Research

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11 pages, 1554 KiB

Open AccessArticle

Assessment of Changes in Cap and Residual Stromal Thickness Values during a 6-Month Observation after Refractive Lenticule Extraction Small Incision Lenticule Extraction

by Dominika Janiszewska-Bil, Barbara Czarnota-Nowakowska, Izabela Kuciel-Polczak, Dariusz Dobrowolski, Beniamin Oskar Grabarek, Anita Lyssek-Boroń, Edward Wylęgała and Joanna Wierzbowska

J. Clin. Med. 2024, 13(7), 2148; https://doi.org/10.3390/jcm13072148 - 08 Apr 2024

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Abstract

Background: In this study, the changes in corneal cap and residual stromal thickness (RST) values during a 180-day observation period after refractive lenticule extraction small incision lenticule extraction (ReLEx SMILE) were assessed. Methods: Fifty patients underwent ReLEx SMILE using the VisuMax 500 [...] Read more.

Background: In this study, the changes in corneal cap and residual stromal thickness (RST) values during a 180-day observation period after refractive lenticule extraction small incision lenticule extraction (ReLEx SMILE) were assessed. Methods: Fifty patients underwent ReLEx SMILE using the VisuMax 500 femtosecond laser, with corneal imaging conducted pre and post procedure via anterior segment optical coherence tomography (AS-OCT). Cap thickness in the center and 1.5 mm from the center in four meridians was measured at various intervals. Results: The results showed a significant decrease in cap thickness 180 days post procedure compared to earlier intervals (p < 0.05). Similarly, RST decreased gradually and significantly post procedure (p < 0.05). Notably, changes in cap thickness within the central 1.5 mm area were more dynamic than RST changes during the 6-month observation period following SMILE. Conclusions: The corneal cap thickness measured with swept-source AS-OCT within the central 1.5 mm area underwent more dynamic changes than the residual stromal thickness during the 6-month observation following SMILE. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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14 pages, 4933 KiB

Open AccessArticle

Comparison of the Clinical Effectiveness of Correcting Different Types of Astigmatism with Small Incision Lenticule Extraction

by Estera Igras, Barbara Czarnota-Nowakowska and Rónán O’Caoimh

J. Clin. Med. 2023, 12(21), 6941; https://doi.org/10.3390/jcm12216941 - 06 Nov 2023

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Abstract

Few studies have reported the differential outcomes of Small Incision Lenticule Extraction (SMILE) on myopic astigmatism. Given this, we examined the effectiveness of SMILE for up to one year, comparing with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism, conducting a retrospective review of patients [...] Read more.

Few studies have reported the differential outcomes of Small Incision Lenticule Extraction (SMILE) on myopic astigmatism. Given this, we examined the effectiveness of SMILE for up to one year, comparing with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism, conducting a retrospective review of patients who underwent correction of myopic astigmatism using the 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec) at two refractive clinics in Poland between 2016–2017. Patients were aged ≥21 with stable refractive errors between −0.5 and −10.0 diopter (D) with astigmatism up to 5D. The mean age of the 209 patients (355 eyes) available was 32 years; 58.4% were female. Of these, 247 had WTR, 62 oblique, and 46 ATR astigmatism. The mean pre-operative spherical equivalent (SE) was −5.4 ± 2.57D and the cylinder −1.7 ± 1.0D. The mean SE for WTR reduced from −5.60 ± 2.37D to −0.31 ± 0.67D at 2 months and −0.38 ± 0.70D at 12 months; the mean cylinder improved from −1.90 ± 1.10D to −0.31 ± 0.39D and −0.36 ± 0.43D, respectively. Eyes with oblique astigmatism also improved from a mean SE of −5.8 ± 3.4 D to −0.82 ± 1.50D and −0.69 ± 1.15D and a cylinder of −1.4 ± 0.73D to −0.17 ± 0.33D at 2 months and −0.1 ± 0.32D at 12. For ATR, the mean SE improved from −4.0 ± 1.8D to −0.08 ± 0.22D and −0.04 ± 0.12D; and the mean cylinder from −1.25 ± 0.53 to −0.02 ± 0.09D −0.08 ± 0.21D at 2 and 12 months, respectively. There were statistically significant improvements in SE, manifest sphere and cylinder refraction, and UDVA and CDVA scores for each cylinder type at 2 months with ATR cylinders having better outcomes. Although missing data limited interpretation at one year, differences were maintained. The magnitude of error calculations suggests that WTR was more prone to under-correction, particularly for high astigmatism (>1.5D). SMILE for myopic astigmatism reliably corrects SE, irrespective of the subtype of astigmatism. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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8 pages, 990 KiB

