Clinical Effectiveness of Laser-Induced Increased Depth of Field for the Simultaneous Correction of Hyperopia and Presbyopia.

PURPOSE: To evaluate the visual outcomes of patients with presbyopic hyperopia, comparing the current standard of monovision treatment with a novel bilateral presbyopic LASIK (Custom-Q mode) technique. METHODS: This prospective comparative study of consecutive eligible patients with presbyopic hyperopia undergoing a bilateral presbyopic laser in situ keratomileusis technique was conducted between January 2018 and February 2019. After contact lens-simulated monovision measurements were obtained, the non-dominant eyes had a negative aspheric ablation profile planned using the Custom-Q nomogram (Alcon Laboratories, Inc). The dominant eye was operated on with a positive aspheric ablation profile. Visual acuity testing, refraction, corneal asphericity (▵Q), higher order aberrations, and a satisfaction questionnaire (National Eye Institute Refractive Error Quality of Life) were evaluated after the monovision trial and postoperatively. RESULTS: Twenty-eight patients, with a mean age of 56.03 ± 4.31 years, were included in the study. At 6 months, 100% of patients achieved 20/20 or better binocular uncorrected distance visual acuity (UDVA) versus 57% in the monovision group, 100% of patients achieved 20/25 or better binocular uncorrected intermediate visual acuity versus 32% in the monovision group, and 92.86% of patients achieved 20/25 or better binocular uncorrected near visual acuity (UNVA) in both groups. In contact lens monovision simulation, no patient reached a UDVA of 20/50 or better, with only 3.6% having a UNVA of 20/40 or better. The questionnaire demonstrated high patient satisfaction. CONCLUSIONS: The outcomes confirm the superiority of increased depth of focus using negative spherical aberration modulation in the non-dominant eye compared with contact lens monovision. They also demonstrate the effectiveness of positive spherical aberration induction to improve intermediate and near vision in the dominant eye. [J Refract Surg. 2021;37(1):16-24.].

Outcomes of Gel Stent Implantation for Glaucoma in Patients With Previous Corneal Graft Surgery: A Case Series.

PURPOSE: To report a series of 5 cases with successful placement of a minimally invasive glaucoma surgery (MIGS) device for glaucoma refractory to medical management in patients with previous corneal grafts. METHODS: This is a retrospective analysis of all cases with a Xen45 Gel Stent (Allergan plc, Dublin, Ireland) for ocular hypertension and glaucoma refractory to medical treatment after corneal graft surgery between 2016 and 2019 at the Rothschild Foundation, Paris. We did the imaging studies and studied the intraocular pressure (IOP) and the endothelial cell count preimplantation and postimplantation with a MIGS device. RESULTS: Five cases were included in this study, demonstrating a well-tolerated, highly effective, and sustained method for controlling the IOP, which was refractory to previous treatment. An average IOP reduction of 70.5% was noted with a needling rate of 20%, and no adverse events were noted except 1 IOP spike day 7 post-op with no long-term effects. CONCLUSIONS: Glaucoma after graft surgery is a well-known and devastating complication, and as numbers of graft surgery performed increases, so will the incidence of glaucoma. MIGS devices such as the Xen45 Gel Stent (Allergan plc) should become a part of our accepted armory to treat raised IOP refractory to medical treatment without delay.