Comparative Analysis of Clinical Outcomes after Placement of Enhanced Monofocal, Monofocal, and Trifocal Intraocular Lenses

Purpose@#To compare the clinical outcomes of patients given an enhanced monofocal intraocular lens (IOL) (Isopure; PhysIOL, Liege, Belgium), and monofocal, and trifocal IOLs. @*Methods@#Patients who underwent cataract surgery with bilateral implantation of monofocal Vivinex IOLs, enhanced monofocal Isopure IOLs, and trifocal Panoptix IOLs were included. Three months postoperatively, the uncorrected distance visual acuity (UDVA), intermediate visual acuity (UIVA), and near visual acuity (UNVA), as well as the spherical equivalent (SE) were determined. Photic symptoms were explored via a questionnaire. @*Results@#The postoperative SE and UDVA did not differ significantly among the three groups (p = 0.100 and 0.204 respectively). The mean UIVAs (logMAR) were 0.61 ± 0.14, 0.3 ± 0.1, and 0.14 ± 0.11 in the Vivinex, Isopure, and Panoptix groups respectively. The Isopure group exhibited a significantly better UIVA than the Vivinex group (p < 0.001) and the Panoptix group exhibited a significantly better UIVA than either the Vivinex or Isopure group (p = 0.002 and < 0.001 respectively). The mean UNVAs (logMAR) were 0.68 ± 0.16, 0.57 ± 0.19, and 0.17 ± 0.12 for the Vivinex, Isopure, and Panoptix groups respectively. There was no significant UNVA difference between the Vivinex and Isopure groups (p = 0.185) but the UNVA of the Panoptix group was significantly better than the UNVAs of the Vivinex and Isopure groups (both p < 0.001). There was no significant difference in photic symptoms between the Vivinex and Isopure groups (p = 0.980); however, the Panoptix group evidenced significantly more severe symptoms than did the other two groups (p = 0.021 and 0.042 respectively). @*Conclusions@#Enhanced monofocal Isopure IOL showed superior intermediate vision compared to Vivinex monofocal IOL, and inferior intermediate and near visual acuity compared Panoptix trifocal IOL, but with fewer photic symptoms.

Changes in Intraocular Pressure and Factors that Influence such Changes after FS-LASIK and SMILE

Purpose@#We compared the intraocular pressure (IOP) changes and the relationships thereof with corneal biomechanics after small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). @*Methods@#A total of 234 eyes of 117 patients who underwent FS-LASIK surgery and 244 eyes of 122 patients who underwent SMILE surgery were included in this retrospective study. Data were collected preoperatively, and at 1, 3, and 6 months postoperatively, including IOP measured via non-contract tonometry, central corneal thickness (CCT), and mean keratometry (Km), flat keratometry (Kf), and steep keratometry (Ks) data obtained using a dual Scheimpflug analyzer. Between-group differences were compared. Simple linear regression analysis was used to determine the relationship between changes in the IOP and the various parameters. @*Results@#The IOP changes were 5.41 ± 2.28 mmHg in the FS-LASIK group and 4.77 ± 2.38 mmHg in the SMILE group, thus significantly different (p = 0.004). The IOP did not change significantly from 1 to 6 months after FS-LASIK but increased significantly from 12.07 ± 1.77 mmHg at 3 months postoperatively to 12.77 ± 1.89 mmHg at 6 months postoperatively after SMILE (p = 0.002). All of the preoperative spherical equivalent and IOP, and changes in the Km, Kf, Ks, and CCT, were significantly associated with the IOP changes in both groups. The preoperative IOP evidenced the strongest relationship with the IOP changes in both groups (R2 = 0.414 in the FS-LASIK group, R2 = 0.292 in the SMILE group). @*Conclusions@#The IOP fell significantly after FS-LASIK and SMILE surgery, significantly more so after FS-LASIK than SMILE. The preoperative IOP exhibited the greatest influence on the IOP decreases after both FS-LASIK and SMILE.

