Visual and refractive outcomes after implantation of two models of trifocal intraocular lenses in eyes with previous corneal ablation to treat hyperopia.

BACKGROUND: To assess whether a trifocal intraocular lens (IOL) with neutral spherical aberration (SA) provides better visual and refractive outcomes than a trifocal IOL with negative SA after hyperopic corneal laser ablation. METHODS: This is a retrospective comparative study. Patients were classified according to the IOL implanted after cataract or clear lens phacoemulsification [group 1, PhysIOL FineVision Pod-F (negative SA); group 2, Rayner RayOne Trifocal (neutral SA)]. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction. RESULTS: 198 eyes of 119 patients met the inclusion criteria. Group 1 comprised 120 eyes and group 2 comprised 78 eyes. At completion, the refractive and predictability results were significantly better in group 1 than in group 2 for manifest refraction spherical equivalent (MRSE) (P < 0.001). Differences were not significant for UDVA (P = 0.647), CDVA (P = 0.343), UIVA (P = 0.059), UNVA (P = 0.382), binocular UIVA (P = 0.157), or binocular UNVA (P = 0.527). Safety and efficacy indices in refractive lens exchange (RLE) eyes were 0.96 and 0.91, and 0.89 and 0.93 in groups 1 and 2, respectively (P = 0.254 and 0.168). Patient satisfaction was similar in both groups (P > 0.05, all items). CONCLUSION: In eyes previously treated with hyperopic corneal ablation, implantation of a trifocal IOL with neutral SA provided better efficacy and safety outcomes but worse predictability outcomes than those obtained with a trifocal model with negative SA.

Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens: a retrospective cohort study.

BACKGROUND: Diffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling. METHODS: This is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE). RESULTS: Mean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 µm with the ERM to 313.70 ± 36.98 µm after PPV. Mean SE after lensectomy was - 0.18 ± 0.38 D, which minimally changed to - 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV. CONCLUSION: PPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.

Bilateral Refractive Lens Exchange With Trifocal Intraocular Lens for Hyperopia in Patients Younger Than 40 Years: A Case-Control Study.

PURPOSE: To evaluate visual outcomes, satisfaction, and spectacle independence in non-presbyopic hyperopic patients who underwent bilateral refractive lens exchange with a trifocal intraocular lens (IOL) and to compare them with presbyopic hyperopic patients. METHODS: In this retrospective study, patients younger than 40 years underwent bilateral refractive lens exchange with a diffractive trifocal IOL (FineVision Micro F; PhysIOL SA) for hyperopia with at least 3 months of follow-up. A control group of patients older than 50 years was matched by axial length, sex, and follow-up. Safety, efficacy, predictability, patient satisfaction, and spectacle independence were evaluated. RESULTS: One hundred thirty-three patients (average age = 36.94 ± 2.91 years; range = 21.50 to 40 years) were included in this study. After a mean follow-up of 8.83 ± 5.69 months (range = 2.75 to 77.63 months), the safety and efficacy indexes and predictability within ±1.00 diopters (D) were 1.02%, 0.98%, and 99.62%, respectively, which was not different from the control group (P > .05). No intraoperative complications were recorded. The only postoperative complication was posterior capsule opacification in 21 eyes (7.89%), which was similar to the control group (P > .05). Ninety-seven percent of patients in each group expressed that they were satisfied and all of them in each group reported that they did not use spectacles for distance, intermediate, or near vision. CONCLUSIONS: Refractive lens exchange and trifocal IOL implantation for hyperopia in patients without presbyopia provided the same good visual outcomes as in presbyopic patients with a high rate of patient satisfaction and spectacle independence. [J Refract Surg. 2021;37(8):524-531.].

Laser in Situ Keratomileusis and Surface Ablation in Breastfeeding Patients.

PURPOSE: Our objectives were to determine the anatomical and functional (visual and refractive) outcomes of corneal refractive surgery during breastfeeding and to compare the results with those of women who stopped breastfeeding at least 3 months before the procedure. We also evaluated predictability, safety, and efficacy indexes; number of retreatments; and adverse effects reported in babies. METHODS: We performed a multicenter, retrospective, interventional case series review of patients who were breastfeeding and who underwent laser in situ keratomileusis or surface ablation (photorefractive keratectomy) from September 11, 2002 to December 12, 2017 (group 1, n = 142 eyes in the case group). Patients were compared with women who stopped breastfeeding at least 3 months before the procedure from September 11, 2002 to December 12, 2017 (group 2, n = 95 eyes in the control group). A total of 168 women (237 eyes) were included. Patients were incorporated consecutively. Functional (visual and refractive) and anatomical outcomes are described. RESULTS: No significant intraoperative or postoperative complications were recorded. There were no significant differences between the groups in visual acuity, postoperative spherical equivalent, efficacy index, predictability, safety index, or retreatments. No infants experienced adverse effects. CONCLUSIONS: In our experience, laser in situ keratomileusis and photorefractive keratectomy can be performed effectively and safely in breastfeeding women.

