Refractive results with SMILE using lower energy settings in the United States.

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.

Capsulorhexis phimosis with anterior flexing of an accommodating IOL: case report and histopathological analyses.

We describe the case of a patient who had cataract surgery with implantation of an accommodating hydrophilic acrylic intraocular lens (IOL) that exhibited capsulorhexis phimosis and in-the-bag IOL luxation leading to explantation of the IOL-capsular bag complex 10 years after implantation. Constriction of the capsular bag secondary to fibrosis caused significant anterior flexing of the haptic elements of the IOL. Histopathological analysis revealed dense anterior subcapsular fibrosis and fibrous metaplasia of the anterior lens epithelial cells. No signs suggestive of pseudoexfoliation were found. This case raises concerns related to the continuously evolving indications for implantation of accommodating and other highly flexible IOLs (eg, microincision IOLs), particularly in patients with no clear predisposition to zonular weakness and, accordingly, excessive capsular bag contraction.

Calcification of a hydrophilic acrylic intraocular lens after Descemet-stripping endothelial keratoplasty: case report and laboratory analyses.

We describe the case of an 83-year-old woman who had uneventful phacoemulsification with implantation of a tripod hydrophilic acrylic intraocular lens (IOL). Because of postoperative corneal decompensation, 2 Descemet-stripping endothelial keratoplasty (DSEK) procedures were performed within 2 years. After the second procedure, the graft was not well attached, requiring an intracameral injection of air on day 3. Approximately 9 months later, opacification was observed on the anterior surface of the IOL, with a significant decrease in visual acuity. The IOL was explanted within the capsular bag. Laboratory analyses revealed granular deposits densely distributed in a round pattern within the margins of the capsulorhexis. Granules were located at the anterior surface/subsurface of the IOL and stained positive for calcium (alizarin red and von Kossa method). Scheimpflug photography revealed high levels of light scattering from the opacified area. Surgeons should be aware of possible localized calcification following DSEK procedures in pseudophakic patients with hydrophilic acrylic IOLs.