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Objectives To assess and compare the six-month outcome of the two-step transepithelial phototherapeutic keratectomy- photorefractive keratectomy (PTK-PRK) and the single-step transepithelial PRK for myopia and myopic astigmatism. Methods A prospective randomized study. The study enrolled 100 eyes of 50 patients with mild to moderate myopia or myopic astigmatism stratified into two groups, PTK-PRK ( n = 50 eyes) and single step PRK ( n  = 50 eyes). Primary outcome measures were visual acuity and manifest refraction. Secondary outcome measures were epithelial healing duration, post-PRK pain scores and 3-month postoperative haze grading. Results Preoperative characteristics were similar in both groups ( p value > 0.05). The mean uncorrected distance visual acuity (UDVA) at 1 week, 1 month, 3 and 6 months was significantly better in the single-step PRK group than in the two-step PTK-PRK group ( p  < 0.001). The mean manifest sphere, cylinder and spherical equivalent showed a significant difference at all follow up visits in favour of the single-step PRK ( p value < 0.001). Epithelial healing duration was faster in single-step PRK ( p value < 0.001). Pain scores were significantly lower following single-step PRK at 8 h, 1 day, 3 days ( p value < 0.001) but were similar at the 7th day. Haze scores showed no statistical difference between the two groups at 3-month follow-up. Conclusion The two transepithelial PRK techniques were effective in correcting mild to moderate myopia and myopic astigmatism. However, Single-step transepithelial PRK achieved faster visual recovery, better refractive outcome and shorter epithelial healing time with less post-PRK pain. Clinical trials registry (Clinical Trials.gov Identifier): NCT04710082.

To compare safety and efficacy of topography-guided LASIK and contralateral eye SMILE for myopia and myopic astigmatism correction. This prospective, randomized contralateral eye study included 44 eyes of 22 patients with bilateral myopia or myopic astigmatism. Treated eyes were divided into two groups: 22 eyes were treated with topography-guided LASIK and the fellow eye of each patient was treated with SMILE. The following parameters were evaluated preoperatively and up to 3 months postoperatively: uncorrected distance vision acuity (UDVA), corrected distance vision acuity (CDVA), refractive error, corneal keratometry, contrast sensitivity, and Objective Scatter Index. At 3 months, 86.4% of the LASIK group and 68.2% of the SMILE group had UDVA of 20/20 (P < .002) and 59.1% and 31.8%, respectively, had UDVA of 20/16 (P < .002). Spherical equivalent refraction (±0.50 D) was 95.5% for the LASIK group and 77.3% for the SMILE group (P < .002). Residual refraction cylinder (≤ 0.25 D) was 81.8% for the LASIK group and 50% for the SMILE group (P < .001). Contrast sensitivity (6 cycles/degree) was 7.2 ± 1.01 in the LASIK group and 6.20 ± 1.52 in the SMILE group. Objective Scatter Index measurements at 3 months were 1.35 in the LASIK group and 1.42 in the SMILE group. Topography-guided LASIK was superior in all visual performance parameters studied, both subjective and objective. The main difference between the two techniques likely derives from the eye tracking, cyclorotation compensation, and active centration control in the LASIK technology studied in contrast to the current technology available with SMILE-like procedures. This difference appears to affect refractive and visual aberration performance outcomes. [J Refract Surg. 2017;33(5):306-312.].

