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Purpose: To evaluate the postoperative visual outcomes, that is, corneal higher?order aberrations (HOAs) and visual quality, of patients with an angle kappa greater than 0.30 mm who underwent angle kappa adjustment during small?incision lenticule extraction (SMILE) 2 years after surgery compared to eyes with an angle kappa less than 0.30 mm. Methods: This was a retrospective study and included 12 patients from October 2019 to December 2019 who underwent the SMILE procedure for correction of myopia and myopic astigmatism and had one eye with a large kappa angle and another eye with a small kappa angle. Twenty?four months after surgery, an optical quality analysis system (OQAS II; Visiometrics, Terrassa, Spain) was used to measure the modulation transfer function cutoff frequency (MTFcutoff), Strehl2D ratio, and objective scatter index (OSI). HOAs were measured with a Tracey iTrace Visual Function Analyzer (Tracey version 6.1.0; Tracey Technologies, Houston, TX, USA). Assessment of subjective visual quality was achieved using the quality of vision (QOV) questionnaire. Results: At 24 months postoperatively, the mean spherical equivalent (SE) refraction was ? 0.32 ± 0.40 and ? 0.31 ± 0.35 in the S?kappa group (kappa <0.3 mm) and the L?kappa group (kappa ?0.3 mm), respectively (P > 0.05). The mean OSI was 0.73 ± 0.32 and 0.81 ± 0.47, respectively (P > 0.05). There was no significant difference in MTFcutoff and Strehl2D ratio between the two groups (P > 0.05). Total HOA, coma, spherical, trefoil, and secondary astigmatism were not significantly different (P > 0.05) between the two groups. Conclusion: Adjustment of angle kappa during SMILE helps reduce the decentration, results in less HOAs, and promotes visual quality. It provides a reliable method to optimize the treatment concentration in SMILE.
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Introducción: La cirugía actual de la catarata no comprende solo restablecer la visión en su mayor cantidad posible, sino que incluye además la psicofísica de la visión. Objetivo: Evaluar los resultados de la cantidad, calidad visual y de vida en la cirugía refractiva bilateral simultánea del cristalino en pacientes hipermétropes. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo de serie de casos en 108 ojos de 54 pacientes con catarata bilateral e hipermetropía operados por cirugía bilateral simultánea en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer" desde noviembre 2018 hasta abril 2022. Se emplearon los porcentajes y los números absolutos para resumir las variables cualitativas. En el caso de las cuantitativas se usó la media con su desviación estándar (DE) y el intervalo de confianza del 95 por ciento. Resultados: Fue más frecuente el sexo femenino con una edad media de 69,1 ± 8,1 años. El 55,11 por ciento de los pacientes tuvo dureza NO3. La agudeza visual monocular mejoró en el 97,2 por ciento y el 100 por ciento la mejoró de forma bilateral. Hubo una pérdida celular endotelial de 10,19 por ciento. La visión de colores y la sensibilidad al contraste mostraron de igual manera mejoría significativa. Conclusiones: La cirugía bilateral simultánea del cristalino en pacientes hipermétropes contribuye de manera significativa a la mejoría de la visión en cantidad y calidad, por lo que permite recuperar la calidad de vida(AU)
Introduction: Current cataract surgery does not comprise only restoring vision to its greatest possible quantity, but also includes the psychophysics of vision. Objective: To evaluate the results of quantity, visual quality and quality of life in simultaneous bilateral refractive surgery of the crystalline lens in hyperopic patients. Methods: A prospective longitudinal descriptive case series prospective study was performed in 108 eyes of 54 patients with bilateral cataract and hyperopia operated by simultaneous bilateral surgery at the Cuban Institute of Ophthalmology "Ramón Pando Ferrer" from November 2018 to April 2022. Quality of life was also taken into account by the FV-14 survey. Percentages and absolute numbers were used to summarize the qualitative variables. In the case of quantitative variables, the mean with standard deviation (SD) and 95 percent confidence interval were used. Results: The female gender was more frequent with an average age of 69.1±8.1 years. 55.11 percent of patients had NO3 hardness. Monocular visual acuity improved in 97.2 percent and 100 percent improved bilaterally. There was an endothelial cell loss of 10.19 percent. Color vision and contrast sensitivity likewise showed significant improvement. Conclusions: Simultaneous bilateral lens surgery in hyperopic patients, contributes significantly to the improvement of vision in quantity and quality, thus allowing recovery of quality of life(AU)
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Humans , Female , Aged , Cataract Extraction/adverse effects , Hyperopia , Epidemiology, Descriptive , Longitudinal StudiesABSTRACT
In recent years, the incidence of myopia in adolescents has been increasing year by year, and how to effectively control the development of myopia has become a research hotspot in the field of public health.The orthokeratology lens has been widely used in myopia control because of its great safety, reliability, and little impact on daily life.The cornea after overnight orthokeratology lens wear can be divided into a relatively flat central treatment zone and a steep peripheral defocus zone.Decentration of the treatment zone is common in clinical practice and is mainly located in the inferior temporal quadrant.Studies have shown that the greater the asymmetry of the anterior corneal surface, the greater the degree of myopia at baseline, and the smaller the diameter of the lens, the greater the deviation of the treatment zone.In addition, decentration of the treatment zone is also related to the gravity of the lens, Bell phenomenon, eyelid, and so on.Large decentration of the treatment zone results in decreased visual quality, including clinical symptoms such as ghosting vision and glare, which may be caused by the increase in comatic aberration.Decentration of the treatment zone may have better myopia control, due to the increase of defocus in the pupil area.Obvious decentration of the treatment zone can be solved by increasing the sagittal height, adjusting the alignment curve, increasing the lens diameter and switching to toric lenses, etc.This article reviewed the factors that affect the decentration of the treatment zone after overnight orthokeratology wear, the influence of decentration on visual quality and myopia control, and the methods to help solve the problems caused by the decentration of the treatment zone, which can guide fitting and replacement of orthokeratology lenses.
