Efficacy and safety of transepithelial photorefractive keratectomy combined with accelerated corneal cross-linking for refractive error in thin or irregular cornea / 中华实验眼科杂志

Objective:To evaluate the efficacy and safety of transepithelial photorefractive keratectomy (Trans-PRK) combined with accelerated corneal cross-linking (CXL) for refractive error in patients with thin or irregular corneas, excluding keratoconus.Methods:An observational case series study was performed.Fifty-five right eyes of 55 myopic patients diagnosed with thin or irregular corneas, who underwent Trans-PRK combined with prophylactic CXL surgery, were included at Baotou Chaoju Eye Ophthalmic Hospital from August 2017 to July 2018.Uncorrected distance visual acuity (UDVA) of the operated eye was measured using international standard visual acuity charts, and refractive diopters were measured by computer and comprehensive refraction before surgery and at 1 week, 1, 3, 6, and 12 months after surgery.Corneal morphology was assessed with the Pentacam anterior segment analyzer before surgery and at 3, 6, and 12 months after surgery.Intraocular pressure (IOP) was measured with a non-contact tonometer before surgery and at 1, 3, 6, and 12 months after surgery.The incidence of postoperative complications was recorded.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Baotou Chaoju Ophthalmic Hospital (No.btcj-u-1). Written informed consent was obtained from each subject.Results:Preoperative, 1-week, 1-, 3-, 6-, and 12-month postoperative UDVA (LogMAR) were 0.52(0.55, 0.78), 0.22(0.12, 0.17), 0.10(0.04, 0.07), 0.00(-0.04, -0.16), -0.08(-0.05, -0.03) and -0.08(-0.06, -0.04), respectively, showing a statistically significant overall difference ( Z=249.44, P<0.001). UDVA at each postoperative time point was improved compared to preoperative, and UDVA at 3, 6, and 12 months postoperatively was significantly improved compared to 1 week and 1 month postoperatively (all at P<0.001). The spherical diopter at each postoperative time point decreased significantly compared to preoperative, with the spherical diopter at 1, 3, 6, and 12 months postoperatively being lower than that at 1 week postoperatively, and the 12-month postoperative spherical diopter being lower than that at 3 and 6 months postoperatively, showing statistically significant differences (all at P<0.001). The cylindrical degree at 1, 3, 6, and 12 months postoperatively was lower than that at preoperative and 1 week postoperatively, with statistically significant differences (all at P<0.05). After the operation, the spherical equivalent of the operated eye gradually decreased with time, tending toward emmetropia.The spherical equivalent at each postoperative time point decreased compared to preoperative, with the spherical equivalent at 1, 3, 6, and 12 months postoperatively being lower than that at 1 week postoperatively, and the spherical equivalent at 12 months postoperatively being lower than that at 3 and 6 months postoperatively, showing statistically significant differences (all at P<0.001). The corneal K1 and K2 values at 3, 6, and 12 months postoperatively were significantly lower than preoperatively (all at P<0.001), and the corneal K1 and K2 values at 3 months postoperatively tended to stabilize.The IOP of the operated eye at 3, 6, and 12 months postoperatively was significantly lower than preoperatively, and the IOP at 6 and 12 months postoperatively was lower than that at 1 and 3 months postoperatively, with statistically significant differences (all at P<0.001). One eye developed grade 0.5 corneal haze at 1 week postoperatively, which spontaneously resolved to transparency at 1 month postoperatively. Conclusions:Trans-PRK combined with accelerated CXL has good efficacy, stability and safety for refractive error patients with thin or irregular corneas, except for keratoconus.

Comparison of corneal higher order aberration after femtosecond laser-assisted laser in situ keratomileusis and small incision lenticule extraction / 中华实验眼科杂志

Objective:To analyze and compare the corneal higher order aberration (HOA) after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE).Methods:A non-randomized controlled study was conducted.Sixty myopic patients (60 eyes) who underwent FS-LASIK or SMILE correction at Shandong Eye Hospital from April 2018 to January 2020 were enrolled and the data from the right eye were collected for analysis.Thirty cases (30 eyes) who received FS-LASIK in FS-LASIK group and 30 cases (30 eyes) who received SMILE in SMILE group had a preoperative equivalent spherical diopter of (-5.36±1.11)D and (-4.93±1.03)D, respectively.The HOA of the 6-mm anterior surface, posterior surface, and whole cornea were measured before surgery and at 1, 3, 6, and 12 months after surgery using Pentacam.The root mean square values (μm) of total corneal HOA, spherical aberration, coma and trefoil were obtained.Differences in the above root mean square values at different time points were compared between the two groups.The study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Shandong Eye Hospital (No.SDSYKYY20180306). Written informed consent was obtained from each subject.Results:The preoperative and 1-, 3-, 6-, 12-month postoperative total HOA of the anterior corneal surface were (0.428±0.126), (0.775±0.169), (0.811±0.194), (0.759±0.214), (0.704±0.199)μm in the FS-LASIK group and (0.409±0.094), (0.656±0.148), (0.681±0.161), (0.668±0.175), (0.648±0.160)μm in the SMILE group, with a significant overall difference ( Fgroup=5.652, P=0.024; Ftime=107.169, P<0.01). Compared with SMILE group, the postoperative total HOA of anterior corneal surface and spherical aberration at different time points were increased in FS-LASIK group, showing statistically significant differences (all at P<0.05). Compared with before surgery, the postoperative total HOA of the anterior corneal surface and spherical aberration at different time points were increased in both groups, showing statistically significant differences (all at P<0.05). In the two groups, the 6- and 12-month postoperative total HOA of the anterior corneal surface were reduced in comparison with the 3-month postoperative ones of the anterior corneal surface, and the 12-month postoperative spherical aberrations of the anterior corneal surface were significantly reduced in comparison with the 1- and 3-month postoperative ones of the anterior corneal surface, showing statistically significant differences (all at P<0.05). There were significant differences in the coma and trefoil of the anterior corneal surface between before and after the operation (coma: Ftime=47.848, P<0.01; trefoil: Ftime=2.497, P=0.046). Compared with before surgery, the postoperative coma was significantly increased in the two groups (all at P<0.05). There were significant differences in total corneal HOA and spherical aberration at different postoperative time points between the two groups (total HOA: Fgroup=8.093, P=0.008; Ftime=125.019, P<0.01.spherical aberration: Fgroup=4.771, P=0.037; Ftime=34.033, P<0.01). Compared with SMILE group, the total corneal HOA and spherical aberration were significantly increased in FS-LASIK group at different postoperative time points (all at P<0.05). Compared with before surgery, postoperative total HOA of the anterior corneal surface and spherical aberration at different postoperative time points were significantly increased in both groups (all at P<0.05). In both groups, the 12-month postoperative corneal spherical aberration was significantly reduced in comparison with the 1- and 3-month postoperative ones (all at P<0.05). There was a significant difference in coma between before and after surgery ( Ftime=30.829, P<0.01). Compared with before surgery, the postoperative coma was significantly increased at different time points in both groups (all at P<0.05). Conclusions:Both FS-LASIK and SMILE increase the HOA of the anterior corneal surface and the whole cornea.Compared with FS-LASIK, SMILE introduces less HOA of the anterior corneal surface and the whole cornea as well as spherical aberrations.

