Aberrometría corneal en el queratocono subclínico

Objetivo: Determinar parámetros aberrométricos de la córnea para la detección del queratocono subclínico. Métodos: Se realizó un estudio observacional, analítico de corte transversal que incluyó 36 pacientes con queratocono subclínico (grupo de estudio) y 36 estudiantes con córneas aparentemente sanas (grupo control), que asistieron a la consulta de córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre mayo de 2018 y junio de 2022. Se analizaron topografía y aberrometría corneal con el tomógrafo corneal Pentacam AXL. Resultados: El grupo queratocono subclínico mostró valores similares para la queratometría, asfericidad corneal, paquimetría y el valor total de desviación en comparación con el grupo normal. Hubo diferencias estadísticamente significativas en los parámetros aberrométricos, como el coma a 90º (Z3 -1), y la raíz cuadrada media de las aberraciones de alto orden, de cara anterior, posterior y total corneal, en queratocono subclínico en comparación con el grupo normal. El coma posterior a 90º presentó un área bajo la curva (0,894) mayor dentro de las aberrometrías, con un punto de corte de -0,013 μm, con sensibilidad del 86,1 % y especificidad del 88,9 %. Conclusiones: El coma posterior a 90º (parámetro aberrométrico) presenta una alta sensibilidad y especificidad para el diagnóstico de queratocono subclínico, mediante el análisis tomográfico Pentacam AXL.

Objective: To determine corneal aberrometric parameters for the detection of subclinical keratoconus. Methods: An observational, analytical, cross-sectional study was performed including 36 patients with subclinical keratoconus (study group) and 36 students with apparently healthy corneas (control group), who attended the cornea consultation at the Cuban Institute of Ophthalmology Ramón Pando Ferrer, between May 2018 and June 2022. Corneal topography and aberrometry were analyzed with the Pentacam AXL corneal tomographer. Results: The subclinical keratoconus group showed similar values for keratometry, corneal asphericity, pachymetry and total deviation value compared to the normal group. There were statistically significant differences in aberrometric parameters, such as coma at 90° (Z3-1), and root mean square of high-order anterior, posterior and total corneal aberrations in subclinical keratoconus compared to the normal group. The 90° posterior coma presented a higher area under the curve (0.894) within the aberrometries, with a cutoff point of -0.013 μm, with sensitivity of 86.1 % and specificity of 88.9 %. Conclusions: Coma posterior to 90º (aberrometric parameter) presents high sensitivity and specificity for the diagnosis of subclinical keratoconus, using Pentacam AXL tomographic analysis.

Comparative evaluation of intraoperative aberrometry and Barrett’s toric calculator in toric intraocular lens implantation

Purpose: Barrett toric calculator (BTC) is known for its accuracy in toric IOL (tIOL) calculation over standard calculators; however, there is no study in literature to compare it with real?time intraoperative aberrometry (IA). The aim was to compare the accuracy of BTC and IA in predicting refractive outcomes in tIOL implantation. Methods: This was an institution?based prospective, observational study. Patients undergoing routine phacoemulsification with tIOL implantation were enrolled. Biometry was obtained from Lenstar?LS 900 and IOL power calculated using online BTC; however, IOL was implanted as per IA (Optiwave Refractive Analysis, ORA, Alcon) recommendation. Postoperative refractive astigmatism (RA) and spherical equivalent (SE) were recorded at one month, and respective prediction errors (PEs) were calculated using predicted refractive outcomes for both methods. The primary outcome measure was a comparison between mean PE with IA and BTC, and secondary outcome measures were uncorrected distance visual acuity (UCDVA), postoperative RA, and SE at one month. SPSS Version?21 was used; P < 0.05 considered significant. Results: Thirty eyes of 29 patients were included. Mean arithmetic and mean absolute PEs for RA were comparable between BTC (?0.70 ± 0.35D; 0.70 ± 0.34D) and IA (0.77 ± 0.32D; 0.80 ± 0.39D) (P = 0.09 and 0.09, respectively). Mean arithmetic PE for residual SE was significantly lower for BTC (?0.14 ± 0.32D) than IA (0.001 ± 0.33D) (?0.14 ± 0.32D; P = 0.002); however, there was no difference between respective mean absolute PEs (0.27 ± 0.21 D; 0.27 ± 0.18; P = 0.80). At one?month, mean UCDVA, RA, and SE were 0.09 ± 0.10D, ?0.57 ± 0.26D, and ?0.18 ± 0.27D, respectively. Conclusion: Both IA and BTC give reliable and comparable refractive results for tIOL implantation.

Intra-operative aberrometry versus conventional biometry for intraocular lens power calculation: A prospective observational study from a tertiary referral center

Purpose: To evaluate the per operative intra?ocular lens (IOL) power calculation using intra?operative aberrometry (ORA) and its comparison with conventional methods. Methods: Patients with cataract planned for phacoemulsification by a single surgeon under topical anesthesia were enrolled in this prospective observational study in this prospective observational study. All patients underwent pre?operative biometry (Manual SRK?II and IOLMaster® 500) to determine the intra?ocular lens (IOL) power. Intra?operative aberrometry using ORA was also performed; however, IOL was inserted according to IOLMaster® (SRK/T). Spherical equivalent (SE) was recorded on post?operative days 1, 7, and 30. Patients were divided into three groups based on axial lengths for analysis. Comparative analysis was performed for the calculated IOL powers and prediction errors of ORA with conventional methods. Adjusted IOL power to calculate the emmetropic IOL using the LiHue formula was also determined and was compared with existing methods. A P-value less than 0.05 was considered statistically significant. Results: A total of 115 eyes from 113 patients were included, with a median age of 54.90 ± 14.3 years. The mean axial length was found to be 23.94 ± 2.3 mm. There was good agreement (87%) between ORA and IOLMaster® for calculated IOL powers with a mean difference of 0.047 ± 0.5D between the two (P = 0.33). A positive correlation was found between IOL power calculated using ORA, IOLMaster®, SRK?II, and adjusted IOL. Conclusion: The use of intra?operative aberrometry (ORA) to calculate IOL power in patients undergoing uncomplicated phacoemulsification is non?inferior relative to standard pre?operative measurement and planning.