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AIM: To investigate the short-term visual quality outcomes after femtosecond laser small incision lenticule extraction(SMILE)and evolution implantable collamer lens(EVO-ICL)implantation for the correction of moderate myopia.METHODS: Prospective control study. A total of 51 cases(51 eyes)with moderate myopia who underwent SMILE or EVO-ICL implantation surgery at Weifang Eye Hospital from April 2021 to February 2022 were selected. They were divided into SMILE group(30 patients, 30 eyes)and EVO-ICL group(21 patients, 21 eyes)according to the surgical methods. The changes of visual acuity [uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA)], diopter [spherical equivalent(SE)] and related parameters of optical quality analysis system(OQAS Ⅱ)were observed before surgery and at 1wk, 1 and 3mo after surgery, and the quality of vision(QoV)questionnaire was completed.RESULTS: At 3mo after surgery, the safety index(postoperative CDVA/preoperative CDVA)of SMILE gruop and EVO-ICL group were 1.20(1.00, 1.20)and 1.20(1.00, 1.38), respectively, the efficacy index(postoperative UDVA/preoperative CDVA)were 1.00(1.00, 1.20)and 1.00(1.00, 1.20), respectively, and the percentage of SE within ±0.50D was 87% and 100%, respectively. In SMILE group, the objective scattering index(OSI)was increased after surgery, while modulation transfer function cutoff frequency(MTF cutoff), contrast visual acuity(VA)100%, and VA20% at 1wk and 1mo after surgery, and Strehl ratio(SR)and VA9% at each time point after surgery were all decreased compared with those before surgery(all P&#x003C;0.05). The OSI, MTF cutoff, SR and VA of EVO-ICL group showed no difference at each time point after surgery compared with those before surgery(all P&#x003E;0.05). The most common visual symptoms after SMILE and EVO-ICL implantation were visual haze and halos, respectively.CONCLUSION: Both SMILE and EVO-ICL implantation have good safety, efficacy and predictability in the short term after the correction of moderate myopia. Both groups had visual symptoms after surgery, but the overall satisfaction of patients was high. Furthermore, EVO-ICL implantation has better objective visual quality performance.
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AIM: To evaluate the visual quality of patients with high myopia and cataract who received micro binocular single vision implantation of Tecnis Symfony intraocular lens(IOL), hybrid implantation of Tecnis Symfony IOL and Tecnis ZMB00 multifocal IOL, and binocular implantation of AcrySof IQ Panoptix IOL.METHODS: A prospective non-randomized controlled study was conducted to select patients with high myopia and cataract who underwent phacoemulsification combined with IOL implantation in the First Affiliated Hospital of Baotou Medical College from August 2020 to March 2022. According to the different IOL implantation schemes selected by patients, they are divided into micro single vision group, hybrid group and trifocal group. The postoperative follow-up was 3mo. The observation indexes included uncorrected far(5m), middle(80, 60cm)and near(33cm)visual acuity at 3mo after operation, contrast sensitivity(CS), uncorrected defocus curve under far vision, subjective visual quality score and light interference at 1 and 3mo after operation.RESULTS: There was no significant difference among the three groups in uncorrected far(5m)and middle(60cm)visual acuity at 3mo after operation(P<0.05); Uncorrected middle(80cm)distance visual acuity in the micro single vision group was similar to that in the hybrid group, and both were better than that in the trifocal group(P<0.05); Uncorrected near(33cm)distance vision of the hybrid group showed the best, followed by the trifocal group, and the lowest was in the micro single vision group(all P<0.05). The CS of dark light plus glare(12, 18c/d)was the best in the trifocal group, followed by the hybrid group, and the lowest was in the micro single vision group(all P<0.05). The defocus curve at 3mo after operation showed a span of +1.00～-3.00D, and the visual acuity of the three groups was better than 0.3 LogMAR; In the span of -1.00～-1.25D, the visual acuity of the hybrid group and micro single vision group was better than that of the trifocal group(all P<0.05); In the span of -3.00～-3.50D, the visual acuity of the hybrid group was the best, followed by trifocal group, and the lowest was in the micro single vision group(all P<0.05). At 3mo after operation, there was no significant difference in subjective visual quality scores among the three groups(P<0.05). Light interference in the micro single vision group was higher than that of the other two groups at 1mo after operation(P<0.05), and it decreased in the three groups at 3mo after operation, with no statistical significance(P<0.05).CONCLUSION: The three IOL implantation schemes can provide excellent visual quality for patients with high myopia and cataract. The vision of the micro single vision group and the hybrid group is better in the span of -1.00～-1.25D, and the hybrid group performs the best near vision in the span of -3.00～-3.50D. Although the design of micro single vision can make up for the weakness of Symfony IOL's lack of near vision, it is still worse than the hybrid group and the trifocal group.
