Dynamic assessment of variations in pupil diameter using swept-source anterior segment optical coherence tomography after phakic collamer lens implantation.

PURPOSE: To dynamically assess variations in pupil diameter induced by changes in brightness in myopic eyes implanted with an implantable collamer lens (ICL, STAAR Surgical) with a central port. METHODS: This prospective, observational single-center case series study comprised 65 eyes from 65 consecutive patients undergoing ICL implant. A modified commercially available swept-source Fourier-domain anterior segment optical coherence tomography (AS-OCT) device was used for imaging and performing dynamic pupillometry under changing light conditions before and after a mean follow-up interval of four months after surgery. RESULTS: Preoperative mean pupil size under photopic conditions was 3.38 ± 0.64 mm; after surgery, this increased to 3.48 ± 0.61 mm. Mean pupil size under scotopic light conditions was 5.72 ± 0.79 mm before surgery and 5.84 ± 0.77 mm postoperatively. The differences between preoperative and postoperative pupil diameter in miosis and mydriasis were 0.10 ± 0.44 mm (P = 0.078) and 0.12 ± 0.58 mm (P = 0.098), respectively. The scotopic pupil exceeded the optic zone of the implanted lens in 39 eyes (60%). The mean central vault value was 412 ± 177 µm under maximum miosis and 506 ± 190 µm under maximum mydriasis. We found a positive correlation between vault and differences in pupil diameter under all light conditions (P < 0.05). CONCLUSION: Dynamic AS-OCT enables a very precise determination of the pupillary diameter in the iris plane. The changes in the pupil diameter under different light conditions after the implantation of an ICL are related to the postoperative vault.

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.].

Case Report: Double Intrastromal Corneal Ring Segment and Posterior Chamber Phakic Intraocular Lens Implantation.

SIGNIFICANCE: Keratoconus can manifest asymmetrically, affecting binocularity and becoming a refractive problem that is sometimes complex to solve. We propose a therapeutic approach for correction of keratoconus based on parallel implantation of a second intrastromal corneal ring segment (ICRS). PURPOSE: This study aimed to improve the refractive status of a patient affected with advanced bilateral keratoconus using implantation of a second ICRS and a phakic intraocular lens. CASE REPORT: A 44-year-old man came to our clinic requesting a refractive solution for his visual impairment. He had been diagnosed with bilateral severe keratoconus categorized by the Amsler-Krumeich classification scale as grade III (right eye) and grade II (left eye). He had previously undergone corneal cross-linking and implantation of ICRS (Intacs) in both eyes. Significant anisometropia was present between the eyes, and the patient also complained of poor quality of vision. We decided to implant a posterior chamber phakic collamer lens in his right eye and to insert a new ICRS (Keraring) deep and parallel to the previous one in his left eye. We aimed to prevent anisometropia in his right eye and to further regularize the affected cornea in his left eye. Refractive symmetry was achieved, and vision was optimized after surgery. CONCLUSIONS: In a patient with keratoconus, refractive surgery should be performed from a bilateral perspective. Specific cases of keratoconus can be managed by parallel implantation of a second ICRS.

Long-term assessment of crystalline lens transparency in eyes implanted with a central-hole phakic collamer lens developing low postoperative vault.

PURPOSE: To assess long-term crystalline lens transparency in eyes implanted with phakic collamer intraocular lens (pIOL) with a central port and low postoperative vault for correction of myopia. SETTING: Clinica Baviera, Madrid, Spain. DESIGN: Retrospective cross-sectional single-center study. METHODS: Using a noninvasive Fourier-domain swept-source anterior segment optical coherence tomography system, shifts in myopic and astigmatic myopic eyes implanted with a pIOL with vaulting lower than 100 µm in miosis and more than 4 years of follow-up were dynamically evaluated. Main outcome measures were pIOL dynamic vault (vault interval and vault range [VR]), crystalline lens density, and anterior subcapsular lens opacities. Crystalline lenses were examined under slitlamp microscopy, and lens density was evaluated using quantitative Scheimpflug images. Scheimpflug images were compared with those of a control group comprising eyes that were candidates for pIOL implantation. RESULTS: The study population comprised 24 eyes from 16 patients previously implanted with a pIOL (5.82 ± 0.9 years) with central vault lower than 100 µm under photopically induced miosis. The mean vault value was 52 ± 19 µm under photopic light conditions and 113 ± 37 µm under scotopic conditions. The mean VR was 58 ± 24 µm. Anterior subcapsular lens opacities were found in only 1 eye (4.17%). The mean lens density was 7.94 ± 0.43, and no statistically significant differences were observed compared with the control group. CONCLUSIONS: Long-term low vaulting in eyes implanted with a pIOL with a central port for correction of myopia was associated with a low risk for developing anterior crystalline lens opacities.

Comparison of visual outcomes and flap morphology using 2 femtosecond-laser platforms.

PURPOSE: To compare the 3-month postoperative refractive results and flap thickness homogeneity after correction of myopia using the Intralase femtosecond platform and the Victus dual femtosecond laser platform. SETTING: Novovision Clinic, Madrid, Spain. DESIGN: Prospective case series. METHODS: Eyes treated with a 60 kHz femtosecond laser (Group 1) and eyes treated with a dual femtosecond laser (Group 2) were included. The refractive results 3 months postoperatively were compared. The differences between the maximum and the minimum thickness point of each flap, the intraflap standard deviation (SD), and the achieved and the targeted central flap thickness were evaluated in each group. RESULTS: The study comprised 31 eyes in Group 1 and 20 eyes in Group 2. Three months postoperatively, the uncorrected distance visual acuity, residual refraction, efficacy, safety, and predictability were significantly better in Group 1. The dual femtosecond laser induced a significantly greater increase in higher-order aberrations than the conventional femtosecond laser. The mean central flap thickness was 123.2 µm ± 9.2 (SD) in Group 1 and 116.3 ± 14.4 µm in Group 2 (P = .005). The mean difference between the maximum and the minimum flap thickness points in each flap was significantly lower in Group 1 than in Group 2 (22 ± 8.3 µm versus 35.7 ± 16.9 µm) (P = .0007). The intraflap SD was significantly lower in Group 1 than in Group 2 (6.1 µm versus 10.8 µm) (P = .0001). CONCLUSION: The conventional femtosecond laser provided better efficacy, safety, predictability, and flap thickness homogeneity than the dual femtosecond laser for the correction of myopia.