Avaliação das aberrações de alta ordem em pacientes com ceratocone inicial / Assessment of high-order aberrations in patients with early keratoconus

RESUMO Objetivo Identificar alterações de aberrometria de alta ordem em diferentes graus de ceratocone. Métodos Estudo transversal, retrospectivo, observacional. Foram analisados 54 pacientes (108 olhos) diagnosticados com ceratocone pelo mesmo especialista em córnea por meio dos critérios ABCD de Belin/Ambrósio Enhanced Ectasia, utilizando-se o tomógrafo Pentacam® HR 70900 (Oculus Wetzlar, Alemanha). Além disso, foram feitas análises qualitativa e quantitativa das aberrações de alta ordem desses mesmos pacientes por meio do OPD-Scan III-NIDEK. Resultados Por meio da avaliação de ambos os olhos dos pacientes com os critérios de Belin-Ambrósio, constatou-se presença de ceratocone em 34 pacientes. Ademais, por meio da análise estatística, constatou-se relação direta entre a asfericidade posterior e o desenvolvimento do ceratocone, com p<0,001 (referência: p<0,05). Por meio da análise do OPD-Scan III-NIDEK, as principais aberrações de alta ordem encontradas nos pacientes com ceratocone foram coma, trefoil e aberração esférica. Conclusão O raio da curvatura posterior é a primeira variável a se alterar com o desenvolvimento do ceratocone, o que se faz perceptível na análise da asfericidade posterior por meio o Pentacam®. Além disso, a alteração da paquimetria e da asfericidade posterior influencia diretamente o desenvolvimento de aberrações de alta ordem em pacientes com ceratocone.

ABSTRACT Objective To identify higher order aberrometry changes in different degrees of keratoconus. Methods Cross-sectional, retrospective, observational study. Fifty-four patients (108 eyes) diagnosed with keratoconus by the same corneal specialist using the Belin/Ambrósio Enhanced Ectasia ABCD criteria were analyzed, using the Pentacam® HR 70900 tomograph (Oculus Wetzlar, Germany). In addition, qualitative and quantitative analysis of higher order aberrations in these patients was performed using the OPD-Scan III-NIDEK. Results Through the evaluation of both eyes of the patients according to the criteria of Benin Ambrósio, the presence of KCN was verified in 34 patients. Furthermore, through statistical analysis, a direct relationship was found between posterior asphericity and the development of KCN; p<0.001 (reference: p<0.05). Through the analysis of the OPD scan, the main higher order aberrations found in patients with KCN were Coma, Trefoil and Spherical Aberration (AE). Conclusion The posterior curvature radius is the first variable to change with the development of the KCN, which is noticeable in the analysis of posterior asphericity in Pentacam. In addition, alterations in pachymetry and posterior asphericity directly influence the development of higher order aberrations in patients with KCN.

Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in patients with axial hyperopia

Purpose: This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) in intraocular lens (IOL) power calculation and compare it with conventional IOL formulas. Methods: This was a prospective case series. Eyes with visually significant cataract and axial hyperopia (AL <22.0 mm) underwent IA?assisted phacoemulsification with posterior chamber IOL (Alcon AcrySof IQ). Postoperative spherical equivalent (SE) was compared with predicted SE to calculate the outcomes with different formulas (SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal ? and Hill?RBF). Accuracy of intraoperative aberrometer was compared with other formulas in terms of mean absolute prediction error (MAE), percentage of patients within 0.5 D and 1 D of their target, and percentage of patients going into hyperopic shift. Results: Sixty?five eyes (57 patients) were included. In terms of MAE, both Hoffer Q (MAE = 0.30) and IA (MAE = 0.32) were significantly better than Haigis, SRK/T, and Barrett Universal ? (P < 0.05). Outcomes within ±0.5 D of the target were maximum with Hoffer Q (80%), superior to IA (Hoffer Q > IA > Holladay 2 > Hill?RBF > Haigis > SRK/T > Barrett Universal ?). Hoffer Q resulted in minimum hyperopic shift (30.76%) followed by Hill?RBF (38.46%), Holladay 2 (38.46%), Haigis (43.07%), and then IA (46.15%), SRK/T (50.76%) and Barrett Universal ? (53.84%). Conclusion: IA was more effective (statistically significant) in predicting IOL power than Haigis, SRK/T, and Barrett Universal ? although it was equivalent to Hoffer Q. Hoffer Q was superior to all formulas in terms of percentage of patients within 0.5 D of their target refractions and percentage of patients going into hyperopic shift