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AIM: To compare the visual quality between smart pulse technology-assisted(SPT)transepithelial photorefractive keratectomy(TransPRK)of 1 050Hz ablation frequency and small incision lenticule extraction(SMILE)for myopia and astigmatism.METHODS: A total of 138 cases(248 eyes)who received corneal refractive surgery in the Eye Hospital of Chengdu University of TCM were enrolled from July 2020 to January 2021. The patients were divided into TransPRK group(64 cases, 123 eyes)and SMILE group(74 cases, 125 eyes)according to the surgical method. The follow-up duration was 6mo. Strehl ratio(SR)and high-order aberration at 6mm pupil diameter measured by Sirius anterior segment integrated analyzer and LogMAR visual acuity were recorded at different preoperative and postoperative time points.RESULTS: The uncorrected visual acuity(UCVA)of TransPRK group was worse than SMILE group at 1wk and 1mo after surgery(all P<0.05), but UCVA was better in TransPRK group at 6mo after surgery(P<0.05). SR in TransPRK group was lower than that in SMILE group at 1wk and 1mo after surgery(all P<0.05). There was no significant difference in SR between the two groups at 3 and 6mo after surgery(P=0.968, 0.433). At 1wk after surgery, there was no significant difference in coma between the two groups(P=0.554). At 1, 3, and 6mo after surgery, coma in the TransPRK group was lower than that in SMILE group(all P<0.05). At 1wk, 1 and 3mo after surgery, the trefoil aberration in TransPRK group was higher than that in SMILE group(all P<0.05). At 6mo after surgery, there was no significant difference in trefoil aberration between the two groups(P=0.167). At 6mo after surgery, UCVA of TransPRK group and SMILE group were -0.13±0.05 and -0.11±0.08, respectively, which were better than the best corrected visual acuity(BCVA)before surgery(-0.07±0.05 and -0.07±0.05; all P<0.05). Furthermore, the SR of both groups was higher than that before surgery(all P<0.05).CONCLUSION: Both SPT-assisted TransPRK of 1 050Hz ablation frequency and SMILE can achieve better visual acuity after refractive surgery, while SMILE has better visual quality at 1wk and 1mo after surgery. However, SPT-assisted TransPRK of 1 050Hz ablation frequency has better visual acuity at 6mo after surgery than SMILE, and the coma is smaller.
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Corneal refractive surgery and intraocular collamer lens(ICL)implantation are the mainstream refractive surgery methods at present. Many studies have proved that ICL implantation can effectively improve the postoperative visual acuity of patients. ICL implantation has gained favor among refractive doctors and patients because of its multiple advantages. Excellent postoperative visual acuity and visual quality are the key factors to improve patients' satisfaction. In order to evaluate the subjective and objective visual quality of patients after operation and avoid complications, this article reviews the visual quality and postoperative complications after ICL implantation.
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AIM: To investigate the visual quality of LENTIS Comfort Toric intraocular lens implantation in cataract surgery.METHODS: A retrospective controlled clinical study was conducted on 40 patients(40 eyes)who received phacoemulsification combined with intraocular lens implantation assisted by digital navigation, with LENTIS Comfort Toric(MF15T)implanted in group A(24 eyes)and monofocal Toric intraocular lens implanted in group B(16 eyes). The visual acuity at different distances, the postoperative astigmatism center of mass value, the lens loss rate, the change of defocus curve and the stability of intraocular lens were observed at 3mo after surgery.RESULTS: There were no serious complications in both groups, and there was no significant difference in distance vision between group A and group B at 3mo after surgery(P>0.05); the visual acuity and near vision in group A were significantly better than those in group B(P<0.01); the postoperative lens loss rate in group A was 99%, and it was 45% in group B(P<0.05); the value of astigmatism center of mass in 3mo after surgery was improved compared with that before surgery, and there was no significant difference between groups(P>0.05); the defocus curve of group A peaked at +0.50 and -1.75D at 3mo after surgery, forming plateau and gently declining, while group B showed a steep decline after peaks at +0.25 and -0.25D. One eye(4%)in group A had the axial rotation of intraocular lens greater than 10° at 1d after surgery; In group B, 6 eyes(38%)had axial rotation of intraocular lenses greater than 10°, 2 eyes(33%)rotated clockwise, and 4 eyes(67%)rotated counterclockwise. No intraocular lens displacement occurred in either group.CONCLUSION: Both kinds of intraocular lenses can correct astigmatism, among which LENTIS Comfort Toric intraocular lens can provide personalized choices for people with cataract and astigmatism, solve astigmatism and obtain full visual acuity at the same time, with low incidence of postoperative optical interference, better stability, high visual quality and satisfaction.