Application of spherical lens with 0.05 D intervals in optometry for small incision lenticule extraction in myopic eyes / 中华实验眼科杂志

Objective:To investigate the clinical value of spherical lens with 0.05 D intervals in optometry for small incision lenticule extraction (SMILE) in myopic eyes.Methods:A randomized controlled clinical study was conducted.Sixty patients (120 eyes) with low to moderate myopia and myopic astigmatism who underwent SMILE in the 989th Hospital of the PLA from June 2021 to February 2022 were enrolled.The patients were randomly divided into 0.05 D interval group (optometry with spherical lens at 0.05 D interval) and 0.25 D interval group (optometry with spherical lens at 0.25 D interval), with 30 cases (60 eyes) in each group.There was no significant difference in matched age, sphericity, cylindricity, and best corrected visual acuity (BCVA) (all at P>0.05). The preoperative monocular red-green balance, 1- and 3-month postoperative monocular red-green balance, uncorrected visual acuity and spherical equivalent of both groups were compared.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the 989th Hospital of the PLA (No.WZLL-2021-034). Written informed consent was obtained from each subject before any medical examination. Results:The preoperative red-green balance rate in 0.05 D interval group was 95.00%(57/60), which was higher than 35.00%(21/60) in 0.25 D interval group, showing a statistically significant difference ( Wald χ2=17.642, P<0.001). The 1- and 3-month postoperative red-green balance rates in 0.05 D interval group were 63.33%(38/60) and 56.67%(34/60), which were higher than 23.33%(14/60) and 21.67%(13/60) in 0.25 D interval group respectively, showing statistically significant differences ( Wald χ2=9.137, P=0.003; Wald χ2=7.483, P=0.006). The 1- and 3-month postoperative visual acuity in 0.05 D interval group were -0.1(-0.1, -0.1) and -0.1(-0.1, -0.1), which were higher than 0.0(-0.1, 0.0) and -0.1(-0.1, 0.0) in 0.25 D interval group respectively, showing statistically significant differences ( Wald χ2=11.624, P=0.001; Wald χ2=12.841, P<0.001). The 1- and 3-month postoperative spherical equivalent were -0.07(-0.25, 0.13)D and -0.13(-0.25, 0.13)D in 0.05 D interval group, which were higher than -0.13(-0.38, 0.25)D and -0.13(-0.38, 0.25)D in 0.25 D interval group respectively, showing no statistically significant difference between the two groups ( Wald χ2=0.029, P=0.866; Wald χ2=0.189, P=0.664). Conclusions:Compared with spherical lens at 0.25 D interval, 0.05 D interval can improve the accuracy of preoperative and postoperative red-green balance rate and postoperative visual acuity in patients with low to moderate myopia who undergo SMILE.

Comparison of early postoperative visual quality between SMILE and SPT-TransPRK / 中华实验眼科杂志

Objective:To investigate the differences and changes in early postoperative visual quality after small incision lenticule extraction (SMILE) and smart pulse technology-assisted transepithelial photorefractive keratectomy (SPT-TransPRK).Methods:A cohort study was performed.A total of 92 patients (92 eyes) who underwent corneal laser refractive surgery were enrolled in Dalian Third People's Hospital Affiliated to Dalian Medical University from February 2021 to May 2021.The data from the right eye were collected for analysis.The patients were divided into SMILE group (40 patients, 40 eyes) and SPT-TransPRK group (52 patients, 52 eyes). Preoperative, 1- and 3-month postoperative visual acuity were measured to calculate the effectiveness, which was defined as the ratio of postoperative uncorrected visual acuity (UCVA) to preoperative best corrected visual acuity.Refraction was measured by an AR-1 autorefractor.Corneal higher-order aberration (HOA) including total HOA, spherical aberration and coma was measured by Sirius corneal topographer.Objective scatter index (OSI), modulation transfer function cut-off frequency (MTF cut-off), Strehl ratio (SR), simulated contrast visual acuity VA100 (day), VA20 (dusk) and VA9 (night) were measured via OQAS II visual quality analysis system.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Dalian Third People's Hospital Affiliated to Dalian Medical University (No.2019-KT-010). Written informed consent was obtained from each subject.Results:There was no significant difference in 3-month postoperative UCVA and effectiveness between the two groups ( Z=0.880, P=0.380; t=0.920, P=0.058). Patients in SPT-TransPRK group showed mild hyperopia 3 months after surgery.Preoperative, 1- and 3-month postoperative total corneal HOA was (0.47±0.18), (0.70±0.22) and (0.74±0.19)μm in SMILE group, and (0.40±0.14), (0.98±0.35) and (0.94±0.22)μm in SPT-TransPRK group respectively, showing statistically significant differences ( Fgroup=13.851, P=0.001; Ftime=29.960, P<0.001). Preoperative, 1- and 3-month postoperative spherical aberration was (-0.20±0.09), (-0.44±0.14) and (-0.44±0.15)μm in SMILE group, and (-0.20±0.10), (-0.71±0.23) and (-0.75±0.20)μm in SPT-TransPRK group respectively, showing statistically significant differences ( Fgroup=31.037, P<0.001; Ftime=48.005, P<0.001). The postoperative total corneal HOA and spherical aberration were increased in both groups compared with before surgery, with statistically significant differences (all at P<0.05). The 1- and 3-month postoperative total corneal HOA and spherical aberrations were smaller in SMILE group than in SPT-TransPRK group, and the differences were statistically significant (all at P<0.05). The 1- and 3-month postoperative coma were increased in both groups compared with before surgery, showing statistically significant differences (all at P<0.05). In SMILE group, 1-month postoperative OSI was higher and 1-month postoperative MTF cut-off, SR, and VA9 were lower than those before surgery, and 3-month postoperative OSI was higher and 3-month postoperative SR and VA9 were lower than those before surgery, showing statistically significant differences (all at P<0.05). In SPT-TransPRK group, 1-month postoperative OSI was higher and 1-month postoperative MTF cut-off, SR, VA100, VA20, and VA9 were lower than those before surgery, showing statistically significant differences (all at P<0.05). There was no significant difference in OSI, MTF cut-off, SR, VA100, VA20, and VA9 between 3 months postoperatively and before surgery in the SPT-TransPRK group (all at P>0.05). There was no significant difference in coma, OSI, MTF cut-off, SR, VA100, VA20, and VA9 between two groups (all at P>0.05). Conclusions:Both SMILE and SPT-TransPRK are effective methods for correcting myopia and they have comparable visual quality.Compared with SPT-TransPRK, corneal total HOA and spherical aberration are smaller after SMILE.

