Changes to corneal aberrations and vision after Presbylasik refractive surgery using the MEL 80 platform.

PURPOSE: To investigate changes to corneal surface aberrations and vision between PresbyLASIK and LASIK for correction of presbyopia using the MEL 80 platform (Carl Zeiss Meditec, Jena, Germany). METHODS: The retrospective data of 31 patients who underwent PresbyLASIK (the PresbyLASIK group) between January 2009 and November 2011 and 20 matched patients who underwent LASIK (the LASIK group) were analyzed for changes to refraction, corrected distance visual acuity, and corneal surface wavefront aberrations calculated over 4- and 6-mm pupils. Outcomes at the 3-month follow-up visit were compared to data collected immediately prior to surgery and between PresbyLASIK and LASIK correction. Associations between induced corneal aberrations and best spherical equivalent refraction were explored. RESULTS: PresbyLASIK and LASIK significantly reduced refractive error in both myopes and hyperopes. Residual refractive error was not significantly different between treatment groups, except for spherical equivalent refraction, which was significantly more myopic following LASIK treatment compared to PresbyLASIK in myopes. There was no significant difference in postoperative corrected distance visual acuity between groups. LASIK and PresbyLASIK induced positive spherical aberration in myopes and negative spherical aberration in hyperopes, with significant differences between treatments only apparent in myopes when analyzed over a 4-mm pupil (PresbyLASIK group: 0.07 ± 0.06 µm; LASIK group: 0.03 ± 0.04 µm, P < .05). In hyperopes, induced spherical aberration was more highly associated with refractive change after LASIK (r = 0.82, P < .05) than PresbyLASIK (r = 0.64, P < .001); instead PresbyLASIK led to a more consistent shift of approximately 0.3 µm independent of induced change to refraction. CONCLUSIONS: PresbyLASIK using the MEL 80 platform induced significant changes in spherical aberration in myopes and hyperopes. PresbyLASIK appears to offer an improved response over LASIK when correcting myopes due to an apparent increase in depth of focus resulting from changes in spherical aberration. For hyperopes, PresbyLASIK provides a more consistent spherical aberration effect independent of refractive change.

Lacquer cracks developing after phakic intraocular lens implantation.

PURPOSE: To describe a case of lacquer cracks developing after phakic intraocular lens implantation. METHODS: Case report. RESULTS: A 46-year-old woman diagnosed as having extreme myopia and corrected distance visual acuity of 20/40 presented with decreased vision and a central scotoma less than 24 hours following phakic intraocular lens implantation. Dilated examination revealed the presence of a macular hemorrhage and possible lacquer crack formation. Documented preoperative imaging showed an absence of lacquer cracks in the eye that was operated on. The patient was treated with intravitreal bevacizumab. At 4 weeks postoperatively, imaging confirmed an almost complete resolution of the hemorrhagic pigment epithelial detachment with evidence of lacquer cracks. Uncorrected visual acuity was 20/50 and the patient was asymptomatic. CONCLUSIONS: This is the first reported case of macular crack formation immediately following phakic intraocular lens implantation. Possible contributing factors are discussed.

Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens.

BACKGROUND/OBJECTIVE: To evaluate the visual performance of a purely refractive extended depth of focus (EDF) intraocular lens (IOL). SUBJECTS/METHODS: A prospective, multi-center, randomized, subject/evaluator-masked study. Subjects were bilaterally implanted with the EDF test (Model ZEN00V, N = 60) or an enhanced monofocal control (Model ICB00, N = 57) IOL. Monocular corrected distance (CDVA), intermediate (DCIVA), near acuities (DCNVA) and patient reported visual symptoms were evaluated at the 6-month visit. Monocular mesopic contrast sensitivity (CS) and depth of focus (DOF) testing were assessed at 3 months. RESULTS: CDVA (Mean ± SD) was -0.06 ± 0.08 for test and -0.05 ± 0.08 logMAR for control groups. DCIVA was 0.13 ± 0.08 for test and 0.18 ± 0.14 logMAR for control groups (p = 0.0127). DCNVA was 0.37 ± 0.10 for test and 0.43 ± 0.16 logMAR for control groups (p = 0.0137). Test lens was statistically superior for intermediate and near. Overall, 91.7% (halos), 95.0% (starbursts) and 95.0% (glare) of test lens patients reported that they did not experience, were not bothered, or were slightly bothered by specific visual symptoms, compared to 98.2%, 100% and 96.5% in the control group. The DOF range over which monocular visual acuity was 0.20 logMAR or better was -1.6 D for the test lens. Mesopic CS was comparable between both groups, falling within 0.11 log units for all measured cycles per degree with and without glare. CONCLUSION: The EDF IOL demonstrated extended range of vision and statistically superior intermediate and near performance compared to the monofocal IOL. Distance visual acuity, contrast sensitivity and dysphotopsia profile were similar to the monofocal IOL.

