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1.
J Refract Surg ; 37(10): 662-673, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34661476

RESUMO

PURPOSE: To investigate whether the degree of astigmatism axis discrepancy between preoperative manifest refractive astigmatism and anterior corneal astigmatism impacts refractive and visual outcomes of primary topography-guided laser in situ keratomileusis (LASIK) targeting the refractive astigmatism, and to provide guidance on treating eyes with very large axis discrepancy. METHODS: Comparative retrospective analysis of 25,396 consecutive eyes treated with topography-guided LASIK on the manifest refractive astigmatism. Standard outcomes of the 14,534 eyes with small axis discrepancy (SAD) (Δ in axis ⩽ 10°) were compared to the 2,222 eyes with very large axis discrepancy (VLAD) (Δ in axis ⩾ 45°). Pearson correlation coefficient was used to assess relationships between selected variables. RESULTS: The mean axis discrepancy was 4.47 ± 2.92° in SAD eyes, and 65.0 ± 13.4° in VLAD eyes. An equivalent number of eyes achieved a cumulative postoperative unilateral uncorrected distance visual acuity of 20/20 in both the SAD and VLAD groups (93.02% vs 93.42%; P = .4892). The efficacy index (0.98 ± 0.13 vs 0.98 ± 0.07; P = .3931) and the safety index (1.00 ± 0.11 vs 1.00 ± 0.03; P = .4757) were identical between groups. There was no clinically meaningful correlation between the preoperative axis discrepancy and preoperative total root mean square anterior corneal coma, postoperative refractive astigmatism, defocus equivalent, spherical equivalent, and angle of error, all with weak correlation coefficients (R = -0.02, -0.03, -0.02, 0.01, and 0.05). CONCLUSIONS: Large preoperative axis discrepancy (45° to 90°) between refractive astigmatism and topography-measured anterior corneal astigmatism does not negatively impact topography-guided LASIK, having identical refractive and visual outcomes compared to eyes with small (0° to 10°) discrepancy. There is no basis to exclude eyes with large axis discrepancy from topography-guided LASIK, and these eyes should be treated on the manifest refractive astigmatism. [J Refract Surg. 2021;37(10):662-673.].


Assuntos
Astigmatismo , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Astigmatismo/cirurgia , Topografia da Córnea , Humanos , Miopia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
2.
J Refract Surg ; 37(10): 707-714, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34661478

RESUMO

PURPOSE: To evaluate the differences in efficacy, predictability, safety, and visual quality between topography-guided customized ablation treatment (TCAT) and wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) for the treatment of myopia with and without astigmatism. METHODS: A comprehensive literature search of PubMed, Embase, the Cochrane library, Web of Science, and ClinicalTrials was used to identify randomized controlled trials (RCTs) comparing TCAT-LASIK with WFO-LASIK for myopia with and without astigmatism up to September 2020. The references of all searched literature were checked as supplements. Literature was screened according to the inclusion and exclusion criteria and relative data were extracted. RevMan software version 5.3.0 (Cochrane Collaboration) was used for meta-analysis. RESULTS: A total of seven RCTs (1,168 eyes) were included. There were no statistically significant differences in the ratio of uncorrected distance visual acuity of 20/20 or better (relative risk [RR] = 1.01, 95% CI [0.97 to 1.06], P = .64) and 20/16 or better (RR = 0.96, 95% CI [0.80 to 1.16], P = .69). Compared with WFO-LASIK, TCAT-LASIK achieved a higher proportion of postoperative manifest refractive spherical equivalent within ±0.50 diopters of the target (RR = 1.06, 95% CI [1.02 to 1.11], P = .003) and less surgically induced higher order aberrations (weighted mean difference [WMD] = -0.11, 95% CI [-0.15 to -0.0], P < .00001), spherical aberrations (WMD = -0.04, 95% CI [-0.05 to -0.03], P < .00001), and coma (WMD = -0.15, 95% CI [-0.28 to -0.01], P = .03). No patient lost two or more lines of distance-corrected visual acuity postoperatively in the two groups. CONCLUSIONS: This meta-analysis suggests that both TCATLASIK and WFO-LASIK show excellent efficacy, predictability, and safety for myopia. TCAT-LASIK exhibited more accurate postoperative refraction predictability and less surgically induced higher order aberrations, spherical aberrations, and coma. More randomized, prospective, and large sample-sized studies are needed to confirm these conclusions in the long term. [J Refract Surg. 2021;37(10):707-714.].


