Five-year follow-up after anterior iris-fixated intraocular lens implantation in phakic eyes to correct high myopia

Purpose

To evaluate the 5-year follow-up of safety, efficacy, predictability, stability, and complications of anterior iris-fixated phakic intraocular lens (pIOL) implantation to correct high myopia, and patients'' satisfaction after implantation.

Design

Prospective, nonrandomized, and comparative (self-controlled) trial.

Methods

A prospective clinical trial of 84 eyes of 43 patients with high myopia was conducted. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, intraocular pressure (IOP), anterior chamber depth, slit lamp biomicroscopy, and indirect ophthalmoscope were measured preoperatively and postoperatively.

Results

At the 5-year follow-up, UCVA was significantly improved, with 85.7% of eyes reaching 20/25 or better. No eyes experienced a loss in BSCVA, and 71.4% gained one or more lines of their preoperative BSCVA. There was a significant reduction in spherical errors in all patients after operation. Loss of endothelial cells was observed 3 years after operation and no more loss was observed 4 years after operation in statistical analysis. No increase in IOP was observed 5 years after operation in statistical analysis. No intraoperative complications were observed in this study. However, pigment precipitates of varying intensities on the lens optic were noted in all patients 1 day after operation, and only five eyes were observed to have the pigment residual five years after operation.

Conclusion

At the 5-year follow-up, the implantation of the anterior iris-fixated pIOL was proved to be effective, predictable and capable of reversibility to correct high myopia in phakic eyes. It was a safety addition to the laser refractive surgery. However, longer follow-up with larger numbers of patients is still necessary to evaluate long-term complications.     

Combined 23-gauge microincisonal vitrectomy surgery and phacoemulsification with AcrySof toric intraocular lens implantation: a comparative study

Aim

To compare AcrySof toric intraocular lens (IOL) and non-toric IOL in patients who had combined 23-gauge microincisional vitrectomy surgery (MIVS) and phacoemulsification for vitreoretinal diseases and cataract with pre-existing corneal astigmatism.

Methods

This is a prospective comparative study comprised of 30 patients (30 eyes) who had combined 23-gauge MIVS and phacoemulsification for vitreoretinal diseases and cataract with pre-existing regular corneal astigmatism greater than 1 diopters (D). In all, 15 eyes had AcrySof toric IOL (Alcon Laboratories) and 15 eyes had non-toric IOL (Akreos AO MI60; Bausch & Lomb) implantation. Main outcome measures were uncorrected visual acuity (UCVA), refractive cylinder, surgically induced astigmatism (SIA), and IOL misalignment during 6 months.

Results

The mean UCVA of the toric IOL group was better than the non-toric IOL group at postoperative months 1, 3, and 6 (P<0.001, respectively). The mean absolute residual refractive cylinder of the toric IOL group at postoperative week 1, and months 1, 3, and 6 was less than the non-toric IOL group (P=0.008, <0.001, <0.001, and <0.001, respectively). There was no difference in the mean SIA between the two groups (P>0.05, respectively). The mean toric IOL axis rotation was 3.52±2.75°, which was within 5° in 66.7% of the toric IOL group and within 10° in 100%.

Conclusions

Combined 23-gauge MIVS and phacoemulsification with AcrySof toric IOL implantation is an effective method of correcting vitreoretinal diseases and cataract and pre-existing corneal astigmatism, and the toric IOL showed good rotational stability, even in vitrectomized eyes for 6 months.     

Foldable iris-fixated phakic intraocular lens implantation for the correction of myopia: two years of follow-up

Purpose:

To evaluate the safety, efficacy and potential risks of Artiflex foldable iris-fixated phakic intraocular lens (pIOL) implantation for the management of myopia.

Materials and Methods:

Seventy-eight eyes of 40 consecutive patients with a mean spherical refraction of –11.70 ± 3.77 diopters (D; range –5.50 to –17.5 D) were included in this prospective, noncomparative, interventional case series. Main parameters assessed were uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), corneal topography (Orbscan II, BauchandLomb, Rochester, NY, USA), manifest and cycloplegic refractive errors, endothelial cell density (ECD) and applanation tonometry.

