Femtosecond laser-assisted cataract surgery in a patient with posterior chamber phakic intraocular lens.

We describe a case of modified femtosecond laser settings for cataract extraction in a patient with a posterior chamber phakic intraocular lens (PIOL), to avoid incomplete treatment patterns and treatment displacement. Modification of laser settings (increased depth for the capsulotomy, increased vertical spot spacing for the capsulotomy and increased anterior and posterior capsule safety margins for lens fragmentation) seems to make femtosecond laser-assisted cataract surgery feasible in patients with posterior chamber PIOLs, as complete treatment patterns are achieved.

Endothelial keratoplasty in children.

PURPOSE OF REVIEW: Descemet stripping endothelial keratoplasty has superseded penetrating keratoplasty (PKP) in adults as the procedure of choice for treating endothelial dysfunction, but endothelial keratoplasty despite the multitude of advantages has undergone a much slower adoption in pediatric patients. This review focuses on the recent advances made in the field of pediatric endothelial keratoplasty and the associated surgical challenges. RECENT FINDINGS: Pediatric endothelial keratoplasty does not require as many sutures as PKP, and the wound size is smaller and more stable. Endothelial keratoplasty grafts clear faster, possibly allowing for a more effective management of amblyopia. Visual outcomes appear to be comparable with PKP but with a lower complication rate. SUMMARY: As corneal surgeons grow more and more familiar with the nuances of pediatric endothelial keratoplasty, our understanding of this procedure will become more complete. The limited data available suggest that endothelial keratoplasty is a suitable surgical alternative to PKP in children.

Recentration of a small-aperture corneal inlay.

UNLABELLED: We report 2 patients implanted with a small-aperture corneal inlay to correct presbyopia. After the surgery, both patients complained of visual symptoms and poor visual acuity. The distances from the center of the inlay to the corneal vertex center were 593 µm nasally and 159 µm superiorly in Case 1 and 72 µm temporally and 17 µm superiorly in Case 2. The 2 inlays were recentered at 2 weeks and 3 weeks postoperatively, resulting in significant improvement in the visual acuity and quality of vision. Accurate centration of a small-aperture corneal inlay seems to be an important factor in obtaining a satisfactory result. Recentration is possible and improves visual acuity if proper centration was not obtained after the first surgery. FINANCIAL DISCLOSURE: Dr. Saad is a consultant to Acufocus, Inc. Dr. Gatinel is an investigator for a clinical trial conducted with the small-aperture inlay. He does not have any financial interest in relation to this inlay. Neither of the other authors has a financial or proprietary interest in any material or method mentioned.

A contralateral, randomized comparison of optimized prolate ablation and conventional LASIK for myopia with the NIDEK excimer laser platform.

PURPOSE: To compare the refractive, visual acuity, topographic, and spherical aberration outcomes of LASIK using the Quest excimer laser platform with the optimized prolate ablation (OPA) profile (NIDEK Co Ltd) in one eye and conventional ablation profile in the fellow eye of the same patient. METHODS: Thirty-seven myopic patients underwent LASIK bilaterally, with one eye randomized to receive OPA ablation (-3.88±1.42 diopters [D], range: -1.53 to -7.50 D) and the fellow eye to receive conventional ablation (-3.89±1.37 D, range: -1.75 to -7.00 D). Independent and paired t tests were used for testing differences between groups at last postoperative follow-up (6 or 12 months). RESULTS: Postoperatively, 97% (32/33) of OPA eyes and 94% (31/33) of conventional eyes saw 20/20 or better without correction (P>.05). No eyes lost 2 or more lines of distance corrected visual acuity. Manifest refraction spherical equivalent was -0.16 D in the OPA group and -0.05 D in the conventional group (P>.05). Ocular spherical aberration was -0.003 µm in the OPA group and +0.102 µm in the conventional group (P<.05). Corneal asphericity was statistically lower after OPA (0.07±0.26) compared to conventional ablation (0.30±0.26) (P<.001). The mean programmed optical zone and achieved postoperative horizontal diameter of the effective optical zone were statistically significantly larger in the OPA group (P<.05). CONCLUSIONS: Postoperative visual acuity and refractive outcomes were similar between groups. Laser in situ keratomileusis using the OPA profile for the correction of myopia induced significantly less corneal and ocular spherical aberration, resulted in normal postoperative asphericity in 94% of eyes, and larger horizontal diameter of the effective optical zone compared to the conventional profile.

The use of fibrin glue to seal Descemet membrane microperforations occurring during deep anterior lamellar keratoplasty.

PURPOSE: To report the use of fibrin glue to seal microperforations in Descemet membrane (DM) during deep anterior lamellar keratoplasty (DALK). METHODS: Two patients with keratoconus underwent DALK complicated by DM microperforation. Fibrin glue was successfully used to seal the microperforation in both cases. RESULTS: DM remained attached postoperatively in both cases, with no opacification, increased inflammation, or vascularization of the corneal stroma. CONCLUSIONS: The use of fibrin glue for managing microperforations in DALK may be a viable option.

Corneal collagen crosslinking in the treatment of infectious keratitis.