Assuntos
Astigmatismo , Aberrações de Frente de Onda da Córnea , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Astigmatismo/cirurgia , Humanos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Estudos Prospectivos , Resultado do Tratamento
3.
PLoS One ; 16(10): e0258835, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34679121

RESUMO

PURPOSE: To report the visual and refractive results of small incision lenticule extraction (SMILE) with low energy settings in the United States (US) and to evaluate outcomes for low astigmatism treatment. SETTING: Private clinical practice. DESIGN: Retrospective cohort study. METHODS: This study retrospectively reviewed 462 consecutive eyes that underwent SMILE with lower energy settings. Inclusion criteria included all patients between the ages of 19-39 with myopic astigmatism up to -11.25 diopters (D) spherical equivalent (sphere up to -10.00 D, astigmatism up to -3.00 D), and corrected distance visual acuity of at least 20/25. Eyes with low astigmatism (0.25 D-0.50 D) were also included. Outcome analysis was performed according to the Standard Graphs for Reporting Refractive Surgery at postoperative month (POM) 1, and POM 3-6 when data were available. RESULTS: The mean preoperative spherical equivalent treated was -4.96 ± 2.07; at POM 1, 92% of eyes achieved uncorrected visual acuity (UCVA) of 20/20 or better and maintained visual stability throughout the remainder of the study. At last visit, 431 eyes (93%) achieved UCVA of 20/20 or better, and 461 eyes (99.8%) were 20/25 or better. Ninety-seven (21%) eyes gained at least 1 Snellen line of corrected distance visual acuity and no eyes lost 2 or more lines. Almost all eyes (n = 453, 98%) were within 0.5D of target; 85% of eyes with low astigmatism had ≤0.25 D at last visit compared to 80% of eyes with moderate astigmatism. CONCLUSIONS: SMILE with U.S.-approved low energy settings is safe, predictable, and efficacious and provides patients with a fast visual recovery.


Assuntos
Astigmatismo/cirurgia , Cirurgia da Córnea a Laser/métodos , Adulto , Feminino , Humanos , Masculino , Refração Ocular , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos , Acuidade Visual , Adulto Jovem
5.
J Cataract Refract Surg ; 47(11): 1436-1440, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34675151

RESUMO

PURPOSE: To evaluate the associations between anterior segment parameters and the rotational stability of a plate-haptic toric intraocular lens (IOL). SETTING: Eye and Ear, Nose, Throat Hospital of Fudan University. DESIGN: Retrospective case series. METHODS: Patients who underwent uneventful phacoemulsification and plate-haptic toric IOL (AT TORBI 709M IOL) implantation were included. Preoperative axial length (AL) and anterior segment parameters, including the white-to-white (WTW) distance, anterior chamber depth (ACD), lens thickness (LT), and anterior segment length (ASL; the sum of ACD and LT) were recorded. IOL rotation, residual astigmatism (RAS), and visual acuity were evaluated 1 month postoperatively. The associations between the anterior segment parameters and IOL rotation were evaluated. RESULTS: A total of 102 eyes of 102 patients were included. The mean AL was 26.43 ± 2.65 mm (range 21.71-34.60 mm). The mean IOL rotation was 4.59 ± 3.18 degrees, and RAS was 0.62 ± 0.39 D postoperatively. No correlation was detected between AL, ACD, or LT and the rotation of the plate-haptic toric IOL (all P > .05). However, its rotation correlated positively with the WTW distance (r = 0.250, P = .011) and ASL (r = 0.214, P = .030). Backward stepwise multiple linear regression revealed that the WTW distance (ß = 2.142, P = .014) and ASL (ß = 2.060, P = .037) were independent predictors of plate-haptic toric IOL rotation. CONCLUSIONS: Plate-haptic toric IOLs rotate more in eyes with larger WTW distances and longer ASLs; therefore, toric IOL implantation should be performed with caution in eyes with these characteristics.