Deciphering the enigma of astigmatism in cataract surgery

Background: With about 87% of patients with cataracts having astigmatism, management of astigmatism in cataract surgery not only yields an improved unaided visual acuity and image quality but also higher patient satisfaction. The video will give a step?wise guide to cataract surgeons to manage astigmatism with cataracts. Purpose: To hit the bull’s eye as far as target refraction is concerned, it is necessary to understand the benefits and limitations of currently available cutting?edgetechnology and formulae and apply them to the cataract surgery practice. The purpose of the video is to make sure that we have no surprises in our Toric intraocular lens (IOL) planning. Synopsis: After a brief introduction to available modalities for the treatment of astigmatism, a step?wise approach to diagnostics is discussed, which will include the role of corneal topography and aberrometers and their application to planning Toric IOLs. Appropriate planning, implementation, and execution in form of preoperative and intraoperative pearls of using Toric IOLs are shown in the video. This will be followed by troubleshooting and case?based discussions and future perspectives including the possible role of corneal biomechanics. Highlights: What this video adds new is the importance of topography, interpretation of Belin?Ambrosio display map and the equivalent keratometry reading (EKR) map, aberrometry, and higher order aberration (HOA) analysis and role of biomechanics in Toric IOL planning. Video also highlights the importance of posterior corneal astigmatism and accurate axis marking. With a case?based approach and relevant examples, we are trying to decipher the enigma of astigmatism by giving a step?wise approach for the same

Relationship between human eye aberration compensation and visual quality / 中华实验眼科杂志

Wavefront aberration is an evaluation index of objective visual quality.In recent years, the relationship between the wavefront aberration compensation in human eyes and the visual quality has been paid more and more attention.There is a mutual compensation relationship between various aberration terms, between corneal aberration and intraocular aberration, and between the anterior and posterior corneal surfaces, and the visual nervous system compensates human eye aberrations.The characteristics of aberration compensation change with age, and are different in analysis of different regions.Vision correction methods, such as refractive surgery and contact lenses, will change the aberration compensation relationship in human eyes, and the changes caused may have an impact on visual quality.It is important to understand the relationship between the aberration compensation characteristics in human eyes and the visual quality.Therefore, not only the existing aberrations should be taken into consideration, but also the compensation characteristics of human eye aberrations must be elucidated to make personalized correction for the aberrations and improve the visual quality after correction.The research progress and significance on the relationship between human eye aberration compensation characteristics and visual quality were reviewed in this article.

Anterior chamber characteristics assessed by rotating Scheimpflug imaging in patients with retinitis pigmentosa / Características da câmara anterior avaliadas por um dispositivo de imagem rotativo Scheimpflug em pacientes com retinite pigmentosa

ABSTRACT Purpose: The aim of this study was to evaluate anterior segment parameters and corneal aberrations in patients with retinitis pigmentosa using Scheimpflug imaging and to compare the findings with those for healthy controls. Methods: This single-center, case-control study included patients diagnosed with retinitis pigmentosa who were followed up at the Department of Ophthalmology of Kayseri Training and Research Hospital between February and June 2018. Age- and sex-matched healthy individuals with no known ophthalmologic disease formed the control group. Both patients with retinitis pigmentosa and controls underwent comprehensive ophthalmic assessments, including the measurement of the best-corrected visual acuity calculation of the spherical equivalent, slit-lamp examination, stereoscopic fundus examination, computerized visual field test, and electroretinography. Topographic and aberrometric values were measured using Scheimpflug-based tomography. Results: This study was performed on 52 eyes of 26 patients with retinitis pigmentosa (14 men) and 52 eyes of 26 healthy controls (11 men). The average keratometry (K avg) values for the patient and control groups were similar (43.87 ± 2.23 versus 43.61 ± 1.68; p=0.546), but the maximum keratometry (K max) value was significantly higher in the patient group (45.85 ± 2.35 and 44.69 ± 1.86; p=0.015). Patients with retinitis pigmentosa had a significantly lower central corneal thickness (518.5 ± 42.3 versus 534.1 ± 24.5, respectively; p=0.042) and maximal corneal thickness (509.1 ± 50.5 versus 530.5 ± 24.1, respectively; p=0.015). Additionally, the iridocorneal angle for the patients was significantly lower (31.6 ± 9.2 versus 35.9 ± 7.7, p=0.025). The aberrometric findings indicated that patients with retinitis pigmentosa had significantly more higher-order aberrations than those in the healthy controls (0.794 ± 51 and 0.398 ± 08, respectively; p<0.001). Conclusions: The results of the present study demonstrated that patients with retinitis pigmentosa have different anterior segment parameters and corneal aberrations compared to healthy controls. These results should be supported by further studies.

RESUMO Objetivo: Este estudo visou avaliar parâmetros do segmento anterior e aberrações corneanas em pacientes com retinite pigmentosa através de imagens de Scheimpflug e comparar os achados com os de controles saudáveis. Métodos: Este foi um estudo caso-controle unicêntrico que incluiu pacientes com o diagnóstico de retinite pigmentosa em acompanhamento no Departamento de Oftalmologia do Hospital de Treinamento e Pesquisa de Kayseri, entre fevereiro e junho de 2018. Indivíduos saudáveis pareados por idade e sexo, sem nenhum conhecimento da doença oftalmológica formou o grupo controle. Ambos os pacientes com retinite pigmentosa quanto os controles foram submetidos a avaliações oftalmológicas abrangentes, incluindo a medição do cálculo da acuidade visual melhor corrigida, o cálculo do equivalente esférico, biomicroscopia, fundoscopia estereoscópica, campimetria computadorizada e eletrorretinografia. Os valores topográficos e de aberrometria foram medidos através de tomografia baseada no sistema Scheimpflug. Resultados: O estudo incluiu 52 olhos de 26 pacientes com retinite pigmentosa (14 homens) e 52 olhos de 26 controles saudáveis (11 homens). Os valores médios da ceratometria (K avg) para grupos dos pacientes e controle foram semelhantes (43,87 ± 2,23 versus 43,61 ± 1,68, p=0,546), mas o valor máximo da ceratometria (K max) foi significativamente maior no grupo de pacientes (45,85 ± 2,35 e 44,69 ± 1,86; p=0,015). Pacientes com retinite pigmentosa apresentaram uma espessura corneana central significativamente menor (518,5 ± 42,3 versus 534,1 ± 24,5, respectivamente; p=0,042) e espessura corneana máxima (509,1 ± 50,5 verus 530,5 ± 24,1, respectivamente; p=0,015). Além disso, o ângulo iridocorneano para os pacientes foi significativamente menor (31,6 ± 9,2 versus 35,9 ± 7,7; p=0,025). Os achados da aberrometria indicaram que os pacientes com retinite pigmentosa apresentaram significativamente mais aberrações de ordem superior em comparação com os controles saudáveis (respectivamente 0,794 ± 51 e 0,398 ± 08, respectivamente; p<0,001). Conclusões: Os resultados do presente estudo demonstraram que pacientes com retinite pigmentosa têm diferentes parâmetros do segmento anterior e aberrações corneanas em comparação com controles saudáveis. Estes resultados precisam ser confirmados por novos estudos.

