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1.
J Refract Surg ; 37(11): 746-753, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34756137

RESUMO

PURPOSE: To investigate the factors affecting near vision spectacle dependence after mix-and-match implantation of the trifocal extended depth of focus (EDOF) and trifocal intraocular lens (IOL). METHODS: A total of 204 eyes of 102 patients who underwent mix-and-match implantation of one trifocal EDOF and one trifocal IOL were enrolled in this study. Patients were divided into two groups according to spectacle dependence for near vision: reading glasses and no glasses. Clinical characteristics were compared between the two groups and multivariate binary logistic regression analysis was performed to determine the odds ratio of factors potentially associated with the need for reading glasses. RESULTS: Eighty-one patients (79.4%) did not need reading glasses and 21 (20.6%) did. The mean age of the no glasses group (55.6 ± 5.6 years) was significantly higher than that of the reading glasses group (52.7 ± 4.1 years). Preoperative refractions were more myopic in the reading glasses group than in the no glasses group. The postoperative uncorrected near visual acuities were better and the satisfaction scores were higher in the no glasses group compared to the reading glasses group. Multivariate binary regression analysis revealed that only pre-operative spherical equivalent (odds ratio: 1.397; P = .025) was related to the spectacle independence for near vision. CONCLUSIONS: Patients who had preoperative myopia and underwent mix-and-match implantation of trifocal EDOF and tri-focal IOLs tended to need spectacles for near vision. Surgeons should be aware of patients with myopia when considering mix-and-match implantation of trifocal EDOF and trifocal IOLs. [J Refract Surg. 2021;37(11):746-753.].


Assuntos
Lentes Intraoculares Multifocais , Miopia , Óculos , Humanos , Implante de Lente Intraocular , Pessoa de Meia-Idade , Miopia/cirurgia , Satisfação do Paciente , Estudos Prospectivos , Pseudofacia/cirurgia
2.
J Refract Surg ; 37(11): 776-780, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34756140

RESUMO

PURPOSE: To report a novel therapeutic use of CIRCLE software (Carl Zeiss Meditec) to manage visually significant epithelial ingrowth following small incision lenticule extraction surgery (SMILE). METHODS: Case series. RESULTS: In this case series, the authors describe three eyes with progressive and visually significant epithelial ingrowth following an uneventful SMILE procedure. The management of epithelial ingrowth following SMILE is challenging, given the small access incision to the interface and the risk of incomplete removal. All cases were successfully managed by converting the SMILE cap into a flap using the CIRCLE software, which provided the necessary access to the original SMILE interface. Once the flap was lifted, the epithelial in-growth was completely debrided from the underlying stroma and undersurface of the flap, followed by a thorough interface wash. Postoperative recovery was uneventful, with no recurrence noted in any of the eyes. CONCLUSIONS: Use of CIRCLE software provides a novel and unique approach to successfully treating vision-threatening epithelial ingrowth after SMILE. [J Refract Surg. 2021;37(11):776-780.].


Assuntos
Cirurgia da Córnea a Laser , Miopia , Substância Própria/cirurgia , Humanos , Lasers de Excimer , Miopia/cirurgia , Refração Ocular , Software , Acuidade Visual
3.
J Refract Surg ; 37(11): 726-733, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34756141