Assuntos
Astigmatismo , Lentes Intraoculares , Facoemulsificação , Astigmatismo/cirurgia , Humanos , Implante de Lente Intraocular , Estudos Prospectivos , Refração Ocular , Estudos Retrospectivos
6.
J Cataract Refract Surg ; 47(11): 1487, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34675155

RESUMO

A 65-year-old woman had undergone bilateral foldable iris-fixated phakic intraocular lens (pIOL) implantation in 2008 to correct for high myopia of -10 diopters (D). 12 years later, she presented with nuclear and subcortical cataract in her right eye. The Artiflex pIOL (Figure 1JOURNAL/jcrs/04.03/02158034-202111000-00021/figure1/v/2021-10-20T185516Z/r/image-tiff) was well centered and fixed to the iris. Endothelial cell count (ECC) was 2159 per mm2 and corneal thickness 515 µm. Residual correction in her distance glass was -1.75 + 1.5 × 60. Topography showed a symmetric bowtie with a mean simulated keratometry of 1.3 D at an axis of 67 degrees (Figure 2JOURNAL/jcrs/04.03/02158034-202111000-00021/figure2/v/2021-10-20T185516Z/r/image-tiff). Keratometry was 1.5 @ 65. Left eye refraction was -1.5 + 1.0 × 175. The patient had also developed chronic open-angle glaucoma with intraocular pressure measurements exceeding 30 mm Hg, which was currently regulated with topical medication. What would be your surgical approach for cataract surgery with IOL removal and replacement when also considering the possible later need for superior glaucoma filtering surgery?


Assuntos
Astigmatismo , Catarata , Glaucoma de Ângulo Aberto , Glaucoma , Miopia , Lentes Intraoculares Fácicas , Idoso , Astigmatismo/etiologia , Astigmatismo/cirurgia , Catarata/complicações , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Iris/cirurgia , Implante de Lente Intraocular , Miopia/cirurgia , Estudos Retrospectivos
7.
BMC Ophthalmol ; 21(1): 336, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530754

RESUMO

BACKGROUND: There are few reports regarding the influence of varying illumination on the compensation effect before and after corneal refractive surgery. We aimed to evaluate the changes in refraction, higher-order aberrations, and aberration compensation between mesopic and photopic illumination before and after small incision lenticule extraction. METHODS: In this prospective cohort study, only the right eyes of patients who underwent small incision lenticule extraction for the correction of myopia and myopic astigmatism at the Tianjin Eye Hospital were included. Wavefront refraction and higher-order aberrations were measured preoperatively and 3 months postoperatively under mesopic and photopic illumination. Compensation factors were calculated as 1 - (aberration of the whole eye/aberration of the anterior corneal surface). RESULTS: Forty patients undergoing small incision lenticule extraction were enrolled. All surgeries were completed without postoperative complications. Preoperatively, the eyes only had a statistically significantly higher (t = - 4.589, p < .001) spherical refractive error under mesopic vs. photopic illumination (median [interquartile range], - 6.146 [2.356] vs. - 6.030 [2.619] diopters [D]), whereas postoperatively, the eyes also exhibited statistically significantly higher (t = - 3.013, p = .005) astigmatism (- 0.608 [0.414] vs. - 0.382 [0.319] D). Differences in spherical refraction between the two illuminations were the highest in postoperative eyes (Δ > 0.5 D). Only postoperative eyes exhibited statistically significant elevations (t ≥ 4.081, p < .001) in higher-order aberrations under mesopic illumination, and only preoperative eyes exhibited statistically significantly enhanced (χ2 = 6.373, p = .01 for fourth-order and χ2 = 11.850, p = .001 for primary spherical aberrations) and decreased (χ2 = 13.653, p = .001 for horizontal trefoil) compensation factors under mesopic illumination. CONCLUSIONS: Exaggerations in higher-order aberrations and myopic shift after small incision lenticule extraction became apparent under mesopic illumination. Slight undercorrection may have an enhanced effect under low illumination and may reduce night vision. The specific changes in compensation effects in preoperative eyes may improve optical quality under mesopic illumination. Postoperative eyes have reduced compensation ability, specifically for spherical aberrations, under mesopic illumination, which may diminish night vision. Further studies that include the measurement of subjective night vision parameters should be conducted.


