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1.
J Refract Surg ; 40(6): e362-e370, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38848058

RESUMO

PURPOSE: To identify potential risk factors that increase the likelihood of re-treatment following keratorefractive lenticule extraction (KLEx) for myopia and myopic astigmatism. METHODS: This was a retrospective study of patients with myopia and myopic astigmatism who underwent KLEx using the VisuMax 500 laser (Carl Zeiss Meditec) between April 2015 and December 2020. Patients were assigned to one of two groups: the control group and the re-treatment group (if they had additional refractive surgery within 2 years of the primary treatment). The effect of different preoperative, intraoperative, and postoperative parameters on the re-treatment rate was analyzed. RESULTS: Overall 1,822 eyes of 938 patients were analyzed. In total, 2.96% of eyes (n = 54) underwent re-treatment. The re-treated patients were more likely to be women and have high myopia, high astigmatism, steep corneas, higher ocular residual astigmatism, and residual myopic and/or astigmatic refractive error. In contrast, no significant correlation was found between re-treatment rate and age, chord µ, type of astigmatism, and corneal thickness. CONCLUSIONS: Factors associated with higher rates of retreatment after KLEx included female gender, manifest refractive high myopia (> -5.00 diopters [D]), astigmatism (> 2.00 D), spherical equivalent (> 6.00 D), ocular residual astigmatism, steeper corneas, and postoperative residual myopic and astigmatic refractive errors. This study may help to preoperatively detect patients at risk for re-treatment, improve preoperative patient counseling, and optimize patient selection to reduce future re-treatment rates. [J Refract Surg. 2024;40(6):e362-e370.].


Assuntos
Astigmatismo , Lasers de Excimer , Miopia , Refração Ocular , Reoperação , Acuidade Visual , Humanos , Estudos Retrospectivos , Masculino , Astigmatismo/cirurgia , Astigmatismo/fisiopatologia , Feminino , Adulto , Fatores de Risco , Miopia/cirurgia , Miopia/fisiopatologia , Acuidade Visual/fisiologia , Refração Ocular/fisiologia , Lasers de Excimer/uso terapêutico , Adulto Jovem , Substância Própria/cirurgia , Topografia da Córnea , Pessoa de Meia-Idade , Adolescente , Cirurgia da Córnea a Laser/métodos
2.
BMC Ophthalmol ; 24(1): 252, 2024 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-38867207

RESUMO

BACKGROUND: To comparatively analyze the surgically induced astigmatism (SIA) of the anterior, posterior, and total corneas of eyes undertaking implantable collamer lens (ICL) implantation with temporal or superior corneal incisions. METHODS: One hundred and nine eyes of 109 patients who received ICL implantation were recruited: 40 eyes had temporal incisions and 69 eyes had superior incisions. Total corneal refractive power (TCRP); simulated keratometry of the anterior (Sim-KAnt) and posterior (Sim-KPost) corneal curvature; and astigmatism of the anterior (CAAnt), posterior (CAPost), and total (CATCRP) cornea were recorded through a Pentacam preoperatively and 3 months postoperatively. The SIA of the anterior, posterior, and total cornea were also compared between the two groups. RESULTS: There were no significant intergroup differences for TCRP, Sim-KAnt, Sim-KPost, CAAnt, CAPost, or CATCRP, preoperatively. However, values of CAAnt, CAPost, and CATCRP with temporal incision were significantly higher than those parameters with superior incision postoperatively. All of the SIA of the anterior, posterior, and total cornea were significantly lower for temporal incision than those with a superior incision (p < 0.001, p = 0.006 and p = 0.001 respectively). Meanwhile, the superior incisions created against-the-rule (ATR) astigmatism, and temporal incisions always induce with-the-rule (WTR) astigmatism in total cornea. CONCLUSIONS: A superior incision may be suitable for correcting WTR astigmatism, while a temporal incision for correcting ATR astigmatism when using a non-toric ICL. Meanwhile, temporal incision could be a better choice with little preoperative astigmatism or that preoperative astigmatism would be corrected with toric ICLs. TRIAL REGISTRATION: Registration number: ChiCTR2100051739. Prospectively registered: 01 October 2021.