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AIM: To evaluate the effect of anterior capsule polishing on visual quality after phacoemulsification.METHODS: Prospective randomized control study. A total of 65 patients(73 eyes)with age-related cataract who underwent phacoemulsification combined with intraocular lens(IOL)implantation in the Emergency General Hospital between November 2021 and June 2022 were included. These patients were randomly assigned to two groups, with one group(anterior polishing group)underwent anterior and posterior capsule polishing(30 cases, 35 eyes), while the other(control group)receive routine posterior capsule polishing(35 cases, 38 eyes). Best corrected visual acuity was observed at 1wk, 1, 3 and 6mo after operation. Area of anterior capsule orifice was measured at 3 and 6mo after operation. Meanwhile, posterior capsular opacification(P score), IOL tilt and decentration were recorded by Pentacam Scheimpflug system. In addition, wavefront aberration, Strehl ratio(SR)of point spread function(PSF)and modulation transfer function(MTF)were evaluated by OPD-Scan Ⅲ.RESULTS: At 1wk, 1, 3 and 6mo after operation, best corrected visual acuity in anterior polishing group is significantly better than that of control group(P<0.05). There were no significant differences in area of anterior capsule opening, P score, IOL decentration, SR of PSF and MTF between two groups at 3 and 6mo after operation(P>0.05). At 3mo follow-up, no significant differences in IOL tilt and wavefront aberration were measured between two groups either(P>0.05). However, IOL tilt [(1.65±0.60)° vs.(2.34±0.43)°, P<0.001] and wavefront aberration(0.03±0.01μm vs. 0.06±0.03μm, P<0.001)in anterior polishing group were significant lower compared to control group at 6mo after operation.CONCLUSION: 360° polishing of anterior and posterior capsule during phacoemulsification can improve best corrected visual quality, with reduced IOL tilt, lower wavefront aberration and better visual quality.
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With people's attention and in-depth research on visual quality, many distinctive survey scales have been developed. The use of visual quality questionnaires is a subjective way to evaluate patients' visual quality, an expression of patients' self feelings, and an important part of reflecting visual quality. With objective detection methods, the results are more convincing. Many scales have been introduced into China and have been revised through translation, back translation, and cultural adaptation, playing an indispensable role in the visual quality evaluation system. It is particularly important to assess visual quality through psychological and sociological content, and whether the content can be appropriately combined with the subjective feelings of patients. The core of the visual quality of life survey questionnaire lies in its high repeatability. This article summarizes commonly used visual quality questionnaires, which have been verified in terms of validity, reliability, and responsiveness. The validity of the measurement scale, the consistency of the measurement results, the ability to reflect the smallest meaningful clinical changes after effective medical intervention, and the design characteristics, main application directions, and trends of the scale are listed to provide reference for clinical workers to choose appropriate survey scales.
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AIM: To investigate the correlation between postoperative lens decentration and tilt and visual quality in eyes implanted with aspherical intraocular lens(IOL)by using a new anterior segment swept-source optical coherence tomography(OCT)CASIA2.METHODS: An observational study. A total of 90 eyes of 62 participants who underwent age-related cataract surgery at 1mo were included. Using CASIA2 by an experienced examiner, IOL tilt and decentration were obtained three consecutive times after mydriasis and the vector mean values were calculated. Double-pass optical quality analysis system(OQAS)and wavefront aberration instrument KR-1W were used for the visual quality measurements, including the total high-order aberration(tHOA), spherical aberration(SA), Coma, objective scatter index(OSI), modulation transfer function cut off frequency(MTF cut off)and Strehl ratio(SR)at 4 and 6mm pupil diameter.RESULTS: IOL decentration was positively correlated with SA(r=0.347, P=0.001)and OSI(r=0.343, P=0.002)at 4mm pupil diameter, and it was negatively correlated with MTF cut off(r=-0.244, P=0.032). There was no significant correlation between IOL decentration and tHOA, Coma and SR. IOL tilt was negatively correlated with MTF cut off(r=0.-345, P=0.002)and SR(r=-0.256, P=0.023)at 4mm pupil diameter, but it was not correlated with tHOA, SA, Coma and OSI. There were no significant correlations between the IOL decentration and tilt and tHOA, SA, Coma, MTF cut off and SR at 6mm pupil diameter.CONCLUSION: After aspherical IOL implantation in age-related cataract patients, IOL decentration was weakly correlated with SA at 4mm pupil diameter, while decentration and tilt were not significantly correlated with other higher-order aberrations. The decentration and tilt were weakly correlated with OSI value and MTF cut off value of the visual quality parameters. The results suggest that clinicians should pay more attention to higher-order aberrations and visual quality during precise cataract surgery.