Assuntos
Astigmatismo , Cirurgia da Córnea a Laser , Aberrações de Frente de Onda da Córnea , Astigmatismo/cirurgia , Substância Própria/cirurgia , Humanos , Lasers de Excimer/uso terapêutico , Iluminação , Estudos Prospectivos , Refração Ocular , Acuidade Visual
8.
J Refract Surg ; 37(9): 642-647, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506242

RESUMO

PURPOSE: To compare the axis position of the measured total corneal astigmatism (TCA) with the axis of the anterior keratometry and the calculated axis position of different toric intraocular lens (IOL) calculators. METHODS: A total of 163 astigmatic eyes of 163 patients were retrospectively analyzed. The axis of the actual TCA, measured with anterior segment optical coherence tomography, was compared to the anterior keratometric value (Group I) and three different methods of TCA calculation for toric IOL power determination: Abulafia-Koch regression formula (Group II), Barrett Toric Calculator V2.0 (Group III), and Barrett Toric Calculator V2.0 including measured posterior keratometric value (Group IV). Eyes were assigned to three subgroups: with-the-rule, against-the-rule, and oblique astigmatism. RESULTS: The mean deviation calculated from measured TCA was +0.56° (Group I), -0.32° (Group II), -0.37° (Group III), and -1.00° (Group IV). For with-the-rule astigmatism, the TCA axis agreed most with Group I (6.5% outliers > 5° deviation). For against-the-rule astigmatism, Group IV and Group II were closest to the measured TCA axis (1.5% and 3% outliers with > 5° deviation). CONCLUSIONS: The means of the calculated axis were similar to the measured TCA, but the proportion of outliers with an axis deviation of greater than 5° showed remarkable differences. Isolated anterior keratometric value measurements showed the fewest outliers in with-the-rule astigmatism. In against-the-rule astigmatism, Abulafia-Koch calculation should be used for axis determination. [J Refract Surg. 2021;37(9):642-647.].


Assuntos
Astigmatismo , Lentes Intraoculares , Facoemulsificação , Astigmatismo/cirurgia , Córnea , Humanos , Implante de Lente Intraocular , Refração Ocular , Estudos Retrospectivos
9.
BMC Ophthalmol ; 21(1): 350, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34587920

RESUMO

BACKGROUND: Assessment of the optical outcome and adverse events in post-epikeratopathic eyes after removal of the epikeratoplasty lenticule (EKPL). METHODS: This was a retrospective case-series study of patients who underwent EKPL removal between 2002 and 2020. Ten eyes were included in the analysis. We compared the clinical characteristics of the patients before surgery, 6 months after surgery, before lenticular removal, and after removal, and reported optical or ocular surface complications. RESULTS: We removed EKPL due to the lenticular opacity in five eyes (50%), intraocular lens (IOL) insertion (n = 4, 40%) after cataract surgery (n = 3) or in aphakic eyes (n = 1), and lenticule-induced irregular astigmatism in one eye (10%). After EKPL removal, the mean refractive power of the cornea (Km) revealed a tendency to increase. Out of nine cases, six cases showed corneal steepening and three cases revealed corneal flattening. When the keratometric readings of pre-epikeratoplasty and post-lenticular removal were compared within the same case, the average difference was 5.1 D ± 4.0 (n = 8). Complications were observed in 3 of 10 cases (excessive corneal flatness, ectatic change, and abnormal epithelial cell ingrowth) after removal. CONCLUSIONS: The surgeon should expect the corneal refractive power to steepen or flatten in some cases with abnormal astigmatism and irregularity. Epikeratophakic eyes may exhibit serious ectatic changes, and abnormal epithelial cell ingrowth after removal of epikeratophakic lenticules.