Comparison of higher order wavefront aberrations with four aberrometers

Purpose: To evaluate the agreement of selected higher order aberration measurements between aberrometers based on three different wavefront technologies. Methods: Twenty-three eyes of 23 participants were compared between Zywave, OPD-Scan III, and iDesign aberrometers, for total ocular aberrations. Participants were between 19 and 69 years of age, and exclusion criteria were previous ocular surgery or trauma, contact lens wear within the preceding 2 weeks, and ocular or systemic disease. Corneal aberrations were compared between the OPD-Scan III and GALILEI™ G2 aberrometers. Zernike coefficients of vertical and oblique trefoil, vertical and horizontal coma, and spherical aberration were analyzed in R software. Results: In all, 276 scans were captured in total, with a male-to-female ratio of 11:12. Total ocular vertical coma [mean difference (MD) = 0.026 ?m, P < 0.005], vertical trefoil (MD = 0.033 ?m, P < 0.05), and spherical aberration (MD = 0.022 ?m, P < 0.05) differed significantly between the iDesign and OPD-Scan III. Differences in total vertical (MD = 0.072 ?m, P < 0.05) and oblique trefoil (MD = 0.058 ?m, P < 0.05) were demonstrated between the Zywave and OPD-Scan III, and spherical aberration (MD = 0.030 ?m, P < 0.005) between iDesign and Zywave. iDesign corneal horizontal coma (MD = 0.025 ?m, P < 0.05) and spherical aberration (MD = 0.043 ?m, P < 0.005) measurements were significantly different between the GALILEI™ G2 and the OPD-Scan III. Conclusion: Zywave, iDesign, and OPD-Scan III, and GALILEITM G2 and OPD-Scan III may be used interchangeably for their total ocular and corneal wavefront functions, respectively; however, care must be taken if using these devices for guiding ablation or monitoring corneal disease.

Relación entre la clasificación subjetiva de la opacidad del cristalino y la calidad visual / Relationship between subjective lens opacity classification and visual quality

RESUMEN Objetivo: Determinar la relación entre la clasificación subjetiva de la opacidad del cristalino por LOCS III, la agudeza visual mejor corregida y el análisis objetivo de la calidad visual por aberrometría. Métodos: En este estudio observacional, descriptivo y transversal se realizó la categorización con LOCS III de cataratas seniles en paciente con agudeza visual mayor a 0,7 y una medición objetiva de la calidad visual por análisis de frente de onda en pacientes que asistieron al Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" entre junio del año 2016 y diciembre de 2017. Resultados: Las cataratas corticales estuvieron relacionadas con una gran magnitud de aberraciones ópticas de alto orden, principalmente coma y trefoil. También se encontró un valor significativo de la aberración esférica en el grupo de cataratas nucleares. Las cataratas del grupo subcapsular posterior no mostraron un tipo de aberración predominante. No se pudo obtener la relación entre la magnitud de la catarata catalogada por LOCS III y los indicadores de calidad visual o la agudeza visual mejor corregida porque el tamaño de la muestra fue insuficiente para relacionarlo con el gran número de categorías en LOCS III. Conclusiones: En los pacientes con catarata senil y buena agudeza visual, el tipo y el grado de opacidad categorizada por LOCS III condiciona el tipo y la magnitud de las aberraciones, y por tanto el deterioro de la calidad visual(AU)

ABSTRACT Objective: Determine the relationship between subjective lens opacity classification by LOCS III, best corrected visual acuity and objective visual quality analysis by aberrometry. Methods: A cross-sectional observational descriptive study was conducted based on LOCS III to classify senile cataracts in patients with visual acuity above 0.7 and objective visual quality measurement by wavefront analysis attending the Ocular Microsurgery Center of Ramón Pando Ferrer Cuban Institute of Ophthalmology from June 2016 to December 2017. Results: Cortical cataracts were associated to a large number of higher-order ocular aberrations, mainly coma and trefoil. Significant spherical aberration values were also found in the nuclear cataract group. Cataracts in the posterior subcapsular group did not display a prevailing aberration type. It was not possible to determine the relationship between the magnitude of the cataract as classified by LOCS III and visual quality indicators or best corrected visual acuity, because sample size was insufficient to be related to the large number of categories in LOCS III. Conclusions: In patients with senile cataract and good visual acuity, the type and degree of opacity as classified by LOCS III determines the type and magnitude of the aberrations, and thus the deterioration of visual quality(AU)

Los sistemas de imágenes de alta tecnología en la cirugía de catarata / High-technology imaging systems in cataract surgery