Comparison of corneal epithelial remodeling and corneal aberration changes after FS-LASIK and FS-LASIK Xtra / 中华实验眼科杂志

Objective:To investigate the status of corneal epithelial remodeling and changes in corneal aberration after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and FS-LASIK combined with corneal collagen cross-linking (FS-LASIK Xtra), and to analyze the relationship between corneal epithelial thickness (CET) and corneal aberration.Methods:A cohort study was conducted.A total of 172 patients (172 eyes) who underwent FS-LASIK at Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine were enrolled from June 2021 to February 2022.The 172 eyes were divided into FS-LASIK group (94 eyes) and FS-LASIK Xtra group (78 eyes) according to the surgical procedure, with a total follow-up of 6 months.The cornea was divided into a central 2-mm ring and a ring of 2-5 mm centered on the central cornea.CET at 9 regions in the central 0-5 mm area was measured by OCT before and at 1, 3 and 6 months after surgery, and the corneal higher-order aberration (HOA) was measured by the iTrace visual function analyzer.The main outcomes were the increase in CET (ΔCET), and corneal HOA at 6 months after surgery.The relationship between central corneal ΔCET and corneal aberration was analyzed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Yinhai Eye Hospital of Chengdu University of Traditional Chinese Medicine (No.2021yh-009). Written informed consent was obtained from each subject.Results:At 1, 3 and 6 months after surgery, the central, superior, superior nasal, nasal, inferior nasal, inferior, inferior temporal, temporal and superior temporal ΔCET were significantly smaller in FS-LASIK Xtra group than in FS-LASIK group (all at P<0.05). In FS-LASIK Xtra group, 6-month postoperative central, superior, superior nasal, inferior and inferior temporal ΔCET were significantly larger than those at 1 month after surgery, and 3- and 6-month postoperative temporal ΔCET were significantly larger than that at 1 month after surgery, and 6-month postoperative superior temporal ΔCET was significantly larger than those at 1 and 3 months after surgery (all at P<0.05). In FS-LASIK group, 3- and 6-month postoperative central, superior, inferior and inferior temporal ΔCET were significantly larger than those at 1 month after surgery, and 6-month postoperative superior nasal ΔCET was significantly larger than that at 3 months after surgery, and 6-month postoperative nasal, inferior nasal, temporal, superior temporal ΔCET were significantly larger than those at 1 and 3 months after surgery (all at P<0.05). There was no significant difference in vertical trefoil, vertical and horizontal coma changes at different time points after surgery between both groups (vertical trefoil: χ2group=4.27, P=0.118; χ2time=0.01, P>0.05.vertical coma: χ2group=5.74, P=0.057; χ2time=0.08, P=0.957.horizontal coma: χ2group=3.97, P=0.137; χ2time=0.51, P=0.773). The tilted trefoil changes at 1, 3 and 6 months after surgery of FS-LASIK Xtra group were significantly larger than those of FS-LASIK group (all at P<0.05). The 6-month spherical aberration change in FS-LASIK Xtra group was significantly higher than that at 1 month after surgery, and the 6-month spherical aberration change in FS-LASIK group was significantly higher than that at 1 and 3 months after surgery (all at P<0.05). The 6-month total HOA change in FS-LASIK group was significantly lower than that at 1 and 3 months after surgery (all at P<0.05). In FS-LASIK group, central corneal ΔCET was weakly positively correlated with spherical aberration at 1 and 6 months after surgery ( rs=0.257, P=0.008; rs=0.244, P=0.012), and was weakly positively correlated with total HOA ( rs=0.253, P=0.009; rs=0.279, P=0.004). Conclusions:The postoperative ΔCET after FS-LASIK Xtra is smaller than that after FS-LASIK, but the homogeneity of ΔCET in each region is similar between the two groups.The changes in corneal HOA after surgery are similar in both groups, and there is a certain association between the overall epithelial distribution and corneal aberration.

Effects of femtosecond laser assistcataract extraction on the levels of inflammatory factors in aqueous humor, corneal perception and high order aberration / 中国医师进修杂志

Objective:To investigate the effects of femtosecond laser assistcataract extraction on the levels of inflammatory factors in aqueous humor, corneal perception and high order aberration.Methods:Forty-eight patients (56 eyes) undergoing cataract surgery in the Shouguang People′s Hospital from June 2018 to February 2020 were enrolled in this study, and they were divided into observation group (24 patients and 27 eyes, femtosecond laser cataract phacoemulsification) and control group (24 patients and 29 eyes, coaxial microincision phacoemulsification) by random number table method. The levels of prostglndin E2 (PGE2), interleukin (IL)-6 and IL-1β in aqueous humor were detected before and after operation. Upper corneal and central corneal perception thresholds were recorded before surgery, 7 d after surgery, 1 month after surgery and 3 months after surgery. High order aberrations of the whole eye and cornea at 4mm pupil diameter before and after operation were recorded.Results:After operation, the levels of PGE2, IL-6 and IL-1β in aqueous humor in the observation group were lower than those in the control group: (45.62 ± 5.71) ng/L vs. (63.65 ± 5.62) ng/L, (15.25 ± 3.21) ng/L vs. (24.59 ± 6.13) ng/L, (17.16 ± 1.28) ng/L vs. (25.74 ± 4.62) ng/L, the differences were statistically significant ( P<0.05). The upper and central corneal perception threshold of observation group after operation for 7 d were higher than those in the control group: 4.55 ± 0.50 vs. 4.20 ± 0.33, 5.68 ± 0.49 vs. 5.52 ± 0.45, the differences were statistically significant ( P<0.05). The indexes of high order aberration of the whole eye decreased in the two groups ( P<0.05), while the indexes of cornea did not change significantly. The indexes of high order aberration of the whole eye and cornea between before and after surgery between the two groups had no significant differences ( P>0.05). Conclusions:Femtosecond laser assist cataractextraction can relieve inflammation, reduce the whole eye high order aberration, but not affect the cornea, and can improve corneal perception.

Comparison of corneal biomechanics in the early postoperative period between TransPRK and SMILE / 中华实验眼科杂志

Objective:To investigate the effects of transepithelial photorefractive keratectomy (TransPRK) and femtosecond small incision lenticule extraction (SMILE) on corneal biomechanics measured by the Ocular Response Analyzer in the early postoperative period.Methods:A cohort study was conducted.The right eyes of 56 patients who underwent TransPRK and 52 patients who underwent SMILE in Dalian Medical University Affiliated Dalian Third People's Hospital from November 2020 to June 2021 were continuously included.The postoperative follow-up was 3 months.The central corneal thickness (CCT) and keratometry (Km) were measured 1 month and 3 months after surgery.The corneal-compensated intraocular pressure (IOPcc), corneal resistance factor (CRF), corneal hysteresis (CH), and 19 repeatable mechanical infrared signal waveform parameters measured by the Ocular Response Analyzer were recorded before the surgery, 1 month and 3 months after the surgery, respectively.The measurement indexs at different time points between two groups were compared.This study adhered to the Declaration of Helsinki and the study protocol was approved by the Ethics Committee of Dalian Medical University Affiliated Dalian Third People's Hospital (No.2019-KT-010). Written informed consent was obtained from each patient before surgery.Results:There was no significant difference in CCT, Km, and IOPcc between the two groups at 1 month and 3 months after the surgery (all at P>0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1, dive2 and mslew1 were decreased, while path1, path2, path11, and aplhf were increased at 1 month after the surgery compared with before surgery, showing statistically significant differences (all at P<0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1 decreased, while path1, path2, path11, and aplhf were increased at 3 months after the surgery in comparison with before surgery, showing statistically significant differences (all at P<0.05). In SMILE group, the dive2 were decreased at 3 months after the surgery compared with before surgery, and the difference was statistically significant ( P<0.01). At 1 month after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, dive1 and dive2 were higher, while CH, path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). At 3 months after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h2, h21, dive1 and dive2 were higher, while path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). Conclusions:Corneal biomechanics are weakened after both TransPRK and SMILE.In the early postoperative period, the mechanical infrared waveform parameters measured by the Ocular Response Analyzer are better after TransPRK than after SMILE.

