Toric人工晶状体植入矫正角膜散光的疗效观察

目的：观察Toric人工晶状体(intraocular lens, IOL)植入用于治疗合并角膜散光的白内障患者的临床治疗效果。

方法：对41例47眼合并角膜散光的白内障患者行超声乳化白内障吸出及IOL植入术治疗,进行回顾性分析。其中22眼植入Toric IOL,25眼植入Acrysof IQ IOL。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,比较两种IOL的疗效。观察Toric IOL植入后的稳定性。

结果： 术后随访观察6mo,植入Toric IOL的试验组,术后裸眼视力平均0.73±0.37,明显优于植入Acrysof IQ IOL的对照组(平均0.47±0.18),结果有显著性差异。试验组术后裸眼视力0.5以上者占81.8%,优于对照组32.0%。试验组患者术后残余散光0.53±0.40D,明显低于对照组(2.13±0.76D),差异有统计学意义。植入Toric IOL组,随访6mo,术后平均旋转4.22±1.46度。

结论：对于合并角膜散光的白内障患者,行白内障超声乳化吸出联合Toric IOL植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

Toric人工晶状体植入矫正特殊角膜散光的疗效观察

目的：回顾分析Toric(环曲面)人工晶状体植入治疗合并特殊角膜散光的白内障患者的临床治疗效果。

方法：对10例12眼合并特殊角膜散光的白内障患者行超声乳化白内障吸出及人工晶状体植入术治疗,进行回顾性分析。其中4眼为翼状胬肉切除术后,3眼为外伤后角膜散光,5眼为角膜云翳或斑翳患者。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,观察Toric人工晶状体植入后的疗效,旋转稳定性。

结果：术后随访观察6mo,术后裸眼视力平均0.62±0.31,最佳矫正视力0.70±0.35。裸眼视力≥0.8者2眼,占17%。裸眼视力≥0.5者9眼,占75%。术后残余散光0.51±0.36D。术后角膜源性散光未见明显改变,全眼总合散光得到明显改善,差异有统计学意义。术后全眼总合散光与术前预计残余散光值接近,无显著性差异。术后6mo旋转度为(3.80±1.46)°。末次随访时间点,植入Toric人工晶状体的12眼中,旋转度小于5°的11眼,占92%。仅1例术后旋转度为6°。

结论：对于某些特殊原因导致角膜散光的白内障患者,经过严格的手术前筛选,行白内障超声乳化吸出联合Toric人工晶状体植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

The refractive outcome of Toric Lentis Mplus implant in cataract surgery

AIM: To evaluate the refractive outcome of Toric Lentis Mplus intraocular lens (IOL) implant. METHODS: This is a retrospective case series. Consecutive patients with corneal astigmatism of at least 1.5 D had Toric Lentis Mplus IOL implant during cataract surgery. The exclusion criteria included irregular astigmatism on corneal topography, large scotopic pupil diameter (>6 mm), poor visual potential and significant ocular comorbidity. Postoperative manifest refraction, uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), uncorrected intermediate visual acuity (UIVA) at 3/4 m and uncorrected near visual acuity (UNVA) were obtained. RESULTS: There were 70 eyes from 49 patients in this study. Patients were refracted at a median of 8.9wk (range 4.0 to 15.5) from the operation date. Sixty-five percent of eyes had 6/7.5 (0.10 logMAR) or better, and 99% 6/12 (0.30 logMAR) or better postoperative UDVA. Eighty-nine percent could read Jaeger (J) 3 (0.28 logMAR) and 95% J5 (0.37 logMAR) at 40 cm. The median magnitude of astigmatism decreased from 1.91 D to 0.49 D (Wilcoxon, P<0.001) after the operation. The range of the cylindrical error was reduced from 1.5-3.95 D (keratometric) preoperatively to 0.00-1.46 D (subjective refraction transposed to corneal plane) postoperatively. CONCLUSION: Toric Lentis Mplus IOL has good predictability in reducing preexisting corneal astigmatism.     