Assuntos
Astigmatismo , Epiceratofacia , Lentes Intraoculares , Astigmatismo/etiologia , Astigmatismo/cirurgia , Córnea , Humanos , Refração Ocular , Estudos Retrospectivos , Acuidade Visual
10.
Sci Rep ; 11(1): 17854, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497302

RESUMO

Little is known about the connection between preoperative keratometry and postoperative results of myopic small-incision lenticule extraction (SMILE). To determine the influence of extreme (flat and steep) corneal keratometry on the safety and efficacy of SMILE, the databases of the Department of Ophthalmology, Ludwig-Maximilians-University Munich, Germany, and SMILE Eyes Linz, Austria, were screened for patients with steep and flat keratometry who had undergone SMILE. In this cross-sectional matched comparative cohort study, eyes with markedly flat (< 42.0 diopters; D) or steep (≥ 47.0D) preoperative corneal keratometry were matched to a cohort of eyes with regular keratometry (42.0-46.9D) by preoperative manifest refractive spherical equivalent and cylinder, age, corrected distance visual acuity and surgical SMILE parameters. The standardized graphs and terms for refractive surgery results were applied to compare the three groups. Changes in higher order aberrations (HOAs) were evaluated on Scheimpflug imaging. In total, 63 eyes (21 each) of 54 patients with a mean refractive spherical equivalent of - 5.21 ± 1.59 D were followed up for a mean of 9.2 ± 6.1 (minimum ≥ 3) months. Mean baseline keratometry was 41.3 ± 0.7D (flat), 45.5 ± 1.0D (regular) and 47.7 ± 0.6D (steep) (p < 0.0001). Compared to the regular group, the flat and the steep cornea group resulted in a non-inferior percentage of eyes within ± 0.50 D of target refraction (p = 0.20), uncorrected distance visual acuity (p = 0.95) and corrected distance visual acuity (p = 0.20). Flat corneas however experienced a stronger induction of spherical aberration (SA) compared to the steep group (p = 0.0005). In conclusion, non-inferior outcomes of SMILE can also be expected in eyes with steep (≥ 47D) or flat (< 42D) preoperative keratometry, while SMILE however induces more SA in eyes with a flat keratometry.


Assuntos
Astigmatismo/cirurgia , Córnea/cirurgia , Miopia/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Adulto , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Indian J Ophthalmol ; 69(10): 2650-2656, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34571607

RESUMO

Purpose: To report the short-term changes in a corneal stress-strain index (SSI) and other corneal biomechanical parameters post-laser in situ keratomileusis (LASIK) surgery. Methods: A retrospective study was conducted at a tertiary eye care center wherein patients who had undergone LASIK (microkeratome blade and femtosecond bladeless LASIK) between July and December 2019 were enrolled. Patients of age group 20-40 years, best-corrected visual acuity of 20/20, intraocular pressure (IOP) <22 mmHg, pre-LASIK pachymetry >500 microns, and corneal astigmatism ≤3.00 D were included. Subjects with a prior history of refractive surgery, any other ocular or systemic disease, poor-quality scans, intraoperative complications, and missing data were excluded. Corneal biomechanical properties including SSI were analyzed using Corvis ST and compared using the Paired T-test for each group separately at pre-LASIK, and 1-month post-operatively. Results: Overall, 202 eyes were reviewed, and 79 eyes fulfilled the inclusion criteria. Forty-three and 36 eyes had undergone Microkeratome Blade LASIK (Group I) and Femto LASIK (Group II), respectively. Overall, 29 and 26 corneal biomechanical parameters out of 33 changed significantly post-Microkeratome Blade LASIK and Femto LASIK, respectively. Statistically significant changes were noted in all the parameters at A1, maximum and Vinciguerra screening parameters (P < 0.001), however, no changes were noted in SSI in both the groups when compared with the pre-surgery data. Conclusion: Though the reduction in SSI was not statistically significant, other biomechanical parameters showed significant biomechanical changes pre- and post-LASIK surgeries in both the groups. However, a long-term study with a larger sample size would be required to understand the changes and stability in SSI post-refractive surgery.


