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To evaluate the correlation between preoperative, postoperative, and change in angle kappa and alpha to visual outcomes following implantation of three multifocal intraocular lenses. This is a retrospective study which included 122 eyes of 61 patients. There were 38 eyes in the Synergy (Johnson & Johnson, USA) group and 42 eyes each from both the Panoptix (Alcon Laboratories, USA) and FineVision (Physiol BVI, Belgium) groups. Visual outcome parameters (uncorrected distance, intermediate, near vision, halo and starburst) and angle kappa and alpha were recorded preoperatively and at three months postoperatively. The preoperative, postoperative and the amount of change in angle kappa and alpha were correlated to visual outcomes and photic phenomena among the three different diffractive trifocal IOLs. There were no significant differences in the preoperative and postoperative magnitude of angle kappa and alpha among the Synergy, Panoptix, and FineVision groups. There was no significant correlation between the preoperative and postoperative magnitude, and change in angle kappa and alpha with the postoperative uncorrected distance, intermediate and near visual acuity, and halo and starburst scores of the three different diffractive IOLs. The frequency of eyes with greater than 0.5 mm angle kappa and alpha values were low. Visual outcomes can be good even in eyes in which the angle kappa and alpha were greater than 0.5 mm. The newer diffractive multifocal IOLs were observed to be more tolerant to low and intermediate levels of angle kappa and alpha.

Purpose Compare intraocular pressure (IOP) measured by a standard Goldmann applanation tonometer prism (IOPg) and a modified correcting applanation tonometer surface Goldmann prism (IOPc) before and after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). Methods Goldmann tonometry was analyzed in a retrospective, cross-sectional study, using both GAT and modified-GAT prisms pre-operatively and at the 3 month post-operative appointment on 120 eyes (64 patients) who received LASIK ( n  = 58) or PRK ( n  = 62). Demographics, central corneal thickness (CCT), manifest refraction and corneal curvature (CC) data was collected at each visit as well as surgical parameters, including maximum ablation depth. Results Mean paired IOP following LASIK decreased by − 3.28 ± 3.2 mmHg measured by IOPg and − 1.93 ± 3.3 mmHg by IOPc ( p  ≤ 0.0001). Mean paired IOP following PRK reduced by − 1.92 ± 3.6 mmHg measured by IOPg and − 1.06 ± 3.6 mmHg by IOPc (p ≤ 0.0001). Increased LASIK ablation depth and post-procedural change in CCT trended toward a statistically significant reduction in IOPg ( p  = 0.07, p  = 0.12), but not IOPc ( p  = 0.18, p  = 0.32). PRK ablation depth was not associated with a reduction in IOPg or IOPc. Discussion The modified Goldmann (IOPc) prism measured less of an IOP reduction following LASIK and PRK compared to the standard (IOPg) prism, and the IOP reduction with both prisms was associated with the degree of myopic correction. What is already known and the residual query Corneal refractive surgery generally demonstrates significant postoperative Goldmann IOP reductions. Presumably, this is due to corneal biomechanical changes for which a newer method of Goldmann IOP measurement may be able to compensate. What this study adds A modified, corneal conforming Goldmann prism demonstrates significantly less IOP reduction following myopic LASIK and PRK compared to the standard flat Goldmann prism. How this study might affect research, practice or policy A newer, modified Goldmann prism may help detect glaucoma and OHT at an earlier stage in patients which have undergone LASIK or PRK. The findings corroborate predicted corneal biomechanical changes following the most common corneal refractive procedures.

Objective To evaluate higher order aberrations and spherical aberration in various age groups after corneal and lenticular treatments. Methods Two hundred forty untreated eyes across various age groups and 182 eyes post-corneal or lenticular treatment were included and iTrace (Tracey Technologies, Houston, Texas) aberrometry measurements were gathered. Treated patients were classified into 2 groups according to treatment administered: eyes that underwent different algorithms of laser in situ keratomileusis (Lasik) demonstrating quantifiable differences in corneal aberrations, and eyes that underwent uncomplicated phacoemulsification with in-the-bag implantation of aspheric neutral EnVista MX60 (Bausch & Lomb, USA), negative aspheric Tecnis ZCB00 (Johnson and Johnson, USA), or spherical Akreos Adapt (Bausch & Lomb, USA) intraocular lens (IOL) showing differences in internal spherical aberrations. Results Aging was associated with less myopic refractions ( p  = 0.0001) and an increase in internal spherical aberration ( p  = 0.0001). Following corneal refractive surgery, the corneal spherical aberration measured through 3 mm pupils for Standard LASIK, Zyoptix wavefront-aspheric Lasik, Supracor Myopic Lasik, and Supracor Hyperopic Lasik, were + 0.054 u m, + 0.074 u m, -0.013 u m, and − 0.032 u m, respectively. ( p  = 0.001) Following cataract surgery and measured through 5 mm pupils, the internal spherical aberration were significantly lower in the neutral aspheric EnVista and negative aspheric Tecnis compared to spherical Akreos Adapt IOLs, calculated to be + 0.022 u m, -0.150 u m, and + 0.094 u m, respectively. ( p  = 0.00) Conclusion The study indicated a trend of increasing internal spherical aberration with age. In Lasik surgery, manipulating spherical aberration in the corneal periphery improves overall vision while in the central cornea provides presbyopic treatment. In cataract surgery, patients with larger scotopic pupil sizes may benefit more from aspheric IOLs.