Avaliação do conhecimento sobre cirurgia refrativa por meio de questionário eletrônico / Evaluation of knowledge in refractive surgery using an on-line questionnaire

RESUMO Objetivo: Desenvolver e aplicar um questionário eletrônico para avaliação do conhecimento em cirurgia refrativa na população analisada. Métodos: Foi aplicado um questionário eletrônico a uma população composta de 840 participantes voluntários maiores de 18 anos. Resultados: A média da idade dos participantes foi 37,85 anos, sendo 60,1% do feminino. Dentre os participantes, 20,95% reportaram ter sido submetidos a alguma cirurgia ocular prévia, sendo 73,86% com objetivo refrativo. Entre estes, 73,08% mostraram-se satisfeitos/muito satisfeitos com o resultado. O critério mais importante na escolha de um cirurgião refrativo foi a indicação por um conhecido que realizara a cirurgia (43,81%). Destaca-se que os participantes submetidos à cirurgia refrativa discordaram que "a cirurgia é um procedimento simples e isento de riscos" mais do que as demais pessoas (p=0,0045) e também que "o objetivo principal da cirurgia é 'zerar' o grau" (p=0,0252). Conclusão: Nota-se a necessidade de melhorar o conhecimento pré-operatório da população sobre cirurgia refrativa e também de educação continuada para os oftalmologistas. Este estudo fomenta o desenvolvimento de novas ferramentas de educação com informações claras e de fácil acesso, que tenham caráter informativo, e não de convencimento.

ABSTRACT Objective: The purpose of this study was to develop and apply an online questionnaire to assess knowledge in Refractive Surgery in the analyzed population. Methods: An online questionnaire was applied to a population composed of 840 volunteer participants over 18 years of age. Results: The mean age of population was 37.85 years, of whom 60.1% were female. 20.95% of the participants reported having undergone previous eye surgery, 73.86% of which had a refractive objective. Among these, 73.08% were satisfied / very satisfied with the result. The most important criterion when choosing a refractive surgeon was the indication by a friend who underwent the procedure (43.81%). It is noteworthy that the participants who underwent refractive surgery disagreed more than the other people that "the surgery is a simple and risk-free procedure" (p = 0.0045) and that "the main objective of the surgery is to "zero" the diopter" (p = 0.0252). Conclusion: It is essential to improve population's preoperative knowledge about Refractive Surgery, as well as continuing education for ophthalmologists. Therefore, this study encourages the development of new education tools with clear and easily accessible information, which should be informative, and not convincing.

Comparison of the preservation effect of DX solution and glycerin preservation solution on corneal stromal lens / 中华实验眼科杂志

Objective:To compare the preservation effect of DX preservation solution and glycerin preservation solution on the corneal stromal lens.Methods:Sixty intact corneal stromal lens samples were collected during femtosecond small incision lenticule extraction (SMILE) from 60 myopic eyes of 30 subjects at Qingdao Eye Hospital of Shandong First Medical University from February 2019 to May 2019.The samples were randomized into DX preserved 1-day group, DX preserved 1-week group, glycerin preserved 1-day group, glycerin preserved 1-week group and glycerin preserved 2-week group according to the different preservation methods, with 10 samples in each group.No intervention was done in the samples of the normal control group.Trypan blue staining was used to count the number of dead cells in the corneal stromal lens.The morphological structure of the corneal stromal lens was examined with an optical microscope, and its ultrastructure was observed under the transmission electron microscope.This study adhered to the Declaration of Helsinki.Written informed consent was obtained from each patient prior to any medical intervention.The study protocol was approved by an Ethics Committee of Qingdao Eye Hospital of Shandong First Medical University (No.2019-30).Results:The number of dead cells was (53.1±14.2), (50.8±9.8), (70.4±13.6) and (172.8±31.7) and (182.8±14.2) cells/field in the DX preserved 1-day group, DX preserved 1-week group, glycerin preserved 1-day group, glycerin preserved 1-week group and glycerin preserved 2-week group, respectively, showing a significant difference among the five groups ( F=16.37, P<0.05). There was no significant difference between the DX preserved 1-day group and 1-week group ( P>0.05). The number of dead cells was significantly less in the glycerin preserved 1-day group than that of the glycerin preserved 1-week group and glycerin preserved 2-week group, and the number of dead cells was significantly increased in the glycerin preserved 1-week group compared with the DX preserved 1-week group (all at P<0.05). The arrangement of collagen fibers of the corneal stromal lens was regular and the cells were intact in the normal control group, DX preserved 1-day group and DX preserved 1-week group.The tissue edema, bare cell nuclei and loose collagen fibers were found in the samples in the glycerin preserved 1-day group.The corneal stromal lens was compact and the collagen fibers were dense and the nuclei were intact in the DX preserved 1-day group and DX preserved 1-week group.The distribution of the cells was sparse and the cell structure was abnormal under the transmission electron microscope in various glycerin preserved groups. Conclusions:The structure of corneal stromal lens can be well preserved for one week by DX storage solution.The preservation effect of DX solution is better for fresh human corneal stromal lens than glycerin solution.

Influence and significance of angle Kappa on total ocular aberrations before and after SMILE surgery / 中华实验眼科杂志