Assuntos
Astigmatismo , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Adulto , Astigmatismo/cirurgia , Fenômenos Biomecânicos , Córnea , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Lasers de Excimer , Miopia/diagnóstico , Miopia/cirurgia , Estudos Retrospectivos , Adulto Jovem
12.
J Cataract Refract Surg ; 47(9): 1183-1190, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468456

RESUMO

PURPOSE: To compare differences in visual, refractive, and ablating outcomes between corneal topography-guided laser in situ keratomileusis (LASIK) by SCHWIND AMARIS and WaveLight Contoura for myopia and myopic astigmatism correction. SETTING: Department of Refractive Surgery, Guangzhou Aier Eye Hospital, Guangzhou, China. DESIGN: Prospective nonrandomized study. METHODS: Patients treated with LASIK to correct ametropia and corneal higher-order aberrations (HOAs) with 6.5 mm of plan optical zone were recruited. In the AMARIS platform, there were 2 centration strategies: the symmetric (AA) and asymmetric (AS) offset modes. In the WaveLight platform, there was only symmetric offset (ES) mode. HOAs, contrast sensitivity, effective optical zone (EOZ), ablation depth, and ablating center were evaluated 3 months after the operation. RESULTS: The study included 138 eyes. At 3 months after operation, the postoperative manifest refractive spherical equivalent was 0.04 ± 0.34 diopters (D), 0.06 ± 0.25 D, and -0.09 ± 0.21 D in AS, AA, and ES groups, respectively (P = .018). The EOZs of the AS and AA groups were 5.01 mm and 4.96 mm, and both were larger than 4.88 mm in the ES group (P = .04 and .03, respectively). The ablation depth of the AS group was 103.6 µm, which were larger than 86.6 µm in the AA group and 91.2 µm in the ES group. CONCLUSIONS: The SCHWIND AMARIS and WaveLight EX500 corneal topography-guided LASIK achieved comparable and excellent visual and refractive outcomes. The EX500 Contoura LASIK ablated less corneal tissue because of the smaller EOZ compared with the AMARIS, with a similar plan optical zone.


Assuntos
Astigmatismo , Ceratomileuse Assistida por Excimer Laser In Situ , Astigmatismo/cirurgia , Topografia da Córnea , Humanos , Lasers de Excimer/uso terapêutico , Estudos Prospectivos , Refração Ocular , Resultado do Tratamento , Acuidade Visual
15.
J Cataract Refract Surg ; 47(10): 1319-1326, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34544087

RESUMO

PURPOSE: To report refractive and keratometric astigmatism outcomes of resident-performed limbal relaxing incisions (LRIs) during cataract surgery. SETTING: Tertiary care academic teaching hospital. DESIGN: Retrospective case series. METHODS: The length, location, and number of LRIs were determined preoperatively using an online calculator. Variables studied were preoperative keratometry and postoperative uncorrected and corrected distance visual acuity, refraction, and keratometry at 1-month, 3-month, and 12-month visits (POM1, POM3, and POM12, respectively). Subgroup analysis was performed on amount and type of astigmatism. The astigmatism double-angle plot tool and analysis of with-the-wound (WtW) and against-the-wound (AtW) changes were used to assess the effect of astigmatism correction at POM1, POM3, and POM12 visits. RESULTS: In 118 eyes, a higher percentage of eyes demonstrated refractive astigmatism 0.25 diopter (D) or less, 0.50 D or less, 0.75D or less, and 1.0 D or less at POM1 and POM12 (all P < .05) compared with preoperative keratometric astigmatism. Subgroup analysis showed improvement in all groups and types of astigmatism (P < .01). Patients achieved a statistically significant reduction of keratometric astigmatism at POM1, POM3, and POM12 (all P ≤ .0001) relative to baseline, and changes differed significantly based on the preoperative amount of astigmatism (all P ≤ .0001, with greater reductions associated with higher baseline astigmatism) but not by location of the steep meridian. There were significant WtW-AtW changes at POM1, POM3, and POM12. Regression of effect after 1 month was approximately 0.11 D. CONCLUSIONS: Resident-performed LRIs achieved effective and sustained reduction of both refractive and keratometric astigmatism regardless of meridian or magnitude of astigmatism for at least 1 year postoperatively.