Visual performance and positional stability of a capsulorhexis-fixated extended depth-of-focus intraocular lens.

PURPOSE: To examine the 6-month outcomes of visual performance and positional stability of a capsule-fixated intraocular lens (IOL), FEMTIS Comfort MF15, extended depth-focus (EDOF) version, after cataract surgery performed using femtosecond laser-assisted cataract surgery capsulotomy. SETTING: Vision Eye Institute, Sydney, Australia. DESIGN: Prospective open-label postregistration data collection. METHODS: Three-month and 6-month outcomes were measured including visual function, stability of IOL position, and quantitative measurement of glare and halo. Subjective patient satisfaction and spectacle independence rates were documented with a subjective questionnaire. A computer simulator was used to quantify the incidence and severity of unwanted visual phenomena allowing comparison with other EDOF and multifocal IOLs. RESULTS: Forty-four eyes of 25 patients were included in the study. There were 19 bilateral cases. The median shift in IOL position over 6 months (from surgery to 6 months) was 0.095 ± 0.09 mm. There was a marked improvement in uncorrected and corrected distance visual acuity from the preoperative to the 6-month mark. Patient satisfaction and spectacle independence levels were high. There was no IOL enclevation, negative dysphotopsia, decentration, or capsular phimosis. CONCLUSIONS: To the authors' knowledge, this is the first study to report outcomes after insertion of the FEMTIS capsulorhexis-fixated EDOF IOL. This IOL offers excellent refractive predictability, functional range of vision, and minimal unwanted visual phenomena. The attachment to the anterior capsulorhexis is shown to be stable over time with no significant shift in the position or capsular phimosis. There was high patient satisfaction with spectacle independence.

Role of percent peripheral tissue ablated on refractive outcomes following hyperopic LASIK.

OBJECTIVES: To determine the effect of hyperopic laser in situ keratomileusis (H-LASIK) on corneal integrity, by investigating relationships between proportionate corneal tissue ablated and refractive outcomes at 3 months. METHODS: 18 eyes of 18 subjects treated with H-LASIK by Technolas 217c Excimer Laser were included in the study. Orbscan II Topography System was used to determine corneal volume and pachymetry 3mm temporally (3T). The volume of corneal tissue ablated was determined from the laser nomogram. Univariate associations between age, treatment, corneal volume, overall proportion of tissue removed, proportion of tissue removed at 3T, residual bed thickness at 3T and refractive outcomes 3 months post-LASIK were examined and independent factors associated with refractive outcomes determined using linear regression models. RESULTS: At 3 months post-LASIK, the mean difference to expected refractive outcome was -0.20 ± 0.64 (Range -2.00 to +1.00). In univariate analysis, difference to expected refractive outcome was associated with proportion of tissue removed at 3T (P<0.01, r = -0.605) and total number of pulses (P< 0.05, r = -0.574). In multivariable analysis, difference to expected refractive outcome was associated with the proportion of tissue removed at 3T only. CONCLUSION: Subjects undergoing H-LASIK, may present as either over or under-corrected at 3 months. The proportion of tissue removed at 3T was the single significant determinant of this outcome, suggesting unexpected biomechanical alterations resulting in corneal steepening. Future hyperopic LASIK procedures could consider proportionate volume of corneal tissue removed at 3T in addition to laser nomograms to achieve improved refractive outcomes.

Traumatic late flap dehiscence and Enterobacter keratitis following LASIK.

PURPOSE: To report a case of traumatic flap dehiscence and Enterobacter keratitis 34 months after LASIK. METHODS: A 36-year-old man sustained a flap dehiscence following traumatic right eye gouging by a seagull claw. He presented the following day with uncorrected visual acuity (UCVA) in the affected eye of 3/200 and organic foreign body deposits underneath the flap. Systemic and topical antibiotics were administered and urgent surgical debridement and replacement of the LASIK flap was performed. An Enterobacter species was cultured from an intraoperative swab. RESULTS: After a prolonged postoperative course, including administration of topical ofloxacin, tobramycin, chloramphenicol, and dexamethasone, UCVA returned to 20/20. CONCLUSIONS: Good visual outcome after early debridement and appropriate antibiotics was achieved. Patients should be injury advised to seek prompt ophthalmic consultation after LASIK.