Background The incidence of refractive surgery-related dry eye disease (DED) is rising due to the increasing popularity of corneal refractive surgery. The moisture chamber goggles (MCGs) have been shown to tear evaporation by increasing local humidity and minimizing airflow. The current study aims to evaluate the efficacy of moisture chamber goggles for refractive surgery-related DED. Methods In this nonrandomized open-label controlled study, 78 participants (156 eyes) receiving refractive surgery were enrolled between July 2021 and April 2022, and sequentially allocated to MGC and control groups. 39 participants were allocated to the MGC groups, of which 53.8% received small-incision lenticule extraction (SMILE) and 46.2% received femtosecond laser-assisted in situ keratomileusis (FS-LASIK), and were instructed to wear MCGs for the duration of 1 month postoperatively, in addition to the standard postoperative treatment received by the control groups (56.4% SMILE, 43.6% FS-LASIK). Participants underwent full ophthalmic examinations, including visual acuity, manifest refraction, DED evaluations, and higher-order aberrations (HOAs), both preoperatively and at routine follow-ups 1 day, 1 week, and 1 month after surgery. DED parameters included non-invasive tear film break-up time (NIBUT), tear meniscus height (TMH), conjunctival congestion, lipid layer thickness (LLT), and ocular surface disease index (OSDI) questionnaires. Student’s t-test was used for comparisons between control and MCG groups, and between preoperative and postoperative parameters within groups. Results Postoperative NIBUT decreased in both SMILE and FS-LASIK control groups 1 day after the surgery (SMILE, P  = 0.001; FS-LASIK, P  = 0.008), but not in the corresponding MCG groups (SMILE, P  = 0.097; FS-LASIK, P  = 0.331). TMH in the MCG group was significantly higher at 1 week ( P  = 0.039) and 1 month ( P  = 0.015) in SMILE, and 1 day ( P  = 0.003) in FS-LASIK groups. In FS-LASIK participants, significantly lower HOAs and coma levels in the MCG group were observed 1 day (total HOAs, P  = 0.023; coma, P  = 0.004) and 1 week (total HOAs, P  = 0.010, coma, P  = 0.004) after surgery. No consistent statistically significant intergroup difference was observed between MCG and control groups in conjunctival congestion, LLT, and OSDI. Conclusions MCGs effectively slowed tear evaporation, increased tear film stability, and improved HOAs in patients receiving SMILE and FS-LASIK surgeries. MCG is an effective adjuvant therapy in the comprehensive management of refractive surgery-related DED.

Background To evaluate the safety and efficacy of the pre-chop technique using a novel reverse chopper vs. the classic stop-and-chop technique in phacoemulsification for patients with high myopia and associated grade III–IV nuclear cataracts. Methods In this prospective cohort study, a total of 44 consecutive patients (44 eyes) with grade III–IV nuclear cataracts who were admitted to our hospital for cataract surgery between March 2018 and September 2018 were enrolled. All patients had ocular axial length > 27 mm and myopic refraction more than -10 diopters. Patients were randomly divided into a pre-chop group and stop-and-chop group using a randomization table. Nucleus splitting was performed surgically in both groups using either the pre-chop technique with reverse chopper or the classic stop-and-chop technique. Results Postoperative visual acuity was significantly improved in both groups compared with preoperative values. Significantly better visual acuity, lower degree of corneal edema and lower rates of corneal endothelial cell loss were observed in the pre-chop group compared to those in the classic stop-and-chop group. No complications were reported in either group. Conclusions In treating patients with high myopia associated with grade III–IV cataracts, the pre-chop technique using a reverse chopper reduces damage to corneal endothelial cells and improves visual acuity better than the classic stop-and-chop technique.