Open AccessArticle

One-Year Results of Photorefractive Keratectomy for Myopia and Compound Myopic Astigmatism with 210 nm Wavelength All Solid-State Laser for Refractive Surgery

by Anna M. Roszkowska, Giuseppe Tumminello, Carmelo Licitra, Alice A. Severo, Leandro Inferrera, Umberto Camellin, Domenico Schiano-Lomoriello and Pasquale Aragona

J. Clin. Med. 2023, 12(13), 4311; https://doi.org/10.3390/jcm12134311 - 27 Jun 2023

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Abstract

Background: To examine the 12-month clinical and refractive outcomes of PRK performed with a UV all-solid-state laser. Methods: The study included healthy patients with myopia and/or compound myopic astigmatism enrolled for refractive surgery and treated with PRK using a 210 nm wavelength, 2 [...] Read more.

Background: To examine the 12-month clinical and refractive outcomes of PRK performed with a UV all-solid-state laser. Methods: The study included healthy patients with myopia and/or compound myopic astigmatism enrolled for refractive surgery and treated with PRK using a 210 nm wavelength, 2 kHz repetition rate, UV all-solid-state laser (LaserSoft, Katana Technologies GmbH, Kleinmachnow, Germany). All subjects were examined at baseline and after 1, 3, 6, and 12 months after the treatment with a slit lamp, refraction, visual acuity assessment (logMAR chart), tonometry, ophthalmoscopy, and corneal tomography with a Scheimpflug camera. The outcome measures considered were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, central corneal thickness, and transparency. The efficacy, safety, predictability, and stability were determined. Results: The study included 34 eyes of 19 patients. The mean UDVA changed from 1.20 ± 0.43 to −0.05 ± 0.10 logMAR at 12 months, and the mean CDVA changed from −0.03 ± 0.06 to −0.06 ± 0.09 logMAR, respectively. The mean spherical equivalent (SE) changed from −4.90 ± 2.12 D to −0.01 ± 0.40 D and was within ±0.50 D of the intended correction in 91% of eyes and within ±1.00 D in 97% of eyes at 12 months. No eyes lost lines of visual acuity, and 64% of eyes gained one or more lines. Conclusions: PRK with the 210 nm wavelength, 2 kHz repetition rate, all-solid-state laser LaserSoft system proved to have good visual, refractive, and clinical outcomes after the follow-up at 12 months. The emerging gas-free, solid-state technology might be considered a valid alternative for the gas operating lasers for corneal refractive surgery. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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9 pages, 795 KiB

Open AccessArticle

Enhanced Monofocal Intraocular Lenses: A Retrospective, Comparative Study between Three Different Models

by Rita Mencucci, Alberto Morelli, Michela Cennamo, Anna Maria Roszkowska and Eleonora Favuzza

J. Clin. Med. 2023, 12(10), 3588; https://doi.org/10.3390/jcm12103588 - 21 May 2023

Cited by 5 | Viewed by 3036

Abstract

The purpose of this study was to compare the visual performance and optical quality between three new enhanced monofocal intraocular lenses (IOLs). This retrospective study included patients affected by cataracts with corneal astigmatism less than 0.75 D and no ocular comorbidities who underwent [...] Read more.

The purpose of this study was to compare the visual performance and optical quality between three new enhanced monofocal intraocular lenses (IOLs). This retrospective study included patients affected by cataracts with corneal astigmatism less than 0.75 D and no ocular comorbidities who underwent cataract surgery with bilateral implantation of Tecnis Eyhance ICB00 (Johnson & Johnson Vision Care, Inc., Jacksonville, FL, USA), Vivinex Impress XY1-EM (Hoya Surgical Optics, Singapore) or IsoPure 123 (PhysIOL, Liege, Belgium) IOLs. Three months postoperatively, monocular and binocular uncorrected and corrected distant, and intermediate and near visual acuities were measured. Binocular defocus curve, photopic contrast sensitivity, Point Spread Function (PSF), low order aberrations (LOAs), high order aberrations (HOAs), objective scatter index (OSI), halo and glare perception were also evaluated. This study included a total of 72 eyes from 36 patients. Visual acuity outcomes, PSF, LOAs, HOAs and OSI were similar between groups. There were no statistically significant differences in terms of photopic contrast sensitivity, halo or glare perception. In patients without ocular comorbidities, the Eyhance ICB00 IOL, the Vivinex Impress IOL and the Isopure IOL—even though based on different optical properties—provided similar results in terms of visual acuity, contrast sensitivity and intraocular aberrations, with no influence on photic phenomena. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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13 pages, 2453 KiB