La cirugía de catarata actual se ha convertido en una cirugía refractiva, pues se busca además la corrección del defecto refractivo tanto esférico como cilíndrico en el mismo proceder y, por tanto, la emetropía sin corrección óptica en todas las distancias. Para esto debemos tener una verdadera lectura del astigmatismo corneal total y una identificación correcta del meridiano a tratar. Hoy en día existen dispositivos de avanzada tecnología capaces de brindar estos y otros datos preoperatorios e intraoperatorios de gran confiabilidad. Algunos de estos sistemas como Verion, Callisto Eye y el TrueGuide, utilizan la topografía corneal con registro del limbo y, luego de capturar una imagen preoperatoria, la recuerdan durante la cirugía para generar el meridiano objetivo en un monitor o a través del microscopio quirúrgico, y de esta manera ayudar en la alineación precisa de la lente intraocular tórica. Incluso pueden ofrecer imágenes tridimensionales en vivo. Otros, por su parte, utilizan la aberrometría de frente de onda intraoperatoria para ayudar al cirujano a elegir el poder de la lente intraocular tórica y luego alinearla, como los sistemas ORA y Holos IntraOp. Estos instrumentos proporcionan retroalimentación refractiva continua en tiempo real para la corrección astigmática en el mismo acto quirúrgico. Sin dudas, estos sistemas son parte de una revolución tecnológica dentro del campo de la cirugía del cristalino actual que posibilitan una mayor precisión y predicción de los resultados refractivos y constituyen elementos imprescindibles si queremos conseguir una cirugía de catarata de excelencia. Se realiza esta revisión con el objetivo de obtener información acerca de los sistemas de imágenes de alta tecnología que se usan hoy día en la cirugía del cristalino y mostrar sus potencialidades para obtener resultados refractivos posoperatorios más exactos(AU)

Current cataract surgery has become refractive surgery, for it is also aimed at correcting both spherical and cylindrical refractive defects in the same procedure, thus achieving emmetropia without optical correction at all distances. For this we must have a true reading of the total corneal astigmatism and a correct identification of the meridian to be treated. Today there are advanced technological devices capable of providing these and other preoperative and intraoperative data with great reliability. Some of these systems, such as Verion, Callisto Eye and TrueGuide, use corneal topography with limbus registration and after capturing a preoperative image, they remember it during surgery to generate the target meridian on a monitor or through the surgical microscope, thus helping achieve precise alignment of the toric intraocular lens. They can even offer live three-dimensional images. Others, such as the ORA and Holos IntraOp systems, use intraoperative wavefront aberrometry to help the surgeon choose the power of the toric intraocular lens and then align it. These instruments provide continuous refractive feedback in real time for astigmatic correction in the same surgical act. Undoubtedly, these systems are part of a technological revolution within the field of current crystalline lens surgery that enable greater precision and prediction of refractive results and are essential elements if we want to achieve cataract surgery of excellence. This review was conducted to obtain information about high-technology imaging systems currently used in crystalline lens surgery, and show their potential to achieve more accurate postoperative refractive results(AU)

Manejo do astigmatismo residual após implante de lente intraocular / Management of residual astigmatism after intraocular lens implantation

RESUMO Relatamos um caso de astigmatismo residual, após cirurgia de catarata com implante de lente intra-ocular (LIO) tórica (Acrysof Toric, Alcon, Frot Worth TX). A refração residual (+1,25 -2,50 x 105º) e o posicionamento da LIO implantada neste olho, foram correlacionados com a aberrometria total obtida por ray tracing de pontos individuais integrada à da face anterior da córnea obtida por topografia de Plácido, para cálculo das aberrações internas (iTrace, Tracey, Technologies, Houston TX). O cálculo do eixo ideal da LIO, para minimizar a refração residual foi realizado de acordo com Berdahl & Hardten (astigmatismfix.com). A rotação da LIO foi realizada com sucesso 5 meses após a cirurgia inicial para o eixo indicado, reduzindo o erro residual para +0,25 -0,25 x 61º e promovendo reabilitação visual sem correção de 20/20.

ABSTRACT We report a case of residual astigmatism after cataract surgery with toric intraocular lens (IOL) implantation (Acrysof Toric, Alcon, Frot Worth TX). Residual refraction (+1,25 -2,50 x 105º) and IOL positioning were correlated with total ray-tracing wavefront aberrometry integrated with anterior corneal surface Placido-based topography to calculate internal aberrations (iTrace, Tracey Technologies, Houston TX). The ideal IOL axis to minimize residual refraction was calculated with Berdahl & Hardten (astigmatismfix.com). IOL rotation to the indicated axis was successfully performed 5 months after initial surgery, reducing residual error to +0,25 -0,25 x 61º, promoting visual reabilitation, with final uncorrected distance visual acuity 20/20.

Comparative study on optical performance and visual outcomes between two diffractive multifocal lenses: AMO Tecnis ® ZMB00 and AcrySof ® IQ ReSTOR ® Multifocal IOL SN6AD1 / Estudo comparativo de desempenho óptico e resultado visual entre duas lentes multifocais difrativas: Tecnis ZMB00 e AcrySof SN6AD1