Trifocal toric intraocular lenses in eyes with low amount of corneal astigmatism

AIM: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens (IOL) in eyes with low degrees of corneal astigmatism. METHODS: Twenty six eyes of 22 patients who underwent implantation a trifocal toric IOL (FineVision PODFT, PhysIOL s.a., Liege, Belgium) were enrolled. Phacoemulsification with femtosecond laser, capsular tension ring insertion and intraoperative aberrometry were performed in all cases. All IOLs used showed a cylinder power of 1.00 D. Main outcome measures were refractive error and corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) values. Eyes were evaluated at 4mo post-surgery. RESULTS: Totally 50% of eyes showed a spherical equivalent (SE) within ±0.13 D and all of them within ±0.50 D. The mean SE and refractive cylinder were -0.02±0.23 and -0.16±0.22 D, respectively. Vector analysis revealed that 100% of eyes were within ±0.50 D for the SE and cylindrical components (J0 and J45). Refractive changes were not correlated with keratometric changes (P>0.05) showing that the reduction in astigmatism comes from the trifocal toric IOL. Of 81% and 96% of eyes showed UDVA and CDVA of 20/20, respectively. The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.97±0.05 and 0.99±0.02 (about 20/20), respectively. CONCLUSIONS: The present study suggests that the use of this trifocal toric IOL in patients with low amount of astigmatism provides accurate refractive outcomes and enables them to achieve excellent visual acuity.     

多焦点人工晶状体植入术后的屈光状态

目的了解白内障摘出多焦点人工晶状体植入术后的属光状态。方法我院行白内障摘出多焦点人工晶状体植入的老年性白内障21例（30眼），在术后3月均采用相同的标准，存暗窄用点状检影镜50em距离进行小瞳孔检影验光，并详细记录屈光度及矫正视力。结果近视14眼，其中9眼为单纯近视，5眼为近视散光；远视7眼，均为远视散光；混合性散光2眼；无屈光异常7眼。裸眼视力：远视力达1．0以上者19眼；0．4—0．8者11眼，其矫正视力有10眼达1．0以上，1眼为0．9。结论白内障摘出多焦点人工晶状体植入明显优于只提高远视力的单焦点人工晶状体。     

AcrySof IQ Toric人工晶状体植入矫正角膜散光的疗效

目的：评价白内障手术中植入AcrySof IQ Toric散光型人工晶状体矫正角膜散光的效果及人工晶状体在囊袋内的稳定性。

方法：对21例26眼伴有角膜规则散光的白内障患者,植入AcrySof IQ Toric散光型人工晶状体,观察术前及术后裸眼视力、最佳矫正视力; 术前角膜散光、预计散光、总散光,术后角膜散光及残余散光; 以及术后人工晶状体旋转度。

结果：术后所有患者裸眼视力及最佳矫正视力均明显提高; 术后残留散光0.55±0.33D,与术前总散光2.05±0.57D相比明显下降(t=13.574,P<0.05); 与术前预留散光0.47±0.19D比较无统计学意义(t=1.149,P>0.05)。术后3mo角膜散光-1.89±0.53D,与术前角膜散光2.01±0.58D相比无差异(t=1.908,P>0.05); 所有26眼的人工晶状体旋转度均<20°,平均旋转为(3.65±2.86)度。

结论：白内障超声乳化吸除联合AcrySof IQ Toric IOL植入矫正散光手术,能够有效的减少患者的散光,术后IOL旋转稳定性良好,是治疗白内障合并散光患者的有效的手术方法。     

球面及非球面散光矫正型人工晶状体植入术后的裸眼视力对比

目的:比较术前伴有角膜散光的白内障患者在植入球面散光矫正型人工晶状体和非球面散光矫正型人工晶状体术后的裸眼视力,并探讨术前角膜散光的程度对散光矫正型人工晶状体植入术后裸眼远视力的提高程度的影响.方法:收集患者44例57眼的病例资料,其中球面组有23例27眼,非球面组有21例30眼,记录术前及术后1d裸眼远视力(UDVA)、术前角膜散光度数、人工晶状体型号及等效球镜度数、术中人工晶状体轴位.比较两组术前与术后1d裸眼远视力(LogMAR)差别以及术后1d裸眼视力0.4以上患者的比例,并按散光度数进行分层,散光度数小于2.0D为低散光层,散光度数≥2.0D为中高散光层,比较两组术后裸眼远视力的提高效果.结果:球面组和非球面组术后1d裸眼远视力0.4以上患者比例分别为92.6％、93.3％,与术前14.8％、13.3％相比明显增加.两组术前、术后1d裸眼远视力比较,差异无统计学意义(P＞0.05);两组术后1d裸眼远视力与术前相比均明显提高,差异有统计学意义(P＜0.01).各散光层内两种人工晶状体植入术后裸眼视力的差异无统计学意义(P＞0.05);植入术后1d裸眼远视力与术前相比均明显提高,差异有统计学意义(P＜0.01).术前不同程度散光的白内障患者在植入散光矫正型人工晶状体后,术后裸眼远视力之间的差异无统计学意义(P＞0.05);植入术后1d裸眼远视力与术前相比均明显提高,差异有统计学意义(P＜0.01).结论:球面及非球面散光矫正型人工晶状体植入可以有效地提高白内障合并角膜散光患者的裸眼远视力,但在提高裸眼视力方面,非球面散光矫正型人工晶状体并不优于球面散光矫正型人工晶状体.     