Assuntos
Astigmatismo , Córnea , Implante de Lente Intraocular , Lentes Intraoculares Fácicas , Refração Ocular , Acuidade Visual , Humanos , Astigmatismo/etiologia , Astigmatismo/fisiopatologia , Astigmatismo/cirurgia , Feminino , Masculino , Adulto , Córnea/cirurgia , Refração Ocular/fisiologia , Adulto Jovem , Miopia/cirurgia , Miopia/fisiopatologia , Pessoa de Meia-Idade , Topografia da Córnea , Estudos Retrospectivos , Complicações Pós-Operatórias/diagnóstico , Estudos Prospectivos
3.
Curr Opin Ophthalmol ; 35(4): 278-283, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38700941

RESUMO

PURPOSE OF REVIEW: Laser keratorefractive surgery achieves excellent visual outcomes for refractive error correction. With femtosecond laser, small incision lenticule extraction (SMILE) is an increasingly viable alternative to laser-assisted in situ keratomileusis (LASIK). Comparative studies demonstrate similar efficacy and predictability between SMILE and LASIK, making it difficult for clinicians to choose which to use. This review thus compares femtosecond-LASIK (FS-LASK) and SMILE in various scenarios, to assist clinicians in deciding which refractive surgery procedure to recommend. RECENT FINDINGS: SMILE may be superior for highly myopic eyes due to a smaller decrease in functional optical zone. SMILE further induces less spherical aberration and less overall higher order aberrations in mesopic conditions. SMIILE also has less postoperative dry eye, making it suitable those with preexisting dry eye. For low to moderate myopic astigmatism correction, FS-LASIK has less undercorrection compared to SMILE. Lastly, SMILE has not yet received Food and Drug Administration or Conformité Européenne approval for hyperopic correction, rendering FS-LASIK the choice of procedure for hyperopic correction. SUMMARY: Both FS-LASIK and SMILE demonstrate good efficacy and predictability. Understanding specific clinical scenarios where one may be superior to the other will aid clinicians in choosing the most suitable procedure for personalized care.


Assuntos
Substância Própria , Ceratomileuse Assistida por Excimer Laser In Situ , Lasers de Excimer , Miopia , Acuidade Visual , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Substância Própria/cirurgia , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Miopia/fisiopatologia , Refração Ocular/fisiologia , Astigmatismo/cirurgia , Astigmatismo/fisiopatologia , Cirurgia da Córnea a Laser/métodos , Microcirurgia/métodos
4.
BMJ Case Rep ; 17(5)2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38719245

RESUMO

We report a case of a woman in her 30s who underwent femtosecond LASIK (laser-assisted in situ keratomileusis) in both eyes to correct her simple myopic astigmatism. After the surgery, both eyes developed diffuse lamellar keratitis, and intensive topical steroids were initiated to control the same. Subsequently, central toxic keratopathy (CTK) developed bilaterally. Three weeks after the surgery, the right eye showed signs of progressive epithelial ingrowth involving the pupillary area. Surgical intervention in the form of flap relift followed by debridement of the epithelial cells and an alcohol interface wash were performed to treat the same. This is the first report of an epithelial ingrowth following CTK after femtosecond LASIK.


Assuntos
Epitélio Corneano , Ceratomileuse Assistida por Excimer Laser In Situ , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Feminino , Adulto , Epitélio Corneano/patologia , Miopia/cirurgia , Complicações Pós-Operatórias/etiologia , Doenças da Córnea/etiologia , Desbridamento/métodos , Astigmatismo/etiologia , Astigmatismo/cirurgia , Retalhos Cirúrgicos/efeitos adversos
5.
Medicine (Baltimore) ; 103(20): e38194, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38758875

RESUMO

This study aimed to compare the postimplantation clinical outcomes of 2 types of posterior chamber phakic intraocular lenses (IOLs): Visian™ implantable collamer lenses (ICL; EVO+ V5; Staar Surgical, Monrovia, CA) and an implantable phakic contact lens (IPCL) (IPCL V2.0, Care Group Sight Solution, India) to correct high myopia and myopic astigmatism. This retrospective study included patients who had undergone phakic IOL implantation performed by a single surgeon between March 2021 and March 2022. Preoperative assessments included slit-lamp examination, fundus examination, spherical equivalent, uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), specular microscope parameters, and optical quality analysis system parameters. Postoperative assessments after 1 year included slit-lamp examination to detect adverse effects and spherical equivalent, UDVA, CDVA, specular microscope, optical quality analysis system, and anterior-segment optical coherence tomography. Eighty eyes from 42 patients (47 eyes from 24 patients in the ICL group and 33 eyes from 18 patients in the IPCL group) were included. No statistically significant differences were observed between the 2 groups regarding preoperative parameters. At 1-year postoperatively, the mean UDVA in the ICL and IPCL groups was 0.019 ±â€…0.040 logMAR and 0.019 ±â€…0.041 logMAR, respectively. The mean CDVA was 0.001 ±â€…0.008 logMAR and 0.001 ±â€…0.007 logMAR in the ICL and IPCL groups, respectively, showing no statistically significant differences. The postoperative parameters did not differ significantly between the 2 groups. The visual acuity and refractive results of both groups were excellent, and both groups exhibited similar efficacy and safety profiles.