Outcomes of Flap Lift Laser In Situ Keratomileusis Enhancements in a Large Patient Population: Does Application of a Bandage Contact Lens Affect Incidence of Epithelial Ingrowth?

PURPOSE: To compare the incidence of corneal epithelial ingrowth (EIG) and the visual outcomes of enhancement with laser in situ keratomileusis (LASIK) by flap lift when a bandage soft contact lens (CL) was fitted after the procedure and when it was not. METHODS: This is a multicenter, retrospective, interventional case series in which all patients who underwent LASIK enhancement from January 2005 to January 2015 were included consecutively. Patients were grouped depending on whether a bandage CL was fitted after re-treatment by flap lift (group 1) or not (group 2). RESULTS: A total of 16,702 eyes from 12,485 patients were included. There were statistically significant differences between the groups regarding corrected distance visual acuity (better in group 1) and safety index (better in group 2) although these were not clinically relevant. The incidence of EIG was 0.58% in group 1 and 0.55% in group 2 although, again, the difference was not statistically different. CONCLUSIONS: We found no relevant differences in LASIK enhancement between patients who received a bandage CL and those who did not regarding the incidence of EIG and visual outcomes.

Incidencia de la queratitis infecciosa y resultados de 351 712 procedimientos de cirugía refractiva con láser excimer / Infectious keratitis incidence and outcomes for 351 712 laser-assisted in situ keratomileusis surgical procedures with excimer laser

Estudiar la incidencia de queratitis infecciosas (QI) tras la cirugía refractiva con láser excimer (laser assisted in situ keratomileusis [LASIK] y ablación de superficie [AS]: LASEK y PRK) el diagnóstico, la actitud terapéutica adoptada, el manejo y los resultados. Material y método: Hemos realizado un estudio retrospectivo multicéntrico en 351 712 ojos intervenidos consecutivamente, de todos aquellos casos susceptibles de ser diagnosticados como QI por la clínica o los hallazgos biológicos. Resultado: Se recolectó un total de 147 casos de QI (lo que supone una incidencia del 0.0417%) ; en 100 casos lo fueron tras la LASIK (0.0307%) y 47 tras la AS (0.176%). La infección corneal se presentó en el 57.8% en el ojo derecho y en el 42.2% en el ojo izquierdo; en 12 pacientes la presentación fue bilateral. El tiempo transcurrido desde la cirugía LASIK hasta el comienzo de los síntomas fue de 16 ± 32 días, fue temprano en el 62%; tras la AS, fue a los 13 ± 26 días (rango: 1 a 160), el 71.79% se presentó en la primera semana. En 23 casos, tras la LASIK, de los 74 en los que se tomaron muestras, el resultado del cultivo fue positivo. Se tomaron muestras en 33 casos de la serie de AS, 15 de los cuales fueron positivos. En el grupo de LASIK, el 22% de los ojos perdió una o más líneas de su agudeza visual lejana corregida (CDVA), mientras que en el 53% de los ojos la visión final fue de 20/20 y en el 95% lo fue de 20/40 o mejor. En 31 ojos (66%) del grupo de AS se mantiene la CDVA; la visión final fue de 20/20 en el 54.7% y de 20/40 en el 93.6% de los ojos. Conclusiones: La incidencia de infección después de la LASIK es baja, pero la tasa de infección después de la AS es estadísticamente más elevada. La aparición de esta complicación en pacientes asintomáticos subraya la necesidad de revisiones posoperatorias. No hemos encontrado diferencias estadísticamente significativas entre la agudeza visual final tras infecciones después de AS y de LASIK...

Interface fluid syndrome in routine cataract surgery 10 years after laser in situ keratomileusis.

