Refractive and visual outcomes of surgical treatments for high myopia

Objective@#To present the refractive and visual outcomes of refractive surgical treatment options in high myopia. @*Methods@#This was a retrospective review of patients diagnosed with high myopia (manifest refractive spherical equivalent [MRSE] ≥-6.00D) who underwent one of the following procedures: laser-in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK), phakic IOL implantation with the Staar Implantable Collamer Lens (ICL), or Alcon Cachet Phakic IOL. Eyes with best corrected distance vision of less than 20/30 due to amblyopia or other eye pathologies were excluded.

Incidence, indications, and outcomes of Yag Capsulotomy in eyes Implanted with an accommodating intraocular lens

Objectives@#To do report the incidence of capsular changes in Crystalens-implanted eyes and analyze the indications and outcomes of yag capsulotomy. @*Methods@#We reviewed the records of 411 eyes of 258 patients implanted with the Crystalens IOL. Capsular change indications for yag capsulotomy were posterior capsular opacification (PCO), lens tilt, and capsular striae. Eyes in each indication were further subdivided into therapeutic yag (TY) and prophylactic yag (PY) groups. Outcomes before and after yag capsulotomy were analyzed. @*Results@#Ninety of 411 crystalens-implanted eyes (22%) had undergone yag capsulotomy. Sixty-one eyes had PCO, 12 had lens tilt, and 17 had striae. Twenty-seven eyes belonged to the therapeutic (TY) and 63 eyes to the prophylactic (PY) yag subgroups. The mean interval between phacoemulsification and yag capsulotomy was 10 months. In the TY PCO subgroup, uncorrected distance visual acuity (UDVA) changed from 20/40 pre-yag to 20/25 post-yag, uncorrected near visual acuity (UNVA) from J3 to J2, manifest refraction spherical equivalent (MRSE) from -0.43D to -0.2D. In the TY tilt subgroup, UDVA changed from 20/50 to 20/30, UNVA was unchanged at J2, and MRSE from -1.21D to -0.89D. In the TY striae group, UDVA changed from 20/50 to 20/30, UNVA from J3 to J2, and MRSE from 0.62D to -0.4D. In the PY PCO subgroup, UDVA was unchanged at 20/25, UNVA unchanged at J2, and MRSE changed from -0.52D to -0.47D. In the PY tilt subgroup, UDVA changed from 20/25 to 20/20, UNVA unchanged at J2, and MRSE changed from -0.87D to -0.45D. In the PY striae subgroup, UDVA was unchanged at 20/30, UNVA changed from J3 to J2, and MRSE changed from -0.62D to -0.7D. @*Conclusion@#Capsular changes occurred after Crystalens implantation that necessitated yag capsulotomy. Once vision has deteriorated, a therapeutic yag treatment can help improve vision. If capsular changes have occurred but vision has not deteriorated, a prophylactic yag capsulotomy can stabilize visual and refractive outcomes.

Comparison of flap thickness, visual outcomes, and higher order aberrations in eyes that underwent LASIK flap creation using a femtosecond laser versus a mechanical microkeratome

Objective@#To compare the predictability of flap thickness, visual and refractive outcomes, and higher order aberrations in eyes that underwent myopic LASIK using either a Technolas femtosecond laser or a Zyoptix XP mechanical microkeratome for flap creation.@*Methods@#The study involved a total of 44 eyes of 22 patients who underwent LASIK. Flap creation was randomized to using the Technolas femtosecond laser in one eye and Zyoptix XP microkeratome in the contralateral eye. Flap thickness was measured intraoperatively using ultrasonic pachymetry and postoperatively using the Visante ASOCT. Refractive outcome, visual acuity (VA), higher order aberrations, and contrast sensitivity were compared between the two groups.@*Results@#Twenty-two patients had LASIK for myopia or myopic astigmatism. Using ultrasonic pachymetry intraoperatively, the mean flap thickness was 134 (±10) um and 124 (±23) um in the femtosecond (FS) and microkeratome (MK) groups respectively. Comparing the deviation of the actual from the intended flap thickness, the FS group had statistically lower standard deviation compared to the MK group (p=0.04). Using the AS-OCT, the mean flap thickness at 3 months postoperatively was 119 (±10.82) um and 123 (±15.77) um in the FS and MK groups respectively. The difference in standard deviation between the two groups did not reach statistical significance (p=0.19). The mean spherical equivalent at 3 months was -0.45D (±0.42) and -0.13D (±0.16) respectively. Eightynine percent (89%) of eyes had uncorrected VA of 20/20 or better in both groups. All eyes attained best corrected VA of 20/20 or better in both groups. Differences in total higher order aberrations (p=0.09) and contrast sensitivity scores (p=0.47) were not statistically different between the two groups. @*Conclusion@#Flap thickness predictability was better using the Technolas femtosecond laser compared to the XP microkeratome blade. Visual and refractive outcomes, higher order aberrations, and contrast sensitivity were comparable between the 2 groups.

Clinical comparison of visual and refractive outcomes of two models of accommodative intraocular lenses

Objective@#To evaluate the visual and refractive outcomes of eyes implanted with the Crystalens HD and the Crystalens AO intraocular lens.@*Methods@#We retrospectively reviewed the records of 159 eyes of 100 patients implanted with the Crystalens HD IOL and 108 eyes of 66 patients implanted with the Crystalens AO IOL. Visual and refractive outcomes preoperatively and postoperatively were assessed and compared between the lenses. @*Results@#At 1 year, uncorrected distance VA was 20/30 in 78% of eyes in the HD and 76% of eyes in the AO groups. Uncorrected intermediate VA was 20/30 in 90% of eyes in both groups. Uncorrected near VA was J3 in 92% in the HD and 90% in the AO groups. Comparing the two groups, the difference in uncorrected distance (p=0.60), intermediate (p=0.77), and near (p=0.64) vision was not statistically significant. Spherical equivalent was -0.42D +/-0.51D in the HD and -0.6 +/-0.48D in the AO groups (p=0.10). @*Conclusion@#Refractive outcomes were similar between the Crystalens HD and AO groups. Mild myopic refractive outcomes were targeted and achieved in both lens groups. These refractive outcomes provided good uncorrected distance, intermediate, and near vision postoperatively.