Objective:To investigate the influence of angle Kappa on total high-order aberration (HOA) before and after small incision lenticule extraction (SMILE).Methods:An observational case series study was conducted.Right eyes of 98 patients with myopia and myopic astigmatism who underwent SMILE surgery at Tianjin Eye Hospital from April 2015 to May 2016 were selected.Uncorrected visual acuity (UCVA), spherical diopter and cylindrical diopter under cycloplegic condition were examined before the surgery and at l and 3 months postoperatively.The chord distance of angle Kappa was measured by Pentacam topography.Wavefront aberrations were measured by WaveScan aberrometer.Pre- and postoperative UCVA, refractive status and each HOA were analyzed.The relationship between angle Kappa and each HOA was analyzed by Pearson correlation.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Tianjin Eye Hospital (No.TJYYLL-2017-17). Written informed consent was obtained from each subject.Results:The preoperative, postoperative 1-month and postoperative 3-month UCVA (LogMAR) were 0.06±0.23, -0.03±0.07 and -0.05±0.07, respectively, showing a statistically significant difference ( F=779.330, P<0.001). There were statistically significant differences in spherical diopter, cylinder diopter and spherical equivalent (SE) between before and after operation ( F=1 107.811, 127.786, 1 191.266; all at P<0.001), and the postoperative spherical diopter, cylinder diopter and SE were significantly lower than those before surgery (all at P<0.001). At 6-mm pupil diameter, significant differences were found between postoperative total HOA, spherical aberration, coma, the third-order aberration (S3), fourth-order aberration (S4), fifth-order aberration (S5) and sixth-order aberration (S6) and the preoperative values ( F=75.915, 78.231, 66.186, 64.521, 97.161, 36.623, 28.852; all at P<0.001). The postoperative 1- and 3-month total HOA, spherical aberration, coma, S3, S4, S5 and S6 were significantly increased in comparison with those before surgery (all at P<0.05). There was a positive correlation between angle Kappa and total HOA, coma and S3 at 1 and 3 months after surgery (total HOA: r=0.357, 0.363; both at P<0.001.coma: r=0.310, 0.341; both at P<0.01.S3∶ r=0.343, 0.371; both at P<0.01). Significant differences were found in preoperative, postoperative 1-month and 3-month total HOA, coma and S3 between groups with different angle Kappa ( Fgroup=3.363, 4.277, 4.029; all at P<0.05). The postoperative total HOA, coma and S3 of the larger angle Kappa group were greater than those of the smaller angle Kappa group, with statistically significant differences between them (all at P<0.05). Conclusions:A larger angle Kappa may induce HOAs in SMILE surgery.

[New glaucoma surgery procedures]. / Nouvelles techniques de chirurgie du glaucome.

New glaucoma surgery procedures. The treatment of glaucoma aims to lower intraocular pressure in order to stop the evolution of the optic neuropathy. Surgery is indicated if medical and/or laser treatments are not sufficient and/or not well tolerated. The new minimally Invasive glaucoma surgery (migs) procedures allow faster visual recovery and reduce the risk of complications.

Fragilité et Précarité des personnes. Vivant avec le vih Vivre avec le vih en 2021 signifie être Atteint d'une maladie chronique qui n'est Toujours pas « comme les autres ¼. La Stigmatisation et les discriminations persistent, Et le pronostic reste incertain dans Les pays du sud, où l'accès aux soins reste Aléatoire et l'apparition de résistances Préoccupante. Être soigné pendant la pandémie de Covid-19 a représenté un défi de santé Publique, mais les personnes vivant Avec le vih (pvvih), plus précaires et Fragiles psychologiquement que la population Générale, ont été davantage Affectées par les difficultés d'accès Aux soins. La population des pvvih comprend en Particulier deux groupes principaux : les Migrants et les hommes qui ont des rapports Sexuels avec des hommes (hsh), Comme l'indiquent, en 2020, les chiffres Des nouvelles contaminations. La population migrante atteinte est hétérogène, Avec des personnes résidant sur Le sol français depuis des décennies mais Aussi des primo-arrivants, au parcours de Migration souvent semé d'événements Traumatiques. Outre le poids de l'atteinte Par le vih lui-même, les agressions fréquentes Et les préoccupations pour les Proches restés au pays, tout comme le Poids de l'exil, aboutissent à une prévalence Elevée des troubles psychiques. Aujourd'hui encore, être homosexuel ne va Pas toujours de soi, que la stigmatisation Provienne des autres ou qu'elle soit intégrée Par la personne elle-même (autostigmatisation). Le vieillissement est globalement Déprécié dans notre société et Particulièrement dans la communauté gay. Celle-ci est également atteinte par la pratique Du chemsex et du slam, des usages De substances psychoactives préoccupants. De tous ces éléments découlent de fortes Prévalences des troubles psychiques et Une éventuelle précarité sociale. La prise En charge des pvvih doit être globale, elle Nécessite de prendre en compte tous ces Aspects, médicaux, psychiques, sociaux, Et d'y associer les patients.

Intraoperative complications and treatment in femtosecond laser small incision lenticule extraction / 中华实验眼科杂志

As a relatively new procedure, femtosecond laser small incision lenticule extraction (SMIIE) is still in its initial stage.Despite the safety, efficacy, predictability and stability it has showed in refractive error correction, there are still reports of intraoperative complications resulting in different clinical outcomes in SMILE.SMILE includes the production of lenticule by femtosecond laser, the separation and extraction of lenticule, and intraoperative complications may occur in every step.The production of the lenticule is completely dependent on the femtosecond laser, so complications related to femtosecond lasers are inevitable, such as suction loss, opaque bubble layer and black spots.Separation and extraction of the lenticule relies on the experience and surgical skills of surgeon, during which, torn corneal cap, difficult lenticule extraction, lenticule remnants, bleeding and lenticule decentration may occur.In this article, the categories, reasons, management and effects of intraoperative complications on outcome in SMILE were summarized to improve the ability of ophthalmologists to handle intraoperative incidents and enhance surgical safety.

Femtosecond laser-assisted anterior lamellar keratoplasty with suboptimal outcomes: a case series / Ceratoplastia lamelar anterior assistida por laser de femtosegundo com resultados subótimos: uma série de casos

ABSTRACT Objective To identify preoperative clinical characteristics of patients undergoing femtosecond laser-assisted anterior lamellar keratoplasty who failed to achieve optimal postoperative visual outcomes. Methods In this single-center, retrospective case series, patients who underwent femtosecond laser-assisted anterior lamellar keratoplasty between 2013 and 2018 were included if they required graft revision, subsequent corneal procedure, or additional postoperative visits for a femtosecond laser-assisted anterior lamellar keratoplasty-related issue. Visual outcomes assessed included best-corrected visual acuities and postoperative corneal astigmatism. Results Eight eyes of eight patients meeting the above criteria were included. Mean patient age was 64.5 years (range, 21 to 89 years). Mean included preoperative best-corrected visual acuities was one logarithm of the minimum angle of resolution (range, 0.3 logarithm of the minimum angle of resolution to counting fingers). Indications for femtosecond laser-assisted anterior lamellar keratoplasty included anterior stromal scarring due to viral keratitis (two cases), bacterial keratitis (one case), chronic epithelial defect (one case), Avellino dystrophy (one case), trauma (one case), and chronic endothelial failure (two cases). Six patients had history of prior intraocular surgeries including phacoemulsification (four cases), pars plana vitrectomy (one case), endothelial keratoplasty (two cases), and trabeculectomy (one case). Mean included best-corrected visual acuities at most recent follow-up was one logarithm of the minimum angle of resolution (range zero logarithm of the minimum angle of resolution to hand movements) representing improvement or stability in six of eight patients. Visually significant corneal astigmatism was present in four of eight patients. Post-femtosecond laser-assisted anterior lamellar keratoplasty procedures included graft repositioning, arcuate keratotomy, phacoemulsification, and regraft. Conclusion While femtosecond laser-assisted anterior lamellar keratoplasty offers a less-invasive treatment option compared to penetrating keratoplasty, intraoperative and postoperative management can be complex. Femtosecond laser-assisted anterior lamellar keratoplasty in patients with history of prior endothelial keratoplasty or ongoing ocular comorbidities should be pursued with caution.