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@#AIM: To investigate the effects of long-term orthokeratology lens wearing on corneal morphology, corneal biomechanics and objective visual quality.METHODS: A retrospective study was conducted to collect 33 myopic patients(60 eyes), including 19 males(35 eyes)and 14 females(25 eyes), mean age 11.80±1.51 years old, with an average equivalent spherical lens of -3.25±0.69D, who had been wearing orthokeratology lens for 2a from October 2019 to December 2020 in our hospital. Relevant data were collected before wearing and 2a after wearing. The radius of curvature(ARC and PRC), the thickness of the thinnest cornea(THP)and the index of comprehensive deviation analysis of corneal dilation(BADD)were measured by Pentacam anterior segment analysis system. Corvis ST biomechanical analyzer measured non-contact biomechanical corrected intraocular pressure(blOP), maximum deformation amplitude(DA), maximum reverse radius(HCR), ratio of deformation amplitude between apex and 1mm(DR), hardness parameters(SPA1), and corneal biomechanical parameters(CBI). The biomechanical index(TBI)of CT scan was obtained by the combined diagnosis system of Pentacam and Corvis ST. OQAS-II objective visual quality analysis system measured modulation transfer function cutoff frequency(MTF cutoff), Stryl ratio(SR), objective scattering coefficient(OSI)and OV value(OV100%, OV20% and OV9%). The above parameters were compared before and continuously wearing orthokeratoscope for 2a. RESULTS: After 2a of wearing orthokeratology, ARC increased, THP decreased, and BADD increased(<i>t</i>=-9.38, 2.85, -13.08; all <i>P</i><0.05), while there was no significant difference between PRC and before wearing(<i>t</i>=1.49, <i>P</i>>0.05). DA increased and HCR decreased compared with before wearing orthokeratology lens(<i>t</i>=-2.37, 2.28; all <i>P</i><0.05), but bIOP, DR, SPA1, CBI and TBI showed no difference(<i>t</i>=1.36, -1.87, 1.27, -0.95, -1.49; all <i>P</i>>0.05). SR was higher than before, OV20% and OV9% were lower than before(<i>t</i>=-5.31, 8.37, 2.34; all <i>P</i><0.05), MTF cutoff, OSI and OV100% had no difference compared with before(<i>t</i>=-1.57, -1.35, 1.11; all <i>P</i>>0.05).CONCLUSION: Long-term wearing of orthokeratology lens changed the morphology of the anterior corneal surface, but had no significant effect on the corneal biomechanics, and the objective visual quality of patients was improved during the day, but decreased at night.
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AIM: The clinical outcomes of unilateral single-focal intraocular len(SIOL), contralateral implanted multifocal IOL(MIOL)and the SIOL was implanted in binoculus were compared.METHODS: There were 60 cases with 120 eyes age-related cataract patients in January 2019 to January 2021 underwent phacoemulsification and IOL implantation in Chengdu Aier Eye Hospital. The SIOL has been implanted in the dominant eyes, all patients were divided into three groups according to the types of IOL implanted in the contralateral non-dominant eyes, among them, there were 36 eyes of 18 cases in group A with non-dominant eyes implanted MIOL(SBL-3); 38 eyes of 19 cases in group B were implanted MIOL(SN6AD1)in non-dominant eyes. SIOL was implanted in all 46 eyes of 23 cases of control group. After operation at 3mo,the results of binocular vision and visual quality of the three groups were evaluated and compared.RESULTS: After operationat 3mo, there was no difference in the uncorrected distance vision and corrected distance vision, uncorrected medium vision and corrected near vision among the three groups(P<0.05).The uncorrected near visual acuity and corrected intermediate visual acuity of both eyes in groups A and B were significantly improved in both groups compared with the control group(P<0.05). The scores of Catquest 9SF-CN scale showed that the quality of life of patients in group A and group B(11.11±1.323, 11.89±1.883 scores)was better than that in the control group(14.65±1.722 scores, both P<0.05). The rate of lens removal in group A, B and control group were 88.9%, 84.2% and 39.1%, respectively, and the rate of lens removal in group A was significantly higher than that in the control group(P<0.0167).CONCLUSION: Dominant eye implantation of SIOL in patients with cataract and contralateral non-dominant eye implantation of MIOL(SBL-3/SN6AD1)can obtain better full-range visual acuity than binoculus, less postoperative adverse visual symptoms, and higher patient disengagement rate and satisfaction.