Assuntos
Astigmatismo , Extração de Catarata , Cirurgiões , Astigmatismo/cirurgia , Córnea , Humanos , Refração Ocular , Estudos Retrospectivos
16.
PLoS One ; 16(9): e0255525, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34469435

RESUMO

PURPOSE: To identify mechanical factors, as well as patients' biometric and surgeons' experience factors that correlate with the FF incidence in microkeratome (MK)-assisted LASIK and to construct a predictive model based on these parameters. METHODS: 55,700 consecutive LASIK treatments of 28,506 patients between January 2017 and April 2020 done by 50 surgeons in 10 centers, all with Sub Bowman Keratome (SBK) and 90µ head (OUP) were analyzed retrospectively for the incidence of FF and their correlation to mean keratometry, central corneal thickness, MK ring height and stop, as well as surgeons' experience. A prediction model was built and tested for sensitivity and specificity. RESULTS: The incidence of FF using the SBK MK was 0.276%. Risk factors were low central corneal thickness, very flat (-1) or very thick (+2) ring height, and higher stop values (p<0.001). Mean keratometry and low surgeon experience were not correlated to FF incidence. A prediction model with a cut-off FF risk of 0.274%, a 76% specificity, and a 73% sensitivity was applied. CONCLUSIONS: Free flaps are rarely seen in modern MK LASIK. However, the incidence of this complication using the SBK MK increases using higher stop values, very thick and very thin MK rings, and in eyes with thin corneas.


Assuntos
Astigmatismo/cirurgia , Retalhos de Tecido Biológico/estatística & dados numéricos , Hiperopia/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Modelos Estatísticos , Miopia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Biometria , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
17.
BMC Ophthalmol ; 21(1): 292, 2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34340669

RESUMO

BACKGROUND: To compare the correction effect and optical quality after small-incision lenticule extraction (SMILE) and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK) for high myopia. METHODS: 51 high myopia eyes after SMILE and 49 high myopia eyes after FS-LASIK were enrolled and divided into two groups retrospectively. The OQAS and iTrace analyzer were used for optical quality inspection. Between the two groups the spherical equivalent (SE), astigmatism, uncorrected distant visual acuity (UDVA), strehl ratio (SR), modulation transfer function cutoff frequency (MTF cutoff), objective scatter index (OSI) and wavefront aberrations were analyzed and compared before surgery and at 1, 6 and 12 months after surgery. RESULTS: After the operation: (1) SE and astigmatism declined and UDVA increased significantly in both groups, and UDVA was better after SMILE than FS-LASIK. (2) SR and MTF cutoff reduced and OSI increased significantly after SMILE and FS-LASIK. SR and MTF cutoff were significantly higher after SMILE than FS-LASIK. OSI was significantly lower after SMILE than FS-LASIK. (3) The total wavefront aberration, total low-order wavefront aberration, defocus and astigmatism aberration as well as trefoil aberration reduced significantly in both groups. The total high-order wavefront aberration increased significantly after FS-LASIK. The spherical and coma aberration increased significantly in both groups. The total high-order wavefront aberration and coma aberration at 1 month were higher after FS-LASIK than SMILE. CONCLUSION: The optical quality descended after SMILE and FS-LASIK. SMILE was superior to FS-LASIK at the correction effect and optical quality for high myopia. The combination of OQAS and iTrace analyzer is a valuable complementary measurement in evaluating the optical quality after the refractive surgery. TRIAL REGISTRATION: This is a retrospective study. This research was approved by the ethics committee of Xiangya Hospital and the IRB approval number is 201612074.