Assuntos
Implante de Lente Intraocular , Lentes Intraoculares Fácicas , Acuidade Visual , Humanos , Masculino , Feminino , Estudos Retrospectivos , Adulto , Implante de Lente Intraocular/métodos , Implante de Lente Intraocular/efeitos adversos , Adulto Jovem , Astigmatismo/cirurgia , Miopia/cirurgia , Resultado do Tratamento
6.
J Refract Surg ; 40(5): e328-e335, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38717080

RESUMO

PURPOSE: To evaluate moderate to high astigmatism corrections on the outcomes of SmartSight lenticule extraction for myopic astigmatism with a new femtosecond laser system. METHODS: Two hundred ninety-two eyes consecutively treated for myopic astigmatism with astigmatism magnitude greater than 1.00 diopter (D) were evaluated at the 6-month follow-up visit. The mean age of the patients was 29 ± 6 years with a mean spherical equivalent of -5.06 ± 2.20 diopters (D) and a mean magnitude of refractive astigmatism of 1.74 ± 0.61 D. RESULTS: At 6 months, astigmatism was 0.10 ± 0.20 D. Uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively) were both 0.0 ± 0.1 logMAR. Differences between postoperative UDVA and preoperative CDVA and the change in CDVA were both +0.4 ± 0.7 lines better than preoperatively (P < .0003). CONCLUSIONS: Lenticule extraction treatment using Smart-Sight is safe and efficacious at 6 months. Findings suggest that moderate to high astigmatism improves after SmartSight lenticule extraction in the treatment of myopic astigmatism. [J Refract Surg. 2024;40(5):e328-e335.].


Assuntos
Astigmatismo , Substância Própria , Lasers de Excimer , Miopia , Refração Ocular , Acuidade Visual , Humanos , Astigmatismo/fisiopatologia , Astigmatismo/cirurgia , Acuidade Visual/fisiologia , Estudos Retrospectivos , Adulto , Refração Ocular/fisiologia , Masculino , Feminino , Miopia/cirurgia , Miopia/fisiopatologia , Adulto Jovem , Substância Própria/cirurgia , Lasers de Excimer/uso terapêutico , Topografia da Córnea , Seguimentos , Resultado do Tratamento , Cirurgia da Córnea a Laser/métodos
7.
J Refract Surg ; 40(5): e291-e303, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38717083

RESUMO

PURPOSE: To compare differences in corneal densitometry (CD) and higher order aberrations (HOAs) in eyes that underwent small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for the treatment of myopia and myopic astigmatism at postoperative months 3, 6, and 12, and to evaluate their changes in a separate cohort of eyes after SMILE enhancement. METHODS: In this prospective, randomized, paired-eye clinical trial, consecutive eligible participants were randomized to undergo SMILE or FS-LASIK in either eye. Main outcome measures were CD and HOAs preoperatively and at 3, 6, and 12 months postoperatively. A separate cohort of consecutive patients who had SMILE and underwent enhancement were also included for comparison. RESULTS: For CD, no significant differences were found between SMILE and FS-LASIK up to month 12. For HOA measured by wavefront aberrometry, both SMILE and FS-LASIK had an increase in total root mean square (RMS) HOAs, spherical aberration (SA), and vertical coma up to month 12. SMILE had an additional increase in vertical quatrefoil, and FS-LASIK had an increase in horizontal coma at month 12. FS-LASIK had higher SA than SMILE, whereas SMILE had higher vertical quatrefoil than FS-LASIK at month 12. Central and posterior zone CD had significantly decreased after SMILE enhancement compared to after primary SMILE up to 2 years after enhancement. RMS HOAs, lower order aberrations, and SA were all increased after SMILE enhancement compared to after primary SMILE. CONCLUSIONS: SMILE induced lower SA but higher vertical quatrefoil than FS-LASIK at 1 year. Both SMILE and FS-LASIK had similar increases in RMS HOAs and vertical coma up to 1 year. There were no differences in CD between both groups. SMILE enhancement additionally had decreased central and posterior CD but greater RMS HOAs and SA compared to primary SMILE. [J Refract Surg. 2024;40(5):e291-e303.].