Results:

After 2 years, BSCVA was 20/40 or better in 82% of the eyes and UCVA was 20/40 or better in 84% of the eyes. After 1 month, 1 year, and 2 years, 51.3% (37 of 72 eyes), 58.9% (46 of 78 eyes) and 76.0% (38 of 50 eyes) of eyes gained 1 line or more of BSCVA, respectively. Compared to preoperative values, the mean endothelial cell loss was 2.6% at 1 month, 4.9% at 1 year and 7.4% at 2 years. Pigmented or non-pigmented precipitates were observed in17 eyes (21.7%) which were treated with topical corticosteroids. At the second postoperative year, pigmented precipitates persisted in nine eyes. However, this was not associated with a loss of BSCVA.

Conclusion:

The implantation of Artiflex pIOL is an effective surgical option for the management of high myopia. The most common complication observed within 2 years of follow-up was accumulation of pigmented precipitates with no effect on the final BSCVA.     

Long-Term Efficacy and Rotational Stability of AcrySof Toric Intraocular Lens Implantation in Cataract Surgery

Purpose

To evaluate the long-term efficacy and rotational stability of the AcrySof toric intraocular lens (IOL) in correcting preoperative astigmatism in cataract patients.

Methods

This prospective observational study included 30 eyes from 24 consecutive patients who underwent implantation of an AcrySof toric IOL with micro-coaxial cataract surgery between May 2008 and September 2008. Outcomes of visual acuity, refractive and keratometric astigmatism, and IOL rotation after 1 day, 1 month, 3 months, and long-term (mean, 13.3±5.0 months) follow-up were evaluated.

Results

At final follow-up, 73.3% of eyes showed an uncorrected visual acuity of 20/25 or better. The postoperative keratometric value was not different from the preoperative value; mean refractive astigmatism was reduced to -0.28±0.38 diopter (D) from -1.28±0.48 D. The mean rotation of the toric IOL was 3.45±3.39 degrees at final follow-up. One eye (3.3%) exhibited IOL rotation of 10.3 degrees, the remaining eyes (96.7%) had IOL rotation of less than 10 degrees.

Conclusions

Early postoperative and long-term follow-up showed that implantation of the AcrySof toric IOL is an effective, safe, and predictable method for managing corneal astigmatism in cataract patients.     

Outcome of posterior chamber phakic intraocular lens procedure to correct myopia

Purpose

To assess the safety and efficacy of the implantable contact lens (ICL™) to treat myopia.

Design

Clinical, retrospective, single center, non-randomized case series.

Participants

Sixty-nine eyes of 46 patients with myopia ranging from −3.00 to 25.00 D were included in this study.

Intervention

Implantation of the ICL™.

Main outcome measures

Uncorrected Visual Acuity (UCVA), refraction, best spectacle corrected visual acuity (BSCVA), adverse events, operative and postoperative complications, subjective assessment and symptoms.

Results

The mean follow-up was 12.35 ± 6.13 (SD) months (range, 6 months–32 months). At the last visit, 49.20% of eyes had 20/20 or better UCVA compared to preoperative 20/20 or better BSCVA of 31.9% of eyes; 69.23% of eyes had postoperative UCVA better than or equal to preoperative BSCVA. The mean manifest refractive cylinder was 1.93 ± 1.21 D at baseline and 1.00 ± 0.92 D postoperatively. The mean manifest refraction spherical equivalent (MRSE) was −11.70 ± 4.24 D preoperatively and −0.69 ± 1.13 D postoperatively. A total of 69.8% of eyes were within ±0.5 D of the predicted MRSE; 84.1% were within ±1.0 D, and 88.90% were within ±2.0 D. BSCVA of 20/20 or better was achieved in 64.6% of eyes postoperatively, compared to 31.9% preoperatively. Mean improvement in BSCVA was 1line. One eye (1.5%) lost ⩾2 lines of BSCVA at the last visit, whereas 20% of eyes improved by ⩾2 lines. A total of 56.92% of cases gained ⩾1 line of BSCVA and 4.62% of cases lost ⩾1 line. Four ICL lenses were removed without significant loss of BSCVA, and 2 eyes with clinically significant lens opacities were observed. Four eyes (5.8%) developed a pupillary block the first day postoperatively. One eye (1.4%) developed a hypotony and AC shallowing.