RESUMO

PURPOSE: To explore the impact of different surgical sequences on the visual and refractive outcomes of bilateral small incision lenticule extraction (SMILE) surgery using propensity score matching (PSM) analysis. METHODS: Participants who underwent uneventful SMILE between March 2018 and September 2019 were retrospectively analyzed and were divided into two groups: Sequence A (laser scanning [LS] of the right eye, manual separation lenticule [MSL] of the right eye, and LS and MSL of the left eye) and Sequence B (LS of the right eye, LS of the left eye, MSL of the left eye, and MSL of the right eye). PSM was conducted to minimize the effect of confounding factors on postoperative visual outcomes at days 1 and 7 and months 1, 3, and 6. Safety, efficacy, predictability, and stability were compared between groups. RESULTS: Overall, 1,854 eyes of 927 participants were included (Sequence A, n = 280; Sequence B, n = 647). After PSM, there were no significant differences in baseline characteristics, and 534 eyes (267 patients) in the Sequence A group were matched (1:1) to the Sequence B group. The postoperative corrected distance visual acuity significantly differed between groups at 3 months (adjusted P = .007). The uncorrected distance visual acuity significantly differed between groups at all follow-up visits (adjusted P < .01). The safety index (1.341 ± 0.265 and 1.413 ± 0.294) and efficacy index (1.173 ± 0.191 and 1.251 ± 0.269) were different in the Sequence A and Sequence B groups, respectively, at 3 months (adjusted P < .01). No difference in visual outcomes was found between right and left eyes. CONCLUSIONS: Patients who had bilateral lenticule creation followed by bilateral lenticule separation had better postoperative visual outcomes than those who underwent complete SMILE surgery in each eye separately. Regardless of the surgical sequence chosen for the SMILE procedure, there was no impact on outcomes between the right and left eyes. Adjusting the sequence of the surgical procedure may be a way to improve the visual results. [J Refract Surg. 2021;37(11):726-733.].


Assuntos
Cirurgia da Córnea a Laser , Miopia , Substância Própria/cirurgia , Humanos , Miopia/cirurgia , Refração Ocular , Estudos Retrospectivos , Resultado do Tratamento
4.
J Refract Surg ; 37(11): 754-758, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34756144

RESUMO

PURPOSE: To compare the accuracy of the Barrett Universal II, Emmetropia Verifying Optical (EVO), Haigis, Kane, and SRK/T formulas for intraocular lens power calculation in patients with high axial myopia. METHODS: In this retrospective study, 175 eyes (175 patients) that underwent uneventful cataract surgery were enrolled. According to the axial length (AL), the eyes were divided into long AL (26 ⩽ AL < 28 mm), super long AL (28 ⩽ AL < 30 mm), and extremely long AL (⩾ 30 mm). The mean absolute prediction errors (MAE) 3 months postoperatively and the percentage of eyes within different prediction error were compared, followed by subgroup analysis. RESULTS: The MAE and percentage of eyes within ±0.50 diopters (D) of the five formulas were as follows: Barrett Universal II (0.342, 74.9%), EVO 2.0 (0.314, 82.3%), Haigis (0.336, 74.9%), Kane (0.318, 78.9%), and SRK/T (0.398, 69.7%) (P = .552 and .071, respectively). Although no significant difference was found among the five formulas in the super and extremely long AL groups (P = .792 and .227, respectively), the EVO 2.0 formula achieved the highest accuracy (88.9%, 72 of 81) in the long AL group (P = .049). Moreover, the accuracy of the EVO 2.0 and Haigis formulas was stable, regardless of AL. The SRK/T formula showed a negative trend in the long and super long AL groups, whereas the Barrett Universal II, Kane, and SRK/T formulas showed positive trends in the extremely long AL group. CONCLUSIONS: Overall, the EVO 2.0 and Kane formulas achieved better results in patients with high axial myopia, whereas the other three formulas showed slightly poor outcomes. [J Refract Surg. 2021;37(11):754-758.].


Assuntos
Lentes Intraoculares , Miopia , Facoemulsificação , Biometria , Humanos , Implante de Lente Intraocular , Miopia/cirurgia , Óptica e Fotônica , Refração Ocular , Estudos Retrospectivos
5.
Middle East Afr J Ophthalmol ; 28(2): 111-115, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759669

