had comparable DCIVA at 60 cm (P > .05). Defocus curves showed no significant between-group differences from 4 m to 2 m (P > .05). The EDOF group had better visual acuity from 1 m to 67 cm than the trifocal and SegRef groups and better visual acuity than the panfocal group at 1 m (P > .05). Compared with the other IOLs, the panfocal IOL yielded significantly better visual acuity at 50 cm (P < .001) and the EDOF IOL worse visual acuity at 40 cm (P < .01). There was a significant difference in spectacle independence between the panfocal group and EDOF group (P < .05) but no difference between the other groups. CONCLUSIONS: The 4 IOLs provided equally good CDVA. The EDOF IOL yielded slightly better DCIVA but worse DCNVA than the other IOLs. Only the panfocal IOL gave better DCIVA at 50 cm.