Conclusion

Implantation of ICL for the correction of myopia was a safe procedure with good visual and refractive results from the early postoperative period to 1 year. Long-term follow-up is required to confirm the long-term safety of this implant.     

Intraocular lens exchange through a 3.2-mm corneal incision for opacified intraocular lenses

Aim:

The aim was to evaluate visual and refractive results and complications of intraocular lens (IOL) exchange through a 3.2 mm corneal incision for opacified IOLs.

Materials and Methods:

This retrospective study comprised 33 eyes of 32 patients with IOL opacification requiring an IOL exchange between July 2003 and March 2007. Exchange surgery was performed through a 3.2-mm temporal clear corneal incision followed by implantation of a new foldable hydrophobic IOL. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), topographical astigmatism, and refractive cylinder were evaluated. Surgically induced astigmatism (SIA) was calculated and complications were recorded.

Results:

Opacification was observed in 25 eyes (76%) with Aqua-Sense, 3 eyes (9%) with Hydroview, 3 eyes (9%) with MemoryLens IOLs, and 2 eyes (6%) with DgR. The mean follow-up period was 36.54 months. An uneventful IOL exchange was achieved in 18 eyes (55%). Zonular dehiscence occurred in 9 eyes (27%), and posterior capsule tear developed in 4 eyes (12%). The mean preoperative BSCVA (mean ± standard deviation, decimal scale) was 0.13 ± 0.08 (mean: 20/150, range 20/2000 to 20/60) and improved to 0.63 ± 0.18 (mean: 20/32, range 20/60 to 20/20, P < 0.001). The mean SIA was 0.70 D. Seven eyes (21%) had 0.5 D or lower SIA.

Conclusion:

IOL exchange is a technically challenging procedure with potential risks of reversing the advantages of a prior small-incision cataract surgery. The use of a small corneal incision for IOL exchange could preserve the advantages of modern phacoemulsification surgery with acceptable SIA related to the procedure.     

Late in-the-bag intraocular lens dislocation requiring explantation: risk factors and outcomes

Purpose

To study the predisposing factors for late in-the-bag intraocular lens (IOL) dislocation and to analyze the outcomes after explantation surgery.

Methods

In this retrospective multicentre study, 61 eyes were enrolled. The main inclusion criterion was in-the-bag spontaneous IOL dislocation after uneventful phacoemulsification cataract extraction. Only eyes with serious dislocation that required IOL explantation were eligible. Follow-up after explantation surgery of at least 3 months was required. Exclusion criteria were complicated cataract surgery, out-of-the-bag IOL dislocation, and dislocations that occurred in the first year after the cataract surgery. The main outcome measures were predisposing factors for dislocation, interval between cataract surgery and dislocation, surgical treatment at the time of explantation, preoperative and postoperative corrected distance visual acuity (CDVA), and postoperative complications.

Results

High myopia was detected in 12 cases (19.7%) and it was the main predisposing factor. Mean time interval from cataract surgery to dislocation was 7.5 (SD 5.2) years. The dislocated in-the-bag IOL was replaced with a scleral fixated IOL (36.1%), angle-supported anterior chamber IOL (31.1%), sulcus repositioning (18%), or posterior chamber iris sutured IOL (4.9%). Finally, 9.8% of the patients were left aphakic. Mean CDVA improved significantly after surgery (P=0.005). Final CDVA of 20/40 or better was achieved in 29 cases (47.5%).

Conclusions

High myopia was the main risk factor for late in-the-bag IOL dislocation. Surgical treatment significantly improved the CDVA in our sample and was associated with a low complication rate.     