Assuntos
Aberrometria , Astigmatismo , Córnea , Substância Própria , Aberrações de Frente de Onda da Córnea , Densitometria , Ceratomileuse Assistida por Excimer Laser In Situ , Lasers de Excimer , Miopia , Refração Ocular , Acuidade Visual , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Aberrações de Frente de Onda da Córnea/fisiopatologia , Estudos Prospectivos , Miopia/cirurgia , Miopia/fisiopatologia , Adulto , Feminino , Masculino , Lasers de Excimer/uso terapêutico , Acuidade Visual/fisiologia , Substância Própria/cirurgia , Córnea/cirurgia , Córnea/fisiopatologia , Adulto Jovem , Refração Ocular/fisiologia , Astigmatismo/cirurgia , Astigmatismo/fisiopatologia , Cirurgia da Córnea a Laser/métodos , Topografia da Córnea
8.
J Refract Surg ; 40(4): e208-e217, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38593256

RESUMO

PURPOSE: To evaluate spherical intraocular lens (IOL) implantation for cataracts in keratoconic eyes followed by optional refractive toric lens exchange to improve uncorrected visual acuity. METHODS: This retrospective study evaluated cataract surgery outcomes in keratoconic eyes. Eyes treated with a spherical IOL targeted for -2.00 diopters (D) either achieved acceptable manifest refraction and desired exchange with a toric IOL (Group 1); achieved satisfactory manifest refraction and chose to use spectacles or contact lenses (Group 2); or did not achieve acceptable refraction and used contact lenses (Group 3). Group 4 had single-stage toric IOL implantation with plano target. Corrected and uncorrected distance visual acuity (CDVA and UDVA) and keratometry were analyzed. RESULTS: Groups 1 to 4 had 18, 23, 18, and 26 eyes, respectively. A staged toric exchange resulted in significantly better (P = .02) UDVA (mean: 0.15 logMAR; 20/25 Snellen) than initial toric IOL implantation (0.24 logMAR; 20/30 Snellen). All toric IOL exchange eyes achieved 20/30 or better CDVA and 94% had 20/40 or better UDVA. Mean manifest cylinder significantly decreased from 3.39 D before lens exchange to 1.10 D postoperatively. CONCLUSIONS: Initial implantation of a spherical IOL in keratoconic eyes allows basing toric calculations on the manifest refraction, which may be more reliable than keratometry measurements in keratoconic eyes. UDVA after staged toric IOL exchange was significantly better than after initial toric IOL implantation. Importantly, by staging use of toric lenses, the authors avoided cases where patients required a rigid contact lens after a toric IOL was implanted. [J Refract Surg. 2024;40(4):e207-e217.].


Assuntos
Astigmatismo , Catarata , Ceratocone , Lentes Intraoculares , Facoemulsificação , Humanos , Ceratocone/complicações , Ceratocone/cirurgia , Estudos Retrospectivos , Facoemulsificação/métodos , Resultado do Tratamento , Astigmatismo/cirurgia , Refração Ocular , Catarata/complicações
9.
J Refract Surg ; 40(4): e239-e244, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38593260

RESUMO

PURPOSE: To explore changes in corneal epithelial thickness (CET) after femtosecond laser-assisted laser in situ keratomileusis in patients with high astigmatism. METHODS: CET was measured at every intersection of the concentric circles and specific axes using AngioVue optical coherence tomography (Angio-OCT) preoperatively and 1 month postoperatively. The average thickness of corneal central, paracentral, and peripheral regions was the mean of the points within the central 2, 2 to 5, and 5 to 7 mm areas, respectively. Correlation analysis was performed to investigate the association between CET along different axes and other preoperative and postoperative parameters. RESULTS: Forty-two eyes of 28 patients were included. CET along the astigmatic (K1) and perpendicular (K2) axes in the central and paracentral areas increased (P < .001), whereas that along the K2 axis decreased in the peripheral area 1 month postoperatively (P = .001). The amount of CET change in the peripheral area between the K1 and K2 axes was significantly different (P < .001). In the central area, the change in CET along the K2 axis was positively correlated with ablation depth (r = 0.315, P = .042) and negatively with refractive power after surgery (r = -0.347, P = .024). In the peripheral area, the changes in CET along both K1 and K2 axes were negatively correlated with ablation depth (r = -0.431, P = .004; r = -0.387, P = .011, respectively). CONCLUSIONS: Epithelial modeling differed between the different astigmatism axes after refractive surgery. The compensatory response of the corneal epithelium is more pronounced along the steeper axis. [J Refract Surg. 2024;40(4):e239-e244.].