Open AccessArticle

Early Impact of Laser Vision Correction (LVC) on the Stability and Quality of the Retinal Image

by David Smadja, Nir Erdinest, Denise Wajnsztajn, Yishay Weill, Adi Abulafia, David Zadok and Itay Lavy

J. Clin. Med. 2023, 12(5), 1779; https://doi.org/10.3390/jcm12051779 - 23 Feb 2023

Cited by 1 | Viewed by 1715

Abstract

This retrospective comparative study analyzes the early postoperative impact of laser vision correction for myopia on the optical quality and stability of functional vision using a double-pass aberrometer. Retinal image quality and visual function stability were assessed preoperatively, one and three months after [...] Read more.

This retrospective comparative study analyzes the early postoperative impact of laser vision correction for myopia on the optical quality and stability of functional vision using a double-pass aberrometer. Retinal image quality and visual function stability were assessed preoperatively, one and three months after myopic laser in situ keratomileuses (LASIK) and photorefractive keratectomy (PRK) using double-pass aberrometry (HD Analyzer, Visiometrics S.L, Terrassa, Spain). The parameters analyzed included vision break-up time (VBUT), objective scattering index (OSI), modulation transfer function (MTF), and Strehl ratio (SR). The study included 141 eyes of 141 patients, of whom 89 underwent PRK and 52 underwent LASIK. No statistically significant differences were noted between the two techniques in any analyzed parameters at three months postoperatively. However, a significant drop was observed in all parameters one month after PRK. Only the OSI and VBUT remained significantly altered from baseline at the three months follow-up visit, with an increased OSI by 0.14 +/− 0.36 (p < 0.01) and a shortened VBUT by 0.57 +/− 2.3 s (p < 0.01). No correlation was found between the changes in optical and visual quality parameters and age, ablation depth, or postoperative spherical equivalent. The stability and quality of the retinal images were similar between LASIK and PRK at three months postoperatively. However, significant degradation in all parameters was found one month after PRK. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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9 pages, 1131 KiB

Open AccessArticle

Clinical Evaluation of the Efficacy of Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty

by Adam Wylęgała, Anna M. Roszkowska, Joanna Kokot, Dariusz Dobrowolski and Edward Wylęgała

J. Clin. Med. 2023, 12(3), 1158; https://doi.org/10.3390/jcm12031158 - 01 Feb 2023

Cited by 2 | Viewed by 1144

Abstract

Background: To evaluate the clinical outcome, efficacy, and safety of femtosecond laser-assisted anterior lamellar keratoplasty. Material and Methods: In this prospective study, 21 males and 10 females aged from 15 to 62 years (mean 38.5) with different pathologies of the anterior corneal layers [...] Read more.

Background: To evaluate the clinical outcome, efficacy, and safety of femtosecond laser-assisted anterior lamellar keratoplasty. Material and Methods: In this prospective study, 21 males and 10 females aged from 15 to 62 years (mean 38.5) with different pathologies of the anterior corneal layers were enrolled for anterior lamellar keratoplasty using femtosecond laser VisuMax (Carl Zeiss, Germany). All patients were examined for uncorrected (UCVA) and best-corrected (BCVA) distance and near visual acuity, astigmatism, endothelial cell density, corneal thickness, and intraocular pressure. These examinations were performed before transplantation, at hospital discharge, and after 3 and 12 months. The mean follow-up time was 65.36 ± 28.54 months. Results: A statistically significant improvement of both UCVA and BCVA for distance and near vision was registered. BCVA improved from 0.11 preoperatively to 0.168 (p = 0.03), 0.267 (p < 0.01), and 0.472 (p < 0.01) on the hospital discharge day, three months, and 12 months respectively. There were no statistically significant differences in astigmatism, intraocular pressure, endothelial cell density, and corneal pachymetry as compared to preoperative and postoperative values. Six patients (19%) had a graft failure with a rate of 33% at 26 months. Conclusions: Femtosecond laser-assisted anterior lamellar keratoplasty is a safe and effective surgical method, providing satisfactory graft survival rates. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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13 pages, 1124 KiB

Open AccessArticle

One-Year Visual Outcomes and Corneal Higher-Order Aberration Assessment of Small-Incision Lenticule Extraction for the Treatment of Myopia and Myopic Astigmatism

by Carter J. Payne, Courtney R. Webster, Majid Moshirfar, Jaiden J. Handlon, Yasmyne C. Ronquillo and Phillip C. Hoopes

J. Clin. Med. 2022, 11(21), 6294; https://doi.org/10.3390/jcm11216294 - 26 Oct 2022

Cited by 4 | Viewed by 1504

Abstract

We present a retrospective, single-center report of one-year visual outcomes for Small Incision Lenticule Extraction (SMILE) to treat myopia and myopic astigmatism, as well as to compare outcomes with other published literature, including results from the United States Food and Drug Administration (US [...] Read more.

