Search Results (62)

Background: To present the management of upside–down Descemet membrane endothelial keratoplasty (DMEK) with intraoperative optical coherence tomography (iOCT). Methods: We report the case of a 74-year-old woman who underwent DMEK for Fuchs’ endothelial corneal dystrophy (FECD) of the right eye. Preoperative corrected distance visual acuity (CDVA) was 20/1500 (counting fingers [CF]), and the central corneal thickness (CCT) was 637 μm. No graft markings were made. Graft positioning was determined using iOCT. An improper graft position was suspected due to the lack of postoperative anatomical and functional improvements. The CDVA noted at that time was 20/1500 (CF), and the CCT was 708 μm. The graft was subsequently repositioned. This procedure was performed 33 days after the primary surgery. Results: The central corneal thickness and CDVA were 495 μm and 20/40 sc, respectively, at the final 18-month postoperative follow-up. Conclusions: Incorrect positioning of the transplanted corneal graft should be considered if no improvement is observed after DMEK. The learning curve significantly affects the occurrence of these complications. Graft repositioning, even 33 days after surgery, is associated with a favorable prognosis. Full article

Background: Intraocular lens (IOL) alignment is crucial for optimal performance in presbyopia-correcting designs. The aim was to report a case of a patient with a high angle kappa implanted with the continuous transitional focus (CTF) Precizon Prebyopic NVA IOL. Case presentation: A 51-year-old patient presenting large angle kappa values (0.6/0.8 mm) was implanted with the Precizon Prebyopic NVA IOL and followed-up 1 and 10 months post-surgery. This IOL is designed with a butterfly-shaped central area that allows the orientation of the lens so that the visual axis passes through the wider diameter of the optic zone. Postoperative refraction was −0.25D of cyl at 80° for the right eye and +0.25D −0.50D cyl at 170°. Corrected distance visual acuity (CDVA) at the last visit was −0.1 logMAR monocularly and −0.2 logMAR binocularly. Binocular uncorrected distance (UDVA), intermediate (UIVA) and near visual acuities (UNVA) were −0.1, 0.1 and 0.1 logMAR, respectively. The corrected binocular defocus curve exhibited outstanding vision at the 0.00D defocus level and showed a continuous range of functional vision from distance to near. Overall excellent satisfaction was reported, along with low levels of photopic phenomena. Conclusions: Precizon Presbyopic NVA IOL provided satisfactory vision and low levels of photic phenomena in a high angle kappa patient who would potentially be excluded from presbyopia-correcting IOL implantation. Full article

Background/Objectives: The objective of this study is to compare the optical and visual quality provided by the advanced monofocal intraocular lens (IOL) ISOPure and the standard monofocal IOL MicroPure in cataract patients, using objective and subjective assessments. Methods: This prospective, single-blind clinical study includes 28 patients with cataracts, bilaterally implanted with either the ISOPure or MicroPure IOL. Eligible eyes had no ocular comorbidities and regular corneal astigmatism ≤ 1.00 D. Three months postoperatively, uncorrected distance and intermediate (UDVA, UIVA) and corrected distance and intermediate (CDVA, DCIVA) visual acuities were measured at 4 m, 80 cm, and 66 cm under photopic (85 cd/m²) and mesopic (3.5 cd/m²) conditions. Photic phenomena, including halo and glare, were evaluated. Objective optical quality was assessed using Objective Scattering Index (OSI), Modulation Transfer Function (MTF), Strehl Ratio (SR), and ocular aberrations. Subjective patient satisfaction was evaluated using Quality of Vision (QoV) and Catquest-9SF questionnaires. Results: Under photopic conditions, logMAR DCIVA at 80 cm, UIVA at 66 cm, and DCIVA at 66 cm were 0.18 ± 0.06, 0.25 ± 0.12, and 0.20 ± 0.13, respectively, for ISOPure, and 0.22 ± 0.06, 0.30 ± 0.09, and 0.25 ± 0.09 for MicroPure (p = 0.05, 0.02, and 0.05, respectively). No significant differences were observed in halo/glare size or intensity, OSI, MTF, or SR. However, statistically significant differences were found in higher-order total aberrations for pupil sizes of 3.0, 4.0 mm, and 5.0 mm. Questionnaires indicated greater satisfaction and functional intermediate vision with ISOPure. Conclusions: The ISOPure IOL offers superior intermediate vision without compromising distance vision, delivering a balanced combination of optical quality, functional performance, and patient satisfaction. Full article