Assuntos
Astigmatismo , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Acuidade Visual , Astigmatismo/cirurgia , Miopia/cirurgia , Estudos Prospectivos , Lasers , Lasers de Excimer/uso terapêutico
10.
J Refract Surg ; 40(4): e245-e252, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38593261

RESUMO

PURPOSE: To evaluate clinical outcomes and visual quality 12 months after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) performed with the Custom-Q algorithm for correction of myopia with or without astigmatism and compensate for age-related accommodation deficiency. METHODS: Patients who had Custom-Q FS-LASIK for myopia and myopic astigmatism with age-related accommodation deficiency were included in this retrospective study. Distance, intermediate, and near visual acuities, objective and subjective refractions, Q-factor, corneal higher order aberrations (HOAs), accommodation function, defocus curve, contrast sensitivity, and a subjective questionnaire assessing visual quality were evaluated 12 months postoperatively. RESULTS: Clinical data of 43 cases were analyzed. The mean age was 42.02 ± 1.85 years (range: 40 to 48 years). At the 12-month follow-up visit, there were 43 (100%), 42 (97%), and 33 (77%) patients who achieved a binocular uncorrected distance, intermediate, and near visual acuity, respectively, better than 20/20 separately. Defocus curves revealed better distance vision in the dominant eyes, and the nondominant eyes performed better at intermediate and near vergence (P < .001). The Q-value and corneal spherical aberration coefficient were more positive in the dominant eyes than those in the nondominant eyes (P < .001). The accommodative amplitude and relative accommodation improved binocularly (P < .001). The questionnaire demonstrated high patient satisfaction with near vision, and no one reported having severe visual disturbance. CONCLUSIONS: For myopic patients with age-related accommodation deficiency, the Custom-Q algorithm proved to be an effective way to achieve acceptable near vision without compromising distance vision. [J Refract Surg. 2024;40(4):e245-e252.].


Assuntos
Astigmatismo , Aberrações de Frente de Onda da Córnea , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Humanos , Adulto , Estudos Retrospectivos , Acuidade Visual , Córnea , Miopia/cirurgia , Astigmatismo/cirurgia , Lasers de Excimer/uso terapêutico , Refração Ocular , Resultado do Tratamento
11.
Sci Rep ; 14(1): 8868, 2024 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-38632326

RESUMO

A retrospective cohort study was conducted to observe the correction effect of Toric intraocular lens (IOL) implantation in cataract eyes with specific types of irregular corneal astigmatism. Thirty-four eyes with either the "asymmetric bow-tie" pattern (Type I) or the "angled bow-tie" pattern (Type II) were included. Corneal topography was assessed using Pentacam HR, and changes in preoperative corneal astigmatism, visual acuity, manifest refraction, and objective visual quality were measured and compared. The average uncorrected distance visual acuity improved significantly from 0.86 ± 0.40 logMAR to 0.22 ± 0.15 logMAR (P < 0.001). Preoperative corneal astigmatism of 2.05 ± 0.90 D was corrected to a postoperative residual astigmatism of 0.78 ± 0.57 D (P < 0.001), with 32% of eyes within 0.50 D. The residual astigmatism prediction errors in Type I and Type II cases were (0.97 ± 0.68 D) and (0.66 ± 0.37 D), respectively (P = 0.100). The mean spherical equivalent prediction error in Type II cases (0.07 ± 0.36 D) was significantly smaller than that in Type I cases (- 0.29 ± 0.52 D) (P = 0.030). This study concludes that Toric IOL implantation effectively corrects specific types of irregular corneal astigmatism in cataract surgery. Eyes with the "angled bow-tie" pattern show higher accuracy in refractive predictions compared to eyes with the "asymmetric bow-tie" pattern.