RESUMO Objetivo Identificar as características clínicas pré-operatórias de pacientes submetidos à ceratoplastia lamelar anterior assistida por laser de femtossegundo que não alcançaram resultados visuais pós-operatórios ideais. Métodos Nesta série de casos retrospectiva em um único centro, os pacientes submetidos à ceratoplastia lamelar anterior assistida por laser de femtossegundo entre 2013 e 2018 foram incluídos se precisassem de revisão do enxerto, procedimento corneano subsequente ou visitas pós-operatórias adicionais por uma intercorrência relacionada à ceratoplastia lamelar anterior assistida por laser de femtossegundo. Os resultados visuais avaliados incluíram melhor acuidade visual corrigida e astigmatismo pós-operatório da córnea. Resultados Oito olhos de oito pacientes que atenderam aos critérios descritos foram incluídos. A idade média dos pacientes foi de 64,5 anos (variação de 21 a 89). A melhor acuidade visual corrigida pré-operatória média foi de um logaritmo do mínimo ângulo de resolução (variação de 0,3 logaritmo do mínimo ângulo de resolução para contagem de dedos). As indicações para ceratoplastia lamelar anterior assistida por laser de femtossegundo incluíram cicatriz do estroma anterior devido à ceratite viral (dois casos), ceratite bacteriana (um caso), defeito epitelial crônico (um caso), distrofia de Avellino (um caso), trauma (um caso) e insuficiência endotelial crônica (dois casos). Seis pacientes tinham história de cirurgias intraoculares anteriores, incluindo facoemulsificação (quatro casos), vitrectomia via pars plana (um caso), ceratoplastia endotelial (dois casos) e trabeculectomia (um caso). O mínimo ângulo de resolução médio no acompanhamento mais recente foi de um logaritmo do mínimo ângulo de resolução (variação de zero logaritmo do mínimo ângulo de resolução para movimentos das mãos), representando melhora ou estabilidade em seis de oito pacientes. Astigmatismo corneano visualmente significativo estava presente em quatro de oito pacientes. Os procedimentos pós-ceratoplastia lamelar anterior assistida por laser de femtossegundo incluíram reposicionamento do enxerto, ceratotomia arqueada, facoemulsificação e enxerto. Conclusão Embora a ceratoplastia lamelar anterior assistida por laser de femtossegundo ofereça uma opção de tratamento menos invasiva em comparação com a ceratoplastia penetrante, o manejo intra e pós-operatório pode ser complexo. A ceratoplastia lamelar anterior assistida por laser de femtossegundo em pacientes com história de ceratoplastia endotelial anterior ou comorbidades oculares correntes deve ser avaliada com cautela.

[The rapid development and changes of corneal refractive surgery in China].

Corneal refractive surgery in China, represented by laser corneal surgery, has undergone great changes in recent 30 years. Almost one million corneal refractive surgeries are performed each year. With the rapid technological innovation, the corrective effect is constantly higher, and complications are continuously controlled and reduced. The team of practitioners keeps expanding, and the academic strength is approaching the international level. With the application and promotion of various new technologies, the formulation of relevant norms and the increase of academic researches, corneal refractive surgery in China has stepped into the stage of diversification, intelligence and standardization. However, we should recognize the shortcomings while facing the great achievements. More efforts are still needed to provide the best visual quality and natural vision correction effect for patients. We would like to send congratulations on the 70th anniversary of Chinese Journal of Ophthalmology with this article. (Chin J Ophthalmol, 2020, 56: 81-85).

[Enhancing the management and control of perioperative infection in small incision lenticule extraction].

Small incision lenticule extraction (SMILE) has been widely used in the treatment of myopia and astigmatism due to its small incision (2 mm), without open corneal flap, rapid recovery of the ocular surface function and good comfort. However, it is the microincision and the potential cavity under the corneal cap that provide a suitable environment for microbial nourishment. In this article, the characteristics of SMILE and the particularity of postoperative infection are stated, and the key points of risk management and control during the period of operation as well as the principles of identification and treatment of infection after SMILE surgery are put forward, so as to enhance the perioperative preparation in SMILE and make sure of the safety and high quality for myopic eyes. (Chin J Ophthalmol, 2020, 56: 86-88).

[Comparison of corneal epithelial remodeling after small incision lenticule extraction and femtosecond laser-assisted LASIK].

Objective: To investigate the corneal epithelial thickness changes between small incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK (FS-LASIK), study the related factors and analyze the relationship between the changes in corneal epithelial thickness and corneal aberration. Methods: This case control study included 59 patients (118 eyes), 27 males and 32 females, aged 25.64±5.57 years, who were scheduled for SMILE or FS-LASIK for treatment of myopia with or without myopic astigmatism at the First Affiliated Hospital of Soochow University between October 2016 and May 2017. All patients were divided into two groups according to the surgery. Epithelial thickness was obtained in nine zones with Fourier-domain optical coherence tomography across a 5-mm diameter centered by the pupil before surgery and at 1 week, 1 month, 3 months and 6 months postoperatively. The observed changes were analyzed by linear-regression analysis with the central corneal thickness decrement, ablation rate and corneal aberration. Comparison between two groups was analyzed by independent sample t-test, analysis of variance and Mann-Whitney U test. Results: There was no significant difference in corneal epithelial thickness of nine zones between SMILE and FS-LASIK for low to moderate myopia (manifest refraction sphere equivalent<-6.00 diopters) and high myopia (manifest refraction sphere equivalent ≥-6.00 to -10.00 diopters), respectively, before surgery (P>0.05). At 1 month, no significant difference existed in corneal epithelial thickness increment in nine zones between FS-LASIK and SMILE for low to moderate myopia (P>0.05), but a larger increase was observed in the superior (t=2.670, P=0.010), superonasal (t=2.506, P=0.015) and nasal (t=2.831, P=0.007) zones following FS-LASIK [(4.2±3.2), (3.4±2.7) and (3.7±2.5) µm] than SMILE [(2.2±2.2), (1.6±2.5) and (1.7±2.6) µm] for high myopia. At 3 months, a larger increase in corneal epithelial thickness was observed in the superior (t=2.703, P=0.009) zone following FS-LASIK than SMILE for low to moderate myopia, and the same increase was observed in the central (t=2.660, P=0.010), superior (t=3.229, P=0.002), nasal (t=2.420, P=0.019), inferonasal (t=2.651, P=0.011), inferotemporal (t=2.153, P=0.036) and superotemporal (t=2.281, P=0.027) zones after FS-LASIK [(6.7±2.6), (5.0±2.1), (3.9±1.9), (4.8±1.8), (7.5±2.5) and (6.4±2.7) µm] than SMILE [(4.7±2.9), (2.9±2.5), (2.4±2.4), (3.3±2.2), (6.0±2.4) and (4.8±2.4) µm] for high myopia. At 6 months, a larger increase in corneal epithelial thickness was observed in the superior (t=3.340, P=0.001) and nasal (t=1.952, P=0.055) zones following FS-LASIK than SMILE for low to moderate myopia, and the same increase was observed in the superior (t=2.332, P=0.024) and inferonasal (t=2.172, P=0.034) zones after FS-LASIK than SMILEfor high myopia. The central corneal thickness decrement after SMILE was much more than FS-LASIK both in the low to moderate myopia and high myopia groups (P<0.05). The average corneal epithelial thickness increment correlated positively with the central corneal thickness decrement and ablation rate at 1 month, 3 months and 6 months postoperatively (P<0.01). For SMILE, the total higher orders aberration (0.81±0.26, 0.79±0.28 and 0.81±0.31) and spherical aberration (0.50±0.21, 0.48±0.20 and 0.52±0.23) were less than FS-LASIK (0.97±0.34, 0.97±0.33 and 0.93±0.32; 0.72±0.25, 0.66±0.30 and 0.71±0.25) at 1 month, 3 months and 6 months postoperatively (P<0.05). Furthermore, the corneal aberration increment correlated positively with the average corneal epithelial thickness increment (P<0.05). Conclusions: The corneal epithelial thickness increment after SMILE was less than FS-LASIK. SMILE had better uniformity of the corneal epithelial thickness increment at the observed zones, which may explain the finding that the postoperative spherical aberration of SMILE was less than FS-LASIK. (Chin J Ophthalmol, 2020, 56:93-102).

