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Purpose To compare clinical outcomes of transepithelial photorefractive keratectomy (t-PRK) and conventional epithelium-off PRK (PRK) in patients with high compound myopic astigmatism. Methods Sixty eyes of 30 myopic individuals with at least −2.50 diopters (D) of spherical equivalent and 3.00 D of cylindrical refractive error were enrolled in the study. Both eyes of each patient were randomly assigned to either the t-PRK method or epithelium-off PRK as a matched contralateral control group. Refractive outcomes were evaluated 6 months after surgery. Results At the 6-month visit, cylindrical refractive error magnitude was lower in the t-PRK (0.51 ± 0.29 D) compared to the PRK (0.67 ± 0.30 D) group (P = .04). The residual astigmatism was 0.50 diopters or less in 23 eyes (76%) in the t-PRK group and 15 eyes (50%) in the PRK group. In vector analysis using the Alpins method, t-PRK resulted in a significantly higher percentage of success of astigmatic surgery (84.68 ± 8.95 in t-PRK versus 79.46 ± 10.88 in PRK, P = .04). Additionally, there was a marginal advantage for the t-PRK group regarding index of success of astigmatism surgery (P = .06) and absolute (P = .08) and arithmetic (P = .07) angles of error compared to the PRK group. Both groups had an equal safety profile. Conclusions T-PRK is more accurate for astigmatic correction in high astigmatism than conventional PRK. Both t-PRK and PRK are comparable respecting safety and efficacy. [J Refract Surg. 2024;40(12):e956–e965.]

PurposeTo evaluate the efficacy of a combined macular buckle under direct vision and 23-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in refractory macular hole retinal detachment (MHRD) with extreme high axial myopia.DesignProspective, randomised controlled study.ParticipantsThe study included 98 eyes of 98 patients of MHRD with extreme high axial (>30 mm) myopia.InterventionPatients were randomly assigned to undergo PPV with ILM peeling (group 1, n=52) or PPV with ILM peeling combined with macular buckle under direct vision (group 2, n=46).Main outcome measuresComplete ocular examination included best-corrected visual acuity (BCVA) (LogMAR), applanation tonometry, optical biometry, slit-lamp biomicroscopy, colour fundus photography, ultrasound examination and optical coherence tomography at baseline and every follow-up visit.ResultsInitial retinal reattachment rate was significantly higher in group 2 than in group 1 at 12-month postoperatively (χ2 test, p=0.020). Macular hole closure rate in group 2 was significantly higher than that in group 1 at 3, 12, 18 and 24 months postoperatively (Fisher's exact test, p<0.05). In initial retinal reattachment cases, the mean BCVA decreased significantly in group 2 than in group 1 at 3 months postoperatively (Wilcoxon matched pairs signed rank test, p=0.036), and had increased significantly in group 2 than in group 1 since 6 months postoperatively (Wilcoxon matched pairs signed rank test, p<0.05). Mean axial lengths in group 2 were significantly shorter than that of group 1 at each follow-up time point (Wilcoxon matched pairs signed rank test, p<0.05).ConclusionsCombined macular buckle under direct vision and PPV with ILM peeling is more effective in treatment of MHRD with extreme high axial (>30 mm) myopia.

Introduction High myopia correction is essential for improving visual acuity and quality of life. Traditional intraocular collamer lens (ICL) implantation using an ophthalmic viscosurgical device (OVD) is effective but often results in prolonged surgical times, impacting patient comfort and recovery. This study investigates a novel non-OVD ICL implantation technique aimed at reducing surgical duration and improving patient outcomes. Methods This prospective, randomized controlled trial was conducted at Changsha Aier Eye Hospital from May to August 2024, enrolling 162 right eyes from high myopic patients aged 21 to 45 years. Participants were randomly assigned to either the non-OVD group, which utilized a disposable sterile irrigator for anterior chamber maintenance, or the OVD group, which underwent traditional ICL implantation. Primary outcomes included surgical time, endothelial cell density (ECD), intraocular pressure (IOP), and patient-reported experiences. Results The non-OVD group demonstrated a significant reduction in surgical time (113 ± 103 s) compared to the OVD group (436 ± 118 s, p  < 0.001). ECD and IOP remained stable postoperatively, indicating no adverse effects on ocular health. Patient experiences were assessed through pain levels and self-perception reports; the non-OVD group reported comparable pain levels with enhanced self-perception compared to the OVD group. Conclusion The novel non-OVD ICL implantation technique significantly reduces surgical duration while maintaining ocular health and improving patient self-perception. Additional to it, we also explored patients' self-perception, which refers to their subjective evaluation of recovery, well-being, and visual outcomes post-surgery. Unlike satisfaction, which primarily measures how pleased patients are with the results, self-perception encompasses how patients feel about their overall recovery process, including psychological and emotional factors. This approach may enhance operational efficiency and patient comfort in high myopia surgeries. Trial registration The study was registered with the China Clinical Trial Registration Center (Registration No. ChiCTR2100046483, Trial Registration: 2021–03-06).

