Comparative Analysis of the Clinical Outcomes of Two Toric Presbyopia-Correcting Intraocular Lenses.

INTRODUCTION: To evaluate and compare the clinical outcomes of two toric presbyopia-correcting intraocular lenses (IOLs). METHODS: Non-randomized prospective comparative study including 86 eyes of 51 patients (age 43-83 years) that underwent cataract surgery with implantation of one of the following two IOLs: TECNIS Toric Synergy (Johnson & Johnson Vision) (Synergy group) or AT LISA tri toric 939MP (Carl Zeiss Meditec) (ATLISA group). Visual and refractive outcomes were evaluated during a 6-month follow-up. RESULTS: At 6 months after surgery, all eyes achieved uncorrected distance visual acuity 20/25 or better in both groups, whereas 96.2% and 100% of eyes achieved uncorrected near visual acuity (UNVA) 20/25 or better in the ATLISA and Synergy groups, respectively. All eyes achieved postoperative mesopic UNVA 20/30 or better in both IOL groups; 96.2% and 100% of eyes had a manifest cylinder ≤ 0.50 D at 6 months in ATLISA and Synergy groups, respectively. Mean magnitude of error was 0.04 ± 0.20 and - 0.04 ± 0.09 D in ATLISA and Synergy groups, respectively (p = 0.05). In the defocus curve, significant differences were found between IOL groups for most of distance-corrected visual acuities, except those corresponding to defocus of 0 D (p = 0.268) and - 1 D (p = 0.361). CONCLUSIONS: The two toric presbyopia-correcting IOLs evaluated provide an efficacious astigmatic correction combined with a successful distance, intermediate and near visual rehabilitation. The visual performance seems to be better for most visual demands with the TECNIS Toric Synergy IOL, especially for distances closer than 40 cm.

Predictability of the Achieved Lenticule Thickness in Keratorefractive Lenticule Extraction for Myopia Correction.

PURPOSE: To assess the predictability between the SCHWIND ATOS femtosecond laser (SCHWIND eye-tech-solutions) read-out and achieved lenticule thickness measured using MS-39 anterior segment optical coherence tomography (ASOCT; CSO) at the corneal vertex at postoperative 1 day and 1 and 3 months of follow-up. METHODS: This retrospective case series included 130 eyes of 65 consecutive patients who were treated with SmartSight (SCHWIND eye-tech-solutions) lenticule extraction. Sixty-four percent of patients were women with a mean spherical refraction of -4.98 ± 1.19 diopters (D) and mean astigmatism of 0.53 ± 0.64 D. The measurements were performed using AS-OCT with the Phoenix Software v 4.1.1.5. Lenticule thickness was obtained by the subtraction method between preoperative and postoperative total corneal thickness. RESULTS: A lower reduction in central corneal thickness (CCT) compared to the laser read-out for all three follow-up visits can be observed. Essentially, the reduction in CCT was identical at 3 months versus 1 month. The reduction in CCT was lowest at postoperative 1 day. Examining the 1- and 3-month data (essentially equivalent), one can see a best fit of y = 0.94 x -7 µm. CONCLUSIONS: The reduction in CCT was stable from 1 month of follow-up. The stable reduction in CCT was -6% (-1.5% after accounting for design decisions) and -7 µm lower than the respective laser read-out. The findings are predictable, showing a certain level of the lenticules becoming slightly thinner than their respective laser read-outs. [J Refract Surg. 2023;39(11):728-735.].

First European results of a new refractive lenticular extraction procedure-SmartSight by SCHWIND eye-tech-solutions.

BACKGROUND: To evaluate vision 3 months after SmartSight lenticule extraction treatments. DESIGN: Case series. METHODS: This case series of patients were treated at Specialty Eye Hospital Svjetlost in Zagreb, Croatia. Sixty eyes of 31 patients consecutively treated with SmartSight lenticule extraction were assessed. The mean age of the patients was 33 ± 6 years (range 23-45 years) at the time of treatment with a mean spherical equivalent refraction of -5.10 ± 1.35 D and mean astigmatism of 0.46 ± 0.36 D. Monocular corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA) were assessed pre- and post-operatively. Ocular and corneal wavefront aberrations have been postoperatively compared to the preoperative baseline values. Changes in ocular wavefront refraction, as well as changes in keratometric readings are reported. RESULTS: At 3 months post-operatively, mean UDVA was 20/20 ± 2. Spherical equivalent showed a low myopic residual refraction of -0.37 ± 0.58 D with refractive astigmatism of 0.46 ± 0.26 D postoperatively. There was a slight improvement of 0.1 Snellen lines at 3-months follow-up. Compared to the preoperative status, ocular aberrations (at 6 mm diameter) did not change at 3 months follow-up; whereas corneal aberrations increased (+0.22 ± 0.21 µm for coma; +0.17 ± 0.19 µm for spherical aberration; and +0.32 ± 0.26 µm for HOA-RMS). The same correction was determined using changes in ocular wavefront refraction, as well as changes in keratometric readings. CONCLUSION: Lenticule extraction after SmartSight is safe and efficacious in the first 3 months postoperatively. The post-operative outcomes indicate improvements in vision.