ABSTRACT Purpose: To compare the optical performance and visual outcomes between two diffractive multifocal lenses: AMO Tecnis® ZMB00 and AcrySof® ReSTOR® SN6AD1. Methods: This prospective, non-randomized comparative study included the assessment of 74 eyes in 37 patients referred for cataract surgery and candidates for multifocal intraocular lens implants. Exclusion criteria included existence of any other eye disease, previous eye surgery, high axial myopia, preoperative corneal astigmatism of >1.00 cylindrical diopter (D), and intraoperative or postoperative complications. Ophthalmological evaluation included the measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), and distance-corrected intermediate visual acuity (DCIVA), with analysis of contrast sensitivity (CS), wavefront, and visual defocus curve. Results: Postoperative UDVA was 0.09 and 0.08 logMAR in the SN6AD1 and ZMB00 groups, respectively (p=0.868); postoperative CDVA was 0.04 and 0.02 logMAR in the SN6AD1 and ZMB00 groups, respectively (p=0.68); DCIVA was 0.17 and 0.54 logMAR in the SN6AD1 and ZMB00 groups, respectively (p=0.000); and DCNVA was 0.04 and 0.09 logMAR in the SN6AD1 and ZMB00 groups, respectively (p=0.001). In both cases, there was an improvement in the spherical equivalent and UDVA (p<0.05). Under photopic conditions, the SN6AD1 group had better CS at low frequencies without glare (p=0.04); however, the ZMB00 group achieved better sensitivity at high frequencies with glare (p=0.003). The SN6AD1 and ZMB00 lenses exhibited similar behavior for intermediate vision, according to the defocus curve; however, the ZMB00 group showed a shorter reading distance than the SN6AD1 group. There were no significant differences regarding aberrometry between the two groups. Conclusion: Both lenses promoted better quality of vision for both long and short distances and exhibited a similar behavior for intermediate vision. The SN6AD1 and ZMB00 groups showed better results for CS under photopic conditions at low and high spatial frequencies, respectively.

RESUMO Objetivo: Comparar o desempenho óptico e resultado visual entre duas lentes multifocais difrativas: AMO Tecnis® ZMB00 e AcrySof® ReSTOR® SN6AD1. Métodos: O estudo prospectivo, comparativo não randomizado incluiu avaliação de 74 olhos em 37 pacientes com indicação de facectomia e candidatos a implante de lente multifocal. Critérios de exclusão foram: presença de outras doenças oculares; cirurgia ocular prévia; alta miopia axial; astigmatismo cornenano maior que 1,00 D cilíndrica; complicações intraoperatórias ou pós-operatórias. A avaliação oftalmológica contou com medida da acuidade visual para longe corrigida (CDVA) e não corrigida (UDVA), intermediária (DCIVA) e curta distância (DCNVA) com melhor correção óptica para longe; teste de sensibilidade ao contraste; análise de frente de onda e curva visual de Defocus. Resultados: A UDVA foi de 0,09 logMAR para o grupo SN6AD1 e 0,08 logMAR para o grupo ZMB00; com correção foi de 0,04 logMAR para SN6AD1 e 0,02 para o grupo ZMB00 (p>0,05). O grupo SN6AD1 obteve valor de 0,04 logMAR e o grupo ZMB00 de 0,09 logMAR para DCNVA (p<0,05) e DCIVA de 0,17 logMAR para SN6AD1 e 0,54 logMAR para ZMB00 (p=0,000). Houve melhora do equivalente esférico e da UDVA em ambos os grupos (p<0,05). Em condições fotópicas, o grupo SN6AD1 teve melhor sensibilidade ao contraste em baixas frequências sem ofuscamento (p<0,05), contudo grupo ZMB00 obteve melhor sensibilidade em altas frequências (p<0,05) com ofuscamento. As lentes SN6AD1 e ZMB00 obtiveram comportamento semelhantes para visão intermediária na curva de Defocus, porém, o grupo ZMB00 mostrou menor distância de leitura que o grupo SN6AD1. Não houve diferença com significância estatística relacionada à aberrometria na comparação dos dois grupos. Conclusão: As duas lentes promoveram melhor qualidade de visão para longe e perto e comportamento semelhante para visão intermediária. O grupo ZMB00 exibiu melhores resultados para sensibilidade ao contraste em condições fotópicas em alta frequência espacial e SN6AD1 em baixa frequência espacial.

Change of higher order aberration after 2 mm micro-incision SMILE in myopia / 中华实验眼科杂志

Background Small incision lenticule extraction (SMILE) is increasingly used for myopia.However,the size of the incision varied in different operators.The influence of 2 mm micro-incision SMILE on postoperative diopter and aberrations is not clear yet.Objective The aim of the current study was to perform a clinical analysis of the efficacy,safety,stability and predictability of 2 mm micro-incision SMILE and investigate the influence of preoperative sphere and cylinder power on postoperative aberrations.Methods A serial cases observational study was carried out under the approval of Ethic Committee of Tianjin Eye Hospital and informed consent of each patient.Fifty-five eyes of 31 subjects with myopia and myopic astigmatism were enrolled in this study in Tianjin Eye Hospital from January to April 2013 and a 2 mm micro-incision SMILE was performed on the eyes.Follow-up visits were performed at 1 week,1 month and 6 months after operation.Uncorrected visual acuity (UCVA),best corrected visual acuity (BCVA),manifest and cycloplegic refraction were examined at each postoperative time points to evaluate the efficacy,safety,stability and predictability of 2 mm micro-incision SMILE.Wave-front aberrations were measured by WaveScan aberrometer.Repeated measurement analysis of variance was used for the comparison of the differences of aberrations before and after the surgery.And the differences between various follow-up visits were compared with LSD-t test.The relationship between preoperative sphere or cylinder power and aberrations postoperatively were analyzed by Spearman rank correlation.Results At 1 week,1 month and 6 months postoperatively,the effective index was 1.2,and the safety indexes were 1.2,1.2 and 1.5 respectively.The spherical equivalent remained 0.00 D at each postoperative time point.And 96.4％ and 97.8％ of eyes were within ±0.5 D of intend correction and 100％ were within ± 1.0 D of the intend correction at 1 month and 6 months postoperatively.Vertical coma (Z7) and spherical aberration (Z12) were significantly raised at 1 week,1 month and 6 months after surgery compared with the values preoperatively (Z7:t =9.668,10.607,9.772,all at P ＜ 0.001 ;Z 12:t =-6.227,-6.923,-7.441,all at P＜0.001).The Zernike coefficients were relatively symmetrical between various time points postoperatively (all at P＞0.05).Third-order to sixth-order aberrations and higher order abberration (HOA) showed significant increase at various time points after the surgery compared with the values before surgery (all at P＜0.05),and no significant differences were seen between various follow-up visits (all at P＞0.05).Positive correlations were found between preoperative sphere and S3,S4 and HOA at 1 week,1 month and 6 months postoperatively (P＜0.05).Negative correlations were found between preoperative cylinder and S3,S4 and HOA at postoperatively various time points (all at P＜0.05).In addition,significant positive correlations were seen between Z7 and preoperative cylinder as well as between Z12 and sphere preoperatively,and negative correlations also were observed between Z7 and preoperative sphere as well as between Z12 and cylinder preoperatively at each follow-up visits(all at P＜0.05).Conclusions SMILE with 2 mm micro-incision is a safe,effective,stable and predictable procedure for myopic and myopic astigmatism eyes.The aberrations and Zernike terms remain stable after surgery until 6 months although these parameters present elevation to a certain extent.Preoperative SE and astigmatism power affect postoperative aberrations.