This systematic review and meta-analysis evaluated refractive outcomes, particularly astigmatic correction, in keratoconus following toric intraocular lens (tIOL) implantation. A systematic search identified eligible studies reporting pre- and postoperative refractive cylinder, spherical equivalent (SE), uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA). Eight studies, comprising 135 eyes, were included. Outcomes were pooled using a random-effects model with restricted maximum likelihood as the estimator for tau². Methodological quality was assessed using the MINORS tool for non-comparative studies and the JBI checklist for case series. Postoperative refractive cylinder and SE improved by 2.28 dioptres (95% CI, 1.60–2.96) and 4.17 dioptres (95% CI, 2.32–6.01), respectively. UDVA and CDVA also improved substantially, with pooled gains of 0.87 logMAR (95% CI, 0.71–1.03) and 0.19 logMAR (95% CI, 0.12–0.26), respectively. Most tIOL rotations did not exceed 10 degrees, with only one case requiring realignment surgery. Complications were infrequent and mostly minor. tIOL implantation is effective in reducing astigmatism and improving vision in stable keratoconus patients. However, limitations in vector analysis and methodology heterogeneity underscore the need for standardised reporting to optimise outcomes. Full article

Background/Objectives: This retrospective observational study evaluates the efficacy of Descemetorhexis without Keratoplasty (DSO) compared to Descemet Membrane Endothelial Keratoplasty (DMEK) in the management of Fuchs Endothelial Corneal Dystrophy (FECD). The outcomes were compared in terms of the corneal anatomical changes, visual results, and complication rates between the two surgical techniques for FECD. Methods: We conducted a retrospective, descriptive, observational study including 31 eyes from 26 patients who underwent either DSO (n = 16) or DMEK (n = 15) at the Department of Ophthalmology, Hospital Arruzafa. Patients were included if they had complete follow-up data at baseline, 6 months, and 1 year post-intervention. Their clinical information was collected from medical records and complementary tests, including the Snellen visual acuity test, Pentacam corneal tomography, and specular microscopy. Results: The average time to achieve best corrected distance visual acuity (CDVA) was significantly longer for DSO (7.44 ± 2.3 months) than for DMEK (5.73 ± 1.9 months, p = 0.004). Complication rates were higher in the DMEK group (26.7%), and in comparison, there was an absence of complications in the DSO group (p = 0.043). Corneal endothelial cell migration was confirmed in patients who underwent DSO, with a mean cell density of 817.17 ± 91.7 cells/mm² after one year. Conclusions: DSO effectively treated the selected patients with FECD who presented central guttata and corneal edema, achieving visual outcomes equivalent to those of DMEK while reducing complication rates. This technique eliminates the need for donor tissue and immunosuppressive medications, making it a viable alternative for specific cases. Full article