RESUMO

PURPOSE: The aim of the study was to assess the effect of mitomycin-C (MMC) 0.02% application on corneal endothelium in patients undergoing photorefractive keratectomy (PRK) for the correction of myopia and compound myopic astigmatism. METHODS: A prospective observational study including patients with myopia who underwent PRK plus intraoperative application of MMC 0.02%. All patients underwent noncontact specular microscopy preoperatively and 6 months postoperatively. The following parameters were analyzed: mean cell area (MCA), central corneal endothelial cell density (ECD), and coefficient of variation (CV) in cell size. RESULTS: One hundred and thirty-nine eyes of 73 patients with a mean age of 24.95 ± 3.23 years were included in the study. Mean baseline preoperative pachymetry was 519.54 ± 28.62 µm. The mean preoperative spherical equivalent was -4.6 ± 2.3D (range from -1D to -10D) which decreased to mean postoperative spherical equivalent of -0.125 ± 0.32D. Mean baseline ECD was 2829.3 ± 188.8 cells/mm2, MCA was 354.6 ± 24.9 µm2/cell, CV was 0.35 ± 0.06, and hexagonality was 50.1 ± 6.64. The mean ECD decreased by 43 ± 1.6 cells/mm2 which was not statistically significant (P = 0.07). The MCA increased by 5 ± 1.3 µm2/cell, but this was not statistically significant (P = 0.07). However, both the CV and percentage of hexagonal cells showed statistically significant differences in the median values as compared to preoperatively (P < 0.001). CONCLUSION: In our study, MMC had no significant effect on corneal endothelial cell counts or MCA. While there were statistically reduced CV and percentage of hexagonal cells, these did not appear to be clinically significant. MMC is safe to use routinely to prevent haze formation in PRK.


Assuntos
Miopia , Ceratectomia Fotorrefrativa , Adulto , Alquilantes , Endotélio Corneano , Humanos , Lasers de Excimer/uso terapêutico , Mitomicina , Miopia/cirurgia , Acuidade Visual , Adulto Jovem
6.
BMC Ophthalmol ; 21(1): 397, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34784925

RESUMO

BACKGROUND: To investigate the surgical outcomes of implantable collamer lens (ICL) implantation in eyes with residual myopia after primary laser vision correction (LVC) surgeries. METHODS: This study included patients who underwent ICL implantation and had a history of LVC surgery, including photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK). Visual acuity and refractive error were assessed pre and 3-months postoperatively and the efficacy and safety indices calculated accordingly. RESULTS: A total of 30 eyes of 17 patients were included in this study. At 3 months, the mean logMAR uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalent were - 0.03 ± 0.11 (include logMAR), - 0.04 ± 0.09 (include logMAR), and - 0.06 ± 0.33 diopters (D), respectively. The 3-month Snellen UDVA was better than 20/20 for 83% of eyes, and 97% of eyes showed an unchanged or improved CDVA after surgery. The mean efficacy and safety indices were 1.11 ± 0.22 and 1.13 ± 0.20, respectively. Further, 93 and 100% of eyes were within ±0.5 and ± 1.0 D of the attempted spherical equivalent refraction, respectively. CONCLUSIONS: ICL implantation in eyes with myopic regression after previous LVC surgery showed safe, effective, and predictable outcomes. TRIAL REGISTRATION: retrospectively registered.


Assuntos
Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Ceratectomia Fotorrefrativa , Humanos , Lasers , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Refração Ocular , Estudos Retrospectivos , Resultado do Tratamento
7.
J Refract Surg ; 37(10): 654-661, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34661473