Objective To evaluate the refractive, keratometric, and biomechanical changes in keratoconus patients following modified accelerated corneal cross-linking (A-CXL). Methods This retrospective observational study analyzed clinical data from patients with progressive keratoconus who underwent modified A-CXL with a prolonged riboflavin imbibition period prior to UV irradiation. Preoperative and post-operative data on vision, refraction, tomography using OCULUS Pentacam and biomechanics using Corvis ST were analyzed at various follow-up intervals. Subgroup analysis was conducted based on topographic keratoconus classification. Statistical comparison was performed to assess changes in these parameters over time. Results A total of 70 eyes of 55 patients were included. A statistically significant improvement in mean change of logMAR BCVA was noted at 6 and 12 months ( p  = 0.006 and p  = 0.018). Six months following A-CXL, statistically significant improvements were observed in keratometry and pachymetry ( p  = 0.003 and p  < 0.001). Mean changes in biomechanical parameters deformation amplitude ratio (DAR) and Integrated Radius (IR) were found to be significantly decreased at 6 months ( p  = 0.001 and p  = 0.011). Other biomechanical parameters SPA1, SSI and ARTh had no significant changes suggesting stability. Comparative analysis between different stages of keratoconus revealed that patients classified under TKC-4 exhibited greater improvement in keratometry compared to those with TKC-2 and TKC-3 staging. Conclusion A-CXL with extended riboflavin exposure was effective in stabilizing both tomographic and biomechanical parameters which resulted in increased corneal stiffness and maintained stability. All KC stages demonstrated corneal stability following A-CXL.

Purpose This study described the clinical profile and post-operative outcomes of patients who underwent pterygium surgery at an ambulatory eye center in the Philippines over a ten-year period. Methods This retrospective study analyzed medical records of 462 eyes from 408 patients who underwent pterygium surgery by a single surgeon between February 2013 and August 2023. The study examined the clinical characteristics of patients with pterygium and evaluated the recurrence rates of three treatment methods: pterygium excision with conjunctival autograft (CAG), pterygium excision with dehydrated amniotic membrane graft (DAG), and primary excision with mitomycin C application. Descriptive statistics were used for analysis of patient demographics, clinical profile, and postoperative outcomes. Results The mean patient age was 48 years (range 17–81), with a slight male predominance (57%). Nasal pterygium was the most common type (72%), followed by bipolar (8%) and temporal (3%) pterygium. Most cases were primary (81%), with T2G1 being the most common grading. Conjunctival autograft was the predominant surgical technique (94%), followed by dehydrated amniotic membrane graft (5%) and primary excision with mitomycin C application (1%). The overall recurrence rate was 1%, with conjunctival autograft showing the lowest rate, compared to dehydrated amniotic membrane graft and primary excision with mitomycin C. The complication rate was 4.5%, primarily minor findings such as conjunctival granuloma, wound dehiscence, and residual pterygium. Conclusion Most pterygium cases presented as primary and in the nasal area with T2G1 grading. This study supports conjunctival autograft as the preferred surgical technique for pterygium because of the low recurrence and complication rates.

