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To report outcomes of phakic intraocular lens (IOL) implantation after deep anterior lamellar keratoplasty (DALK) to correct high ametropia. Centro Hospitalar Universitário do Porto, Portugal. Retrospective case series with 11 eyes submitted to phakic IOL implantation after DALK. Main outcomes measured were uncorrected and corrected distance visual acuity (UDVA and CDVA), refractive error components, tomographic parameters and endothelial cell density (ECD). The minimum follow-up was 3 years for all cases. Mean ECD loss was 8.7±6.7% at 1 year, 13.1±8.6% at 3 years (n=11; p=0.016, p=0.007, respectively) and 14.0±20.4% at 5 years (n=5, p=0.212). Mean logMAR UDVA increased from 1.27±0.90logMAR preoperatively to 0.16±0.15logMAR postoperatively ( ≤0.001) and no statistically significant differences were registered during follow-up. All patients gained at least 5 lines of UDVA. 54.5% of the eyes gained 1 line in CDVA postoperative and only one eye lost one CDVA line through follow-up. Efficacy and safety indexes at 1 and 3 years were 1.01-0.97 and 1.24-1.21, respectively. Mean spherical equivalent was reduced from -7.84±4.63 D preoperatively to -1.05±1.07 D postoperatively ( =0.001). Mean percentage of reduction in refractive cylinder and spherical error was 83.8±15.8% and 73.1±31.5%, respectively, ≤0.001 for both. In one eye there was a significantly gradual ECD loss over 5 years follow-up and the patient will be submitted to IOL explant. Phakic IOLs were effective for correction high ametropia after DALK, showing high efficacy and safety indexes with stability over time. However, it was registered a continuing endothelial cell loss postoperatively, which assumed to be higher than those reported in eyes without DALK.

PurposeTo investigate preoperative ocular risk factors and indications for secondary intraocular lens (IOL) implantation and compare postoperative complications, visual and refractive outcomes in a tertiary referral center.MethodsPatients older than 14 years that underwent secondary IOL implantation and had a minimum follow-up of 3 months were enrolled in this retrospective case series. Preoperative ocular risk factors, indications for surgery, postoperative complications, and visual and refractive outcomes including prediction error (PE) and absolute error (AE) were evaluated. IOLs were fixated in following positions: anterior chamber (AC), retropupillary iris-claw (IC), sulcus, and capsular bag or sclera.ResultsOne-hundred eighty-two eyes of 174 patients with mean follow-up of 17 ± 13.6 months were evaluated. Leading cause for surgery was IOL dislocation (75%), followed by secondary aphakia (19%) and IOL opacifications (6%). Previous vitrectomy was the major preoperative ocular risk factor (43%). Mean corrected distance visual acuity improved from preoperative 0.68 ± 0.55 to 0.42 ± 0.31LogMAR by the last follow-up (p = 0.001). PE and AE differed highly depending on the indication for surgery (p = 0.041 and p = 0.008, respectively) and the IOL fixation (p = 0.011 and p = 0.028, respectively), with IC-IOLs showing the lowest PE and AE. Postoperative AC-hemorrhage occurred mainly after IC-IOLs (p = 0.003), and postoperative hypotony was significantly higher in eyes with previous uveitis (p = 0.026).ConclusionsPrevious vitrectomy seems to be a major underreported risk factor in eyes that undergo secondary IOL implantation. Refractive outcomes depend on indication for surgery and fixation type, with retropupillary IC-IOLs providing the best refractive results, though not statistically significant compared to other IOL positions.

Dry eye disease (DED) is a multifactorial ocular surface disorder characterized by loss of tear film homeostasis with associated ocular symptoms, like dryness, foreign body sensation, and inflammation. Numerous reports confirm an increase in dry eye symptoms after cataract surgery. DED also significantly disturbs preoperative biometric measurements, mainly by changes in keratometry measurements. The purpose of this study is to evaluate the effect of DED on biometric measurements before cataract surgery and postoperative refractive errors. PubMed database was searched for keywords: cataract surgery, dry eye disease, refractive error, refractive outcomes, keratometry, and biometry. Four clinical studies evaluating the effect of DED on refractive errors were included. In all studies, biometry was performed before and after dry eye treatment, and the mean absolute error was compared. Various substances have been used to treat dry eye, such as cyclosporin A, liftitegrast, and loteprednol. The refractive error was significantly lower after treatment in all studies. The results unanimously indicate that refractive errors can be reduced by proper treatment of DED before cataract surgery.