Optical quality of toric intraocular lens implantation in cataract surgery

AIM: To analyze the optical quality after implantation of toric intraocular lens with optical quality analysis system. METHODS: Fifty-two eyes of forty-four patients with regular corneal astigmatism of at least 1.00 D underwent implantation of AcrySof toric intraocular lens, including T3 group 19 eyes, T4 group 18 eyes, T5 group 10 eyes, T6 group 5 eyes. Main outcomes evaluated at 3mo of follow-up, included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual refractive cylinder and intraocular lens (IOL) axis rotation. Objective optical quality were measured using optical quality analysis system (OQAS Ⅱ?, Visiometrics, Spain), included the cutoff frequency of modulation transfer function (MTFcutoff), objective scattering index (OSI), Strehl ratio, optical quality analysis system value (OV) 100%, OV 20% and OV 9% [the optical quality analysis system (OQAS) values at contrasts of 100%, 20%, and 9%]. RESULTS: At 3mo postoperative, the mean UDVA and CDVA was 0.18±0.11 and 0.07±0.08 logMAR; the mean residual refractive cylinder was 0.50±0.29 D; the mean toric IOL axis rotation was 3.62±1.76 degrees, the mean MTFcutoff, OSI, Strehl ratio, OV 100%, OV 20% and OV 9% were 22.862±5.584, 1.80±0.84, 0.155±0.038, 0.76±0.18, 0.77±0.19 and 0.78±0.21. The values of UDVA, CDVA, IOL axis rotation, MTFcutoff, OSI, Strehl ratio, OV100%, OV20% and OV9% depending on the power of the cylinder of the implantation were not significantly different (P>0.05), except the residual refractive cylinder (P<0.05). CONCLUSION: The optical quality analysis system was useful for characterizing the optical quality of AcrySof toric IOL implantation. Implantation of an AcrySof toric IOL is an effective and safe method to correct corneal astigmatism during cataract surgery.     

Phakic intraocular lenses outcomes and complications: Artisan vs Visian ICL

Purpose

To evaluate the safety and visual outcomes of two phakic intraocular lenses (IOLs) for correction of high myopia: Artisan and Visian ICL (ICL).

Patients and methods

In this retrospective study, a phakic IOL was implanted in 68 highly myopic eyes of 34 patients; 42 eyes received an Artisan IOL, and 26 eyes received ICL IOL.

Results

All patients completed a 1-year follow-up. The mean preoperative spherical equivalent (SEQ) was −12.89±3.78, and −12.44±4.15 diopters (D) for Artisan and ICL (P=0.078), respectively. The mean postoperative (1-year) uncorrected distance visual acuity was 0.39±0.13 and 0.41±0.15 logMAR for Artisan and ICL, respectively (P=0.268). The mean postoperative (1-year) corrected distance visual acuity was 0.36±0.12 and 0.31±0.12 logMAR for Artisan and ICL, respectively (P=0.128). The mean postoperative SEQ was −0.86±0.5 and −0.63±0.38 D for Artisan and ICL, respectively (P=0.67). Intraocular pressure change at 1 year was 0.64±2.7 and 1.88±0.6 mm Hg for Artisan and ICL, respectively (P=0.77).

Conclusion

Artisan and ICL showed equal and comparable safety, predictability, and efficacy.     

Corneal collagen crosslinking for keratoconus or corneal ectasia without epithelial debridement

Purpose

Corneal collagen crosslinking (CXL) is a relatively new technique to reduce the progression of keratoconus. The technique can be performed with or without complete debridement of the corneal epithelium. We describe a novel intermediate technique involving mechanical disruption of the epithelium, and evaluate its safety and efficacy.

Methods

The case notes of 128 eyes with progressive keratoconus or iatrogenic corneal ectasia who had undergone CXL using the epithelial disruption technique were retrospectively reviewed. Thin corneas were treated with hypotonic riboflavin. All others were treated with an isotonic solution. Note was made of preoperative and postoperative parameters, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, and corneal tomography. Occurrence of procedure-related complications was recorded. Statistical analyses were performed using the paired sample t-test and Wilcoxon signed-rank test, with a level of P<0.05 being accepted as statistically significant.

Results

At 12 months, 41.8% of patients treated with isotonic riboflavin had improved UCVA and 29.7% had improved BSCVA. Only 13.4% lost lines of UCVA and 14.9% lost BSCVA. Of the patients treated with hypotonic riboflavin, at 12 months, 75% demonstrated stability of BSCVA and 25% had stable Kmax. In addition, 25% showed improved visual acuity at 12 months, and 58.3% showed regression of their Kmax. Our rate of short-term complications was comparable to studies using complete epithelial removal.

Conclusions

CXL with epithelial disruption is a safe and effective treatment for keratoconus or iatrogenic corneal ectasia, and may be better tolerated by patients than the epithelium-off technique.     