[Assessment of corneal biomechanical changes after small incision lenticule extraction with Pentacam and Corvis ST].

Objective: To investigate the application value of Pentacam combined with Corvis ST in evaluation of the changes of corneal biomechanics after femtosecond laser small incision lenticule extraction (SMILE) in Chinese myopia with an irregular cornea. Methods: The clinical records for 104 eyes of 57 patients who received SMILE in the Refractive Center of Beijing Tongren Hospital during January 2018 and May 2018 were collected. According to the keratoconus severity index (KSI), they were divided into two groups: regular corneal group (KSI<15%) and irregular corneal group (KSI: 15% to 25%). In both groups, the anterior corneal surface radius curvature was>7.25 mm (K<46.50 diopters), the posterior corneal surface radius curvature was>5.90 mm, the thinnest pachymetry was>490 µm, and best corrected visual acuity was ≥1.0. The vision, refraction, and corneal biomechanics before and after SMILE were assessed. The Topographic and Biomechanics Index (TBI) was analyzed by Pentacam combined with Corvis ST. Results: Before SMILE, the Corvis Biomechanical Index (CBI), TBI, and Belin/Ambrósio Deviation Normalized Index (BADD) of the irregular corneal group were significantly higher (t=-2.17, -6.78, -4.37, P<0.05) than the regular corneal group, while the stiffness parameter (SPA1) was significantly lower (t=2.58, P=0.011) compared to the regular corneal group (P<0.05). In the irregular group, the TBI was (0.28±0.2); the maximum value was 0.03, and the minimum value was 0.43. The CBI was (0.09±0.21); the maximum value was 0.00, and the minimum value was 0.54. The BADD was (1.33±0.47); the maximum value was 0.42, and the minimum value was 2.26. In the regular group, the TBI was (0.05±0.08); the maximum value was 0.00, and the minimum value was 0.20. The CBI was (0.01±0.03); the maximum value was 0.00, and the minimum value was 0.17. The BADD was (0.92±0.46); the maximum value was 0.00, and the minimum value was 1.64. There was no significant difference between two groups in age (t=0.20, P=0.508), central corneal thickness (t=1.64, P=0.104), biomechanical corrected IOP (t=0.73, P=0.468), max inverse radius (t=-0.24, P=0.815), spherical equivalent (t=-0.97, P=0.335), and best corrected visual acuity (t=0.21, P=0.833). After SMILE, the deformation amplitude in the irregular group was significantly higher at 1 month and 3 months (t=-3.13, -3.09, P<0.05). The irregular group had a significantly higher deformation amplitude ratio at 1 week, 1 month, and 1 year (t=-2.72, -3.39, -2.51, P<0.05). The SPA1 in the irregular group was significantly lower than the regular group at 1 week, 1 month, and 3 months (t=2.11, 2.73, 3.70, P=0.335, 0.010,<0.001). The changes of deformation amplitude (t=0.50, -1.10, -0.73, 2.12, P>0.05), max inverse radius (t=-1.52, -1.41, 0.01, -0.79, P>0.05), and SPA1(t=0.89, 0.90, 1.12, 0.90, P>0.05) after SMILE were similar between the irregular and regular groups, except that at 1 month after SIMILE, the deformation amplitude ratio changed more significantly in the irregular group (t=-3.01, P=0.003). Conclusions: The changes of corneal biomechanics in the groups of regular cornea and irregular cornea were stable with no significant difference during 1 year of post-SMILE. The diagnosis based on the corneal topography and corneal biomechanics is of certain significance for the screening of early keratoconus before keratorefractive surgery. (Chin J Ophthalmol, 2020, 56:103-109).

[Comparison of the visual quality at 1 year following femtosecond laser-assisted LASIK, wavefront-guided femtosecond LASIK and small incision lenticule extraction for myopia and astigmatism].