PURPOSE: To report the use of corneal collagen crosslinking in the treatment of infective keratitis not responding to antimicrobial therapy. METHODS: Two retrospective case reports of infective keratitis treated with corneal collagen crosslinking. RESULTS: In both cases, corneal collagen crosslinking caused a rapid resolution of the infective keratitis, leaving residual stromal scarring. Due to the density of scarring, one case required subsequent penetrating keratoplasty for visual rehabilitation. CONCLUSION: Corneal collagen crosslinking is a promising new technique for the management of infective keratitis not responding to antimicrobial therapy. Further elucidation of its safety and role in management of infectious keratitis is needed by way of future studies.

Effect of the direct application of riboflavin and UVA on the Visian Implantable Collamer Lens.

PURPOSE: To report the effect of corneal collagen cross-linking (CXL) with riboflavin and ultraviolet A (UVA) on the optical and material characteristics of a posterior chamber phakic intraocular lens (Visian ICL, STAAR Surgical). METHODS: Optical and material characteristics were assessed in vitro, analyzing potential changes in riboflavin staining, dioptric power, transmission characteristics, and surface structure. A total of 9 lenses were analyzed: 3 lenses were irradiated with 0.23 mW/cm², the maximal intensity that may be encountered during actual surgery; 3 lenses were irradiated with 2.3 mW/cm², 10 times the maximal intensity encountered during surgery; and 3 lenses served as controls. RESULTS: Following CXL with UVA and riboflavin, no changes were observed in the parameters tested; in particular, dioptric power and transmission characteristics were similar before and after CXL. CONCLUSIONS: Cross-linking with UVA and riboflavin does not affect the optical and material characteristics of the Visian ICL after irradiation with the maximal UVA energy levels that may be encountered during surgery. Even when the UVA irradiation dose was increased by a factor of 10, no changes were observed.

Customized aspheric treatment zone ablation to treat irregular corneas after corneal refractive surgery.

PURPOSE: To describe the retreatment of highly aberrated corneas due to previous keratorefractive surgery using topography-guided aspheric treatments. METHODS: Eight eyes (five patients) with reduced mesopic visual quality due to previous keratomileusis, excimer laser surgery, or radial keratotomy underwent retreatment with the customized aspheric treatment zone (CATz) algorithm with the CXIII excimer laser (NIDEK Co Ltd) to correct corneal wavefront aberrations. Before CATz treatments, all patients were satisfied with their preoperative photopic vision (all 20/30 or better uncorrected) yet were dissatisfied with their vision at night. All eyes had >20 microm (range: 20 to 33 microm) of corneal irregularity before CATz retreatment. All eyes had a flap cut or flap lift procedure for CATz retreatment. RESULTS: One year after treatment with CATz, no eyes lost best spectacle-corrected visual acuity (BSCVA); all eyes had BSCVA of 20/30 or better. Mean modulation transfer function increased by 13% by the end of the first postoperative year. A 0.45-microm decrease was noted in coma 1 year postoperatively. CONCLUSIONS: The CATz algorithm is effective in the treatment of severe corneal irregularities due to previous corneal surgery.

Axis alignment and rotational stability after implantation of the toric implantable collamer lens for myopic astigmatism.

PURPOSE: To assess axis alignment and stability of the Toric Implantable Collamer Lens (TICL; STAAR Surgical Co) over time. METHODS: Thirty-five consecutive eyes of 19 patients received the TICL for treatment of myopic astigmatism. Manifest refraction spherical equivalent (MRSE) and manifest refractive cylinder were measured preoperatively and at 3 months postoperatively. The axis alignment of the TICL was measured using the internal OPD map obtained with the OPD-Scan II (NIDEK Co Ltd). RESULTS: Mean refractive cylinder was reduced from 2.80+/-1.45 diopters (D) preoperatively to 0.63+/-0.75 D at 3 months postoperatively; MRSE was -7.61+/-4.02 D preoperatively and -0.14+/-0.38 D at 3 months. Mean absolute value of the measured axis misalignment from baseline (day 1) to 1 month was 2.90+/-2.11 degrees and from 1 month to 3 months was 4.6+/-11.2 degrees. Mean absolute value of the measured changes in axis misalignment from baseline to 3 months was 2.68+/-2.11 degrees (after excluding one eye that required repositioning due to TICL rotation). At 3 months postoperatively, 96.8% (30/31) eyes had

Multizone LASIK with peripheral near zone for correction of presbyopia in myopic and hyperopic eyes: 1-year results.