Angle-supported phakic intraocular lenses in eyes with keratoconus and myopia

PURPOSE: To evaluate the visual results and complications of angle-supported phakic intraocular lenses (IOLs) to correct myopia associated with early-stage keratoconus. SETTING: Private practice, Siena, Italy. METHODS: In a prospective noncomparative single-surgeon interventional case series, outcomes in 12 consecutive eyes of 8 patients with stage I to II keratoconus, myopia from -6.50 to -14.00 diopters (D), and astigmatism from -1.00 to -5.00 D were analyzed after the implantation of angle-supported phakic IOLs (ZSAL-4, Morcher). The minimum follow-up was 12 months. Implantation was performed through a sclerocorneal 5.5 mm x 3.0 mm tunnel along the steepest meridian, after which a surgical basal iridectomy was created. RESULTS: The spherical error in all cases was corrected within +/-1.00 D. Astigmatism magnitude did not significantly improve. The uncorrected visual acuity (UCVA) was 20/40 or better in all cases. The best spectacle-corrected visual acuity (BSCVA) was equal or improved in all cases. The safety index (postoperative BSCVA/preoperative BSCVA) was 1.18; the efficacy index (postoperative UCVA/preoperative BSCVA) was 0.77. Three eyes had significant halos that improved considerably over 3 months. Spectacles were permanently used by 1 patient (2 eyes in the study) and only for driving by 5 patients. Complications were limited to 3 cases of mild pupil ovalization and 1 case of IOL rotation. Endothelial loss at 12 months was 7.2%. CONCLUSIONS: Implantation of angle-supported phakic IOLs to correct myopia in patients with keratoconus stage I to II was an effective procedure. Although astigmatism did not improve by the creation of the incision, it was well tolerated by most patients. Long-term endothelial safety must be assessed.     

Predictive factor and kappa angle analysis for visual satisfactions in patients with multifocal IOL implantation

Purpose

To evaluate the visual acuity and quality-related satisfaction of patients implanted with a refractive design multifocal intraocular lens (IOL), and evaluate the factors predicting it including angle kappa.

Setting

Dr Agarwal''s Eye Hospital and Eye Research Centre, Chennai.

Methods

In this prospective trial, 50 eyes of 44 consecutive patients were included. All patients underwent phacoemulsification with multifocal IOL implantation (Rezoom IOL, Abbott Medical Optics). The preoperative and postoperative assessment included slit lamp biomicroscopy, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and kappa angle assessment. At 1 year, 37 patients (43 eyes), who finished follow-up, were asked to rate their symptoms on a graded questionnaire (0–5 for five queries).

Results

The decimal scores for UCVA and BCVA were 0.38±0.21 and 0.47±0.17 (preoperative), and 0.75±0.22 and 0.99±0.11 (postoperative), respectively. Symptom scores were haloes 0.98±1.7, glare 0.69±1.48, blurred distance 1.0±1.7, intermediate 1.34±1.6, near 1.06±1.8. On regression analysis haloes depended on angle kappa and distance UCVA (R ²=0.26, P=0.029), and glare on angle kappa (R ²=0.26, P=0.033). Poor satisfactions with distance, intermediate, and near vision were linked with distance UCVA (R ²=0.17, P=2.3 × 10⁻⁴), distance UCVA (R ²=0.1, P=0.04), and near UCVA (R ²=0.12, P=0.03), respectively. The strongest predictor, however, for overall visual discomfort was distance UCVA (R ²=0.1, P=0.04).

Conclusions

Our study suggests that there may be a role of misalignment between the visual and pupillary axis (angle kappa) in the occurrence of photic phenomenon after refractive multifocal IOL implantation.     

Boston type 1 keratoprosthesis: the New York Eye and Ear experience

Purpose

The Boston keratoprosthesis has had variable success rates in the past. However, significant modifications to design and management have recently led to successful outcomes. This study was undertaken to evaluate the outcomes of the Boston type 1 keratoprosthesis at our institution.

Methods

A retrospective chart review was performed of all Boston type 1 keratoprosthesis procedures conducted at a single practice at the New York Eye and Ear Infirmary from December 2006 to August 2010. Outcome measures included visual acuity, retention rates, and complications.