We present a retrospective, single-center report of one-year visual outcomes for Small Incision Lenticule Extraction (SMILE) to treat myopia and myopic astigmatism, as well as to compare outcomes with other published literature, including results from the United States Food and Drug Administration (US FDA). A total of 405 eyes with a mean preoperative spherical equivalent of −5.54 diopters (D) underwent SMILE between April 2017 and April 2022. The outcomes measured included visual acuity, manifest refraction, vector analysis, and wavefront aberrometry at various time points, specifically pre-operative and twelve months post-operatively. Results were compared to other similar published studies of SMILE outcomes between 2012 and 2021. A total of 308 and 213 eyes were evaluated at three and twelve months, respectively. At twelve months, 79% of eyes achieved UDVA ≥ 20/20, and 99% had ≥20/40, with no patients losing ≥2 lines of vision. For accuracy, 84% of eyes were within 0.5 D of target SEQ, and 97% were within 1 D. Total corneal higher order aberrations (HOA) increased from 0.33 to 0.61 um. Significant change was found in vertical coma and spherical aberration at twelve months. SMILE remains a safe and effective treatment for myopia and myopic astigmatism. Clinical outcomes are likely to improve with increased surgeon experience and refinement of technology and nomograms. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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10 pages, 995 KiB

Open AccessArticle

Inflammatory Bowel Disease Guidelines for Corneal Refractive Surgery Evaluation

by Majid Moshirfar, David A. Fuhriman, Amir Ali, Varshini Odayar, Yasmyne C. Ronquillo and Phillip C. Hoopes

J. Clin. Med. 2022, 11(16), 4861; https://doi.org/10.3390/jcm11164861 - 19 Aug 2022

Cited by 3 | Viewed by 1641

Abstract

Inflammatory bowel disease (IBD) is a chronic systemic inflammatory condition that can potentially adversely affect surgical outcomes in patients receiving elective ophthalmic procedures. In this case series, 21 eyes of 11 patients with ulcerative colitis or Crohn’s disease underwent laser in situ keratomileusis [...] Read more.

Inflammatory bowel disease (IBD) is a chronic systemic inflammatory condition that can potentially adversely affect surgical outcomes in patients receiving elective ophthalmic procedures. In this case series, 21 eyes of 11 patients with ulcerative colitis or Crohn’s disease underwent laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE). Their surgical outcomes were followed up for an average of 8.9 ± 4.6 months. All the patients in this study did well, with 100% of eyes corrected for distance vision achieving uncorrected distance visual acuity 20/20 by postoperative month three. Common symptoms noted during the postoperative period included dry eyes, irritation, foreign body sensation, and blurry vision, all of which improved in prevalence and severity over the follow-up period, and none of the patients experienced a flare-up of their disease. Despite the successful outcomes in these patients, the authors recognize the inherent risks of operating on patients with IBD. Currently, there are no consensus guidelines for clinicians to follow to ensure that they are adequately screening these patients for eligibility, so the authors are suggesting a relevant, focused review of systems, a brief IBD history-related questionnaire, and a preliminary surgical decision-making flowchart for use in surgical evaluation. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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12 pages, 1205 KiB

Open AccessArticle

Laser-Assisted In Situ Keratomileusis (LASIK) Enhancement for Residual Refractive Error after Primary LASIK

by Majid Moshirfar, Noor F. Basharat, Nour Bundogji, Emilie L. Ungricht, Ines M. Darquea, Matthew E. Conley, Yasmyne C. Ronquillo and Phillip C. Hoopes

J. Clin. Med. 2022, 11(16), 4832; https://doi.org/10.3390/jcm11164832 - 18 Aug 2022

Cited by 4 | Viewed by 1507

Abstract

Background: To evaluate the safety, efficacy, and predictability of laser-assisted in situ keratomileusis (LASIK) enhancement after primary LASIK and compare to Food and Drug Administration (FDA) criteria. Methods: Patients who underwent LASIK enhancement after primary LASIK between 2002 and 2019 were compared to [...] Read more.