A critical evaluation of longitudinal changes of astigmatism following implantation of toric implantable collamer lens (TICL): a comparison between treated and untreated cases over 4 years.

PURPOSE: To evaluate residual astigmatism following correction with toric implantable collamer lens (TICL) (group I) over a period of 4 years and compare with the change of astigmatism in spectacle wearers (group II). METHODS: Groups I (86 cases implanted with TICL [EVO + Visian ICL, Staar Surgical, Nidau, Switzeland], preop refractive error [sphere and cylinder] - 22.25 DS to - 1.00 DS and - 5.50 DC to - 1.00 DC) and II (80 cases initial refractive error [sphere and cylinder] - 18.00 DS to 0.00 DS and - 7.00 DC to - 1.00 DC) were reviewed annually. Refractive and tomography data were subjected to vector analysis to determine surgically induced astigmatism (SIA), angle of error [Δθ° = angle of target-induced astigmatism (TIA) - angle of SIA], and ΔC [TIA-SIA powers] and total corneal astigmatism (TCA) in group I and induced change in astigmatism (ICA) in group II. RESULTS: In group I, on all occasions, SIA correlated with TIA (p < 0.05); differences between SIA and TIA means were insignificant and changes in TCA were not correlated with ΔC. Mean (± sd, 95% CI) residual astigmatic powers (RA) in attending group I cases (1-4 years) were - 0.40 DC (0.58, - 0.52 to - 0.28), - 0.40 DC (0.59, - 0.52 to - 0.27), - 0.41 DC (0.58, - 0.54 to - 0.28), and - 0.61 DC (0.74, - 0.82 to - 0.40). In group II, the corresponding ICA powers were - 0.47 DC (0.53, - 0.61 to - 0.32), - 0.49 DC (0.48, - 0.69 to - 0.29), - 0.60 DC (0.40, - 0.76 to - 0.44), and - 0.86 DC (0.71, - 1.19 to - 0.52). Differences between RA and ICA were not significant. Of the group I cases presenting at 1-4 years postop, 23, 18, 16, and 28 had RA powers ≤ - 0.75 DC. Of these 12, 10, 6, and 16 were associated with Δθ° > 5° (ΔC - 0.50 to 0 DC) and 5, 1, 4, and 4 were related to ΔC (Δθ° < 5°). CONCLUSION: The development of astigmatism after TICL implantation is on par with the natural change in astigmatism in untreated cases. In about 50% of TICL cases presenting with astigmatism ≤ - 0.75 DC, the residual astigmatism could be neutralized by realigning the TICL.

Comparison between the change in total corneal astigmatism and actual change in refractive astigmatism in transepithelial photorefractive keratectomy (tPRK), laser in situ keratomileusis (LASIK) and femtosecond laser assisted laser in situ keratomileusis (FsLASIK).