Small incision lenticule extraction (SMILE) in 2015.

Small incision lenticule extraction (SMILE) represents a recent addition to the refractive surgeon's range of procedures. Although there remains a number of similarities to existing techniques in terms of patient selection and treatment parameters, consideration is required to optimise patient outcomes and satisfaction. Here, we review the selection criteria, contraindications, indications and existing published safety and efficacy outcomes.

Cornea-sparing laser in situ keratomileusis: ablation on the flap.

PURPOSE: To evaluate the safety and efficacy of laser ablation on the flap as a treatment for a refractive error. SETTING: Laser Sight Centres, Sydney, Australia. METHODS: In this noncomparative case series, 142 treatments were performed in 98 patients using cornea-sparing laser in situ keratomileusis (LASIK) with ablation of the corneal flap and, in some cases, also the stromal bed for spherical equivalent (SE) refractive errors from -0.50 diopter (D) to -12.38 D. The procedure was performed as a primary treatment in 104 eyes, an initial enhancement in 32 eyes, and a second enhancement in 6 eyes. Data were extracted for analysis by retrospective review of patients' charts. RESULTS: After LASIK, the mean SE was -0.20 D +/- 0.47 (SD) (range +0.87 to -2.35 D) excluding eyes with monovision. The 6 eyes with monovision had a mean SE of -1.90 D with myopia of -1.70 D (range -1.00 to -3.00 D) and mean astigmatism of -0.37 D (range 0 to -0.75 D). Excluding eyes with monovision, 97% of eyes achieved an uncorrected visual acuity of 6/12 or better and 64% of eyes, better than or equal to 6/6. Ninety-six percent were within +/-1.0 D of the intended correction (SE). The safety index was 1.02 and the efficacy index, 0.8. CONCLUSIONS: Laser ablation of the corneal flap achieved good visual results and enabled preservation of the posterior corneal stroma. This technique may aid the prevention of corneal keratectasia following LASIK.

Intraocular contact lens tamponade to facilitate penetrating keratoplasty in perforated corneas.

Penetrating keratoplasty in the presence of a perforated cornea is a relatively common and difficult surgical problem. In the worst scenario, there may be extrusion of ocular contents during trephination. Two cases of perforated corneas are presented in which a new technique was used to close the perforation and normalize intraocular pressure. This involves inserting a soft contact lens through a paracentesis into the anterior chamber. An ophthalmic viscosurgical device is then injected behind the contact lens, opening it, and allowing it to tamponade the perforation. This stabilizes the anterior chamber and allows a stable operating environment. This has not been described previously.

Axial myopic progression following phakic intraocular lens implantation.

UNLABELLED: A 45-year-old woman presented to her ophthalmologist complaining of worsening uncorrected distance visual acuity following placement of an Implantable Collamer Lens phakic intraocular lens (pIOL) approximately 10 years earlier. Prior to the pIOL surgery, contact ultrasound axial length (AL) measurements of 28.28 mm in the right eye and 27.90 mm in the left eye indicated the presence of axial myopia. At review 10 years after the initial pIOL surgery, the AL measured by partial coherence interferometry had increased to 30.25 mm and 29.22 mm, respectively, indicating a progression of the axial myopia. This case suggests that in some patients, age and recent myopic stability are insufficient criteria to conclude that the high myopia is nonprogressive. In our patient, placement of a pIOL and induction of a stable, constant, and focused foveal image were not sufficient to prevent further axial myopic progression. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Ocular association of HIV infection in the era of highly active antiretroviral therapy and the global perspective.

Ocular involvement is a common complication of HIV infection. Since the late 1990s, widespread use of highly active antiretroviral therapy (HAART) has altered the spectrum, and reduced the incidence of ocular involvement in developed countries. The incidence of the most common ocular opportunistic infection, cytomegalovirus retinitis, has decreased tremendously. However, immune recovery uveitis secondary to HAART has emerged as a frequent visually threatening condition. Early diagnosis and treatment with periocular steroids is helpful in minimizing visual loss. Clinicians should also be aware that certain antimicrobial agents used to treat opportunistic infections in HIV-positive patients are associated with potentially serious ocular side effects. In developing countries, where most of the world's 40 million HIV-positive patients live, the spectrum and incidence of ocular involvement differ from those in developed countries. The lack of HAART availability is among the many causes of these differences, which may include nutritional factors, basic medical care availability and the levels of exposure to different infectious agents. These factors add to the already challenging task of treating ocular complications and preventing blindness in HIV-positive patients in developing countries.