双焦点Toric人工晶状体植入矫正白内障合并角膜散光的疗效观察

目的:评价白内障超声乳化吸除联合双焦点Toric人工晶状体(IOL)植入术的散光矫正临床效果。方法:回顾性分析。纳入2020-08/2021-09间我院白内障超声乳化吸除联合双焦点Toric IOL治疗白内障合并角膜规则散光患者46例46眼的临床资料。术后随访3mo,评价术前及术后1、3mo裸眼远视力(UDVA)、裸眼近视力(UNVA)、矫正远视力(BCDVA)、矫正近视力(BCNVA)及散光的变化。测量并计算IOL轴位旋转度,行问卷调查在不同距离使用眼镜的必要性以及总体满意度。结果:术后1、3mo UDVA、BCDVA、UNVA、BCNVA与术前比较均有差异(均P<0.001),而术后1mo UDVA、BCDVA、UNVA、BCNVA与术后3mo比较均无差异(均P>0.0167)。术后3mo UDVA达到0.20(LogMAR)者46眼(100%),UNVA达到0.20(LogMAR)者40眼(87%)。散光矢量分析显示,术前角膜散光均值为1.88±0.70D,质心值为0.61D@177°±1.93D,术后3mo残余散光均值为0.33±0.30D,质心值为0.03D@34...     

Toric人工晶状体植入矫正规则性角膜散光的疗效观察

目的:观察Toric人工晶状体植入用于治疗合并角膜散光的白内障患者的临床治疗效果。方法:对41例47眼合并角膜散光的白内障患者行超声乳化白内障吸出及人工晶状体植入术治疗,进行回顾性分析。其中22眼植入Toric人工晶状体,25眼植入AcrySof IQ人工晶状体。术后随访6mo,分析不同时间点裸眼视力、术后残余散光、并发症等,比较两种人工晶状体的疗效。观察Toric人工晶状体植入后的稳定性。结果:术后随访观察6mo,植入Toric人工晶状体的实验组,术后裸眼视力平均0.73±0.37,明显优于植入AcrySof IQ人工晶状体的对照组平均0.47±0.18,结果有显著性差异。实验组患者术后残余散光0.53±0.40D,明显低于对照组2.13±0.76D,差异有统计学意义。植入Toric人工晶状体组,随访6mo内视力稳定,人工晶状体位置稳定,术后平均旋转4.22±1.46°。结论:对于合并角膜散光的白内障患者,行白内障超声乳化吸出联合Toric人工晶状体植入,能够安全、有效的改善患者的散光,提高术后视觉质量,预测性好。     

Refractive outcomes after V4c Toric collamer lens implantation over 1y of follow-up