RESUMO

PURPOSE: To evaluate the 7-year visual, refractive, and optical outcomes following small incision lenticule extraction (SMILE) for high myopia and myopic astigmatism. METHODS: Sixty-nine eyes (69 patients) undergoing SMILE between March 2011 and January 2012 at Aarhus University Hospital were included. Preoperative, 3-month, 3-year, and 7-year evaluation included: manifest refraction and uncorrected (UDVA) and corrected (CDVA) distance visual acuities, total corneal refractive power (TCRP), average keratometry (Km), aberrations, and central corneal thickness (CCT). RESULTS: Preoperative spherical equivalent averaged -7.53 ± 1.18 diopters (D). Twenty-seven eyes were targeted emmetropia. In the emmetropic eyes, the postoperative logMAR UDVA remained stable (P = .11). When including all eyes, UDVA became worse from 3 to 7 years (3 months: 0.050 ± 0.16 logMAR; 3 years: 0.044 ± 0.21 logMAR; 7 years: 0.131 ± 0.29 logMAR; P < .027), whereas CDVA remained stable (3 months: -0.07 ± 0.09 logMAR; 3 years: -0.09 ± 0.08 logMAR; 7 years: -0.09 ± 0.08 logMAR, P > .99). At 7 years, 59.4% and 81.2% were within ±0.50 and ±1.00 D of target refraction, respectively. Average refractive regression was significant from 3 months to 7 years (-0.34 ± 0.69 D) and from 3 to 7 years (-0.25 ± 0.41 D, P < .05). After exclusion of three outliers with high myopic correction (< 9.63 D) and considerable regression (<-1.50 D), the average regression over 7 years was -0.25 ± 0.49 D (P = .004) with no significant change from 3 to 7 years (P = .069). Average CCT, TCRP, and anterior Km significantly increased (P < .001), whereas the posterior Km and total corneal aberrations remained stable (P > .092). CONCLUSIONS: The long-term visual outcome remained stable after SMILE, but with an average regression of -0.34 D over 7 years. A minor group with high myopic correction exhibited considerable refractive regression years after SMILE. [J Refract Surg. 2021;37(10):654-661.].


Assuntos
Substância Própria , Miopia , Substância Própria/cirurgia , Seguimentos , Humanos , Microcirurgia , Miopia/cirurgia , Estudos Prospectivos
8.
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
9.
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
10.
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
11.
Cir Cir ; 89(5): 570-573, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665161

RESUMO

OBJECTIVE: To evaluate confocal microscopy finding after SMILE surgery by in vivo confocal microscopy and stromal lenticule and stromal interface accuracy planed vs measured. METHOD: Thirty eyes of 15 patients were evaluated before and 1 month after SMILE surgery by using confocal microscopy. Cellular morphology was studied. Planed stromal lenticule thickness was compared vs measured stromal lenticule thickness after surgery by comparing the total stromal corneal thickness before vs after surgery. Stromal corneal interface was evaluated and depth of this planed interface was compared vs measured post-surgery interface depth. RESULTS: Sub-epithelial nerve plexus was absent at 1 month after surgery. Activated keratocytes were found before and after stromal corneal interface depth. There was not statistical significant difference between mean planed stromal lenticule vs. post-surgery measured (102.3 ± 25.7 vs. 104.2 ± 29.9 mm; p = 0.73). There was not statistical significant difference between mean planed stromal interface depth vs. post-surgical measured (113.7 ± 8.2 vs. 120.5 ± 17.3 mm; p = 0.058). CONCLUSIONS: Confocal microscopy is useful to evaluate changes after SMILE surgery; lenticule thickness and stromal interface depth are exact.


Assuntos
Miopia , Procedimentos Cirúrgicos Refrativos , Substância Própria/diagnóstico por imagem , Substância Própria/cirurgia , Humanos , Lasers de Excimer , Microscopia Confocal , Miopia/cirurgia , Estudos Prospectivos
12.
BMC Ophthalmol ; 21(1): 366, 2021 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-34656092

RESUMO

BACKGROUND: Achieving an appropriate vault is the main concern after the implantation of Implantable Collamer Lens (ICLs) for surgical correction of high myopia. The vault will vary with time and optical parameters, such as accommodation and pupil size. This research is to evaluate the vault change in Myopic and Toric ICLs under different lighting conditions; and to analyze the relationship between vault changes and pupillary responses to light. METHODS: We enrolled and analyzed 68 eyes from 68 patients who were implanted with Myopic EVO ICLs; we also included 60 eyes from 60 patients who were implanted with Toric EVO ICLs. The anterior chamber depth, pupil size and the post-operative vault were evaluated, 1 week after the operation, using a Visante Optical Coherence Tomography (OCT) under different lighting conditions. For each eye that was assessed, we calculated the vault change, which is defined as the difference between vault under mesopic condition and photopic condition; and the rate of vault change, which is defined as the vault change divided by mesopic vault. RESULTS: No significant difference was noted with the anterior chamber depth between mesopic and photopic conditions in either group. A significant decrease in vault and pupil size was detected under photopic condition in both groups. We found no difference in vault change between Myopic and Toric EVO ICLs under different lighting conditions. Moreover, the rate of vault change had a significant decrease with increased mesopic vault (baseline value). CONCLUSIONS: Too low a mesopic vault has a big rate of vault change, which may cause the contact of ICL with crystalline lens in photopic state; Too high a mesopic vault would constrict the posterior movement of pupil. The findings of the study suggest that, for patients with high or low vault, we should be more careful and must perform checks in different lighting conditions.