Assuntos
Astigmatismo , Catarata , Doenças da Córnea , Lentes Intraoculares , Facoemulsificação , Humanos , Astigmatismo/cirurgia , Implante de Lente Intraocular , Estudos Retrospectivos , Refração Ocular , Doenças da Córnea/cirurgia
13.
BMC Ophthalmol ; 24(1): 174, 2024 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-38627647

RESUMO

PURPOSE: To evaluate the long-term clinical outcomes of femtosecond thin-flap LASIK (femto-LASIK) for correction of refractive error after penetrating keratoplasty in keratoconus-affected eyes. SETTING: a private ophthalmology clinic. DESIGN: Prospective interventional case series. METHODS: This prospective interventional case series enrolled 22 eyes of 22 patients who underwent femto-LASIK for the management of post-penetrating keratoplasty ametropia. The refractive error, uncorrected (UDVA), and corrected (CDVA) distance visual acuities and vector analysis were reported in short-term and long-term period after surgery. RESULTS: The mean age was 32.7 ± 7.5 years (range, 23 to 47 years) at the surgery time. The average time between PK and femto-LASIK was 42.5 ± 31.7 months. The average follow-up duration after femto-LASIK was 81.2 ± 18.6 months. The mean preoperative UDVA significantly improved from 0.47 ± 0.15 logMAR to 0.35 ± 0.14 logMAR at 12 months (P = 0.048) and 0.4 ± 0.17 at final follow-up exam (P = 0.007). CDVA was 0.22 ± 0.1 at baseline which improved to 0.18 ± 0.15 and 0.15 ± 0.1 logMAR at 12 and 81 months, respectively. (Ps = 0.027, 0.014). The mean cylinder before surgery was - 5.04 ± 1.4D which significantly decreased to -1.5 ± 0.8 D at 12 months postoperatively. (P < 0.001). There was a significant increase in refractive astigmatism from 12 months to 81 months postoperatively (-3.1 ± 2.0, P = 0.002). At the final visit, the efficacy index was 0.83, and the safety index was 1.16. CONCLUSIONS: Despite the short-term outcome indicated that femo-LASIK was effective for correction of post-keratoplasty ametropia during short-term period, a notable regression in its effect was observed in the long-term follow-up. Therefore, the predictability of this technique might decrease in the long-term.


Assuntos
Astigmatismo , Ceratomileuse Assistida por Excimer Laser In Situ , Erros de Refração , Humanos , Adulto , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Ceratoplastia Penetrante/efeitos adversos , Estudos Prospectivos , Astigmatismo/etiologia , Astigmatismo/cirurgia , Refração Ocular , Lasers , Resultado do Tratamento , Lasers de Excimer/uso terapêutico
14.
BMC Ophthalmol ; 24(1): 158, 2024 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-38600456

RESUMO

BACKGROUND: This study aimed to compare the visual outcomes of the first operated eyes with those of the second operated eyes following small-incision lenticule extraction (SMILE). METHODS: A total of 202 patients (404 eyes) underwent SMILE using the tear film mark centration method for myopia and myopic astigmatism correction. Baseline characteristics, objective optical quality, decentered displacement, induced corneal aberrations, and modulation transfer function (MTF) values were assessed. Linear regression analyzed the relationship between decentration and visual quality parameters, including corneal aberrations and MTF values. RESULTS: No significant difference was observed in objective visual quality, efficacy, and safety indexes between the two groups (all P > 0.05). The average decentered displacement for the first and second surgical eyes was 0.278 ± 0.17 mm and 0.315 ± 0.15 mm, respectively (P = 0.002). The horizontal coma in the first surgical eyes were notably lower than in the second (P = 0.000). MTF values at spatial frequencies of 5, 10, 15, and 20 cycles/degree (c/d) were higher in the first surgical eyes compared to the second (all P < 0.05). Linear regression indicated that high-order aberrations (HOAs), root mean square (RMS) coma, spherical aberration, horizontal coma, vertical coma, and eccentric displacement were all linearly correlated. Furthermore, MTF values exhibited a linear relationship with eccentric displacement across these spatial frequencies. CONCLUSIONS: There was no discernible difference in visual acuity, efficacy, or safety between the two operated eyes. Nonetheless, the first operated eyes exhibited reduced decentered displacement and demonstrated superior outcomes in terms of horizontal coma and MTF values compared to the second operated eyes following SMILE. The variations in visual quality parameters were linearly correlated with decentered displacement.