Results

In all, 58 eyes of 51 patients who received a Boston type 1 keratoprosthesis were included. The most common indication for the keratoprosthesis was failed penetrating keratoplasty (PK) (81.0% mean 2.4±1.3 PKs per eye). Glaucoma was the most common comorbidity (75.9%). Pre-operative best corrected visual acuity (BCVA) was <20/400 in 87.9% of eyes. At last follow-up, 43.1% of eyes had a BCVA of 20/200. Retention rate was 87.9% over an average follow-up of 21.5±11.4 months (median 22 months, range 3–47 months). Complications increased with time, with 65.5% of eyes experiencing at least one event by 6 months and 75.9% by 1 year. The most common post-operative complication was retroprosthetic membrane formation (50.0%).

Conclusions

The Boston type 1 keratoprosthesis provides visual recovery for eyes with multiple PK failures or with poor prognosis for primary PK, showing excellent retention rates. However, there is a trend towards a decline in visual acuity with time and the development of late complications, highlighting a need for longer-term studies.     

Agreement analysis of LENSTAR with other techniques of biometry

Purpose

To assess the agreement of the optical low-coherence reflectometry (OLCR) device LENSTAR LS900 with partial coherence interferometry (PCI) device IOLMaster and applanation and immersion ultrasound biometry.

Methods

We conducted the study at the Ophthalmology Clinic, University of Malaya Medical Center, Malaysia. Phakic eyes of 76 consecutive cataract patients were measured using four different methods: IOLMaster, LENSTAR and A-scan applanation and immersion ultrasound biometry. We assessed the method agreement in the LENSTAR-IOLMaster, LENSTAR-applanation, and LENSTAR-immersion comparisons for axial length (AL) and intraocular lens (IOL) power using Bland–Altman plots. For average K, we compared LENSTAR with IOLMaster and the TOPCON KR-8100 autorefractor-keratometer. SRK/T formula was used to compute IOL power, with emmetropia as the target refractive outcome.

Results

For all the variables studied, LENSTAR agreement with IOLMaster is strongest, followed by those with immersion and applanation. For the LENSTAR-IOLMaster comparison, the estimated proportion of differences falling within 0.33 mm from zero AL and within 1D from zero IOL power is 100%. The estimated proportion of differences falling within 0.5 D from zero average K is almost 100% in the LENSTAR-IOLMaster comparison but 88% in the LENSTAR-TOPCON comparison. The proportion of differences falling within 0.10 mm (AL) and within 1D (IOL power) in the LENSTAR-IOLMaster comparison has practically significant discrepancy with that of LENSTAR-applanation and LENSTAR-immersion comparisons.

Conclusions

In phakic eyes of cataract patients, measurements of AL, average K, and IOL power calculated using the SRK/T formula from LENSTAR are biometrically equivalent to those from IOLMaster, but not with those from applanation and immersion ultrasound biometry.     

Corneal collagen crosslinking for corneal ectasia of post-LASIK: one-year results

AIM: To evaluate the efficacy and safety of corneal collagen crosslinking (CXL) to prevent the progression of post-laser in situ keratomileusis (LASIK) corneal ectasia. METHODS: In a prospective, nonrandomized, single-centre study, CXL was performed in 20 eyes of 11 patients who had LASIK for myopic astigmatism and subsequently developed keratectasia.The procedure included instillation of 0.1% riboflavin-20% dextrane solution 30 minutes before UVA irradiation and every 5 minutes for an additional 30 minutes during irradiation. The eyes were evaluated preoperatively and at 1-, 3-, 6-, and 12-month intervals. The complete ophthalmologic examination comprised uncorrected visual acuity, best spectacle-corrected visual acuity, endothelial cell count, ultrasound pachymetry, corneal topography, and in vivo confocal microscopy. RESULTS: CXL appeared to stabilise or partially reverse the progression of post-LASIK corneal ectasia without apparent complication in our cohort. UCVA and BCVA improvements were statistically significant(P＜0.05) beyond 12 months after surgery (improvement of 0.07 and 0.13 logMAR at 1 year, respectively). Mean baseline flattest meridian keratometry and mean steepest meridian keratometry reduction (improvement of 2.00 and 1.50 diopters(D), respectively) were statistically significant (P＜0.05) at 12 months postoperatively. At 1 year after CXL, mean endothelial cell count did not deteriorate. Mean thinnest cornea pachymetry increased significantly. CONCLUSION: The results of the study showed a long-term stability of post-LASIK corneal ectasia after crosslinking without relevant side effects. It seems to be a safe and promising procedure to stop the progression of post-LASIK keratectasia, thereby avoiding or delaying keratoplasty.     