AIM: To evaluate refractive outcomes and corneal astigmatism changes after Toric implantable collamer lens with a central port (V4c T-ICL) implantation over 1y of follow-up. METHODS: A retrospective study was performed including 50 eyes of 50 patients that underwent V4c T-ICL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, refractive and corneal astigmatism changes and corneal coupling correction were evaluated preoperatively, 1 and 12mo postoperatively. Vector analysis was used for astigmatism changes. Coefficient of adjustment (CAdj) was calculated for corneal coupling analysis. RESULTS: The mean UDVA achieved was 0.03 logMAR at 1mo and remained unchanged throughout the whole follow-up (P=0.193). At the last visit, 84% of the eyes achieved a CDVA of 0.00 logMAR or better. Regarding spherical equivalent refraction (SEQ), 96% of eyes were ranges of ±1.00 D and 84% of them within ±0.50 D. Also, 94% of eyes had a remaining refractive cylinder within ±1.00 D and 78% of them within ±0.50 D. Both, SEQ and refractive cylinder, remain stable over the postoperative follow-up (P=1.000 and P=0.660, respectively). In terms of surgically induced astigmatism (SIA), no statistically significant differences were found over the follow-up (P=0.102) and under correction was found with a correction index lower than the unit at each visit. A keratometric astigmatism induced of 0.59±0.53 (vector mean: 0.26×73º) D was reached at the last visit. No significant changes in terms of corneal astigmatism orientation were reported over post-surgery visits (P=0.129 and P=0.097 at 1 and 12mo respectively). No clinical significance was found for CAdj on with-the-rule astigmatism. No postoperative complications resulting from the surgery were found. CONCLUSION: Refractive outcomes suggest that the V4c T-ICL implantation for correction of myopic astigmatism was satisfactory in terms of effectiveness, safety, and stability during 1y of follow-up. Corneal astigmatism induced by the incision around 0.5 D is achieved according to the remaining refractive cylinder found at one-year post-surgery. Corneal coupling analysis results in no unexpected spherical change.     

Photorefractive keratectomy after cataract surgery in uncommon cases: long-term results

AIM: To evaluate the efficacy and safety of the excimer laser correction of the residual refractive errors after cataract extraction with intraocular lens (IOL) implantation in uncommon cases. METHODS: Totally 24 patients with high residual refractive error after cataract surgery with IOL implantation were examined. Twenty-two patients had a history of phacoemulsification and IOL implantation, and two had extra-capsular cataract extraction with IOL implantation. Detailed examination of preoperative medical records was done to explain the origin of the post-cataract refractive errors. All patients underwent photorefractire keratectomy (PRK) enhancement. The mean outcome measures were refraction, uncorretted visual acuity (UCVA), best corrected visual acuity (BCVA) and corneal transparency and follow up ranged from 1 to 8y. RESULTS: The principal causes of residual ametropia was inexact IOL calculation in abnormal eyes with high myopia and congenital lens abnormalities, followed by corneal astigmatism both suture induced and preexisting. After cataract surgery and before the laser enhancement the mean spherical equivalent (SE) was -0.56±3 D ranging from -4.62 to +2.25 D in high myopic patients, instead it was -1±1.73 D ranging from -3.25 to +3.75 D in the astigmatic eyes, with a mean cylinder of -3.75±0 ranging from -3 to +5.50 D. After laser refractive surgery the mean SE was 0.1±0.73, ranging from -0.50 to +1.50 in the myopic group, and it was -0.50±0.57 ranging from -1.25 to +0.50 in astigmatic patients, with a mean cylinder of -0.25±0.75. In myopic patients the mean UCVA and BCVA were 0.038±0.072 logMAR and 0.018±0.04 respectively, both ranging from 0.10 to 0.0. In astigmatic patients, the mean UCVA and BCVA were 0.213±0.132 and 0.00±0.0 respectively, UCVA ranging from 0.50 to 0.22 and BCVA was 0.00. All patients presented normal corneal transparency. No ocular hypertension was detected and no corneal haze was observed. All registered values remained stable also at the end line evaluation. CONCLUSION: The excimer laser treatment of residual refractive errors after cataract surgery with IOL implantation in abnormal eyes resulted in satisfactory and stable visual outcome with good safety and efficacy.     

多焦点IOL植入联合角膜松解切口矫正白内障合并角膜散光的分析

目的:比较多焦点IOL植入联合角膜切口矫正散光与单焦点IOL植入术治疗白内障合并低度散光患者的视觉质量差异。方法:选取老年性白内障合并低度散光患者80例100眼,按随机原则分为对照组及干预组,各40例50眼。干预组行最陡角膜散光轴向上做一对透明角膜松解切口,同时按常规行透明角膜切口白内障超声乳化+多焦点IOL植入术;而对照组仅行透明角膜切口白内障超声乳化+单焦点IOL植入术。分别于术后1d;1wk;1,3mo观察两组术眼的角膜散光情况及裸眼远视力(uncorrected distance visual acuity,UCDVA),裸眼近视力(uncorrected near visual acuity,UCNVA);3mo时最佳矫正远视力(best corrected distance visual acuity,BCDVA)、最佳矫正近视力(best corrected near visual acuity,BCNVA)及最佳矫正远视力下最佳矫正近视力(distant corrected near visual acuity,DCNVA)并进行统计分析。结果:术后UCDVA和UCNVA干预组均高于对照组,而各时期角膜散光干预组均低于对照组。两组患者术后3d均有明显改善。术后1wk;1,3mo,UCDVA和UCNVA及3mo时BCDVA,BCNVA无显著差异。结论:多焦点IOL植入联合透明角膜松解切口可有效矫正白内障术前散光,提高全程视力,从而扩大多焦点IOL适用人群。     