Long-term Clinical Outcomes of Implantable Collamer Lens

Purpose@#To evaluate the long-term clinical outcomes of implantable collamer lens (ICL) implantation in myopic patients. @*Methods@#This retrospective study included 129 eyes of 68 patients who underwent ICL implantation for correction of myopia with a 10-year follow-up. @*Results@#Ten years after ICL implantation, the mean uncorrected and corrected distance visual acuities (LogMAR) were 0.03 ± 0.13 and -0.07 ± 0.06, respectively. Ten years postoperatively, 52.7% and 84.5% of the eyes were within ± 0.5 and ± 1.0 diopters, respectively. The mean efficacy and safety indices were 0.91 ± 0.22 and 1.07 ± 0.19, respectively. There was no significant difference between mean preoperative (13.52 ± 2.88 mmHg) and postoperative (13.59 ± 3.55 mmHg) intraocular pressures. The endothelial cell density decreased from before surgery to 10 years after surgery (3,074 ± 365 cells/mm2, 2,812 ± 406 cells/mm2, respectively; mean decrease: 8.5 ± 10.8%; p = 0.011). Eight eyes (6.2%) developed cataract during follow-up, which was symptomatic in three eyes (2.3%) and treated with ICL explantation and phacoemulsification. Rhegmatogenous retinal detachment occurred in one eye (0.8%) and was treated with vitrectomy. @*Conclusions@#ICL implantation for the correction of myopia had good efficacy and safety outcomes during long-term follow-up of 10 years. However, patients should be closely monitored for complications such as cataract formation, endothelial cell loss, and retinal detachment.

Long-term Clinical Outcomes of Implantable Collamer Lens

Purpose@#To evaluate the long-term clinical outcomes of implantable collamer lens (ICL) implantation in myopic patients. @*Methods@#This retrospective study included 129 eyes of 68 patients who underwent ICL implantation for correction of myopia with a 10-year follow-up. @*Results@#Ten years after ICL implantation, the mean uncorrected and corrected distance visual acuities (LogMAR) were 0.03 ± 0.13 and -0.07 ± 0.06, respectively. Ten years postoperatively, 52.7% and 84.5% of the eyes were within ± 0.5 and ± 1.0 diopters, respectively. The mean efficacy and safety indices were 0.91 ± 0.22 and 1.07 ± 0.19, respectively. There was no significant difference between mean preoperative (13.52 ± 2.88 mmHg) and postoperative (13.59 ± 3.55 mmHg) intraocular pressures. The endothelial cell density decreased from before surgery to 10 years after surgery (3,074 ± 365 cells/mm2, 2,812 ± 406 cells/mm2, respectively; mean decrease: 8.5 ± 10.8%; p = 0.011). Eight eyes (6.2%) developed cataract during follow-up, which was symptomatic in three eyes (2.3%) and treated with ICL explantation and phacoemulsification. Rhegmatogenous retinal detachment occurred in one eye (0.8%) and was treated with vitrectomy. @*Conclusions@#ICL implantation for the correction of myopia had good efficacy and safety outcomes during long-term follow-up of 10 years. However, patients should be closely monitored for complications such as cataract formation, endothelial cell loss, and retinal detachment.

Clinical Outcomes of Combined Procedure of Astigmatic Keratotomy and Laser in situ Keratomileusis

PURPOSE: To evaluate the clinical outcomes of a combined procedure of astigmatic keratotomy (AK) and laser in situ keratomileusis (LASIK) for the correction of high astigmatism. METHODS: Thirty-five eyes of 19 patients who had astigmatic keratotomy were studied. The patients had a secondary procedure, LASIK, to correct the residual refractive error. Follow-up visits were at 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity, refractive error, efficacy, safety, and predictability. We compared preoperative and post-AK expected corneal ablation depth using an Amaris Ablation depth table. RESULTS: After astigmatic keratotomy, astigmatism was reduced by 61.43 ± 14.62%, and after LASIK, astigmatism was reduced by 91.65 ± 8.68%. Expected corneal ablation depth was reduced by 18.72 ± 11.77% after astigmatic keratotomy. The proportion of eyes with spherical equivalent 0.5 D or less was 85.71% at 6 months after the combined procedure of astigmatic keratotomy and LASIK. No intraoperative or postoperative complications were observed. CONCLUSIONS: This study showed the combined procedure of astigmatic keratotomy and LASIK is effective for visual acuity, refraction, and reduction in corneal ablation depth.