Assuntos
Astigmatismo , Aberrações de Frente de Onda da Córnea , Miopia , Humanos , Refração Ocular , Coma , Topografia da Córnea , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Astigmatismo/cirurgia , Substância Própria/cirurgia
15.
J Pak Med Assoc ; 74(3): 450-455, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38591276

RESUMO

Objectives: To assess the visual improvement and mean residual astigmatism in patients who underwent cataract surgery with toric intraocular lens. METHODS: The retrospective, observational study was conducted at the Department of Ophthalmology, Aga Khan University Hospital, Karachi, and comprised data from January 1, 2018, to December 31, 2020, related to adult patients who had regular astigmatism of at least 0.75D and underwent cataract surgery with toric intraocular lens implantation using a digital marker. The patients were followed up on post-operative days 1, 7, 30, 90 and 180. Along with age, the degree of astigmatism was noted. The visual acuity was calculated pre- and post-operatively. The mean residual astigmatism was then noted for all patients post-operatively. Data was analysed using SPSS 22. RESULTS: The sample comprised 240 eyes of 177 patients; 99(55.9%) males and 78(44.1%) females. The mean age of the sample was 62.5±10.6 years. The mean unaided visual acuity improved post-operatively from 0.57±0.38 to 0.07±0.22 at 90 days. At the 30-day follow-up, mean residual astigmatism had reduced from 1.52±0.84 to 0.01±0.09 (p<0.001). The mean intraocular lens rotation from the intended axis was 0.73°±0.92° on day 30. CONCLUSIONS: Toric intraocular lens implantation using a digital marker could effectively reduce the post-operative cylinder, and improve the unaided visual acuity following cataract surgery.


Assuntos
Astigmatismo , Catarata , Lentes Intraoculares , Facoemulsificação , Masculino , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Implante de Lente Intraocular , Astigmatismo/cirurgia , Estudos Retrospectivos , Catarata/complicações , Catarata/terapia , Refração Ocular
16.
Arq Bras Oftalmol ; 87(4): e2023, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38656029

RESUMO

PURPOSE: To assess the outcomes of deep anterior lamellar keratoplasty or penetrating keratoplasty at the scar and the edema stages. METHODS: Forty-five patients (45 eyes) with keratoconus scar stage (scar group, n=26; penetrating keratoplasty a subgroup, n=7; deep anterior lamellar keratoplasty b subgroup, n=19) and keratoconus edema stage (edema group, n=19; penetrating keratoplasty c subgroup, n=12; deep anterior lamellar keratoplasty d group, n=7) who received penetrating keratoplasty or deep anterior lamellar keratoplasty from 2000 to 2022 were retrospectively studied. At 1, 6, and 12 months after surgery, the best-corrected visual acuity, astigmatism, spherical equivalent, corneal endothelial cell density, and complications were analyzed. RESULTS: The best-corrected visual acuity and average corneal endothelial cell loss rate were not significantly different between the scar and edema groups (p>0.05). At 6 and 12 months after surgery, the astigmatism and spherical equivalent in the scar group were significantly lower than those in the edema group (p<0.05). The spherical equivalent of the deep anterior lamellar keratoplasty b subgroup was lower than that of the penetrating keratoplasty a subgroup in the scar group 6 months after surgery (p<0.05). In the edema group, there was no significant difference in spherical equivalent between subgroups (p>0.05). There were no significant differences in best-corrected visual acuity and astigmatism between subgroups within the two groups (p>0.05). In comparison to the scar group, the edema group experienced more complications. According to a survival analysis, there was no statistically significant difference between the scar group and the edema group regarding the progression of vision. CONCLUSIONS: In terms of the outcomes and prognosis for vision after keratoplasty with edema stage and scar stage, deep anterior lamellar keratoplasty may be as effective as penetrating keratoplasty.


Assuntos
Cicatriz , Edema da Córnea , Ceratocone , Ceratoplastia Penetrante , Acuidade Visual , Humanos , Ceratocone/cirurgia , Ceratocone/complicações , Ceratocone/fisiopatologia , Masculino , Feminino , Estudos Retrospectivos , Ceratoplastia Penetrante/métodos , Adulto , Cicatriz/etiologia , Resultado do Tratamento , Edema da Córnea/cirurgia , Edema da Córnea/etiologia , Adulto Jovem , Transplante de Córnea/métodos , Fatores de Tempo , Adolescente , Astigmatismo/cirurgia , Astigmatismo/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Contagem de Células , Endotélio Corneano/patologia , Endotélio Corneano/cirurgia
18.
J Cataract Refract Surg ; 50(4): 430-435, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38523280