PURPOSE: To compare changes in astigmatism by refraction and total corneal astigmatism after tPRK, LASIK and FsLASIK. SETTING: Specialty Eye Hospital Svjetlost, Zagreb, Croatia. DESIGN: Partially masked, semi-randomized, prospective, case-by-case, interventional, clinical study. METHODS: Patients with a stable refraction (-0.75DS to -8.00DS, astigmatism ≤1.00DC) underwent tPRK, LASIK or FsLASIK without complication. Astigmatism was measured at both corneal surfaces over the central 3.2 mm zone (approximately using Pentacam HRTM) preoperatively and 3 months postoperatively. Pentacam and refraction data were subjected to vector analysis to calculate the surgically induced changes in i) total corneal astigmatism (SIATCA) ii) any astigmatism by refraction (SIAR) and the vectorial difference (DV) between SIATCA and SIAR. RESULTS: Reporting key findings (p < .01), there was a significant difference between mean SIATCA and SIAR powers after tPRK (75eyes) but not after LASIK (100eyes) or FsLASIK (100eyes). Mean (±sd,95% CIs) values for DV powers were, tPRK -1.13DC(±0.71, -1.29 to -0.97), LASIK -0.39DC(±0.23,-0.44 to -0.34), FsLASIK -0.55DC(±0.38,-0.62 to -0.47). The differences were significant. For the tPRK and FsLASIK cases, linear regression revealed significant associations between I) SIATCA (x) &DV (z) powers (tPRK z = 1.586x-0.179, r = 0.767, p < .01; FsLASIK z = 0.442x-0.303, r = .484,p < .01), II) sines of SIATCA (x1) &DV (z1) axes (tPRK, z1 = 0.523 × 1 + 0.394, r = .650,p < .01; FsLASIK z1 = 0.460 × 1-0.308, r = .465,p < .01). CONCLUSIONS: tPRK is more prone to unintended changes in astigmatism. The difference between SIATCA & SIAR after tPRK or FsLASIK is mediated by SIATCA. Photoablating deeper regions of the cornea reduces the gap between SIATCA & SIAR.

Predicted and Measured Changes in Posterior Corneal Astigmatism after Uncomplicated Femtosecond Assisted LASIK (FsLASIK) and Microkeratome LASIK Correction for Myopia and Low Astigmatism.

Purpose: To compare predicted and measured changes in astigmatism at the posterior corneal surface (PCS) after FsLASIK or LASIK.Methods: Astigmatism was measured at both corneal surfaces (PentacamTM) before and 3 months after unremarkable FFsLASIK (roup 1,n = 100) or LLASIK (roup 2,n = 100) for myopia (-7.25DS to -0.75DS) and low astigmatism (≤1.00DC). Photoablation was achieved using Schwind Amaris750STM laser (Aberration Free profile, centered on corneal vertex). Pre-and postop astigmatic data, according to subjective refraction and estimates for the corneal surfaces (over the central 3.2 mm zone), were subjected to vector analysis to calculate surgically induced astigmatism (SIA) by refraction (SIAR), at the anterior (SIAFact) and posterior corneal surfaces (SIABact). The difference vector between SIAR and SIAFact was regarded as the predicted SIA at the PCS (SIABest).Results: Reporting key findings. Mean(±sd,95%CI) SIABest and SIABact powers in group 1 were -0.52DC(±0.35,-0.56 to -0.45) and -0.11DC(±0.08,-0.13 to -0.10) in group 1, -0.35DC(0.20,-0.39 to -0.32) and -0.08DC(0.07,-0.09 to -0.06) in group 2. Differences between SIABest and SIABact were significant for powers but not axes. Significant correlations(p < .01) were revealed between (I) SIAR and SIAFact powers [Group 1, SIAR = 0.370.SIAFact-0.292,r = 0.299. Group 2, SIAR = 0.484.SIAFact-0.394,r = 0.519] but not the axes and (II) ΔC (difference between pre-[x1] and postop measured PCS astigmatic powers) and x1 [Group 1, ΔC = 0.384x1 + 0.119,r = 0.423. Group 2, ΔC = 0.135x1 + 0.047,r = 0.229,p = .022]. There was no correlation between SIABest and SIABact powers or axes.Conclusion: The changes in posterior corneal astigmatic powers according to Pentacam measurements are small and do not account for the deficit between SIAR and SIAFact after FsLASIK or LASIK.

Clinical Outcomes With a New Continuous Range of Vision Presbyopia-Correcting Intraocular Lens.

PURPOSE: To evaluate the clinical outcomes including patient-reported outcome measures in a sample of eyes undergoing bilateral cataract surgery with implantation of a new model of presbyopia-correcting intraocular lens (IOL). METHODS: This non-randomized prospective case series enrolled 206 eyes of 103 patients undergoing phacoemulsification cataract surgery with bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Vision). High and low contrast visual acuity, refractive, defocus curve, and patient-reported visual performance (Catquest-9SF questionnaire) outcomes were evaluated during a 3-month follow-up. RESULTS: A total of 96.1% (99 of 103) and 91.3% (94 of 103) of patients achieved binocular postoperative uncorrected distance (UDVA) and near visual acuity (UNVA) of 0.00 logMAR (20/20), respectively. Mean postoperative mesopic UNVA for both eyes was 0.14 ± 0.03 logMAR. Likewise, mean binocular UDVA and UNVA were 0.00 ± 0.03 and 0.04 ± 0.02 logMAR. An almost flat mean defocus curve was obtained, with visual acuities between 0.00 and 0.10 logMAR for most defocus levels in both eyes. A reduction of contrast led to a limited but statistically significant change in UNVA in both eyes (P < .001). The Rasch calibrated scoring of item 2 and the Rasch calibrated mean score of the Catquest-9SF questionnaire increased significantly with surgery (P < .001). CONCLUSIONS: This new presbyopia-correcting IOL provides a continuous range of functional focus, with a limited deterioration under mesopic conditions, which is perceived as a satisfactory outcome by the patient if proper patient selection is performed. [J Refract Surg. 2021;37(4):256-262.].