Background/Objectives: To evaluate the efficacy, accuracy, safety, and long-term stability of topography-guided photorefractive keratectomy (TGPRK) in eyes where post-LASIK (PLE) ectasia progression was stabilized with under-flap corneal crosslinking (ufCXL). Methods: This retrospective interventional case series included six eyes from five patients with PLE after microkeratome LASIK. All eyes underwent ufCXL to halt ectatic progression. A shallow TGPRK enhancement was performed on the LASIK flap surface after corneal and refractive stability was confirmed (18 months median) post ufCXL Outcome measures included uncorrected and corrected distance visual acuity (UDVA, CDVA), spherical equivalent (SEQ), refractive astigmatism, keratometry, and corneal irregularity indices over a mean follow-up of 47 months. Results: ufCXL stabilized ectatic progression but left residual refractive errors, limiting UDVA. TGPRK performed subsequently significantly improved UDVA, from 0.38 to 0.10 LogMAR (p = 0.017), and increased the LASIK efficacy index from 0.46 to 0.83 (p = 0.0087). Refractive astigmatism was reduced in all eyes achieving a SEQ within ±1.00 D of the target. Long-term stability was maintained, with no ectasia progression, no change in SEQ, no change in corneal irregularity indices, and no increase in maximal keratometry. Conclusions: TGPRK performed in ufCXL stabilized corneas can safely correct residual refractive errors, resulting in significant and sustained improvements in both refractive and visual outcomes in PLE. Full article

Background/Objectives: To evaluate the clinical efficacy and safety of combined phacoemulsification, extended depth-of-focus (EDOF) intraocular lens (IOL) implantation, and epiretinal membrane (ERM) peeling during vitrectomy surgery for treating patients with ERM, cataracts, and presbyopia. Methods: Patients with preexisting low-grade ERM who underwent cataract surgery with the implantation of an EDOF IOL were included. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), autorefraction and keratometry, manifest refraction, and central foveal thickness (CFT) were measured before surgery and at postoperative months 3 and 6. A monocular defocus curve was measured 6 months postoperatively. Furthermore, patients were instructed to report symptoms of photic phenomena at each visit. Results: In total, 16 eyes of 16 patients (median age, 59.5 years) were included in this study. Compared with those at baseline, the CDVA, UDVA, UIVA, UNVA, and CFT significantly improved at 3 and 6 months postoperatively. The defocus curve revealed that a visual acuity of 0.12 logarithm of the minimal angle of resolution or better was maintained from +0.5 to –1.5 diopters. No patients reported visual disturbances suggestive of photic phenomena, such as glare or halo. Conclusions: EDOF IOL implantation had excellent outcomes, including improved distance and intermediate visual acuity, functional near visual acuity, and absence of visual symptoms in patients who received phacovitrectomy to treat low-grade ERM. Full article

Background/Objectives: this study aims to assess the safety of ciliary sulcus-placed hydrophilic acrylic intraocular lenses (IOLs). Methods: In this retrospective cohort study, consecutive patients who underwent phacoemulsification with implantation of IOLs into the ciliary sulcus without suture fixation between 2014 and 2016 at the Meir Medical Center were included. Clinical outcomes were compared between one-piece (1P) hydrophilic acrylic IOLs (Seelens AF, Hanita Lenses, Kibbutz Hanita, Israel) and three-piece hydrophobic acrylic IOLs with PMMA haptics (3P) (MA60AC, Alcon Laboratories, USA). Results: Thirty-eight eyes met the inclusion criteria and had ciliary sulcus IOLs implanted, twenty-three eyes with 1P hydrophilic (60.52%) and fifteen (39.47%) with 3P hydrophobic IOLs. Mean follow-up was 47.36 ± 7.25 months for the 1P group and 46.54 ± 9.82 months for the 3P group (p = 0.87). The mean peak IOP was higher in the 3P group (p = 0.038). No differences in the incidence of anterior uveitis or cystoid macula edema (CME) were detected between the groups (p > 0.05). None of the patients in our study developed uveitis, bleeding episodes, or required treatment for increased intraocular pressure, and no patient was diagnosed with uveitis-glaucoma-hyphema (UGH) syndrome. Post-operative corrected distance visual acuity (CDVA) was similar between the groups (p = 0.66). Conclusions: Hydrophilic IOLs can be safely placed in the ciliary sulcus and are non-inferior to the implantation of three-piece hydrophobic IOLs in the sulcus. In our cohort, with an average follow-up of approximately four years, no UGH was diagnosed, and none of the lenses were explanted. Full article