Assuntos
Cristalino , Miopia , Lentes Intraoculares Fácicas , Acomodação Ocular , Humanos , Implante de Lente Intraocular , Miopia/cirurgia
13.
BMC Ophthalmol ; 21(1): 367, 2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34663265

RESUMO

BACKGROUND: Capsule contraction syndrome (CCS) after cataract surgery causes intraocular lens (IOL) haptic flexion and IOL optic displacement in most former reports. However, there are few reports on CCS-induced deformation of the IOL optic. We report two cases of CCS after cataract surgery in highly myopic eyes and describe a previously unreported "double arch" complication. CASE PRESENTATION: Two patients with history of high myopia had cataract surgery with hydrophilic acrylic plate haptic IOLs implanted in their eyes. CCS with arch shape deformation of the pupil as well as the optic of the IOL were noticed in both cases after three months, which induced refractive changes and corrected distance visual acuity (CDVA) deterioration. Visual acuity of the patients was restored by replacing the IOL from the capsular bag to the ciliary sulcus and the following neodymium: YAG (Nd:YAG) laser capsulotomy. We propose that such "double arch" change brought by CCS is related to the plate-haptic design of the IOL and the incomplete overlap between the capsular opening and the IOL optic. CONCLUSIONS: We recommend careful IOL selection and proper capsulorhexis in patients with high myopia or with other risk factors of CCS. Early diagnosis and timely treatment of CCS are critical to prevent visual symptoms and further ocular complications.


Assuntos
Opacificação da Cápsula , Lentes Intraoculares , Miopia , Opacificação da Cápsula/cirurgia , Capsulorrexe , Humanos , Implante de Lente Intraocular , Miopia/complicações , Miopia/cirurgia
14.
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
15.
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
16.
BMC Ophthalmol ; 21(1): 326, 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493248

RESUMO

BACKGROUND: Highly myopic eyes differ in morphology from emmetropic eyes, and the correct estimation of the vitreous volume is difficult. To explore an effective method to estimate ocular volume using refractive factors in children. METHODS: This is a retrospective study of children with high myopia who visited the Shenzhen Shekou People's Hospital (July-December 2018) before undergoing posterior scleral reinforcement surgery. Data on refractive factors and ocular 3D reconstruction imaging based on high-end CT were collected for linear correlation and linear regression analyses. RESULTS: Ten patients (20 eyes) were included. There are nine males and one female. They were 4 to 12 years of age. The spherical equivalent ranges from + 0.25 to -20.00 D. The cylindrical equivalent ranges from - 0.50 to -6.25 D. The AL(axial length, AL) ranges from 21.78 to 33.90 mm. The corneal curvature (mean) ranges from 42.44 to 46.75. The 3D reconstruction of the CT images shows that the ocular volume ranges from 4.591 to 10.988 ml. The ocular volume of the 20 eyes decreases with the increase of diopter and total curvature, both presenting a linear trend, with the Pearson correlation coefficients being - 0.776 (P < 0.001) and - 0.633 (P = 0.003), respectively. The ocular volume of the 20 eyes increases with the increasing AL, also presenting a linear trend, with the Pearson correlation coefficient being 0.939 (P < 0.001). CONCLUSIONS: In children, the ocular volume is negatively and linearly correlated with the diopter and curvature, and positively and linearly correlated with the AL.