A Case of Suction Loss During SMILE and a Switch to LASIK

PURPOSE: To report a case of suction loss during small incision lenticule extraction (SMILE) and a good visual outcome after switching to femtosecond laser-assisted in-situ keratomileusis (LASIK). CASE SUMMARY: A 20-year-old female was admitted to receive refractive surgery. During SMILE in the left eye, suction loss occurred at 65% of posterior cut completion. We switched to LASIK and SMILE was performed in the right eye as planned. The uncorrected distance visual acuity was 1.2 with a manifest refraction of +0.25 Dsph with 0 Dcyl. The patient had no complications at 3 months postoperatively. CONCLUSIONS: Suction loss during SMILE is a rare complication. Good visual outcome was achieved by switching to LASIK.

Clinical Outcomes of Beveled, Full Thickness Astigmatic Keratotomy

PURPOSE: To evaluate the beveled, full thickness astigmatic keratotomy. METHODS: This study included 185 eyes of 112 patients treated with beveled, full thickness astigmatic keratotomy. Treated eyes were divided into 3 groups: beveled, full thickness astigmatic keratotomy after implantable collamer lens (ICL) implantation (group A), beveled, full thickness astigmatic keratotomy after cataract surgery (group B) and beveled, full thickness astigmatic keratotomy alone (group C). Follow-up visits were at 1 week, 1 month, 3 months and 6 months. The outcome measures included uncorrected distance visual acuity, astigmatism, efficacy, safety and predictability. RESULTS: At 6 months postoperatively, astigmatism was significantly reduced: 68.9 +/- 18.24% in total, 69.24 +/- 20.76%, in the group A, 67.84 +/- 17.56% in the group B and 67.82 +/- 13.97% in the group C. The proportion of eyes with astigmatism 1.0 or less was 88.65% in total, 91.49% in the group A, 87.5% in the group B and 70.0% in the group C. Mean improvement in corrected distance visual acuity (CDVA) was 0.56 lines; no eyes lost 2 lines of CDVA after 6 months postoperatively. Postoperative complications were not observed. CONCLUSIONS: This study showed the beveled, full thickness astigmatic keratotomy is effective and safe for correcting astigmatism alone as well as correcting astigmatism after ICL implantation or cataract surgery.

Clinical Aspect and Prognosis of Staphylococcus Epidermidis Keratitis

PURPOSE: To investigate the predisposing factors, clinical manifestations, treatment results and risk factors for treatment failure in Staphylococcus epidermidis keratitis. METHODS: Sixty-one eyes of 61 patients who were diagnosed with Staphylococcus epidermidis keratitis were included in the present study. The past history, location and size of ulceration, hypopyon, treatment results, and antibiotic susceptibility were reviewed retrospectively. A logistic regression analysis was performed to identify the main prognostic risk factors for treatment failure. RESULTS: Twenty-six eyes (42.6%) had previous histories of corneal traumas. Polymicrobial infections were observed in 31 cases (50.8%), including 11 cases (35.5%) combined with the Fusarium species. Twenty-five eyes (41.0%) had lesions located at the corneal center. The average size of ulceration was 7.3 +/- 7.2 mm2. Thirteen eyes (21.3%) with lesions that progressed or occurred in the corneal perforation underwent evisceration, penetrating keratoplasty or scleral graft. Risk factors for treatment failure were a history of previous keratitis (P = 0.003) and an ulcer exceeding 5.0 mm2 in size (P = 0.018). CONCLUSIONS: Staphylococcus epidermidis keratitis usually has a good prognosis, although a history of previous keratitis and a large ulcer size are risk factors for treatment failure.