Background/Objectives: Transepithelial accelerated corneal crosslinking (TE-ACXL) is a minimally invasive approach for stabilizing progressive keratoconus while preserving the corneal epithelium. This study aims to evaluate changes in visual acuity, refractive error, and corneal parameters before and six months after TE-ACXL. Methods: A retrospective analysis was conducted on 30 eyes from 20 patients who underwent TE-ACXL between May 2021 and June 2023. Variables included were uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), spherical and cylindrical refractive error, and corneal tomography parameters such as maximum keratometry (Kmax), the symmetry index (Si), the keratoconus vertex (KV), Baiocchi–Calossi–Versaci index (BCV), thinnest corneal thickness (TCT), and central corneal thickness (CCT). Results: CDVA improved from 0.20 ± 0.22 to 0.06 ± 0.11 LogMAR (p = 0.004), while UDVA improved from 0.47 ± 0.35 to 0.29 ± 0.30 LogMAR (p < 0.001). Spherical and cylindrical refractive error showed significant reductions from −2.18 ± 3.05 D to −1.31 ± 1.84 D (p < 0.001) and −3.33 ± 1.98 D to −2.33 ± 1.52 D (p < 0.001), respectively. Pachymetry values decreased significantly, with TCT reducing from 466.43 ± 31.24 µm to 438.63 ± 30.54 µm (p < 0.001) and CCT from 480.80 ± 33.24 µm to 451.23 ± 29.26 µm (p < 0.001). Kmax showed a modest reduction (52.33 ± 3.51 D to 51.19 ± 3.63 D, p < 0.001), while other topographic indices, including Si, KV, and BCV, exhibited minor, non-significant changes, except for BCV back (p = 0.031). Conclusions: TE-ACXL was associated with significant improvements in visual acuity and refractive stability at six months postoperatively while maintaining a favorable safety profile. The procedure may serve as an effective option for early intervention in progressive keratoconus. Full article

Background: Corneal allogenic intrastromal ring segments (CAIRSs) offer a novel, biocompatible alternative to synthetic intracorneal ring segments (ICRSs). This review aims to evaluate the clinical outcomes of CAIRS. Methods: Inclusion criteria were studies with a minimum of 20 eyes and six months of follow up. The primary outcome measure was uncorrected distance visual acuity (UDVA). The secondary outcomes were a change in corrected distance visual acuity (CDVA), spherical equivalent (SE), mean keratometry (K-mean), maximum keratometry (K-max), K1, K2, and pachymetry. Results: The primary outcome UDVA improved from 0.83 ± 0.15 to 0.40 ± 0.08 logMAR (p = 0.01), while CDVA improved from 0.52 ± 0.22 to 0.19 ± 0.09 logMAR (p = 0.01). K-max decreased from 57.8 ± 1.09 D to 53.57 ± 2.66 D (p < 0.01), and K-mean reduced from 49.27 ± 0.28 D to 45.30 ± 1.46 D (p < 0.01). An average of 84.92% ± 11.4% of eyes had an improvement in UDVA. No major complications or significant visual acuity deterioration were reported. Conclusions: CAIRSs serve as an alternative to synthetic ICRSs and even corneal transplantation in some cases. They represent a safe, effective, and biocompatible promising advancement in corneal ectasia management to improve visual acuity and corneal topography with minimal complications. Full article

Background/Objectives: Precise intraocular lens (IOL) power calculations are essential for achieving optimal refractive outcomes in cataract surgery. This study compares the predictive accuracy of swept-source optical coherence tomography (SS-OCT) and optical low-coherence interferometry (OLCI) in biometry measurements and refractive outcomes. Methods: This retrospective study included 170 eyes from 102 patients undergoing cataract surgery. Biometry was performed using Argos^® (MOVU Inc., Komaki, Japan) (SS-OCT) and Aladdin^® (Topcon Corp., Tokyo, Japan) (OLCI), measuring axial length (AL), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), and keratometry. Results: Postoperative outcomes, including uncorrected and corrected distance visual acuity (UDVA, CDVA), spherical equivalent (SE), and refractive error, were assessed at one and six months. Predictive accuracy was evaluated by mean error (ME), mean absolute error (MAE), median absolute error (MedAE), and the percentage of eyes within ±0.25 D to ±1.00 D of predicted SE. Conclusions: Both technologies achieved high refractive accuracy, with 97.7% (SS-OCT) and 97.2% (OLCI) of eyes within ±1.00 D of target SE. SS-OCT demonstrated superior axis alignment, while OLCI provided enhanced postoperative SE. Significant differences were observed in LT (p = 0.030) and ACD (p = 0.009). Postoperative UDVA of 20/20 or better was achieved in 98% of SS-OCT eyes and 100% of OLCI eyes. SS-OCT and OLCI provide comparable refractive outcomes and high reliability in cataract surgery. Full article