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AIM: To compare the visual quality in patients after implantation of extended-range-of-vision(Tecnis Symfony)intraocular lens(IOL)and zonal refractive(Lentis Comfort LS-313 MF15)IOL. METHODS: A prospective clinical study. Collecting 267 cataract patients(305 eyes)who underwent phacoemulsification combined with IOL implantation surgery in our hospital from January 2021 to December 2021,they were divided into the Symfony group(group A, 160 eyes)and MF15 group(group B, 145 eyes)according to the types of implanted IOL. Postoperative visual acuity were observed at 3mo and included uncorrected distance visual acuity(UDVA, 5m), uncorrected intermediate visual acuity(UIVA, 80 cm), uncorrected near visual acuity(UNVA, 40cm), defocus curve, modulation transfer function(MTF)and high-order aberrations(HOAs), including coma, spherical aberration and trefoil aberration, and conducted the Quality of Vision(QoV)questionnaire.RESULTS: There were no significant differences in the preoperative parameters in both groups(P>0.05). There was no significant difference between the UDVA and UNVA in groups A and B(P>0.05); The UIVA was higher in group A than in group B(P<0.05); The MTF value in group A was higher than group B at all spatial frequency, and the difference was statistical significant(P<0.05); The HOAs in group A was lower than that in group B(P<0.05); Defocus curves were plotted 3mo after the operation suggest that the visual acuity of the two groups was similar at 0D, and the visual acuity of the groups A was better than group B from -0.5D to -2.5D, and there was a statistically significant difference at -1.0D and -2.0D(P<0.05). The QoV score in group A was significantly higher than that in group B(P<0.05). The frequency of bad visual interference such as halo and starburst was higher in group A than in group B. CONCLUSION: Both the MF15 and Symfony can provide stable distance and near visual acuity. Compared with MF15, Symfony had better intermediate visual acuity, higher contrast sensitivity and lower HOAs. Compared with Symfony, MF15 IOL had less postoperative bad visual interference symptoms(halo, starburst, etc).
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Objective:To compare the one-year postoperative visual quality after trifocal intraocular lens (IOL) implantation and monofocal IOL implantation.Methods:A cohort study was conducted.Forty-one eyes from 41 age-related cataract patients who underwent phacoemulsification extraction combined with IOL implantation in Nanjing Drum Tower Hospital from May 2017 to June 2018 were enrolled.The patients were divided into trifocal IOL group (20 eyes) receiving ZEISS AT LISA tri 839MP trifocal IOL implantation and monofocal IOL group (21 eyes) receiving ZEISS 603P monofocal IOL implantation according to their willingness.One year after surgery, uncorrected distant visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), best corrected distance visual acuity (BCDVA), distance corrected intermediate visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were detected in both groups.The patient point spread function (PSF), modulation transfer function (MTF) cutoff frequency, Strehl ratio (SR), OQAS Ⅱ values at 100%, 20%, and 9% contrast (OV 100%, OV 20%, OV 9%) and objective scattering index (OSI) were measured by OQAS Ⅱ.Wavefront aberrations including total aberration (TA), total high order aberrations (tHOAs), spherical aberration, coma, trefoil aberration, total low order aberrations (tLOAs), defocus, and astigmatism were evaluated with the iTrace visual function analyzer.All aberrations were represented by root mean square.The visual acuity of operative eyes was measured with a phoropter, and defocus curves were drawn with visual acuity better than 0.5 LogMAR.The incidence of posterior capsular opacification (PCO) in the IOL region was quantitatively analyzed by Sellman method.Visual function was scored by visual function index (VF-14). This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School (No.2018-219-01). Written informed consent was obtained from each subject prior to any medical examination.Results:One year after the operation, UCIVA, UCNVA, DCIVA, and DCNVA of trifocal IOL group were significantly better than those of monofocal IOL group, and the differences were statistically significant (all at P<0.001). OQAS Ⅱ visual quality indicators showed that the MTF cutoff frequency, SR, OV 100%, and OSI values of trifocal IOL group were significantly higher than those of monofocal IOL group, showing statistically significant differences (all at P<0.001). No significant difference in wavefront aberrations was found between the two groups (all at P>0.05). Defocus curve showed that the LogMAR visual acuity of patients at -1.0 D, -1.5 D, -2.0 D, -2.5 D, -3.0 D, and -3.5 D (namely, 1 m, 66 cm, 50 cm, 40 cm, 33 cm, and 29 cm) in monofocal IOL group were significantly better than those in trifocal IOL group (all at P<0.05). There was a higher incidence of PCO in trifocal IOL group than monofocal IOL group, with a statistically significant difference ( χ 2=41.0, P<0.001). The VF-14 score of trifocal IOL group was 87.99±1.09, which was significantly higher than 81.49±1.67 of monofocal IOL group ( t=10.301, P<0.001). Conclusions:One year after trifocal IOL implantation, the full range of vision, subjective and objective visual quality of eyes are better than eyes implanted with monofocal IOL.