RESUMO

A 28-year-old nurse had an aberration-free femto-laser in situ keratomileusis (LASIK) performed for her myopia of -6.25 -0.50 × 096 and -6.75 -0.50 × 175 in the right and left eye, respectively. Corrected distance visual acuity (CDVA) preoperatively was 20/16. Preoperatively, there were no abnormalities on Scheimpflug imaging, and a pachymetry of 585 µm was measured in both eyes. Flap thickness was 115 µm. The patient was quite nervous during the surgery. Since the surgery, her uncorrected distance visual acuity (UDVA) and CDVA are suboptimal at 20/30 and 20/20 in the right eye, and 20/20 and 20/16 in the left eye. 3 months postoperatively, there is a stable manifest refraction of +0.25 -1.25 × 030 and +0.25 -0.00 × 0. The keratometric astigmatism in the Scheimpflug imaging is 1.2 diopter (D) × 114 and 0.4 D × 78 in the right and left eyes, respectively (FIgures 1 and 2). Thinnest pachymetry is 505 µm and 464 µm in the right and left eye, respectively. Her wavefront analysis shows refraction in a 6 mm zone of -0.99 -1.22 × 32 and -0.91 -0.36 × 136. The cycloplegic refraction is 1.25 -1.00 × 023 and +1.00 -0.25 × 006 (Figures 3 and 4). What is the cause of the suboptimal visual outcome in this case? What would be your treatment strategy to improve visual outcome?


Assuntos
Astigmatismo , Aberrações de Frente de Onda da Córnea , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Humanos , Feminino , Adulto , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Aberrações de Frente de Onda da Córnea/cirurgia , Resultado do Tratamento , Acuidade Visual , Refração Ocular , Miopia/cirurgia , Miopia/complicações , Astigmatismo/cirurgia , Astigmatismo/complicações , Lasers de Excimer/uso terapêutico
20.
Sci Rep ; 14(1): 5648, 2024 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-38453996

RESUMO

Implantable collamer lens implantation (ICL) represents a safe and effective treatment for myopia and myopic astigmatism. To compare the outcomes of a bilateral one-stage same day approach to a two-stage approach, the databases of the University Eye Hospital Munich, Ludwig Maximilians-University and Smile Eyes Linz, Austria were screened for eyes that had undergone ICL implantation. Two-stage surgery was performed at an interval of 1 day (17 patients), 2 days (19 patients) and 1 week (2 patients). Variables analyzed were preoperative, 1-day and last follow-up uncorrected distance (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, refractive spherical equivalent (SEQ), astigmatism, age, endothelial cell count (ECD), intraocular pressure (IOP) and ICL vaulting. In total, 178 eyes (100 eyes one-stage, 78 eyes two-stage) of 89 patients were included in this study. Mean follow-up was 1.1 ± 0.8 and 1.3 ± 0.5 years. Mean preoperative SEQ was - 7.9 ± 2.6 diopters (D) in the one-stage and - 8.0 ± 1.7 D in the two-stage group (p = 0.63) and improved to 0.00 ± 0.40 and - 0.20 ± 0.40 D at end of follow-up, showing slightly better stability in the one-stage group (p = 0.004). There was no difference in the efficacy (1.1 vs. 1.2, p = 0.06) and the safety index (1.2 vs. 1.2, p = 0.60) between the two groups. No eye (0%) in either group lost 2 lines or more of UDVA (p > 0.99). Refraction within ± 0.50 D and ± 1.00 D around target was achieved comparably often (89 vs. 86%, p = 0.65; 99 vs. 99%, p > 0.99). Endothelial cell loss was slightly higher in the two-stage group (1.3 vs. 4.3%). Vaulting at the final follow up was higher in the one-stage group (373.8 ± 205.4 µm vs. 260.3 ± 153.5 µm, p = 0.00007). There were no serious intraoperative complications in either group. In conclusion, this study demonstrates that both the one- and two-stage approaches are equally effective, predictable and safe. Regarding endothelial cell loss, vaulting and SEQ stability, the one-stage group showed slightly better outcomes, but these results are clinically questionable because they are so small. Larger studies are needed to quantitatively evaluate a potential benefit.


Assuntos
Astigmatismo , Lentes Intraoculares , Lentes Intraoculares Fácicas , Humanos , Implante de Lente Intraocular , Acuidade Visual , Refração Ocular , Resultado do Tratamento , Astigmatismo/cirurgia , Seguimentos , Estudos Retrospectivos
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