Background: To assess the outcome of Keraring (Mediphacos, Brazil) implantation according to a topographic pattern-based nomogram in eyes with mild to moderate keratoconus. Materials and Methods: A topographic pattern-based nomogram was used to guide Keraring selection in 47 consecutive eyes with stage I-II keratoconus (Amsler-Krumeich staging), which underwent femtosecond laser-assisted implantation at a single center. Electronic data of LogMar uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) manifest refraction and tomographic analysis (Pentacam HR, Oculus, Germany) measured preoperatively and at the last postoperative examination were retrospectively analyzed. Results: Mean follow-up was 18.8 months. (range 3–35). Mean UDVA improved (p < 0.001) from 0.87 ± 0.27 to 0.35 ± 0.21. UDVA increased on average by 5.13 lines. Mean CDVA improved from 0.21 ± 0.10 to 0.09. ± 0.07, and the proportion of eyes with CDVA ≥ 20/25 increased from 29.8% to 85.1% after surgery. No eyes lost lines of CDVA. The Alpins correction index of astigmatism was 0.77 and the mean refractive cylinder decreased from 4.99 ± 1.89 to −2.31 ± 1.47 D (p < 0.001). Mean and maximal keratometry was reduced on average by −2.10 ± 1.42 D and −3.02 ± 3.68 D, respectively (p < 0.001). The RMS of corneal high-order aberrations dropped from 3.296 ± 1.180 µm to 2.192 ± 0.919 µm, and that of vertical coma from −2.656 ± 1.189 µm to −1.427 ± 1.024 µm (p < 0.001). All topometric indices improved after surgery. Conclusions: Planning Keraring implantation using the topographic pattern-based nomogram is very effective and safe in eyes with mild to moderate keratoconus. Using that nomogram of UDVA and CDVA are clinically significant. Full article

Objective: To evaluate the clinical outcomes of cornea transplantation (penetrating keratoplasty, Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty, and deep anterior lamellar keratoplasty) using donor corneas stored in Eusol-C hypothermic storage medium compared to corneas stored in organ-culture. Methods: The clinical outcomes of 92 patients who underwent corneal transplantation with human donor corneas stored in Eusol-C medium at 2–8 °C were retrospectively evaluated. The control group consisted of 169 patients who received corneas organ-cultured at 31 °C. Donor age, sex, death-to-preservation time, and storage time were recorded. Endothelial cell (EC) density (ECD), EC mortality, and EC morphology scores were evaluated during storage in both groups. Complication rates, visual outcomes, and corneal transparency were monitored for up to six months. Results: The mean storage in Eusol-C time was 7.7 ± 2.5 days, while organ-culture time was 14.2 ± 4.0 days. In the Eusol-C group, ECD was 2398 ± 354 cells/mm², with an average EC morphology score of 3.4 ± 0.7/4. Approximately 28% of the corneas in the Eusol-C group had no EC mortality. In the organ-culture group, ECD was 2256 ± 328 cells/mm², with an average EC morphology score of 3.5 ± 0.5/4, and 42% were devoid of EC mortality. No complications, such as re-bubbling, were observed in both groups during surgery. Transparent corneas were achieved in 81.3% of the Eusol-C group the day after surgery. Mean corrected distance visual acuity (CDVA) at 3 and 6 months was 4.5 ± 4.0/10 and 5.4 ± 3.7/10 for the Eusol-C group and 5.0 ± 2.9/10 and 5.7 ± 2.8/10 for the organ-culture group, with no statistical differences observed between the groups. No graft failure was observed up to three months. Graft rejection occurred in the Eusol-C group and in the organ-culture group in, respectively, one and two cases at the six-month follow-up. Conclusions: Comparable surgical outcomes were achieved with donor corneas stored in both hypothermic Eusol-C and organ-culture media. Full article