Assuntos
Astigmatismo , Aberrações de Frente de Onda da Córnea , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Astigmatismo/cirurgia , Substância Própria , Humanos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
18.
J Refract Surg ; 37(8): 545-551, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34388072

RESUMO

PURPOSE: To evaluate the outcomes of resident-performed femtosecond laser-assisted in situ keratomileusis (FS-LASIK). METHODS: Records of 138 eyes of 69 patients treated by residents for myopia or myopic astigmatism between March 2018 and June 2020 were reviewed. All preoperative visits, procedures, and postoperative visits were supervised by attending physicians. Follow-up examinations were performed 1 day and 1 month postoperatively. Complications and enhancements were noted. Outcome measures included postoperative uncorrected distance visual acuity (UDVA), refractive accuracy, and complications. RESULTS: Eighteen residents performed FS-LASIK on a median of 8 eyes (interquartile range: 1.75). Fifty-nine patients (118 eyes) returned for a 1-month postoperative examination. UDVA was 20/40 or better in 117 eyes (99%) and 20/20 or better in 108 eyes (92%). The mean preoperative spherical equivalent (SE) refractive error was -4.01 ± 1.82 diopters (D) in 138 eyes, decreasing to -0.12 ± 0.35 D at 1 month after surgery in the 102 eyes that were refracted. The SE was ±1.00 D in 100 eyes (98%) and ±0.50 D in 94 eyes (93%). The CDVA change was within one line in 100% of eyes. Intraoperative complications occurred in 5 eyes (3.62%), enhancements were performed in 3 eyes (2.17%), and postoperative complications developed in 3 eyes (2.17%). CONCLUSIONS: Resident-performed FS-LASIK is relatively safe and effective in comparison to published U.S. Food and Drug Administration premarket approval studies. Early resident experience performing LASIK can improve the training of ophthalmic surgeons while simultaneously increasing patient access to laser vision correction. [J Refract Surg. 2021;37(8):545-551.].


Assuntos
Astigmatismo , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Astigmatismo/cirurgia , Humanos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Refração Ocular , Resultado do Tratamento
19.
BMC Ophthalmol ; 21(1): 298, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34391403

RESUMO

BACKGROUND: To compare the efficacies in astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus toric intraocular lens (IOL) implantation with conventional phacoemulsification in moderate astigmatism. METHODS: A retrospective chart review was conducted for patients who had undergone cataract surgery by one surgeon. We identified patients with preoperative corneal astigmatism from + 0.75 to + 2.00 diopters (D) who had undergone astigmatic correction with FLACS with ISAK or toric IOL implantation with conventional phacoemulsification. We measured the visual acuity, intraocular pressure, automated keratometer, manifest refraction, and topography preoperatively and 1-day, 1-month, 3-month, and 6-month postoperatively. The vector analysis of refractive astigmatism was performed. RESULTS: Of a total of 48 eyes of 48 patients, 27 eyes of 27 patients had FLACS with ISAK (AK group), and 21 eyes of 21 patients had conventional cataract surgery with toric IOL implantation (toric IOL group). Refractive astigmatism was significantly decreased in both groups. The mean preoperative and 6-month postoperative refractive astigmatism were 1.85 ± 1.07 and 0.99 ± 0.51 D, respectively, in the AK group (P = 0.028), and 1.84 ± 0.81 and 0.68 ± 0.21 D, respectively, in the toric IOL group (P < 0.001). There was no significant difference in refractive astigmatism between the two groups at 6-month postoperatively (0.99 ± 0.51 vs 0.68 ± 0.21 D, P = 0.057). At 6-month postoperatively, parameters for vector analysis of refractive astigmatism showed no statistical difference between the two groups. Corneal astigmatism was significantly decreased in the AK group. Corneal astigmatism from topography and the automated keratometer were significantly lower in the AK group 6-month postoperatively compared to toric IOL group (0.94 ± 0.40 vs. 1.53 ± 0.46 D, P = 0.018 for topography; and 0.98 ± 0.69 vs. 1.37 ± 0.41 D, P = 0.032 for the automated keratometer). CONCLUSIONS: FLACS with ISAK could be an effective procedure for reducing astigmatism as well as toric IOL implantation in cataract surgery.


Assuntos
Astigmatismo , Catarata , Lentes Intraoculares , Facoemulsificação , Astigmatismo/complicações , Astigmatismo/cirurgia , Catarata/complicações , Topografia da Córnea , Humanos , Lasers , Implante de Lente Intraocular , Refração Ocular , Estudos Retrospectivos
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