Assuntos
Miopia , Criança , China/epidemiologia , Olho , Feminino , Humanos , Masculino , Miopia/cirurgia , Refração Ocular , Estudos Retrospectivos
17.
J Refract Surg ; 37(9): 609-615, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506237

RESUMO

PURPOSE: To evaluate whether intraoperative aberrometry improves the accuracy of refractive outcomes after cataract surgery in highly myopic, highly hyperopic, and post-refractive eyes. METHODS: This single-center, retrospective review compared the spherical equivalent of postoperative refraction to that predicted by the Barrett Universal II formula versus Optiwave Refractive Analysis (ORA) (Alcon Laboratories, Inc) for highly myopic and hyperopic eyes and to the Barrett True K formula versus ORA for post-refractive eyes. The number and magnitude of lens changes were analyzed and used to determine in how many cases refractive surprises were affected by ORA, with additional subanalysis of outcomes based on average keratometry values. RESULTS: ORA led to a change in the lens power implanted in 48% (96 of 198) of eyes, and prevented hyperopic surprise in 27% (15 of 55) and excess myopia in 46% (19 of 41). Steeper keratometry values correlated with more frequent changes on ORA-recommended implanted intraocular lens (P = .0031). ORA led to a similar percentage of eyes falling within ±0.50, ±0.75, and ±1.00 diopters compared to the Barrett Universal II and Barrett True K formulas. In post-refractive eyes, ORA led to a similar mean absolute error when compared to the Barrett True K formula (P = .62). For highly myopic eyes with an axial length of greater than 27 mm, ORA demonstrated a trend toward lower mean absolute error when compared to the Barrett Universal II formula (P = .076). CONCLUSIONS: ORA demonstrated similar refractive results to the Barrett True K formula in post-refractive eyes and to the Barrett Universal II formula in highly myopic and hyper-opic eyes and may provide additional benefit for eyes with steeper corneas or an axial length of greater than 27 mm. [J Refract Surg. 2021;37(9):609-615.].


Assuntos
Lentes Intraoculares , Miopia , Facoemulsificação , Aberrometria , Biometria , Humanos , Miopia/cirurgia , Óptica e Fotônica , Refração Ocular , Estudos Retrospectivos
18.
J Refract Surg ; 37(9): 636-641, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506239

RESUMO

PURPOSE: To examine the vault size after Implantable Collamer Lens (ICL) (KS-AquaPORT; STAAR Surgical) surgery using the KS formula. METHODS: In this prospective study, the postoperative vault was examined using the KS formula in 121 eyes of 65 patients (28 men and 37 women) who underwent ICL implantation for myopia and myopic astigmatism. The mean horizontal angle-to-angle (ATA), anterior chamber depth, and axial length before surgery were 11.83 ± 0.40, 3.25 ± 0.34, and 26.52 ± 1.17, respectively. Anterior segment optical coherence tomography (CASIA2; Tomey Corporation) was used for ATA measurement. RESULTS: Multiple regression analysis of the potential factors influencing the predicted vault error (postoperative vault - predicted vault by KS formula) showed that only ICL size was a significant factor (P < .001, r = 0.36). At an ICL size of 12.1 mm, the postoperative vault was smaller than the predicted vault, and the postoperative vault tended to be larger than the predicted vault at ICL sizes of 13.2 and 13.7 mm. CONCLUSIONS: Vault prediction by the KS formula was generally good, but the ICL size influenced the vault prediction error; therefore, a modified KS formula was created to reduce the error in measurements of the postoperative vault. [J Refract Surg. 2021;37(9):636-641.].