Objective: To investigate mesopic contrast sensitivity (CS) and high-order aberrations after femtosecond laser-assisted LASIK (FS-LASIK), wavefront-guided femtosecond LASIK (WF-LASIK) and small incision lenticule extraction (SMILE) for myopia and astigmatism. Methods: In this case-control study, 212 eyes of 108 patients with myopia and astigmatism from September 2014 to September 2016 were treated by refractive surgery. There were 34 males (66 eyes) and 74 females (146 = eyes), aged 27 (24, 32) years. They were divided into 3 groups, with 37 patients (71 eyes), 35 patients (69 eyes) and 36 patients (72 eyes) treated by FS-LASIK, WF-LASIK and SMILE, respectively. Refraction diopters, corneal tomography, wavefront aberrations and contrast sensitivity were evaluated before and at 12 months after surgery. The results of different groups were compared by rank sum test. Results: At 12 = months of follow-up, 69 eyes (97.18%) treated by FS-LASIK, 67 eyes (97.10%) by WF-LASIK and 69 eyes (95.83%) by SMILE had the uncorrected distance visual acuity of 20/20 or better. Fifty-nine eyes (83.10%) treated by FS-LASIK, 60 eyes (86.96%) by WF-LASIK and 61 eyes (84.72%) by SMILE had better postoperative uncorrected distance visual acuity than preoperative corrected distance visual acuity. Surface regularity index of the WF-LASIK group decreased from 0.11 (0.07, 0.28) to 0.07 (0.06, 0.20) (Z=-2.662, P=0.008), which was less than that of the FS-LASIK and SMILE groups (Z=-3.236, -3.118, P=0.001, 0.000). Surface asymmetry index of the WF-LASIK group increased from 0.34 (0.25, 0.43) to 0.38 (0.30, 0.52) (Z=-2.140, P=0.032), which was less than that of the FS-LASIK and SMILE groups (Z=-2.910, -3.779, P=0.004, 0.000). The root mean square of high-order of the FS-LASIK group increased from 0.32 (0.27, 0.41) to 0.53 (0.40, 0.65) (Z=-6.228, P=0.000), which was more than that of the WF-LASIK and SMILE groups (Z=-3.595, -4.806, P=0.000, 0.000). Coma of the WF-LASIK group increased from 0.16 (0.11, 0.24) to 0.26 (0.15, 0.37) (Z=-3.816, P=0.000), which was less than that of the FS-LASIK group (Z=-3.528, P=0.000). Spherical aberration of the FS-LASIK and WF-LASIK groups increased from 0.10 (0.05, 0.21) and 0.08 (0.04, 0.12) to 0.24 (0.13, 0.34) and 0.15 (0.09, 0.26), respectively (Z=-5.141, -4.864, P=0.000, 0.000), which were more than that of the SMILE group (Z=-2.549, -4.682, P=0.011, 0.000). CS of the WF-LASIK group at 12 cycles per degree (c/d) increased from 1.34 (1.18, 1.48) to 1.48 (1.34, 1.63) (Z=-2.985, P=0.003), which was more than that of the FS-LASIK and SMILE groups (Z=-3.194, -2.977, P=0.001, 0.003). CS with glare of the WF-LASIK group at 12.0 c/d increased from 1.26 (1.18, 1.34) to 1.34 (1.34, 1.63) (Z=-3.608, P=0.000), which was more than that of the FS-LASIK and SMILE groups (Z=-4.033, -2.913, P=0.000, 0.004). Conclusions: FS-LASIK, WF-LASIK and SMILE achieved ideal visual outcomes at 12 months postoperatively. WF-LASIK treated eyes showed the best corneal symmetry, the least increase of high-order aberrations and the best visual quality among three kinds of surgeries. (Chin J Ophthalmol, 2020, 56: 118-125).

[New progress in the reuse of human corneal stromal lenticules from SMILE].

With the extensive development of small incision lenticule extraction (SMILE), a large number of human corneal stromal lenticules were extracted integrally during the operation, which led some experts to study the reuse of the lenticules. In experimental research, the lenticules were used to culture fibroblasts, construct corneal scaffolds and describe the biomechanical behaviors of cornea by cytobiology, immunology and biomechanics. In clinical study, the lenticules had been successfully reimplanted into autologous or allogenic cornea of human subjects for correcting hyperopia and presbyopic, patching corneal perforation and treating defective keratopathy and so on. (Chin J Ophthalmol, 2020, 56:144-148).

Refractive and visual outcomes after Ferrara corneal ring segment implantation at a 60% depth in keratoconic eyes: case series / Resultados refrativos e visuais após a inserção do anel de Ferrara a uma profundidade de 60% em olhos com ceratocone: série de casos

ABSTRACT Purpose: This report addresses refractive, topographic, visual acuity, and optical coherence tomography outcomes 12 months after femtosecond, laser-assisted insertion of Ferrara intrastromal corneal ring segments in keratoconic eyes at a depth of 60%. Methods: Interventional, prospective, non-comparative case series. We performed femtosecond, laser-assisted insertion of Ferrara intrastromal corneal ring segments in 15 keratoconic eyes. We included patients with documented keratoconus who voluntarily signed informed consents if they had best spectacle-corrected visual acuity ≥0.30 logMAR and corneal thickness ≥400 μm. We excluded patients with previous ocular surgery or corneal curvatures >65 diopters (D). Our main outcome measures were best spectacle-corrected visual acuity and corneal topographic parameters (flattest, steepest and average keratometry [K]), evaluated at baseline and at 1-,3-,6-, and 12-month follow-ups. Results: The mean ± standard deviation baseline uncorrected visual acuity and best spectacle-corrected visual acuity were 1.03 ± 0.46 and 0.42 ± 0.13, respectively; the 12-month mean standard deviation uncorrected visual acuity and best spectacle-corrected visual acuity were 0.72 ± 0.37 and 0.31 ± 0.16, respectively, without significant differences (p=0.05 for both). The mean best spectacle-corrected visual acuity improvements were statistically significant after 3- (p=0.02) and after 6-months (p=0.02). The mean baseline flattest (K1), steepest (K2), and overall keratometries (mean power) were 48.35 ± 3.65 D, 53.67 ± 3.38 D, and 50.84 ± 3.36 D, respectively. The 12-month mean ± standard deviations for flattest-K1, steepest-K2, and overall K were 46.53 ± 3.70 D, 49.83 ± 3.50 D, and 48.12 ± 3.49 D respectively, with statistically significant differences for all three topographic parameters (p=0.01). Conclusions: Ferrara intrastromal corneal ring segment insertions at a depth of 60% yield satisfactory visual, refractive, and keratometric results in keratoconic eyes.

RESUMO Objetivos: Este estudo aborda os resultados refrativos, topográficos, acuidade visual e tomografia de coerência óptica, 12 meses após a inserção do segmento de Anel de Ferrara em túnel corneano a 60% de profundidade com o laser de femtosegundo, em pacientes com ceratocone. Métodos: Série de casos não comparativos, prospectivos e intervencionistas. Realizamos a inserção do Anel de Ferrara através de incisão com o laser de femtosegundo em 15 olhos ceratocônicos. Foram incluídos pacientes com ceratocone documentado que voluntariamente assinaram consentimentos informados que tivessem melhor acuidade visual corrigida ≥0.30 tabela logMAR, espessura corneana ≥400µm. Foram excluídos pacientes com cirurgia ocular prévia ou curvatura corneana > 65 dioptrias (D). As principais variáveis medidas foram acuidade visual corrigida e os parâmetros topográficos da córnea (ceratometria mais plana (K1), mais curva (K2) e ceratometria média (K médio), avaliadas no pré-operatório e com 1, 3, 6 e 12 meses de seguimento. Resultados: A média ± desvio padrão da acuidade visual sem correção e acuidade visual corrigida foi 1.03 ± 0.46 e 0.42 ± 0.13, respectivamente; o desvio padrão médio de 12 meses, a acuidade visual sem correção e acuidade visual corrigida foram de 0.72 ± 0.37 e 0.31 ± 0.16, respectivamente, sem diferenças significativas (p=0,05 para ambos). A melhora da acuidade visual corrigida foi estatisticamente significante após 3 meses (p=0,02), e após 6 meses (p=0,02). Os valores médios da linha de base K1, K2, e média (K médio) foram 48,35 ± 3,65D, 53,67 ± 3,38D, e 50,84 ± 3,36D, respectivamente. A média de 12 meses ± desvio padrão para K1, K2, e K médio foi 46,53 ± 3,70D, 49,83 ± 3,50 D, e 48,12 ± 3,49D respectivamente, com diferença estatisticamente significativas para todos os 3 parâmetros topográficos (p=0,01). Conclusões: A inserção do Anel de Ferrara a uma profundidade de 60% no estroma corneano produz resultados visuais, refracionais e ceratométricos satisfatórios em olhos com ceratocone.