PURPOSE: To investigate the long-term visual outcomes and optical quality after femtosecond laser small incision lenticule extraction (SMILE) for moderate to high myopia correction. METHODS: Fifty-four patients (37 women, 17 men) who underwent SMILE were enrolled in this prospective clinical study. Patient ages ranged from 18 to 40 years, with a mean spherical equivalent of −6.50 ± 1.64 diopters. Data including refractive parameters, retinal image quality, intraocular scattering, and aberrations were collected at 6 and 18 months after surgery. Patient satisfaction was also evaluated. RESULTS: At 18 months after surgery, both the mean safety index and the efficacy index were 1.23 ± 0.23 (range: 0.80 to 1.50); there was no significant difference with indices measured at 6 months (At 18 months after surgery, both the mean safety index and the efficacy index were 1.23 ± 0.23 (range: 0.80 to 1.50); there was no significant difference with indices measured at 6 months ( P > .05). No patient lost two or more lines of corrected distance visual acuity. Total higher-order aberrations (HOAs) and coma significantly increased after SMILE ( P < .05), whereas total spherical aberrations and trefoil changed only slightly. The mean modulation transfer function cutoff frequency was 36.66 ± 8.54 cycles per degree (cpd) before surgery and 37.81 ± 6.89 cpd at 18 months postoperatively; the mean objective scatter index was 0.62 ± 0.33 before surgery and 0.71 ± 0.38 at 18 months postoperatively. No significant difference was found between the three time points ( P > .05). Mean patient satisfaction was 9.31 ± 0.64 (with a maximum score of 10). CONCLUSIONS: SMILE showed good safety, efficacy, and stability in correcting moderate to high myopia, and patients were highly satisfied. HOAs increased after SMILE, mainly due to the increase of coma, whereas retinal image quality and intraocular scattering barely changed. [[ J Refract Surg. 2015;31(11):726–731.]

To compare central corneal sublayer pachymetry and biomechanical properties after femtosecond lenticule extraction (FLEX) and small-incision lenticule extraction (SMILE). A prospective, randomized, single-masked clinical trial of 35 patients treated for moderate to high myopia with FLEX in one eye and SMILE in the other. Anterior segment optical coherence tomography imaging (Heidelberg Spectralis; Heidelberg Engineering GmbH, Heidelberg, Germany) was used to measure central corneal thickness (CCT) and epithelial, flap/cap, and residual stromal bed thickness centrally. The Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, NY) was used to assess corneal hysteresis (CH) and corneal resistance factor (CRF). Patients were examined before and 6 months after surgery. Mean decrease in CCT was 105 μm in FLEX-treated eyes and 106 μm in SMILE-treated eyes (P = .70), which is equivalent to approximately 14 μm/diopters corrected. Mean central epithelial thickness increased 7 ± 6 μm in FLEX-treated eyes and 6 ± 5 μm in SMILE-treated eyes (P = .64). Achieved mean flap/cap thickness was 4 ± 6 μm from the expected thickness in FLEX-treated eyes and 4 ± 9 μm in SMILE-treated eyes (P = .37). CH was reduced 2.7 ± 1.3 mm Hg in FLEX-treated eyes and 3.3 ± 1.2 mm Hg in SMILE-treated eyes (P = .08). CRF was reduced 4.5 ± 1.2 mm Hg in FLEX-treated eyes and 4.6 ± 1.2 mm Hg in SMILE-treated eyes (P = .71). CH and CRF were highly correlated with CCT, but not patient age. In this paired-eye study, the flap-based FLEX and cap-based SMILE resulted in almost identical changes in central corneal sublayer pachymetry and biomechanical properties for moderate to high myopia 6 months after treatment.