Cataract surgery in aged patients: phacoemul-sification or small-incision extracapsular cataract surgery

AIM: To evaluate the effects and safety of phacoemu- lsification (Phaco) or small-incision extracapsular cataract surgery (SICS) and intraocular lens (IOL) implantation for aged patients. METHODS: Totally 137 aged patients (149 eyes) underwent cataract operation in the case of stable systemic condition, the blood pressure less than 160/95mmHg, blood glucose less than 8mmol/L, and under the help of electrocardiogram surveillance by anesthesiologists during the operation. 106 aged patients (114 eyes) underwent Phaco while 31 aged patients (35 eyes) underwent SICS. The postoperative visual acuity, corneal endothelial cell loss, surgery time and major complications were observed and analyzed retrospectively. RESULTS: The best-corrected visual acuity(BCVA) of ≥0.6 was achieved in 135 eyes (92.6%) at 1 month postoperatively (χ2=259.730, P＜0.001). For aged patients, both Phaco and SICS could significantly improve visual acuity with no significant difference (χ2=4.535,P＞0.05). Postoperative corneal endothelial cell loss was 18.6%, in PHACO group, the rate was 18.5%; in SICS group, the rate was 19.0%, the difference of which was no significant (χ2=0.102, P>0.05). The surgery time was different in two groups. No severe complications occurred. CONCLUSION: Both Phaco and SICS combined with IOL implantation for aged patients are effective and safe. Before surgery, detailed physical examination should be performed. When the systemic condition is stable, cataract surgery for aged patients is safe.     

Laser in-situ keratomileusis for refractive error following radial keratotomy

Aim:

To evaluate the safety and efficacy of laser in-situ keratomileusis (LASIK) in eyes with residual/induced refractive error following radial keratotomy (RK).

Design:

Retrospective study.

Materials and Methods:

A retrospective analysis of data of 18 eyes of 10 patients, who had undergone LASIK for refractive error following RK, was performed. All the patients had undergone RK in both eyes at least one year before LASIK. Parameters like uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), contrast sensitivity, glare acuity and corneal parameters were evaluated both preoperatively and postoperatively.

Statistical Software:

STATA-9.0.

Results:

The mean UCVA before LASIK was 0.16±0.16 which improved to 0.64 ± 0.22 (P < 0.001) after one year following LASIK. Fourteen eyes (out of 18) had UCVA of ≥ 20/30 on Snellen''s acuity chart at one year following LASIK. The mean BCVA before LASIK was 0.75 ± 0.18. This improved to 0.87 ± 0.16 at one year following LASIK. The mean spherical refractive error at the time of LASIK and at one year after the procedure was –5.37 ± 4.83 diopters (D) and –0.22 ± 1.45D, respectively. Only three eyes had a residual spherical refractive error of ≥ 1.0D at one year follow-up. In two eyes, we noted opening up of the RK incisions. No eye developed epithelial in-growth till 1 year after LASIK.

Conclusion:

LASIK is effective in treating refractive error following RK. However, it carries the risk of flap-related complications like opening up of the previously placed RK incisions and splitting of the corneal flap.     