PURPOSE: To investigate the refractive outcomes of multifocal LASIK to create a center far, peripheral near zone in presbyopes. METHODS: This prospective study using LASIK with a center far, peripheral near ablation algorithm comprised 68 eyes of 34 hyperopes and 78 eyes of 39 myopes. Mean patient age was 49 +/- 5.60 years for hyperopes and 46.0 +/- 3.80 years for myopes. Mean baseline manifest refraction spherical equivalent was +1.76 +/- 0.96 diopters (D) in hyperopes and -3.06 +/- 1.73 D in myopes. The mean baseline addition was +1.94 +/- 0.40 D in hyperopes and +1.67 +/- 0.44 D in myopes. One-year postoperative outcomes are reported. RESULTS: The mean postoperative spherical equivalent refraction was -0.10 +/- 0.55 D in hyperopes and -0.48 +/- 0.51 D in myopes. Two percent of eyes in each group lost two lines of best spectacle-corrected visual acuity. With the distance correction in place, 20/40 or better near uncorrected visual acuity (UCVA) (Sloan acuity) was achieved in 33% of hyperopes and 36% of myopes. A statistically significant difference was noted in postoperative near visual acuity measured by the Sloan and Rosenbaum charts (P < .05). Fifty-four percent of hyperopes and 48% of myopes were satisfied or very satisfied with their postoperative near UCVA. CONCLUSIONS: Multifocal LASIK to create a center far and peripheral near zone is safe and allows half of the patients to achieve spectacle independence. A peripheral near zone was only created in myopic treatments.

NIDEK optimized prolate ablation for the treatment of myopia with and without astigmatism.

PURPOSE: To report the ocular and corneal higher order aberrations of a pilot trial of optimized prolate ablations for the treatment of myopia. METHODS: In this prospective study, patients were treated using optimized prolate ablation or conventional ablation. Five patients underwent bilateral optimized prolate ablation treatment, and nine patients were randomized to receive optimized prolate ablation (OPA group) in one eye and conventional ablation (control group) in the other eye. The mean preoperative manifest refraction spherical equivalent was -4.13+/-1.17 diopters (D) (range: -8.00 to -1.50 D), with a mean cylinder of -0.42+/-0.32 D (range: -1.00 to 0.00 D). Predictability, contrast sensitivity, and corneal and ocular aberrations were analyzed out to 6 months postoperatively. RESULTS: Postoperative predictability was similar between the two groups. There was an increase in mesopic contrast sensitivity in the OPA group, and the OPA group had higher mesopic contrast sensitivity postoperatively. At 6 months postoperatively, the root-mean-square (RMS) of the total ocular higher order aberrations was 0.47 microm for the OPA group and 0.75 microm for the control group. Ocular spherical aberration was 0.04 microm for the OPA group and 0.22 microm for the control group. Six-month postoperative RMS of corneal spherical aberration was 0.25 microm for the OPA group and 0.46 microm for the control group. CONCLUSIONS: The preliminary outcomes in this study indicate that optimized prolate ablation-treated eyes had less induction of higher order aberration and spherical aberrations postoperatively. Better contrast sensitivity was noted in eyes that underwent optimized prolate ablation treatment compared with preoperatively.

A prospective, randomized, contralateral eye comparison of epithelial laser in situ keratomileusis and photorefractive keratectomy in eyes prone to haze.

PURPOSE: To compare refractive outcome, subepithelial haze, and pain after epithelial laser in situ keratomileusis (epi-LASIK) and photorefractive keratectomy (PRK). METHODS: In this prospective, randomized study, 32 eyes of 16 patients were treated for myopia with epi-LASIK (epi-LASIK group) in one eye and PRK in the fellow eye (PRK group). All patients underwent ablation using the NIDEK EC-5000 CX II excimer laser platform. Mean patient age was 24.8 years (range: 19 to 35 years). Mean preoperative manifest refractive spherical equivalent (MRSE) was -2.76 diopters (D) (range: -1.00 to -4.88 D). Refractive outcome, subepithelial haze, and pain out to 6 months postoperatively were compared between groups. RESULTS: At 6 months postoperatively, the mean MRSE was -0.22 +/- 0.27 D (range: 0.25 to -0.88 D) in the epi-LASIK group and -0.23 +/- 0.29 D (range: 0.50 to -1.125 D) in the PRK group. There was no statistically significant difference in the refractive outcomes between groups. By postoperative day 4, 18% of the epi-LASIK group and 7% of the PRK group achieved the final uncorrected visual acuity (UCVA). On day 1 postoperatively, 14% fewer patients in the PRK group experienced pain compared with the epi-LASIK group. On postoperative day 2, 36% fewer patients in the epi-LASIK group experienced pain. Seventy-one percent of patients in the epi-LASIK group and 36% of patients in the PRK group had no haze postoperatively. CONCLUSIONS: Epi-LASIK and PRK produced similar refractive outcome. Patients who underwent epi-LASIK experienced faster recovery of vision, less haze, and less pain.

Optimized prolate corneal ablation: case report of the first treated eye.

PURPOSE: To present the first patient treated with an optimized prolate ablation algorithm (OPA) with the NIDEK Advanced Vision Excimer laser platform (NAVEX; NIDEK, Gamagori, Japan). METHODS: A patient with moderate myopia and large scotopic pupils received contralateral LASIK treatment, treating one eye with OPA and the other with conventional treatment. RESULTS: At 3 months postoperatively, corneal topography and wavefront analysis show a prolate result with the OPA treatment and an oblate result with the conventional treatment. CONCLUSIONS: The creation of prolate cornea over the entire scotopic pupil, the reduction of spherical aberrations, and an ablation architecture that compensate for age-related changes was achieved immediately after LASIK. The OPA treatment may result in better visual quality over the long-term compared to conventional LASIK.