白内障植入Toric IOL和单焦点非Toric IOL术后疗效观察

目的观察白内障手术中使用ToricIOL对视力和屈光结果的临床疗效.方法2012年7月至2015年7月在无锡市第九人民医院眼科手术治疗的白内障患者77例(108只眼).患者共分为3组.A组:角膜散光度≥2.0 D植入Toric单焦点晶状体22例患者(30只眼);B组:角膜散光度≥2.0 D植入单焦点非Toric晶状体25例患者38只眼;C组:角膜散光度≤1.5 D植入单焦点非Toric晶状体30例(40只眼).术后随访1周至2个月,观察其裸眼视力、最佳矫正视力、屈光度、角膜散光值,综合各指标评估Toric晶状体的有效及安全性.结果术后三组的裸眼视力LogMAR:A组0.25±0.21;B组0.52±0.22;C组0.16±0.25.最佳矫正视力LogMAR分别是:A组0.08±0.12;B组0.22±0.14;C组0.04±0.11.术前的角膜散光分别是A组(3.68±1.21)D;B组(3.42±1.47)D;C组(0.95±0.41)D.术后眼球散光度分别是A组(1.1±0.65)D;B组(3.15±1.35)D;C组(0.91±0.52)D.术后散光度A组和B组比较有显著的统计学意义(P≤0.001),而在A组和C组之间无明显的统计学意义(P=0.17).结论在白内障手术的同时,相对于角膜散光较大的患者,Toric晶状体植入可以矫正角膜散光,提高视力,是一种安全,有效的选择.     

Use of a T-flex toric intraocular lens to correct clinically significant astigmatism

PurposeTo investigate the stability and effectiveness of T-flex toric intraocular lenses (IOLs) for the correction of regular corneal astigmatism during cataract surgery.MethodsFrom October 2009 to January 2014 we enrolled patients receiving phacoemulsification and T-flex toric IOL implantation in the capsular bag at the Far Eastern Memorial Hospital. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal astigmatism, refractive astigmatism, and the degree to which the IOL axis deviated from the demanded axis were recorded both before the operation and 6 months postoperatively.ResultsWe enrolled 24 eyes of 24 consecutive patients in this study. The mean spherical power of the implanted toric IOLs was 17.13 ± 4.21 D (range 6.0–24.0 D) and the mean cylindrical power of the IOLs was 3.0 ± 0.86 D (range 2.0–5.0 D). At the 6-month follow up examination, the refractive astigmatism had improved from 3.21 ± 1.50 D to 0.77 ± 0.47 D (p < 0.001) and the spherical equivalence had improved from 4.47 ± 5.43 D to 0.63 ± 0.49 D (p = 0.007). The CDVA improved from 0.81 ± 0.45 logMAR to 0.09 ± 0.11 logMAR (p < 0.001). The mean improvement from the preoperative CDVA to the postoperative UDVA was 5.3 lines on the Snellen chart. Ninety-two percent of our patients achieved a postoperative UDVA ≥20/40 and 67% achieved a postoperative UDVA ≥20/25.ConclusionThe T-flex toric IOL can effectively reduce visually significant corneal astigmatism and improve uncorrected distance visual acuity during cataract surgery.     

Toric intraocular lens for correction of high corneal astigmatism in cataract patients

AIM: To evaluate the efficacy of Bi-Flex toric intraocular lens (T-IOL; Medicontur, Medical Engineering, Ltd., Inc.) implantation to correct preexisting astigmatism in patients having cataract surgery. METHODS: This retrospective consecutive study included 22 eyes of 16 patients with more than 2.50 diopters (D) of corneal preexisting astigmatism having cataract. Preoperative and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), objective and subjective refraction and keratometric and topographic cylinder were measured. Postoperative the toric IOL axis was evaluated using vector analysis. RESULTS: Postoperatively, subjective refractive cylinder was reduced significant (P<0.05) from 4.05±1.53 D to 1.35±0.86 D. The component J0 reduced in magnitude from -0.81±2.02 D to -0.12±0.62 D (P<0.05). Both, UCVA and BCVA improved significantly at 1mo after surgery (P<0.05 in both cases). After the surgery, the UCVA and BCVA were 0.24±0.19 and 0.06±0.08, respectively. The mean toric IOL axis rotation was 2.95±5.25 degree, with rotation less than 10 degrees in 86.36% of eyes. No differences in mean keratometric values obtained before and after surgery were found (P>0.05 for J0 and J45). CONCLUSION: Implantation of the Bi-Flex toric IOL is a safe and effective method to correct the preexisting regular astigmatism (greater than 2.50D).     