High order aberration and straylight evaluation after cataract surgery with implantation of an aspheric, aberration correcting monofocal intraocular lens

AIM:To evaluate the quality of vision in respect to high order aberrations and straylight perception after implantation of an aspheric, aberration correcting, monofocal intraocular lens (IOL).METHODS:Twenty-one patients (34 eyes) aged 50 to 83y underwent cataract surgery with implantation of an aspheric, aberration correcting IOL (Tecnis ZCB00, Abbott Medical Optics). Three months after surgery they were examined for uncorrected (UDVA) and corrected distance visual acuity (CDVA), contrast sensitivity (CS) under photopic and mesopic conditions with and without glare source, ocular high order aberrations (HOA, Zywave II) and retinal straylight (C-Quant).RESULTS:Postoperatively, patients achieved a postoperative CDVA of 0.0 logMAR or better in 97.1% of eyes. Mean values of high order abberations were +0.02±0.27 (primary coma components) and -0.04±0.16 (spherical aberration term). Straylight values of the C-Quant were 1.35±0.44 log which is within normal range of age matched phakic patients. The CS measurements under mesopic and photopic conditions in combination with and without glare did not show any statistical significance in the patient group observed (P≥0.28).CONCLUSION:The implantation of an aspherical aberration correcting monofocal IOL after cataract surgery resulted in very low residual higher order aberration (HOA) and normal straylight.     

A comparison of visual outcomes in three different types of monofocal intraocular lenses

AIM: To compare the visual outcomes (distance and near) in patients opting for three different types of monofocal intraocular lens (IOL) (Matrix Aurium, AcrySof single piece, and AcrySof IQ lens). METHODS: The present study is a cross-sectional analysis of secondary clinical data collected from 153 eyes (52 eyes in Matrix Aurium, 48 in AcrySof single piece, and 53 in AcrySof IQ group) undergoing cataract surgery (2011-2012). We compared near vision, distance vision, distance corrected near vision in these three types of lenses on day 15 (±3) post-surgery. RESULTS: About 69% of the eyes in the Matrix Aurium group had good uncorrected distance vision post-surgery; the proportion was 48% and 57% in the AcrySof single piece and AcrySof IQ group (P=0.09). The proportion of eyes with good distance corrected near vision were 38%, 33%, and 15% in the Matrix Aurium, AcrySof single piece, and AcrySof IQ groups respectively (P=0.02). Similarly, The proportion with good “both near and distance vision” were 38%, 33%, and 15% in the Matrix Aurium, AcrySof single piece, and AcrySof IQ groups respectively (P=0.02). It was only the Matrix Aurium group which had significantly better both “distance and near vision” compared with the AcrySof IQ group (odds ratio: 5.87, 95% confidence intervals: 1.68 to 20.56). CONCLUSION: Matrix Aurium monofocal lenses may be a good option for those patients who desire to have a good near as well as distance vision post-surgery.     

Refractive lens exchange versus iris-claw Artisan phakic intraocular lens for hyperopia

PURPOSE: To study a paired-match comparison between refractive lens exchange with pseudophakic IOL implant (RLE) and Artisan phakic IOL for high hyperopia. METHODS: Nineteen eyes (12 patients, 20 to 41 years old) with an Artisan phakic IOL (Model 203: 1.00-D increment) for hyperopia from +2.75 to +9.25 D were matched to 19 eyes (15 patients, 26 to 46 yr) with hyperopia from +2.75 to +7.50 D, who had refractive lens exchange (pseudophakic IOL implantation; lenses: 0.50-D increment). Average paired-match difference was 1.13 D and 7.7 years of age. RESULTS: At 1 month after surgery, 84% of refractive lens exchange/pseudophakic IOL eyes and 94% of Artisan phakic IOL eyes had a spherical equivalent refraction within +/- 1.00 D of emmetropia; 58% and 68% of eyes, respectively, were within +/- 0.50 D (P = .97). No eye lost lines of best spectacle-corrected visual acuity (BSCVA) and no significant changes in BSCVA were found in any eye at 1 month after surgery (P = .17). The percentage of eyes with uncorrected visual acuity (UCVA) of 20/40 or better improved from 79% to 89% of eyes at 1 to 2 months after phakic IOL; it remained at 89% to 82% of eyes from 1 to 2 months after refractive lens exchange/ pseudophakic IOL. The coefficient of correlation showed statistically better accuracy (intended vs. achieved refraction; P = .035) for the Artisan phakic IOL (R = 0.83) than for refractive lens exchange/ pseudophakic IOL (R = 0.50). CONCLUSIONS: Spherical equivalent refraction outcome and BSCVA after surgery were similar for both procedures. The Artisan phakic IOL in carefully selected patients provided a better overall outcome for young patients with high hyperopia whose accommodation was preserved, as compared to refractive lens exchange.