PURPOSE: To study the feasibility of performing myopic femtosecond small incision lenticule extraction (SMILE) with four different cap thicknesses (130, 140, 150, and 160 To study the feasibility of performing myopic femtosecond small incision lenticule extraction (SMILE) with four different cap thicknesses (130, 140, 150, and 160 μ m). METHODS: In this retrospective, comparative, non-randomized clinical trial, a refractive lenticule of intrastromal corneal tissue was cut with the VisuMax femtosecond laser system (Carl Zeiss Meditec AG, Jena, Germany) using different depths of the non-refractive lenticule cut. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and Objective Scattering Index (OSI) were evaluated. Minimum follow-up time was 1 year. RESULTS: Ninety-four eyes of 47 patients with myopia with (14 patients) and without (33 patients) astigmatism were treated. One year after the surgery, mean log-MAR UDVA, logMAR CDVA, SE, and OSI were 0.07 ± 0.12, 0.01 ± 0.37, 0.07 ± 0.57, and 0.88 ± 0.17, respectively (Ninety-four eyes of 47 patients with myopia with (14 patients) and without (33 patients) astigmatism were treated. One year after the surgery, mean log-MAR UDVA, logMAR CDVA, SE, and OSI were 0.07 ± 0.12, 0.01 ± 0.37, 0.07 ± 0.57, and 0.88 ± 0.17, respectively ( P < .05). There were no significant statistical differences in logMAR UDVA, logMAR CDVA, SE, or OSI ( P > .05) variables when the different groups were compared for the same periods of time. CONCLUSIONS: No differences in visual acuity, refractive outcomes in optical visual quality, or complications were observed when using SMILE at four different depths. [[ J Refract Surg. 2015;31(9):580–585.]

Purpose To analyse the topographic characteristics in macular choroidal thickness (mChT) and ocular biometry in myopic maculopathy and to explore the potential cut-off value for prediction of myopic maculopathy (MM). Methods All participants underwent detailed ocular examinations. MM was subdivided into thin choroid, Bruch’s membrane (BM) defects, choroidal neovascularization (CNV), and myopic tractional maculopathy (MTM) according to OCT-based classification system. Peripapillary atrophy area (PPA), tilt ratio, torsion, and mChT were individually measured. Results A total of 1947 participants were included. In multivariate logistics models, older age, longer axial length, larger PPA area, and thinner average mChT were more likely to have MM and different type of MM. Female participants were more likely to have MM and BM defects. A lower tilt ratio was more likely to be associated with CNV and MTM. The area under the curve (AUC) of single tilt ratio, PPA area, torsion, and topographic of mChT for MM, thin choroid, BM Defects, CNV, and MTM were 0.6581 to 0.9423, 0.6564 to 0.9335, 0.6120 to 0.9554, 0.5734 to 0.9312, 0.6415 to 0.9382, respectively. After combining PPA area and average mChT for predicting MM, thin choroid, BM defects, CNV, and MTM, the AUC of the combination were 0.9678, 0.9279, 0.9531, 0.9213, 0.9317, respectively. Conclusion Progressive and continuous PPA area expanding and thin choroid play a role in the development of myopic maculopathy. The present study showed that a combination of peripapillary atrophy area and the choroidal thickness could be used to predict MM and each type of MM.

Macular hole (MH) retinal detachment (MHRD) frequently causes severe visual impairment, mainly in older people with severe myopia and posterior staphyloma. Vitrectomy combined with internal limiting membrane (ILM) peeling is a treatment but has issues. The usefulness of an ILM inverted flap technique has not been clearly defined. Thus, we compared vitrectomy using this technique with vitrectomy using a complete ILM peeling technique for MHRD with severe myopia. The study included 29 patients (29 eyes) who underwent initial vitrectomy for MHRD with severe myopia between January 2011 and August 2019. The inverted ILM flap technique was used in 12 eyes (inverted group), and the complete ILM peeling technique was used in 17 eyes (peeling group). Clinical findings and outcomes were compared. In the peeling and inverted groups, the initial MH closure rate was 35.3% and 50% ( p  = 0.024) and the initial retinal reattachment rate was 82.4% and 75.0% ( p  = 0.630), respectively. The final retinal reattachment rate was 100% in both groups. The postoperative visual acuity during final consultation was better in the inverted than the peeling group. The inverted ILM flap technique may be more useful than the ILM peeling technique for MHRD in severely myopic eyes.