Higher order aberrations in amblyopic children and their role in refractory amblyopia / Aberrações de alta ordem em crianças com ambliopia e seu papel na ambliopia refratária

Objective: Some studies have hypothesized that an unfavourable higher order aberrometric profile could act as an amblyogenic mechanism and may be responsible for some amblyopic cases that are refractory to conventional treatment or cases of “idiopathic” amblyopia. This study compared the aberrometric profile in amblyopic children to that of children with normal visual development and compared the aberrometric profile in corrected amblyopic eyes and refractory amblyopic eyes with that of healthy eyes. Methods: Cross-sectional study with three groups of children – the CA group (22 eyes of 11 children with unilateral corrected amblyopia), the RA group (24 eyes of 13 children with unilateral refractory amblyopia) and the C group (28 eyes of 14 children with normal visual development). Higher order aberrations were evaluated using an OPD-Scan III (NIDEK). Comparisons of the aberrometric profile were made between these groups as well as between the amblyopic and healthy eyes within the CA and RA groups. Results: Higher order aberrations with greater impact in visual quality were not significantly higher in the CA and RA groups when compared with the C group. Moreover, there were no statistically significant differences in the higher order aberrometric profile between the amblyopic and healthy eyes within the CA and RA groups. Conclusions: Contrary to lower order aberrations (e.g., myopia, hyperopia, primary astigmatism), higher order aberrations do not seem to be involved in the etiopathogenesis of amblyopia. Therefore, these are likely not the cause of most cases of refractory amblyopia. .

Objetivo: Alguns estudos levantaram a hipótese de que um perfil aberrométrico de alta ordem desfavorável poderia ser um fator ambliogênico, responsável por certos casos de ambliopia “idiopática” ou refratária ao tratamento convencional. Este trabalho tem como objetivos: 1) comparar o perfil aberrométrico de crianças amblíopes com o de crianças com desenvolvimento visual normal; 2) comparar a aberrometria de olhos amblíopes tratados com sucesso/curados e olhos amblíopes refratários ao tratamento convencional com a aberrometria de olhos saudáveis. Métodos: Estudo transversal com três grupos de crianças: grupo CA (22 olhos de 11 crianças com ambliopia unilateral curada), grupo RA (24 olhos de 13 crianças com ambliopia unilateral refratária) e grupo C (28 olhos de 14 crianças com desenvolvimento visual normal). Avaliou-se a aberrometria ocular total utilizando o OPD Scan-III (NIDEK). Comparou-se o perfil aberrométrico dos três grupos de estudo bem como dentro dos grupos CA e RA, o olho amblíope com o saudável. Resultados: As aberrações de alta ordem com maior impacto na qualidade visual não foram significativamente superiores nos grupos CA e RA, comparativamente ao grupo C. Por outro lado, não se encontraram diferenças estatisticamente significativas entre o perfil aberrométrico de alta ordem dos olhos amblíopes e dos olhos sãos dentro dos grupos CA e RA. Conclusão: Contrariamente às aberrações de baixa ordem (miopia, hipermetropia, astigmatismo primário), as de alta ordem não parecem relacionar-se com a etiopatogênese da ambliopia. É também pouco provável que estas sejam a causa da maioria dos casos de ambliopia refratária. .

Quality of vision in refractive and cataract surgery, indirect measurers: review article / Qualidade visual em cirurgia refrativa e catarata, medidores indiretos: artigo de revisão

Visual acuity is the measurement of an individual's ability to recognize details of an object in a space. Visual function measurements in clinical ophthalmology are limited by factors such as maximum contrast and so it might not adequately reflect the real vision conditions at that moment as well as the subjective aspects of the world perception by the patient. The objective of a successful vision-restoring surgery lies not only in gaining visual acuity lines, but also in vision quality. Therefore, refractive and cataract surgeries have the responsibility of achieving quality results. It is difficult to define quality of vision by a single parameter, and the main functional-vision tests are: contrast sensitivity, disability glare, intraocular stray light and aberrometry. In the current review the different components of the visual function are explained and the several available methods to assess the vision quality are described.