Toric人工晶状体植入术治疗白内障并角膜散光的疗效及远期旋转稳定性

目的 Toric人工晶状体植入用于治疗白内障合并角膜散光的患者,分析其临床疗效及远期旋转稳定性。方法 回顾性系列病例研究。对白内障合并角膜散光的20例（21眼）患者行超声乳化白内障吸除联合Toric人工晶状体植入,观察不同时间点裸眼视力、术后残余散光、并发症等,观察Toric人工晶状体植入术后远期的旋转稳定性。数据采用配对t检验分析。结果 术后随访观察12个月以上,最长24个月,平均（15.5±2.3）个月。术后1周、1个月、12个月裸眼视力（logMAR）平均值分别为0.20±0.08、0.19±0.06、0.17±0.07。术后各时间点裸眼视力较术前有显著性提高,差异有统计学意义。术后12个月,裸眼视力（logMAR）≤0.1者5眼,占24%;裸眼视力≤0.3者18眼,占86%。术后12个月旋转度为4.31°±1.57°。末次随访时间点,旋转度<5°的有18眼,占86%。结论 对于合并角膜散光的白内障患者,行白内障超声乳化吸除联合Toric人工晶状体植入,能够安全、有效地改善患者的散光,提高术后视觉质量,远期旋转稳定性好。     

【In Press】 Five-year follow-up of combined non-topography guided photorefractive keratectomy and corneal collagen cross linking for keratoconus

AIM: To evaluate the visual outcomes of simultaneous non-topography guided photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) in eyes with keratoconus 5 y after the procedure. METHODS: Prospective, interventional, non-randomized, and non-controlled case series design was used. Sixty eyes of 30 patients (16 males and 14 females; age: 21-41y) with mild, non-progressive (stages 1-2) keratoconus were enrolled. Refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, flat and steep keratometry (K) readings, and adverse events were evaluated preoperatively and postoperatively. Data were collected preoperatively and postoperatively at 3-months, 1-, 2-, 3-, 4-, and 5-year follow-up visits after combined non-topography-guided PRK with CXL was performed. All patients had at least 5y of follow-up. RESULTS: All study parameters showed a statistically significant improvement at 5y over baseline values. The mean follow-up time was 68.20±4.71mo (range: 60-106mo). Patients showed a significant improvement in UDVA from 1.24±0.00 logMAR prior to combined non-TG-PRK+CXL to 0.06±0.00 logMAR postoperatively at the time of their last follow-up visit. CDVA significantly increased from 0.06±0.00 logMAR preoperatively to 0.03±0.00 logMAR postoperatively. A significant decrease in the mean spherical equivalent (SE) refraction was observed from -2.28±1.8 to -0.79±0.93 diopters (D) (P<0.05), and the mean cylinder decreased from -1.628±0.76 (preoperative) to -0.25±0 (postoperative) (P=0.001). The mean keratometry was 45.13±0.00 vs 47.28±0.00 D preoperatively (P<0.05), and the manifest astigmatism significantly decreased from -1.63±0.76 to -0.25±0 (P=0.001). CONCLUSION: Combined non-topography-guided PRK with 15min is an effective and safe option for correcting mild refractive error and improving visual acuity in patients with mild stable keratoconus.     