Background To compare the measurements obtained from the Orbscan II, IOLMaster 700, Pentacam AXL, and Castroviejo caliper and their effects on calculating the recommended implantable collamer lens (ICL) size and postoperative vault measurements. Methods This is a retrospective cross-sectional study of patients who underwent ICL surgery by a single surgeon from March 1, 2018 to July 31, 2021. Records were reviewed for the anterior chamber depth (ACD) and white-to-white (WTW) measurements obtained from the Orbscan II, IOLMaster 700, Pentacam AXL, and Castroviejo caliper (WTW only). These were used to calculate the recommended ICL size. The actual ICL size implanted, and vault measurements obtained one month postoperatively were also collected. Results One hundred seven eyes with a mean age of 27.9 ± 7.7 years were included in the study. Mean WTW measurements were significantly different between devices ( P  < 0.0001), with the IOLMaster 700 having the highest value (12.14 ± 0.04 mm) and the caliper having the lowest value (11.45 ± 0.04 mm). Mean ACD measurements were the lowest in Orbscan II (3.12 ± 0.25 mm) and the highest in Pentacam AXL (3.16 ± 0.24 mm). The Pentacam AXL produced an ICL size similar to the Orbscan in 69.2% of eyes. The IOLMaster yielded an ICL measurement one size larger than Orbscan-based calculations in 64.5% of eyes. Using the Orbscan WTW and ACD, the desired vault of 0.25 to 0.75 mm and 0.25 to 1.00 mm was achieved in 70% and 91% of eyes, respectively. Substituting caliper WTW to IOLMaster 700 or Pentacam AXL WTW increases the percentage of achieving the desired vault to 80%, similar to the Orbscan. Conclusions The Orbscan II, IOLMaster 700, and Pentacam AXL cannot be used interchangeably for calculating ICL sizing. Combining the WTW from caliper measurement with the ACD of the IOLMaster 700 or Pentacam AXL could improve ICL sizing and achieve a higher percentage of eyes with the desired vault.

Purpose To compare the biometric measurements obtained from the Pentacam AXL Wave, IOLMaster 700, and ANTERION and calculate the recommended intraocular lens power using the Barrett Formulae. Methods This was a retrospective cross-sectional study of patients who underwent biometry using the Pentacam AXL Wave, IOLMaster 700, and ANTERION. Flat keratometry (K1), steep keratometry (K2), anterior chamber depth (ACD), and axial length (AL) from each device were measured and compared. These parameters were used to calculate the recommended IOL powers using the Barrett formula. Results The study included 252 eyes of 153 patients. The IOLMaster had the highest acquisition rate among the two biometers. The Pentacam obtained the shortest mean AL, the IOLMaster measured the highest mean keratometry values, and the ANTERION measured the highest mean ACD. In terms of pairwise comparisons, keratometry and axial length were not significantly different between the Pentacam-IOLMaster and ANTERION-IOLMaster groups, while the rest of the pairwise comparisons were statistically significant. In nontoric and toric eyes, 35–45% of patients recommended the same sphere of IOL power. In another 30–40%, the Pentacam and ANTERION recommended an IOL power one step greater than that of the IOLMaster-derived data. 50% of the study population recommended the same toric-cylinder IOL power. Conclusions The Pentacam AXL Wave, IOLMaster 700, and ANTERION can reliably provide data for IOL power calculations; however, these data are not interchangeable. In nontoric and toric eyes, 35–45% of cases recommended the same sphere IOL power, and in another 30–40%, the Pentacam and ANTERION recommended one-step higher IOL power than the IOLMaster-derived data. In targeting emmetropia, selecting the first plus IOL power is advisable when using the Pentacam and ANTERION to approximate the IOL power calculations recommended by the IOLMaster 700.

To show the visual and refractive outcomes in Asian eyes with cataract when bilaterally implanted with either a hydrophobic FineVision POD F GF or a hydrophilic FineVision POD F intraocular lens (IOL). Forty-six patients were randomized to receive POD F GF or POD F IOLs. Visual and refractive outcomes were assessed up to 24 months post-surgery. Measurements included uncorrected-distance visual acuity, corrected-distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), refraction, defocus curve, photopic and mesopic contrast sensitivity, and patient-reported outcomes. Mean spherical equivalent was close to emmetropia for both groups and stable across postoperative visits. Overall, 97.73% and 100% of eyes in the POD F GF IOL group and 95.65% and 100%, of eyes in the POD F IOL group were within ±1.00D of the target refraction at 12 and 24 months, respectively. All patients showed a CDVA of ≥20/25 at 12- and 24-months post-surgery. In both groups, 24 months post-surgery 91% of patients presented a DCIVA of ≥20/25 and 83.3% of patients had a DCNVA of ≥20/25. Defocus curve showed continuous visual acuity, being 20/32 or better in both groups over a 4.00D range between 1.00D and -3.00/-3.50D. Both groups showed good contrast sensitivity values for photopic and mesopic conditions. Overall, 86.4%, 86.4%, and 72.7% of patients implanted with the POD F GF IOL reported not wearing glasses at all for distance, intermediate, and near vision, respectively. These values were 81.8%, 86.4%, and 90.9% for patients implanted with the POD F IOL. Both groups of patients reported similar satisfaction percentages (100% very satisfied/satisfied) and would recommend the procedure (100% definitively yes/probably yes). This study demonstrates good visual and refractive outcomes for both the FineVision POD F GF and the FineVision POD F IOLs when implanted in Asian eyes.