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Objective:To evaluate and compare the postoperative visual quality after phacoemulsification combined with toric (ART) and non-toric (ReSTOR) multifocal intraocular lens (IOL) implantation.Methods:A cohort study was conducted.Thirty-nine cataract patients (50 eyes) who underwent phacoemulsification combined with ART IOL implantation were enrolled as ART group, and 32 patients (41 eyes) who received ReSTOR IOL implantation were enrolled as ReSTOR group in Tianjin Medical University Eye Hospital from January 2017 to January 2018.Three months after surgery, the uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA), manifest refraction, defocus curve, contrast sensitivity (CS), modulation transfer function cutoff, Strehl2D ratio (SR), objective scattering index, OQAS values under 100%, 20%, 9% contrasts (OV 100%, OV 20%, OV 9%), total aberrations, total lower-order aberrations, total higher-order aberrations, spherical aberrations, coma and trefoil aberrations of the two groups were tested and compared.The study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Tianjin Medical University Eye Hospital (No.2019KY[L]-04). Written informed consent was obtained from each subject prior to entering the cohort.Results:UDVA at 3 months after surgery was (0.07±0.09)LogMAR and (0.09±0.12)LogMAR in ART group and ReSTOR group, and CDVA was (-0.01±0.07)LogMAR and (-0.01±0.07)LogMAR, and UIVA was (0.23±0.11)LogMAR and (0.22±0.13)LogMAR, and UNVA was (0.11±0.15)LogMAR and (0.06±0.11)LogMAR.UNVA was slightly better in ReSTOR group than ART group, and the difference was statistically significant ( t=2.085, P=0.040). The mean depth of focus was (4.12±0.79)D in ART group and (4.24±0.95)D in ReSTOR group.The postoperative residual astigmatism (0.32±0.31)D was significantly lower than preoperative corneal astigmatism (1.27±0.40)D in ART group ( t=13.209, P<0.001). CS values at 6, 12, and 18 c/d under photopic without glare, 12 and 18 c/d under photopic with glare, 3, 6, and 12 c/d under scotopic without glare in ART group were slightly lower than those in ReSTOR group, showing statistically significant differences (all at P<0.05) without clinical significance.SR and OV 20% values in ART group were 0.14±0.05 and 0.55±0.24, which were slightly lower than 0.17±0.06 and 0.66±0.29 in ReSTOR group, with statistically significant differences ( t=-2.012, P=0.048; t=-2.557, P=0.043). Total aberrations and coma aberration under 5 mm pupil diameter in ART group were 0.88(0.59, 1.13)μm and 0.21(0.13, 0.30)μm, which were higher than 0.58(0.47, 0.74)μm and 0.10(0.08, 0.21)μm in ReSTOR group, showing statistically significant differences ( Z=-2.073, P=0.038; Z=-2.101, P=0.036). Conclusions:Cataract phacoemulsification combined with ART IOL implantation can provide good vision and visual quality while correcting preoperative corneal astigmatism, and the resolution in dim light or low to medium spatial frequencies is slightly weaker than eyes implanted with ReSTOR IOL.
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@#AIM: To investigate the subjective visual quality, reading fluency and patient satisfaction after a unilateral or bilateral implantation of the Tecnis Symfony extended depth of focus intraocular lens(IOL)with cataract.<p>METHODS: The retrospective analysis on the 48 patients(71 eyes)with cataract phacomulsification surgery in our hospital, which were randomly divided into two groups. The bilateral group with 23 patients(46 eyes)bilateral implanted the Symfony extended depth of focus IOL, the unilateral group with 25 patients(25 eyes)implanted the Symfony IOL in one eye and an aspherical monofocal IOL in the other eye. The uncorrected distance visual acuity(UDVA), uncorrected intermediate distance visual acuity(UIVA), uncorrected near distance visual acuity(UNVA), and best corrected distance visual acuity(BCVA)were measured 3, 6mo after surgery. The contrast sensitivity, reading fluency, reading speed, patient satisfaction and the occurrence of complications were also observed.<p>RESULTS: In the unilateral group, there were no significant differences in the UDVA and BCVA between an eye with the Symfony IOL and an eye with monofocal IOL 3mo after surgery(P>0.05). After 6mo of surgery, UDVA were significantly better than pre-operation in two groups, average visual acuity of LogMAR was under 0.1. There were no significant differences in UDVA, BCVA, UIVA and UNVA between two groups(P>0.05). The patients'far, intermediate, and near distances satisfaction were higher after 3mo of surgery. There were no statistically significant differences in spatial frequency contrast sensitivity between the two groups under photopic/mesopic conditions and mesopic with glare 6mo after surgery. The scores of satisfactions for reading fluency were better in the bilateral group than in the unilateral group(P>0.05). After 6mo, the reading speed of binocular group was slightly higher than the unilateral group(P<0.05), but there was no significant difference between two groups(P >0.05).<p>CONCLUSION:The Symfony extended depth of focus IOL provides good far, intermediate, and near visual acuity in the bilateral group and the unilateral group, while maintaining the same level of visual quality. In both groups over 90% patients were spectacle independent. Symfony IOL has widely adaptability and highly predictability, patients can obtain better satisfactions for reading fluency and reading speed. It is more suitable for intermediate vision.