Cataract surgery with toric intraocular lenses can optimize uncorrected postoperative visual acuity in patients with marked corneal astigmatism

PURPOSE: To study the change in visual acuity and refraction after cataract surgery using a toric posterior chamber intraocular lens in patients with astigmatism after penetrating keratoplasty. METHODS: A retrospective case note analysis of cataract surgery involving toric lens implants performed at the Norfolk and Norwich University Hospital was conducted. The pre- and postoperative visual acuities and refractions were recorded. RESULTS: Seven consecutive patients are described (5 men and 2 women) with a mean age of 62 years. They all underwent penetrating keratoplasty, and in every case, all sutures were removed (mean, 11.2 months before cataract surgery). A marked improvement in both unaided visual acuity and astigmatism was shown after the procedure. The average preoperative unaided acuity was 6/120 (range, 6/24 to counting fingers) compared with a postoperative unaided visual acuity average of 6/15 (6/9-6/24). The average preoperative cylinder was 10.12 D (range, 3.40-17.89 D); postoperatively, this fell to 2.75 D (range, 0.75-4.25). CONCLUSIONS: Cataract surgery with toric intraocular lenses allows the correction of high degrees of regular corneal astigmatism. We discussed the potential advantages and complications of performing toric lens cataract surgery as a secondary procedure.     

Evaluation of a toric intraocular lens with a Z-haptic

PURPOSE: To evaluate the efficacy and rotational stability of the MicroSil 6116TU foldable 3-piece silicone toric intraocular lens (IOL) (HumanOptics). SETTING: Department of Ophthalmology, Hillingdon Hospital, Uxbridge, Middlesex, United Kingdom. METHODS: This prospective observational study included 21 eyes of 14 consecutive patients with more than 1.50 diopters (D) of preexisting corneal astigmatism having cataract surgery. Phacoemulsification was performed, and a MicroSil 6116TU toric IOL was inserted through a 3.4 mm temporal corneal incision. LogMAR uncorrected visual acuity (UCVA), best corrected visual acuity, refraction, keratometry, and cylinder axis of the toric IOL were measured. RESULTS: The mean preoperative refractive and keratometric astigmatism was 3.52 D +/- 1.11 (SD) and 3.08 +/- 0.76 D, respectively. Six months postoperatively, the logMAR UCVA in eyes without ocular comorbidity (n = 14) was 0.20 +/- 0.15 (Snellen 20/32). Seventy-nine percent (11 eyes) had a visual acuity of 0.24 (Snellen 20/35) or better. The mean refractive astigmatism at 6 months was 1.23 +/- 0.90 D. Vector analysis using the Holladay-Cravy-Koch method showed a mean reduction in refractive astigmatism of 2.16 +/- 2.33 D. The mean difference between intended and achieved cylinder axis at 6 months was 5.2 degrees (range 0 to 15 degrees). No IOL rotated more than 5 degrees during the follow-up period. CONCLUSIONS: The MicroSil 6116TU toric IOL reduced visually significant keratometric astigmatism and increased spectacle independence. The IOL was stable in the capsular bag, showing no significant rotation up to 6 months postoperatively.     

Clinical outcomes of a diffractive trifocal intraocular lens with femtosecond laser,digital tracking,and intraoperative aberrometry

ObjectiveTo evaluate clinical outcomes of a trifocal intraocular lens using femtosecond laser-assisted cataract surgery (FLACS), digital tracking (DT), and intraoperative aberrometry (IA).SettingOne site (Abbotsford, B.C., Canada)DesignRetrospective, single-surgeon study.MethodsThis was a retrospective, single-surgeon study examining 200 eyes of 100 bilaterally implanted patients. Eligible participants were those presenting with visually significant cataracts or as a candidate for clear lens extraction who were interested in implantation of a diffractive toric or non-toric intraocular lens. Preoperative and postoperative data were collected for manifest refraction spherical equivalent (MRSE), refractive astigmatism (RA), and monocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA).ResultsMean postoperative manifest refraction spherical equivalent (MRSE) was 0.006 ± 0.27 D. The absolute prediction error was 0.50 D or less in 88.0% (176/200) of eyes. Postoperative RA was 0.50 D or less in 98.5% (197/200) of eyes. Postoperative UDVA was 0.10 logMAR or better in 86% (172/200) of eyes, and 66.0% (132/200) of eyes were 0.00 logMAR or better. Postoperative UIVA was 0.10 logMAR or better in 99.5% (199/200) of eyes, and 95.0% (190/200) of eyes were 0.00 logMAR or better. Postoperative UNVA was 0.10 logMAR or better in 91.5% (183/200) of eyes, and 73.5% (147/200) of eyes were 0.00 logMAR or better.ConclusionThe results demonstrate that trifocal implantation with FLACS, DT, and IA can provide excellent refractive and visual outcomes.