To assess refractive and visual outcomes of bilateral implantation of an isofocal optic-design intraocular lens (IOL) or a monofocal IOL following cataract surgery. A total of 127 patients were recruited into a prospective, single-masked, randomized trial. Sixty-five patients bilaterally implanted with the Isopure Isofocal IOL and 62 patients with the Micropure Monofocal IOL were followed for 4-6 months. Refraction, monocular and binocular uncorrected-distance-visual acuity, corrected-distance-visual acuity (CDVA), uncorrected-intermediate-visual acuity and distance-corrected-intermediate-visual acuity (DCIVA, 66/80 cm), uncorrected-near-visual acuity, and distance-corrected-near-visual acuity (DCNVA, 40 cm) were evaluated. Binocular defocus curve, binocular contrast sensitivity (photopic, mesopic with/without glare), and glare and halo phenomena were also measured. 99.23% of eyes were within ±1.00D and 84.62% of eyes within ±0.50D for the Isopure patients and 98.39% and 82.26% for the Micropure patients, respectively. The mean spherical-equivalent was -0.06 ± 0.36D and 0.10 ± 0.32D for the Isopure and Micropure patients, respectively. 98.5% and 100% of patients implanted with the Isopure and Micropure IOLs showed a cumulative binocular CDVA value ≥20/20, respectively. 80% and 67.70% of patients implanted with the Isopure presented a binocular DCIVA ≥20/25 at 80 and 66 cm, respectively. These percentages were 46.8% and 40.3% with the Micropure IOL, respectively. For Isopure, 7.7%, 30.8%, and 58.5% of patients presented a DCNVA ≥20/25, ≥20/32 and ≥20/40, respectively. These values were lower for the Micropure: 1.6%, 19.4% and 46.8%, respectively. Defocus curves showed similar good visual acuity at distance for both lenses with better intermediate vision for the Isopure. Both groups presented good contrast sensitivity, and the size and intensity of halo and glare phenomena were similar between the two. No adverse-events were reported. Our trial shows that both IOLs provide excellent visual acuity and contrast sensitivity for far vision with similar photic phenomena, and the Isopure IOL improved unaided intermediate vision performance.

Purpose To compare visual performance of the Vivinex Impress enhanced monofocal intraocular lens (IOL) (HOYA Surgical Optics) with the Acrysof IQ monofocal IOL (Alcon Laboratories, Inc). Methods In this multicenter, active-controlled trial, participants were randomized 2:1 to bilateral implantation with the enhanced monofocal (test) or standard monofocal (control) IOL and examined through 12 months postoperatively for visual acuities, refractive outcomes, defocus curves, and pupil diameters. Results Ninety-eight test and 46 control participants completed testing for the first implanted eye. The test arm demonstrated a statistically significant benefit in monocular distance-corrected intermediate visual acuity (DCIVA) (photopic: 1.2 lines, P < .001; mesopic: 0.7 lines, P = .01) and uncorrected intermediate visual acuity (0.8 lines; P < .001) but no significant difference in monocular corrected distance visual acuity (P = .07). Using a stepwise regression analysis for DCIVA, the final model (adjusted R-square, 0.31) identified three significant predictor variables (age, pupil diameter, and treatment arm). Photopic defocus curves showed the test arm produced better monocular visual acuity from −1.00 through −2.50 D than the control arm. The intermediate vision benefit of the test IOL is independent of pupil size and axial length. Cumulative and persistent adverse events for the test IOL did not exceed the Safety and Performance Endpoint rates per International Organization for Standardization 11979-7. Conclusions Compared to a standard monofocal IOL, the Vivinex Impress enhanced monofocal IOL offers an extended range of vision, with significant improvements in intermediate vision and a DCIVA benefit unaffected by pupil size and axial length. This IOL is safe and effective for patients seeking improved intermediate vision following cataract surgery. [J Refract Surg. 2025;41(4):e300–e309.]