Background Among sex chromosome aneuploidies, 48, XXYY syndrome is a rare variant. This condition is marked by the existence of an additional X and Y chromosome in males, leading to a diverse range of physical, neurocognitive, behavioral, and psychological manifestations. Typical characteristics include a tall stature and infertility. Other phenotypes include congenital heart defects, skeletal anomalies, tremors, obesity, as well as the potential for type 2 diabetes and/or peripheral vascular disease. Case presentation A 6-year-old boy, who had been experiencing progressive vision deterioration in both eyes for the past two years, presented with a history of poor vision, delayed motor skills. The patient was diagnosed with micropenis in the pediatric outpatient clinic. Sparse hair, an unusually tall stature and craniofacial dysmorphology characterized by ocular hypertelorism, depressed nasal bridge, and epicanthic folds were observed. Comprehensive ophthalmic examination revealed high myopia and grade 3 macular hypoplasia. Diagnostic investigations including karyotype analysis and whole-exome sequencing identified an anomalous male karyotype comprising two X and two Y chromosomes, confirming a diagnosis of 48, XXYY syndrome. Conclusions This study underscores the rare association of high myopia and grade 3 macular dysplasia with 48, XXYY syndrome. To our knowledge, this case marks the first recorded instance of macular dysplasia in a patient with 48, XXYY syndrome. This novel finding enhances our understanding of this syndrome’s phenotypic variability.

Background Idiopathic intracranial hypertension (IIH) is a disease entity characterized by elevated intracranial pressure, which usually accompanied by papilledema. However, diagnosing papilledema can be challenging in patients with preexisting ocular conditions, such as high myopia. Case presentation A 39-year-old woman with a long-standing history of high myopia presented with visual field constriction. Her visual acuity was decreased in both eyes, and she also reported morning headaches, pulsatile tinnitus, and intermittent periocular pain. Although she was diagnosed with IIH based on a cerebrospinal fluid study, there was no evident papilledema, which may have been masked by myopic changes in optic nerve and peripapillary retinal nerve fiber layer. After treatment for IIH with acetazolamide, her visual field and visual acuity markedly improved, and her symptoms were relieved. Conclusions In highly myopic patients, myopic changes in optic nerve head may obscure papilledema, complicating the diagnosis of IIH. This unusual case highlights the need for detailed history taking and a comprehensive clinical evaluation in patients with high myopia. Clinicians should suspect IIH in the presence of symptoms such as pulsatile tinnitus, morning headache, and visual field constriction, even in the absence of evident papilledema.

Background This study aimed to assess the surgical outcomes of Ahmed glaucoma valve (AGV) implantation in high myopic eyes (axial length [AL] of ≥ 26.0 mm) and to determine whether high myopia independently poses a risk of surgical failure. Methods We retrospectively reviewed 68 eyes from 59 patients with refractory glaucoma who underwent AGV implantation. Eyes were categorised into high myopia (23 eyes, 33.8%) and control (45 eyes, 66.2%) groups. The primary outcome was the surgical success rate, defined as postoperative intraocular pressure (IOP) of 6–21 mmHg or a ≥ 20% reduction from baseline. Surgical success was further classified into criterion A (postoperative IOP ≤ 21 mmHg) and criterion B (postoperative IOP ≤ 15 mmHg). Surgical success rates were estimated using Kaplan–Meier analysis, and risk factors for surgical failure were identified via Cox proportional hazards modelling. Results At 1 and 2 years, surgical success was significantly higher in the control group according to criterion A ( p  = 0.013 and 0.043, respectively). Based on criterion B, the control group also showed better surgical success, although the difference did not reach statistical significance. ( p  = 0.051). Postoperative IOP was lower in the control eyes throughout all postoperative periods, and the difference reached statistical significance at 6 months ( p  = 0.017). An AL ≥ 26 mm was a significant risk factor for surgical failure under both criterion A (hazard ratio [HR] = 8.30, p  = 0.026) and criterion B (HR = 6.26, p  = 0.009). Conclusions AGV implantation in glaucoma eyes with high myopia showed lower surgical success compared to those without high myopia. Longer AL is a significant risk factor for surgical failure, underscoring the importance of careful monitoring after AGV implantation in such cases.