The Use of Optical Coherence Tomography in Patients With Ethambutol-induced Optic Neuropathy

PURPOSE: To evaluate the efficacy of optical coherence tomography (OCT) on diagnosis and follow-up in patients with ethambutol-induced optic neuropathy and to evaluate the prognosis of ethambutol-induced optic neuropathy. METHODS: Seven patients (14 eyes) with a history of ethambutol-induced optic neuropathy underwent best corrected visual acuity measurement (BCVA), visual field exam, fundus exam, and OCT at their first visit and again six months later. RESULTS: There was an overall statistically significant improvement in vision (p=0.001); however, two patients (four eyes) showed no improvement. A decrease in RNFL thickness was observed in all eyes. Additionally, there was a statistically significant decrease of 6.4 +/- 5.37 micrometer (6.8%) in the mean RNFL thickness (p=0.003), with the greatest decrease in the temporal quadrant, which showed a mean decrease of 6.1 +/- 5.31 micrometer (9.2%) (p<0.001). CONCLUSIONS: Optical coherence tomography may be not only a valuable tool in the quantitative and structural analysis of RNFL thickness in patients with ethambutol-induced optic neuropathy, but may also provide objective information on diagnosis and follow-up. Toxicity from ethambutol is reversible with discontinuation of the drug, and vision recovers gradually. However, impaired vision can remain even with cessation of ethambutol due to retinal nerve fiber damage.

The Results of a Combination of Cataract Surgery and Intravitreal Bevacizumab Injection for Diabetic Macular Edema

PURPOSE: To evaluate the efficacy and safety of the combination of cataract surgery and intravitreal bevacizumab injection in patients with cataract and diabetic macular edema. METHODS: Patients received an intravitreal injection of bevacizumab(1.25 mg) combined with phacoemulsification and implantation of a posterior chamber intraocular lens. Best corrected visual acuity (BCVA, LogMAR) and, central macular thickness (CMT) were measured using OCT at baseline and at one week, one, three, and six months after surgery, and adverse events were recorded. RESULTS: The mean baseline LogMAR BCVA was 0.84+/-0.50 and mean CMT was 337.1+/-57.50 micrometer. At one week, one, three, and six months after surgery, the mean BCVAs were 0.52+/-0.40, 0.51+/-0.42, 0.52+/-0.34, and 0.46+/-0.37, and the mean CMTs were 356.4+/-86.44 micrometer, 338.8+/-138.4 micrometer, 349.0+/-122.9 micrometer, and 334.2+/-100.4 micrometer, respectively. No adverse events associated with cataract surgery or intravitreal bevacizumab injection were observed. CONCLUSIONS: The short-term results from the present study suggest the combination of cataract surgery and intravitreal bevacizumab injection are safe and effective for the prevention of macular edema aggravation for one month, but has little effect on prevention of macular edema aggravation three months after surgery for diabetic macular edema patients.

Comparison of Time Domain OCT and Spectrum Domain OCT for Retinal Nerve Fiber Layer Assessment

PURPOSE: To compare retinal nerve fiber layer (RNFL) thickness obtained with Stratus optical coherence tomography (OCT) and Cirrus OCT. METHODS: Sixty-one normal eyes were evaluated with Stratus and Cirrus OCT on the same day, and the RNFL thicknesses measured by the two OCT machines were compared. The correlation between the two data sets was obtained using Pearson's correlation coefficient. The correlation between RNFL thickness and the difference in data measured by the two OCT machines was then assessed. RESULTS: The average RNFL thickness was significantly higher with Stratus OCT by 6.54+/-4.48 micrometer (p=0.0008). A strong correlation was present between the two RNFL thickness data sets (r=0.883), and the difference between Stratus and Cirrus values tended to increase as RNFL thickness increased. CONCLUSIONS: RNFL thickness measurements in normal eyes scanned with Cirrus OCT correlate well with Stratus OCT measurements. Average RNFL thickness was significantly higher with Stratus OCT, and as the RNFL thickness increased, the difference between Stratus and Cirrus values increased.