Background The purpose of this study was to compare corneal subbasal nerve morphology, corneal sensation, and tear film parameters after femtosecond lenticule extraction (FLEX) and small-incision lenticule extraction (SMILE). Methods A prospective, randomized, single-masked, paired-eye design clinical trial of 35 patients treated for moderate to high myopia with FLEX in one eye and SMILE in the other. In both techniques, an intrastromal lenticule was cut by a femtosecond laser and manually extracted. In FLEX, a LASIK-like flap allowed removal of the lenticule, whereas in SMILE, it was removed through a small incision. In-vivo confocal microscopy was used to acquire images of the central corneal subbasal nerve plexus, from which nerve density, total nerve number, and nerve tortuosity were analyzed. Corneal sensation was measured using Cochet–Bonnet esthesiometry. A visual analog scale, tear osmolarity, non-invasive tear film break-up time (keratograph) tear meniscus height (anterior segment OCT), Schirmer's test, and fluorescein tear film break-up time were used to evaluate tear film and ocular surface symptoms. Patients were examined before and 6 months after surgery. Results There were no statistically significant differences in baseline parameters between FLEX and SMILE ( p  > 0.050). With regard to changes from before to 6 months after surgery, mean reduction in subbasal nerve density was 14.22 ± 6.24 mm/mm 2 in FLEX eyes, and 9.21 ± 7.80 mm/mm 2 in SMILE eyes ( p  < 0.05). The total number of nerves decreased more in FLEX eyes than in SMILE eyes ( p  < 0.05). No change was found when comparing tortuosity ( p  > 0.05). Corneal sensation was reduced with 0.38 ± 0.49 cm in FLEX eyes, and 0.10 ± 0.34 cm in SMILE eyes ( p  < 0.01). No differences were found between FLEX and SMILE in tear film evaluation tests ( p  > 0.05). Significantly more patients felt postoperative foreign body sensation in the FLEX eye within the first days after surgery, as compared to the SMILE eye. Conclusions Six months after surgery, the less invasive SMILE technique seemed better at sparing the central corneal nerves as compared to FLEX. Corneal sensation was only significantly reduced in FLEX eyes. There were no differences between FLEX and SMILE when comparing tear film evaluation tests 6 months after surgery.

To compare visual outcomes following photorefractive keratectomy (PRK), PRK with mitomycin C (MMC-PRK), and LASEK in moderate and high myopia in military personnel. This prospective, randomized contralateral eye study included 167 patients 21 years or older with manifest spherical equivalent -5.99 ± 1.40 diopters (D) (range: -3.88 to -9.38 D) randomized to either MMC-PRK or LASEK treatment in their dominant eye and conventional PRK without MMC in the fellow eye. All procedures were performed using the LADARVision 4000 Excimer Laser System (Alcon Surgical Inc., Ft. Worth, TX). High- and low-contrast visual acuities, manifest refraction, endothelial cell count, and corneal haze were evaluated up to 12 months postoperatively. At 12 months postoperatively, visual outcomes were comparable among the treatment groups. Corneal haze of any grade was less common in MMC-PRK compared to PRK at 1 month (21.4% vs 31.0%; P < .01) and 3 months (12.8% vs 35.9%; P = .03) postoperatively; it was also less common in MMC-PRK compared to LASEK at 1 month (21.4% vs 55.9%; P < .01), 3 months (12.8% vs 42.4%; P < .01), and 6 months (12.2% vs 36.4%; P = .03) postoperatively. Haze rate (grade 0.5 or higher) was comparable between LASEK and PRK. Clinically significant haze (grade 2 or higher) developed after PRK (4 eyes) and LASEK (2 eyes), but not after MMC-PRK. MMC-PRK showed some benefits in minimizing corneal haze formation. One year after surgery, there was no discernible difference in the postoperative refractive outcomes among the three methods.