Assuntos
Miopia , Lentes Intraoculares Fácicas , Feminino , Humanos , Implante de Lente Intraocular , Masculino , Miopia/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
19.
J Refract Surg ; 37(9): 590-594, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34506241

RESUMO

PURPOSE: To determine patient preference and treatment outcomes with an intracanalicular dexamethasone 0.4 mg insert compared to a standard steroid drop regimen in the contralateral eye following bilateral photorefractive keratectomy (PRK). METHODS: In this randomized, prospective, self-controlled, open-label interventional study, one eye received the dexamethasone insert and the second eye received prednisolone acetate 1% taper following bilateral PRK surgery. Postoperative evaluations were performed on day 3, day 4, month 1, and month 3. Phone call surveys were performed on week 2. The Comparison of Ophthalmic Medications for Tolerability questionnaire was used to determine patient preference between postoperative regimens and postoperative pain. Corneal endpoints included time to epithelialization, presence of corneal haze, sodium fluorescein staining, and modified Standardized Patient Evaluation of Eye Dryness (SPEED) scores. Both corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) were assessed. RESULTS: Twenty patients participated in the study. At month 3, 70% of patients preferred the dexamethasone insert, 20% preferred prednisolone acetate, and 10% expressed no preference. Patient surveys did not show a difference in postoperative pain between the study group and control group. No statistical difference was shown in time to epithelialization, 90-day CDVA or UDVA, postoperative corneal haze, corneal staining, or modified SPEED scores. CONCLUSIONS: In patients undergoing PRK, there was preference toward a dexamethasone insert in place of topical prednisolone acetate for the postoperative steroid treatment. There were no statistically or clinically significant differences between the two cohorts in regard to healing time or visual outcomes. [J Refract Surg. 2021;37(9):590-594.].


Assuntos
Miopia , Ceratectomia Fotorrefrativa , Humanos , Inflamação , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Estudos Prospectivos , Refração Ocular , Resultado do Tratamento
20.
J Cataract Refract Surg ; 47(9): 1175-1182, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34468455

RESUMO

PURPOSE: To study the outcomes of alcohol-assisted photorefractive keratectomy (PRK) when compared with transepithelial PRK (TransPRK) using 2 software programs, with or without SmartPulse Technology (SmartSurfACE), in high myopia. SETTING: Vissum Miranza, University Miguel Hernandez, Alicante, Spain. DESIGN: Retrospective, consecutive, case series. METHODS: High myopic eyes undergoing surface ablation were included. The main inclusion criteria were preoperative spherical equivalent (SE) above -5.50 diopters (D) and no other ocular surgeries. Mitomycin-C was used in all the surgeries. The outcomes were analyzed using the 6-month follow-up visit data. RESULTS: 135 eyes were included. Alcohol-assisted PRK was performed in 65 eyes, transepithelial PRK (TransPRK1) in 32 eyes, and TransPRK2 in 38 eyes. The mean all groups preoperative sphere, cylinder, and SE were -6.00 ± 0.87 D, -1.13 ± 1.03 D, and -6.57 ± 0.69 D, respectively. The mean efficacy index in the alcohol-assisted PRK group was 0.91 ± 0.18 compared with 0.98 ± 0.1 and 0.98 ± 0.12 in the TransPRK1 and TransPRK2, respectively (P = .027). The mean safety index in alcohol-assisted PRK was 0.99 ± 0.05, whereas it was 1 ± 0.06 in the TransPRK1 and 0.99 ± 0.08 in the TransPRK2 (P = .780). A final SE of ± 0.50 D was achieved in 96.9% of eyes in the TransPRK1 group and in 100% eyes in the TransPRK2 group compared with 73.8% in the alcohol-assisted PRK group (P < .001). CONCLUSIONS: Surface ablation with the Amaris 500 excimer laser with flying spot pattern and mitomycin C use showed adequate refractive outcomes in high myopia correction in the 3 groups. TransPRK with or without SmartPulse Technology achieved statistically significant better outcomes than alcohol-assisted PRK in refractive predictability and efficacy.


Assuntos
Epitélio Corneano , Miopia , Ceratectomia Fotorrefrativa , Epitélio Corneano/cirurgia , Seguimentos , Humanos , Lasers de Excimer/uso terapêutico , Miopia/cirurgia , Refração Ocular , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
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