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@#AIM: To analyze the errors of objective visual quality after the implantation of segmented refractive multifocal intraocular lenses in patients with age-related cataract. <p>METHODS: In this retrospective study including 180 eyes of 116 patients with senile cataract, implantation of either Aspira-aA IOL or LS-313 MF30 IOL was performed in Hainan Eye Hospital, Zhongshan Ophthalmic Center, Sun Yat-sen University. According to the implanted IOL, the patients were divided into the SIOL(Aspira-aA)group(61 patients, 96 eyes)and the MIOL(LS-313 MF30)group(55 patients, 84 eyes). Three months postoperatively, uncorrected distance visual acuity(UCDVA), best corrected distance visual acuity(BCDVA), uncorrected intermediate visual acuity(UCIVA)and uncorrected near visual acuity(UCNVA)were assessed. Total higher-order aberrations(HOAt), internal higher-order aberrations(HOAi), corneal higher-order aberrations(HOAc), spherical aberration(SA), coma aberration(CA), trefoil aberration(TA), Strehl ratio(SR), average height of modulation transfer function(MTF AvgHeight)and dysfunctional lens index(DLI)were measured by iTrace visual quality analyzer(scanning diameter 3mm)three months postoperatively. <p>RESULTS: Three months postoperatively, there was no statistically significant difference between the two groups in UCDVA and BCDVA(t=-0.789, -0.815; all P>0.05). UCIVA and UCNVA in the MIOL group were better than those in the SIOL group, with statistically significant difference(t=1.971, 3.215; all P<0.05). No statistically significant differences were observed in HOAc and spherical aberration between the two groups(t=1.126, -0.995; all P>0.05). HOAt, HOAi, coma aberration and trefoil aberration were larger in the MIOL group than those in the SIOL group(t=-2.518, -2.926, -2.859, -3.128; all P<0.05). Strehl ratio, MTF AvgHeight and DLI in the MIOL group were lower than those in the SIOL group, with statistically significant difference(t=2.8537, 2.014, 3.292; all P<0.05). The results of retinal letter, MTF AvgHeight and SR showed that HOAt and HOAi increased significantly in the MIOL group. The retinal spot diagram showed that coma aberration and trefoil aberration increased significantly with the addition of +3D spherical diopter. <p>CONCLUSION: Segmented refractive multifocal intraocular lens can provide excellent uncorrected distance, intermediate and near visual acuity. There may be errors in aberration measurement by iTrace visual quality analyzer after segmented refractive multifocal intraocular lenses implantation. The design of intraocular lens may lead to the postoperative increase in aberration and a decrease in objective visual quality.
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Femtosecond laser small incision lenticule extraction(SMILE)is one of the most advanced corneal refractive operations at present. Different from other traditional corneal refractive operations, SMILE achieves minimally invasive and valveless operation. Therefore, the evaluation of postoperative visual quality of SMILE also has its own characteristics, at present, the latest research at home and abroad has confirmed that the naked eye vision can be significantly improved and the refractive status is stable after SMILE. However, there are different understandings of the objective visual quality indexes and their influencing factors, such as higher-order aberration, modulation transfer function cut off(MTF cut off)and objective scatter index(OSI)after SMILE. This paper reviews the postoperative visual quality and its influencing factors after SMILE to provide clinical help.
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AIM: To evaluate the visual quality of patients after modified design aspheric balance curve(ABC)with intraocular lens(IOL)implantation, and to analyze the influencing factors of clinical IOL selection and guide the patient's IOL selection plan. METHODS: A prospective case-control study was conducted in 67 patients(74 eyes)with simple cataract underwent phacoemulsification and foldable aspheric IOL implantation, and 23 eyes in the observation group were implanted with modified design IOL(HOYA Vivinex XY1 group), the control group was implanted with 51 eyes of traditional design IOL(Tecnis ZCB00 group with 27 eyes, IQ SN60WF group with 24 eyes). The uncorrected visual acuity, the best corrected visual acuity, total ocular spherical aberration(SA)and coma under different pupil diameters(3, 4, 5, 6mm), and different pupil diameters(3, 4, 5mm)were measured 1wk and 1mo after operation, the modulation transfer function(MTF)curve, objective scattering index(OSI), intraocular scattered light value Log(s)and contrast sensitivity were obtained. Statistical analysis was performed on the obtained data.RESULTS: The uncorrected visual acuity and best corrected visual acuity at 1wk and 1mo after operation in the three groups were significantly improved compared with those before operation, there was no significant difference among groups(P>0.05). The difference of total ocular spherical aberration was statistically significant among the three groups with 5 and 6mm pupil diameter 1wk after operation(P=0.045, 0.037)and there were differences among three groups in pupil diameter of 6mm at 1mo after operation(P=0.042). Comparing the total ocular coma aberration, there were differences among the three groups at 1wk and 1mo after the operation at the pupil diameter of 5 and 6 mm(P<0.05). With the increase of pupil diameter at 1wk and 1mo after operation, the total ocular spherical aberration in the HOYA Vivinex XY1 group was lower than that in the other two groups. The MTF values of the Vivinex XY1 group were higher than those that of the control group at each spatial frequency, there was no significant difference among groups(P>0.05), and there were no statistical differences in objective scattering index, intraocular scattered light value Log(s)and contrast sensitivity among the three groups(P>0.05).CONCLUSION:The improved design of the modified Vivinex IOL can reduce the total ocular spherical aberration and coma, improve the visual quality, and provide a new method for the selection of aspheric IOL.