Background: To evaluate the safety, efficacy, and predictability of laser-assisted in situ keratomileusis (LASIK) enhancement after primary LASIK and compare to Food and Drug Administration (FDA) criteria. Methods: Patients who underwent LASIK enhancement after primary LASIK between 2002 and 2019 were compared to those who underwent LASIK without retreatment. Patient demographics, preoperative characteristics, visual outcomes, and postoperative complications were compared between groups. Epithelial ingrowth (EI) development was stratified based on duration between primary and secondary procedures. Results: We compared 901 eyes with LASIK enhancement to 1127 eyes without retreatment. Age, sex, surgical eye, sphere, cylinder, and spherical equivalent (SE) were significantly different between groups (p < 0.05). At 12 months post-enhancement, 86% of the eyes had an uncorrected distance visual acuity of 20/20 or better and 93% of eyes were within ±0.50 D of the target. Development of EI (6.1%) demonstrated an odds ratio of 16.3 in the long-term compared to the short-term (95% CI: 5.9 to 45.18; p < 0.0001). Conclusions: Older age at primary LASIK, female sex, right eye, and larger sphere, cylinder and SE were risk factors for enhancement. Risk of EI significantly increased when duration between primary and enhancement procedures exceeded five years. LASIK enhancements produce favorable outcomes and meet FDA benchmarks for safety, efficacy, and predictability. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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Review

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21 pages, 746 KiB

Open AccessReview

Clinical Evaluation of Corneal Endothelial Parameters following Laser Refractive Surgery in Myopic Eyes: A Review

by Maciej Juda, Maciej Bedliński, Anna Maria Roszkowska and Joanna Wierzbowska

J. Clin. Med. 2024, 13(6), 1665; https://doi.org/10.3390/jcm13061665 - 14 Mar 2024

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Abstract

Background: The aim of this review was to investigate the influence of various laser refractive surgery methods on the corneal endothelium in myopic patients. The role of the corneal endothelium in laser refractive surgery (LRS) is currently being addressed in the assessment of [...] Read more.

Background: The aim of this review was to investigate the influence of various laser refractive surgery methods on the corneal endothelium in myopic patients. The role of the corneal endothelium in laser refractive surgery (LRS) is currently being addressed in the assessment of postoperative corneal edema risk. Methods: Changes in corneal endothelial cell density and morphology after LRS were evaluated based on a systematic review of current studies. The results of a literature search in the PubMed, Science Direct, Google Scholar, and the Web of Science databases, as well as a manual search, were selected for the final review according to the PRISMA 2020 flow diagram. Results: We included 24 prospective clinical trials in the review: surface ablation (twelve), LASIK and FemtoLASIK (two), femtosecond lenticule extraction (two), and comparable studies (eight). Endothelial cell density was determined by specular or in vivo confocal microscopy. In most studies, no statistically significant differences were found between preoperative and postoperative endothelial parameters. In nine studies, the changes were statistically significant, but no vision-threatening complications occurred, and no serious corneal complications developed in any eyes during the follow-up period. Conclusions: Based on collected data, laser keratorefractive surgery appears not to exert a significant effect on the corneal endothelium. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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12 pages, 708 KiB

Open AccessReview

Small Aperture IC-8 Extended-Depth-of-Focus Intraocular Lens in Cataract Surgery: A Systematic Review

by José-María Sánchez-González, María Carmen Sánchez-González, Concepción De-Hita-Cantalejo and Antonio Ballesteros-Sánchez

J. Clin. Med. 2022, 11(16), 4654; https://doi.org/10.3390/jcm11164654 - 09 Aug 2022

Cited by 4 | Viewed by 2127

Abstract

The aim of this paper is to evaluate the visual outcomes and patient satisfaction of small aperture IC-8 IOLs in cataract patients with or without prior ocular events. A systematic review of full-length original English studies reporting the visual results of small aperture [...] Read more.

The aim of this paper is to evaluate the visual outcomes and patient satisfaction of small aperture IC-8 IOLs in cataract patients with or without prior ocular events. A systematic review of full-length original English studies reporting the visual results of small aperture IC-8 IOL implantation after cataract surgery in three databases, PubMed, Web of Science and Scopus, was performed according to the PRISMA statement. The Quality Assessment Tool for case series studies from the National Heart, Lung, and Blood Institute was used to analyze the quality of the studies selected. The search provided 543 articles, of which 22 were included in this systematic review. Significant improvements in uncorrected distance visual acuity (UDVA); uncorrected intermediate visual acuity (UIVA); uncorrected near visual acuity (UNVA); perception of photic phenomena; and patient satisfaction have been reported. Unilateral and bilateral small aperture IC-8 IOL implantation reduces photic phenomena and provides good vision for all distances with high patient satisfaction and minimal postoperative complications. Therefore, the implantation of this IOL may be recommended for patients with cataracts, corneal irregularities and ocular trauma with partial aniridia. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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