Qualidade Visual é a medida da capacidade individual de reconhecer detalhes de um objeto no espaço. Medições de função visual na clínica oftalmológica são limitadas por vários fatores, tal como máximo contraste e assim podem não refletir adequadamente as condições visuais reais, bem como os aspectos subjetivos da percepção do mundo pelo paciente. O sucesso em uma cirurgia está não apenas em restaurar linhas de visão, mas sim qualidade visual. Portanto, as cirurgias refrativas e de catarata têm a responsabilidade de alcançar resultados de qualidade. É difícil definir qualidade visual por um único parâmetro, sendo os principais testes de função visual: sensibilidade ao contraste; glare; dispersão intraocular da luz e aberrometria. Nesta revisão os diferentes componentes da função visual são explicados e os diversos métodos disponíveis para se avaliar a qualidade de visão são descritos.

Analysis of the correlation between ophthalmic examination and quality of life outcomes following intracorneal ring segment implantation for keratoconus / Avaliação dos fatores que influenciam na qualidade de vida de pacientes com ceratocone após implante de anel intraestromal

PURPOSE: To analyze the correlation between quantitative measurements outcomes and keratoconus patients' vision related quality of life (v-QoL) following intrastromal corneal ring segment implantation. METHODS: The NEI-RQL (National Eye Institute Refractive Error Quality of Life) was administered to patients requiring intrastromal corneal ring segment implantation, before and after surgery, wearing best correction for 40 days minimum. Visual acuity, refraction, corneal topography, aberrometry data (VOL-CT. software) and contrast sensitivity were recorded before and 3 months after surgery. The main outcome measures were best corrected visual acuity, refraction, steep keratometric value (Kmax), aberrometry, contrast sensitivity and v-QoL. RESULTS: There were 42 keratoconic patients (69 eyes): 19 male and 23 female, mean age 24.9 ± 5 years in this prospective study. Binocular best corrected visual acuity improved (0.13 ± 0.03 before to -0.01 ± 0.01 logMAR after surgery, p<0.001). There was a statistically significant improvement in mean spherical refraction (2.81 ± 0.44 to 1.71 ± 0.31), cylinder component (3.89 ± 0.22 to 1.82 ± 0.21), spherical equivalent (4.55 ± 0.46 to 2.40 ± 0.30), Kmax (55.92 D ± 0.62 to 52.16 D ± 0.58 D) and root mean square low order (p<0.001). Contrast sensitivity (CS) improved at all spatial frequencies: at 6 cpd improvement was higher. Root mean square higher order did not improved p=0.422. There was significant improvement across all NEI-RQL scales after surgery. Multivariate analysis showed that gender (males more satisfied than females), cylinder (1 D reduction improves 5 points in general NEI-RQL scores) and normal contrast sensitivity at 3 and 6 cpd were correlated with v-QoL. Other variables such as best corrected visual acuity, root mean square low order, root mean square higher order and Kmax did not show influence on NEI-RQL scores. CONCLUSIONS: The best patient response predictors with the NEI-RQL instrument were gender, normal CS at 3 and 6 cpd and cylinder reduction. The use of this questionnaire was crucial to assess the influence of optical tests on v-QoL in keratoconus patients who were referred for intrastromal corneal ring segment implantation.

OBJETIVO: Analisar a correlação entre fatores relacionados aos pacientes com ceratocone e suas medidas quantitativas e os resultados da qualidade de vida com o implante do anel intraestromal (ICRS). MÉTODOS: O questionário de qualidade de vida relacionado a visão (QdV-v) NEI-RQL (National Eye Institute Refractive Error Quality of Life) validado na língua portuguesa foi administrado a pacientes com indicação de implante do anel intraestromal antes e depois da cirurgia quando eles já estavam usando a correção por pelo menos 40 dias. Acuidade visual com a melhor correção, topografia de córnea, aberrometria e sensibilidade ao contraste foram medidos antes e três meses após a cirurgia. RESULTADOS: Foram incluídos neste estudo prospectivo 42 pacientes (69 olhos): 19 homens e 23 mulheres com idade média de 24,9 ± 5 anos. Houve melhora estatisticamente significante na acuidade visual com a melhor correção binocular (0,13 ± 0,03 antes para -0,01 ± 0,01 logMAR após a cirurgia, p<0,001), na refração esférica média (2,81 ± 0,44 para 1,71 ± 0,31), no componente cilíndrico (3,89 ± 0,22 para 1,82 ± 0,21), no equivalente esférico (4,55 ± 0,46 para 2,40 ± 0,30), na ceratometria máxima (55,92 D ± 0,62 para 52,16 D ± 0,58 D) e no RMS (root mean square) de baixa ordem (p<0,001). O RMS de alta ordem não teve melhora significante p=0,422. A sensibilidade ao contraste (SC) melhorou significativamente em todas as frequências especialmente na de 6 cpg. Houve melhora significante em todas as escalas do NEI-RQL após a cirurgia. A análise multivariada mostrou que sexo (homens com melhores índices de QdV-v que as mulheres), cilindro (1 D de redução aumenta em 5 pontos a escala geral do NEI-RQL) e SC normal nas frequências de 3 e 6 cpg são os fatores que interferem nos escores de QdV-v dos pacientes com implante de anel intraestromal. As outras variáveis como acuidade visual com a melhor correção, aberrometria e ceratometria máxima não influenciaram nos escores do NEI-RQL. CONCLUSÕES: Os fatores que se correlacionam a melhores pontuações na QdV-v dos pacientes com implante de anel intraestromal são: sexo, SC normal nas frequências de 3 e 6 cpg e diminuição do cilindro. A análise das medidas objetivas em conjunto com o NEI-RQL foi fundamental para identificar os fatores que influenciam nos resultados subjetivos dos pacientes com ceratocone e implante de anel intraestromal.