Background: This study aims to evaluate the visual performance, both quantitative and qualitative, of the novel non-diffractive extended monofocal intraocular lens (Evolux, Sifi) following cataract surgery. This serves as a preliminary study to assess its feasibility and improve the research methodology. Methods: We conducted a single-arm, non-randomized, retrospective study at Onioptic Hospital, Craiova, Romania, involving patients who underwent cataract surgery from November 2022 to August 2023. The following visual parameters were evaluated 3 months postoperatively: monocular uncorrected (UDVA) and corrected (CDVA) distance visual acuity at 4 m; uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 60 cm; uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 40cm; postoperative refraction expressed as spheric equivalent (SE) and Quality of Vision (QoV) questionnaire scores. The contrast sensitivity and defocus curve were evaluated 1 month postoperation in 22 patients who underwent surgery in both eyes. SPSS Statistics 26.0 was used for statistical analysis, employing percentages, standard deviations (SDs), and a 95% confidence interval (95% CI). Results: Among the 103 eyes from 81 patients (mean age of 68.7 ± 1.845), 64% achieved an UDVA of logMAR 0.1 or better, and 91.26% achieved a CDVA of logMAR 0.1 or better at 3 months. Additionally, 83.24% of the eyes exhibited a UIVA of logMAR 0.3 or better, and 60.19% attained an UNVA of logMAR 0.3 or better. The SE was within ±0.50 D in 77.76% of the eyes. The QoV mean scores were as follows: frequency = 30.20 ± 16; severity = 17.19 ± 12.45; bothersome = 15.45 ± 12.94. Conclusions: The Evolux IOL demonstrated very good biometric predictability and excellent distance visual performance and very good intermediate vision, with no photopic side effects or glare in our sample population. This study provides a strong foundation for a larger comparative study with an extended depth-of-focus (EDOF) IOL, incorporating contrast sensitivity and defocus curve assessments to enhance the research quality. Full article

Although effective, a portion of photorefractive keratectomy (PRK) patients will suffer residual myopia or relapse to myopic regression. This retrospective, non-randomized, comparative study, aimed to compare the efficacy of primary PRK versus PRK performed as retreatment after previous surgery for myopia. Data regarding the right eye of 220 consecutive myopic patients undergoing repeat or primary PRK in 2013–2017 were extracted. Groups were matched for demographics and preoperative spherical equivalent, sphere, astigmatism, uncorrected and corrected distance visual acuity (UDVA and CDVA). Primary outcomes were an efficacy index (ratio between the postoperative UDVA and the preoperative CDVA), a safety index (ratio between the postoperative and the preoperative CDVA), postoperative UDVA and CDVA, and deviation from target refraction. Primary PRK showed significant superiority in logMAR UDVA (0.01 ± 0.05 versus 0.05 ± 0.10, p = 0.001), logMAR CDVA (0.01 ± 0.05 versus 0.04 ± 0.08, p = 0.01), efficacy index (1.00 ± 0.05 versus 0.97 ± 0.09, p = 0.003) and safety index (1.00 ± 0.06 versus 0.98 ± 0.08, p = 0.04) compared to repeat PRK, but had a significantly higher share of patients with postoperative spherical equivalent (74.5% versus 67.3%) and cylinder (74.5% versus 68.2%) in the range of ±0.5 D. To conclude, enhancement PRK leads to inferior efficacy and safety with greater deviation from target refraction. Adjusted nomograms for repeat PRK may be warranted. Full article