PURPOSE: To compare changes in ocular higher order aberrations (HOAs) after Visian Implantable Collamer Lens (ICL, STAAR Surgical Co) implantation and wavefront-guided laser epithelial keratomileusis (WFG-LASEK) to correct high myopia. METHODS: This prospective case series comprised 30 eyes (18 patients) that underwent ICL implantation (ICL group) and 33 eyes (18 patients) that underwent WFG-LASEK (WFG-LASEK group). All eyes had spherical equivalent of −6.00 to −9.00 diopters. Entire ocular, internal optic, and corneal HOAs were measured before surgery and 3 months after surgery using a laser ray tracing aberrometer. Contrast sensitivity testing was performed in 10 eyes from each group at a photopic light level of 85 cd/mThis prospective case series comprised 30 eyes (18 patients) that underwent ICL implantation (ICL group) and 33 eyes (18 patients) that underwent WFG-LASEK (WFG-LASEK group). All eyes had spherical equivalent of −6.00 to −9.00 diopters. Entire ocular, internal optic, and corneal HOAs were measured before surgery and 3 months after surgery using a laser ray tracing aberrometer. Contrast sensitivity testing was performed in 10 eyes from each group at a photopic light level of 85 cd/m 2 and a mesopic level of 3 cd/m 2 3 months after surgery. RESULTS: In the ICL group, HOAs changed for the entire ocular trefoil-y, spherical aberration, internal optic spherical aberration, and corneal trefoil-y. In the WFG-LASEK group, increased HOAs were observed for total HOAs, entire ocular and corneal spherical aberration, secondary astigmatism, and tetrafoil. The ICL group had lower induced aberration values of entire ocular and corneal HOAs compared with the WFG-LASEK group. No significant differences in contrast sensitivity values between groups at the photopic level were noted; however, contrast sensitivity values were significantly lower for 3 (In the ICL group, HOAs changed for the entire ocular trefoil-y, spherical aberration, internal optic spherical aberration, and corneal trefoil-y. In the WFG-LASEK group, increased HOAs were observed for total HOAs, entire ocular and corneal spherical aberration, secondary astigmatism, and tetrafoil. The ICL group had lower induced aberration values of entire ocular and corneal HOAs compared with the WFG-LASEK group. No significant differences in contrast sensitivity values between groups at the photopic level were noted; however, contrast sensitivity values were significantly lower for 3 ( P =.01) and 6 cycles per degree ( P <.001) in the WFG-LASEK group at the mesopic level. At the mesopic level, total HOAs, trefoil-y, spherical aberration, and secondary astigmatism were higher in the WFG-LASEK group. CONCLUSIONS: Implantable Collamer Lens implantation induced fewer ocular and corneal HOAs and resulted in better contrast sensitivity at mesopic levels than WFG-LASEK in eyes with high myopia.

Purpose To compare 18-month outcomes between femtosecond laser-assisted LASIK (femto-LASIK) and photorefractive keratectomy with mitomycin-C (PRK-MMC) for myopia of more than 7.0 D in terms of visual acuity and quality. Methods In this comparative nonrandomized clinical trial, 60 eyes from 30 patients (30 eyes in each group) were enrolled. The two procedures were compared in terms of 18-month changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent, ocular and corneal higher order aberrations (HOAs), and contrast sensitivity (CS). Results Mean myopia was −8.65 ± 1.51 and −8.04 ± 1.70 D ( P  = 0.149) and mean ablation depth was 109.37 ± 9.07 and 105.09 ± 12.59 µm ( P  = 0.138), in the femto-LASIK and PRK-MMC groups, respectively. Baseline parameters were not significantly different between the two groups (all P  > 0.05). At 18 months postoperatively, 75 % in the femto-LASIK, versus 57.1 % in the PRK-MMC group, had 20/20 UDVA ( P  = 0.017). CDVA remained similarly unchanged in both groups ( P  = 0.616). No case had residual refractive error more than 1.0 D in the femto-LASIK group, while 33.5 % in the other group had more than 1.0 D residual error ( P  = 0.390). Changes in corneal HOA were not significantly different between the two groups ( P  = 0.260). Cases in the femto-LASIK group showed more increase in ocular HOA ( P  = 0.032) and coma ( P  = 0.083, power = 72 %). CS remained similarly unchanged in all spatial frequencies in both groups (all P  > 0.05). Conclusion Although femto-LASIK induces more HOA compared to PRK-MMC, considering outcomes in terms of 20/20 UDVA, residual refractive error, and CS stability, femto-LASIK provides more favorable results than PRK-MMC in high myopia.

Purpose To compare the visual outcomes between PRK-MMC and phakic IOL in patients with more than 8 diopter (D) of myopia. Methods This comparative study was performed on 23 eyes under treatment with Artiflex (group A) and 23 eyes under treatment with PRK-MMC (group B). Artiflex phakic IOL (Ophtec BV) was used in group A, and the VISX STAR S4 Excimer Laser (Abbott) was used for PRK-MMC in group B. Results The safety index was 1.11±0.23 and 1.05±0.25 ( P =0.100) and the efficacy index was 1.02±0.11 and 0.98±0.10 ( P =0.266) in group A and B, respectively. At 1 year after surgery, the manifest refraction spherical equivalent was −0.17±1.18 and −0.25±0.18 D in group A and B, respectively ( P =0.471). Mesopic CS showed no significant difference between the two groups in any spatial frequency. Total coma was 0.24±0.17 and 0.67±0.40  μ m ( P <0.001), spherical aberration was −0.11±0.11 and 0.41±0.18  μ m ( P <0.001), and RMS HOA T was 0.50±0.20 and 0.96±0.45  μ m ( P <0.001) in group A and B, respectively. Conclusion Phakic IOL implantation was better than PRK-MMC in the correction of high myopia in terms of visual quality, but the two methods had no difference with regard to visual acuity. Therefore, PRK-MMC can be used when the anterior chamber depth is a limiting factor in the implantation of phakic IOLs.