To assess the efficacy, safety, and stability of refractive outcomes in hyperopic Laser-Assisted in Situ Keratomileusis (LASIK) with and without the application of Mitomycin C (MMC). This randomized, parallel group, controlled multicenter trial included 140 hyperopic eyes. The participants were randomly assigned to two groups: one receiving LASIK with mitomycin C (MMC) ( n  = 70) and the other receiving LASIK without MMC ( n  = 70). The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and safety parameters at six months postoperatively. The statistical analysis employed t-tests, Mann-Whitney tests, and Fisher’s Exact Test, with a significance level of p  < 0.05. All 140 eyes (70 per group) were analyzed. No statistically significant differences were identified between the two groups in postoperative UDVA, CDVA, or safety parameters ( p  > 0.05). Both groups demonstrated highly effective and safe refractive outcomes. No intraoperative complications or postoperative adverse events were observed. Age and preoperative spherical equivalent did not significantly affect outcomes. Hyperopic LASIK with and without MMC showed comparable efficacy, safety, and stability of refractive outcomes at the six-month postoperative interval. Although MMC use in hyperopic LASIK appears to be a safe procedure, it was not found to be significantly superior to conventional LASIK. Further investigation with longer follow-up periods and larger cohorts is necessary to confirm these results.

Relevance. The increasing life expectancy has led to a rise in age-related vision disorders, such as presbyopia and cataracts, with WHO predicting 2.1 billion presbyopia cases and 35 million annual cataract surgeries globally by 2030. In Russia, ~2 million cataract cases are diagnosed yearly, with 760K – 1 million lens replacements performed, highlighting the demand for precise IOL calculations to achieve optimal refractive outcomes. While the IOLMaster 700 remains the gold standard, the newly introduced Argos SS-OCT biometer (with Enhanced Retina Visualization) shows promise for challenging cases (e.g., dense cataracts, corneal opacities), though clinical data, especially in Russian-language literature, remain scarce. Purpose. Comparative analysis of the accuracy of biometric measurements and intraocular lens calculations using optical biometers (Argos and IOLMaster 700) in patients with cataracts of varying density. Material and methods. This prospective study included 194 eyes with cataracts. A comparative evaluation was performed between two SS-OCT biometers: Argos (featuring Sum-of-segments technology and ERV mode) and IOLMaster 700. Special attention was given to cases of dense cataracts (PNS ≥4). Results. Argos demonstrated significantly higher measurement success rates (97.9% vs 92.2%; p<0.001). In the dense cataract group, Argos achieved 92% effectiveness in ERV mode versus 65% for IOLMaster 700. A clinical case confirmed the accuracy of ERV measurements (error <0.3D). Both devices showed comparable accuracy in transparent media. Conclusion. The Argos biometer with ERV mode is the preferred choice for complex cases, providing high measurement accuracy in dense cataracts. SS-OCT technology combined with the Sum-of-segments method meets modern requirements for refractive cataract surgery. Key words: optical biometry, SS-OCT, cataract, axial length, refractive outcomes.

Background In pediatric ophthalmology, calculating intra-ocular lens (IOL) power can be challenging. It is important to predict if the post-surgery refractive error (RE) will meet the intended refractive goal. In this study, we aimed to investigate the factors and predictors influencing RE outcomes in children undergoing IOL implantation. Methods This was a retrospective cross-sectional cohort study that involved 47 eyes with congenital cataracts underwent IOL implantation. Each patient underwent follow-up visits at two months and two years’ post-surgery. The IOL power calculations were conducted using the Holladay 1 formula, and both the prediction error (PE) and absolute prediction error (APE) were calculated. Results The mean age was 6.52 ± 4.61 years, with an age range of 1–15 years. The mean IOL power was 20.31 ± 6.57 D, and the mean post-operative refraction was 1.31 ± 2.65 D. The mean of PE and APE were 0.67 ± 1.77 and 1.55 ± 1.06 D, respectively. Whereas PE was correlated to axial length with an R-value of − 0.29 ( P  = 0.04). The calculation method had a significant negative relationship with APE and PE, with coefficients of − 1.05 ( P  = 0.009) and − 1.81 ( P  = 0.009), respectively. Conclusion High astigmatism was associated with greater errors in the refractive outcome. The calculation methods had the most considerable impact on the post-operative RE. The customization of surgical approaches to accommodate individual characteristics is crucial. Further research with diverse subgroups is needed to comprehensively understand the influence of each factor.

The refractive accuracy of intraocular lens (IOL) formulas varies in eyes that undergo combined phacovitrectomy for different underlying vitreoretinal pathology. A total of 401 eyes that underwent uncomplicated phacovitrectomy (23–25 g) with implantation of a plate haptic IOL (CT Asphina 409 M) in the capsular bag between April 2020 and December 2022 were included in the study. Inclusion criteria were postoperative best corrected visual acuity of 0.4 LogMAR or better at least 8 weeks after surgery. The Barrett Universal II (BUII), Haigis, Hill-Radial Basis Function (Hill-RBFv3.0), Hoffer Q, Holladay I, Holladay II, Kane, K6, Pearl-DGS and SRK/T formulas were compared for their accuracy in mean absolute error (MAE). Furthermore, all formulas were additionally tested by using the prediction for an IOL power 0,5 or 1D above the IOL used (IOLdown). Wilcox-Holladay-Wang-Koch (WHWK) statistical tests with Holm correction were applied. The Barrett IOLdown formula showed the lowest refractive prediction error (0.03D; together with Hill IOLdown), lowest MAE (0.40D), lowest median absolute error (MedAE; 0.31D), lowest standard deviation of MAE (0.55D) and lowest root mean squared absolute error (RMSAE; 0,54D). Barrett IOLdown had the highest percentage of eyes with predicted error within ± 0.25D (41.6%), Kane IOLdown within ± 0.50D (70.5%) and ± 0.75D (89%) and Hill IOLdown within ± 1D (95.2%). Except for Haigis, Hoffer Q and Pearl-DGS, all other formulas showed a statistically significantly lower MAE after IOLdown modification. The newest formulas with IOLdown modification performed better than old generation formulas, with Barrett IOLdown exhibiting the best results.