PURPOSE: Interface fluid syndrome is an unusual complication after laser in situ keratomileusis (LASIK). We present a case of interface fluid syndrome after cataract surgery in a patient who had previous LASIK surgery. METHODS: A 62-year-old man underwent routine cataract surgery on the left eye 10 years after LASIK on both eyes. The day after surgery, the intraocular pressure (IOP) was 21 mm Hg and a pocket of fluid was present in the interface LASIK wound. The patient was treated with 0.50% timolol eye drops twice daily. RESULTS: The problem resolved within 1.5 months. Two months later, the patient underwent routine cataract surgery of the right eye. The next day, the IOP was 11 mm Hg and LASIK interface fluid was present. The patient was treated with 0.5% timolol eye drops twice daily. Two months after the surgery, the problem had completely resolved. CONCLUSIONS: Ocular hypertension and traumatic endothelial cell damage could have been the causes of the syndrome. Although the IOP was not very high, previous LASIK could have led us to underestimate the IOP.

Myopic LASIK in psychiatric patients.

PURPOSE: To evaluate the surgical results obtained in patients with psychiatric disorders who underwent myopic laser in situ keratomileusis. (LASIK). METHODS: Retrospective study of 156 eyes of 82 patients who underwent LASIK to correct a myopic spherical equivalent (SE) at Clínica Baviera-Instituto Oftalmológico Europeo, Bilbao, Spain. All procedures were performed with the Technolas Keracor 217 Z excimer laser. Patients had a preoperative diagnosis of bipolar disorder (79 eyes of 42 patients), schizophrenia (61 eyes of 32 patients), or obsessive-compulsive disorder (16 eyes of 8 patients). Before surgery, the average sphere of the series was -3.92 ± 2.24 D in the first group, -3.45 ± 2.03 D in the second group, and -3.39 ± 1.97 D in the third group. We surveyed the patients to analyze subjective assessment from the patient's perspective. RESULTS: At the last available visit after treatment, we obtained an SE of ±0.50 D in 85.71% of eyes with bipolar disorder, 88.52% of eyes with schizophrenia, and 93.75% of eyes with obsessive-compulsive disorder. The efficacy index was 1.00 ± 0.20 in the first group, 1.03 ± 0.21 in the second group, and 1.00 ± 0.07 in the third group. No eye lost 2 lines or more of best spectacle-corrected visual acuity. CONCLUSIONS: We found that patients with compensated psychiatric disorders, of which the surgeon was aware, achieved excellent results after surgery, with no remarkable complications. Patients tolerated the procedures well and were satisfied.

Myopic LASIK and LASEK in patients with preoperative mean central keratometry ≥47.50 D.

PURPOSE: To evaluate whether patients who undergo myopic LASIK or laser epithelial keratomileusis (LASEK) with preoperative central keratometry ≥47.50 diopters (D) are at higher risk for developing corneal ectasia postoperatively. METHODS: Records of 32 patients (54 eyes) who underwent myopic LASIK or LASEK between May 2002 and July 2005 with preoperative mean central keratometry ≥47.50 D were retrospectively reviewed. Patients eligible for the study were offered free follow-up. Last follow-up was at least 3 years after surgery. All procedures were performed with the Technolas Keracor 217z excimer laser (Bausch & Lomb). RESULTS: Twenty-four patients (40 eyes) had LASIK and 8 patients (14 eyes) had LASEK. At last follow-up, no patient had developed ectasia. CONCLUSIONS: This study suggests that patients with preoperative central keratometry ≥47.50 D as the only parameter evaluated should not be excluded from corneal refractive surgery due to increased risk of postoperative ectasia. However, when this preoperative finding is accompanied by other topographic abnormalities, treatment options should be carefully evaluated.

Retreatment of hyperopia after primary hyperopic LASIK.

PURPOSE: To evaluate factors that influence retreatment results after primary hyperopic LASIK. METHODS: Restrospective study of 86 eyes of 61 patients that underwent LASIK to correct primary hyperopic spherical equivalent refraction and a second hyperopic retreatment due to undercorrection. All procedures were performed with the Technolas Keracor 217C excimer laser, lifting the preexisting flap for the retreatment. Preoperatively, under cycloplegia, mean spherical equivalent refraction of the series was +3.05 +/- 0.99 diopters (D). RESULTS: At last follow-up, mean spherical equivalent refraction was -0.07 +/- 0.50 D. Efficacy of the retreatment procedure was better when the primary LASIK attempted spherical equivalent refraction correction was < +3.00 D (P < .05). Safety of retreatment was lower when attempted spherical equivalent refraction correction was > +1.00 D (P < .05) and when attempted spherical equivalent refraction correction of both procedures combined was >+4.00 D (P < .05). CONCLUSIONS: Efficacy, safety, and predictability of retreatments secondary to undercorrection after primary hyperopic LASIK may be affected depending on the amount of diopters corrected in the primary procedure, in the retreatment procedure, and in both primary and retreatment procedures combined.