Enlarged Foveal Avascular Zone after Whiplash Injury-Acquired Berlin's Edema.

We describe a case of optical coherence tomography angiography (OCTA) changes in the foveal avascular zone (FAZ) in a patient that had suffered Berlin's edema after a whiplash neck injury. The patient reported central scotoma throughout the 1-year follow-up, confirmed by visual field examination. OCTA showed FAZ enlargement of the left eye as compared to the healthy right eye in the superficial capillary layer and even more in the deep capillary layer. To the best of our knowledge, FAZ enlargement has not been previously described by OCTA after whiplash-related macular injury.

Pachymetry and Elevation Back Map Changes in Keratoconus Patients After Crosslinking Procedure.

INTRODUCTION: The crosslinking (CXL) procedure using the standard Dresden protocol is established as the gold standard for the treatment of progressive keratoconus. AIM: The aim of this paper is to correlate the pachymetry and elevation back map (EBM) changes in the period from 3 to12 months of keratoconus patients after the CXL procedure. M. METHODS: Forty-four eyes of 34 patients with keratoconus were analyzed after performed standard Dresden protocol CXL procedure. All of them underwent complete preoperative examination with a follow up of 12 months with a focus on pachymetry and EBM changes performed by Oculus Pentacam (Scheimpflug technology) analysis. RESULTS: Pachymetry changed significantly in 12 months post cross-linking, especially in the first 6 months after which it slightly increased. Differences in EBM preoperatively and 12 months postoperatively were not statistically significant. CONCLUSION: Corneal pachymetry in keratoconus patients decreases after the CXL procedure. Differences in pachymetry preoperatively and 3, 6 and 12 months postoperatively were statistically significant, but the value of corneal thickness increased from the third month to 12 months post-op. Differences in EBM preoperatively and 12 months postoperatively were not still statistically significant, which is good, because the increase in elevation, as one of the signs of progression of the keratoconus - did not occur.

Vector Analysis of Visual Acuity and Refractive Outcomes of Astigmatic Corrections After T-PRK and Fs-LASIK.

INTRODUCTION: T Transepithelial photorefractive keratectomy (T-PRK) and femtosecond laser in situ keratomileusis (Fs-LASIK) are reftactive surgery methods for treating myopia and myopic astigmatism. Although T-PRK obtains similar results to Fs-LASIK with spherical myopia, it has differences in astigmatism correction. Vector analysis is a perfect tool to see the real difference between these two methods regarding astigmatic refraction and visual acuity. AIM: The aim of the study is to investigate changes in astigmatism and visual acuity following treatment of myopia and myopic astigmatism above -5.00DS and up to -2.00DC after either T-PRK or Fs-LASIK. METHODS: Patients (30 eyes per group) underwent unremarkable T-PRK (group I) or Fs-LASIK (group II) using Schwind Amaris 750S laser. Astigmatic data acquired by subjective refraction were subjected to vector analysis to determine the association between surgically (SIA) and target induced (TIA) astigmatic powers and differences in axes(θ). RESULTS: Key results at 6 months were: i) Mean astigmatism changed from -0.92 DC (sd ±0.49,95%CI-1.10to-0.75) to -0.38 DC (sd ±0.40,95% CI-0.52 to -0.24) in group I and -0.93DC (sd±0.55,95%CI -1.07 to -0.67) to -0.14DC (sd±0.31,95% CI-0.25 to -0.03) in group II (P=0.005 at 6 months). ii) Mean (±sd) θ was +9.7° (±19.0°) in group I and -2.2° (±15.5°) in group II (P=0.005). CONCLUSION: There was a greater mismatch between SIA and TIA powers and axes after T-PRK. T-PRK tends to induce more unwanted astigmatism. The predictability of the refractive and optical changes is better following Fs-LASIK.