Purpose To evaluate the surgical outcome in terms of safety, efficacy, predictability, and retreatment rate of LASIK surgery in patients with controlled systemic diseases in comparison with healthy individuals. Methods The retrospective study included data from 1936 eyes of 976 patients with stable systemic diseases who underwent LASIK surgery between January 2016 and June 2019. The safety, efficacy, predictability of the surgery, and retreatment rate were evaluated in comparison with a control group comprising 1951 patients. The study was approved by the local ethics committee and adhered to the principles of the Declaration of Helsinki. Statistical analysis was performed using R team and the level of statistical significance was set at p  < 0.05. Results All treatment groups demonstrated high safety and efficacy indices after LASIK surgery. Furthermore, the study arms demonstrated comparable predictability and retreatment rates to the control group in nearly all cases. Retreatment rates were significantly higher in the rheumatoid arthritis group ( p  = 0.03), while safety indices were significantly lower in the hay fever group compared to the control group ( p  = 0.004). No intra- or postoperative sight-threatening complications were documented. Conclusion Our findings suggest that selected patients with stable systemic conditions can safely undergo LASIK surgery and achieve comparable outcomes to healthy individuals. Further research is needed to better understand the treatment outcomes in this challenging patient population.

PurposeTo compare the refractive outcomes following cataract surgery using conventional keratometry (K) and total keratometry (TK) for intraocular lens (IOL) calculation in the SRK/T, HofferQ, Haigis, and Holladay 1 and 2, as well as Barrett and Barrett TK Universal II formulas.MethodsSixty eyes of 60 patients from Siriraj Hospital, Thailand, were prospectively enrolled in this comparative study. Eyes were assessed using a swept-source optical biometer (IOLMaster 700; Carl Zeiss Meditec, Jena, Germany). Posterior keratometry, K, TK, central corneal thickness, anterior chamber depth, lens thickness, axial length, and white-to-white corneal diameter were recorded. Emmetropic IOL power was calculated using K and TK in all formulas. Selected IOL power and predicted refractive outcomes were recorded. Postoperative manifest refraction was measured 3 months postoperatively. Mean absolute errors (MAEs), median absolute errors (MedAEs), and percentage of eyes within ± 0.25, ± 0.50, and ± 1.00 D of predicted refraction were calculated for all formulas in both groups.ResultsMean difference between K and TK was 0.03 D (44.56 ± 1.18 vs. 44.59 ± 1.22 D), showing excellent agreement (ICC = 0.99, all p < 0.001). Emmetropic IOL powers in all formulas for both groups were very similar, with a trend toward lower MAEs and MedAEs for TK when compared with K. The Barrett TK Universal II formula demonstrated the lowest MAEs. Proportion of eyes within ± 0.25, ± 0.50, and ± 1.00 D of predicted refraction were slightly higher in the TK group.ConclusionsConventional K and TK for IOL calculation showed strong agreement with a trend toward better refractive outcomes using TK. The same IOL constant can be used for both K and TK.

This study aimed to compare the seven-year refractive outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for correction of myopia and myopic astigmatism. This retrospective cohort study included 97 eyes of 53 patients who had undergone SMILE or FS-LASIK for myopia seven years prior. Measured parameters included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction. There were no significant differences between the SMILE and FS-LASIK groups in logMAR UDVA, cylinder, and logMAR CDVA at 7 years postoperatively (P>0.05). However, there were significant differences between the two groups in sphere and spherical equivalent (P=0.035 and P=0.016, respectively). UDVA was better than or equal to 20/20 in 81% of the eyes after SMILE and in 63% after FS-LASIK (P = 0.045). The efficacy indices of the SMILE and FS-LASIK groups were 1.04 ± 0.23 and 0.97 ± 0.23 (P=0.405), and the safety indices were 1.18 ± 0.19 and 1.10 ± 0.17 (P=0.543), respectively. This study demonstrates the good predictivity of both SMILE and FS-LASIK. SMILE could offer superior refractive outcomes than FS-LASIK during a 7-year follow-up in correcting myopia and myopic astigmatism.