Search Results (83)

Background/Objectives: Although both the MEL90 (Carl Zeiss Meditec AG, Jena, Germany) and WaveLight EX500 (Alcon Laboratories, Inc., Fort Worth, TX, USA) are two widely used excimer lasers, comparisons between the two remain limited. This study evaluates visual and refractive outcomes from the U.S. Food and Drug Administration (FDA) premarket approval trials of these platforms in the treatment of myopia with and without astigmatism, hyperopia with and without astigmatism, and mixed astigmatism. Methods: Clinical outcomes from FDA premarket approval trials were compared between the recently approved MEL90 and the WaveLight (now termed EX500) excimer lasers. Results: A total of 714 eyes (358 patients) from MEL90 and 1353 eyes (706 patients) from EX500 were analyzed up to 6 months postoperatively. In the hyperopia/hyperopic astigmatism cohort, the EX500 demonstrated greater efficacy relative to MEL90, with more eyes achieving a postoperative uncorrected distance visual acuity (UDVA) of 20/20 or better (48.6% vs. 68.7%, respectively; p < 0.001). In both the MEL90 and EX500, at least 85% of eyes with myopia/myopic astigmatism and 68% with mixed astigmatism achieved a postoperative UDVA of 20/20 or better. For all refractive cohorts, more than 95% of eyes achieved a UDVA of 20/40 or better at 6 months (all p > 0.05). The EX500 was more likely to demonstrate an improvement of more than two lines of UDVA compared to baseline CDVA (all p < 0.05). In contrast, the MEL90 showed greater predictability of spherical equivalent within ±0.50 D and ±1.00 D for the hyperopia/hyperopic astigmatism cohort (both p = 0.007), as well as within ±0.50 D for the myopia/myopic astigmatism cohort (p < 0.001). Postoperatively, both platforms were associated with decreased glare and halos, although findings were variable in the EX500 mixed astigmatism cohort. Conclusions: Both excimer lasers demonstrated safe and effective outcomes that exceed the threshold set by the FDA. Full article

Background/Objectives: To assess the optical performance of two refractive premium IOLs across pupil sizes and values of corneal spherical aberration (SA). Methods: Two refractive IOLs were evaluated in this study: Tecnis Eyhance and Mini Well. The surface profiles were obtained to calculate the through-object MTF (TO MTF) curves and simulate optotype images. Entrance pupil sizes ranging from 2 to 5.5 and three corneal models were analyzed in the simulation: an average population aberrated cornea, an aberration-free cornea and a post-Lasik myopic cornea. Results: For Model 1 and pupil sizes between 3.0 and 3.5 mm, Mini Well provided acceptable visual quality from far to near distances, whereas Eyhance struggled to maintain visual quality at distances closer than intermediate. For patients with lower-than-normal corneal SA (i.e., more prolate corneas, such as post-hyperopic LASIK) both IOLs exhibited a hyperopic shift in far focus. Conversely, for patients with higher-than-normal corneal SA (i.e., more oblate corneas, such as post-myopic LASIK), the shift occurred in the myopic direction. Despite the implementation of an optimized IOL power to circumvent any shift, the TO MTF nevertheless reflected the interaction between corneal and IOL SA. Furthermore, the Mini Well demonstrated increased tolerance to less negative SA values, while Eyhance exhibited behavior consistent with a monofocal lens for more positive SA values. Conclusions: Surgeons should consider each patient’s corneal asphericity and typical pupil diameter when selecting and calculating the power of the premium IOLs studied, particularly in patients with a history of refractive surgery. Full article

We report a case of herpes simplex virus type 1 (HSV-1) anterior uveitis evolving into an acute iris transillumination-like syndrome with secondary pigmentary glaucoma, highlighting diagnostic challenges and treatment considerations. A 61-year-old immunocompetent woman presented with unilateral anterior uveitis characterized by keratic precipitates and mild anterior chamber inflammation. The condition was initially treated with topical and subconjunctival corticosteroids without antiviral therapy. After an initial resolution of symptoms, upon the cessation of treatment, the patient developed features resembling unilateral acute iris transillumination (UAIT) syndrome with elevated intraocular pressure, diffuse pigment dispersion, and progressive iris transillumination defects. Aqueous polymerase chain reaction (PCR) testing confirmed the presence of HSV-1. Despite the initiation of antiviral therapy, the condition progressed to severe pigmentary glaucoma, with unreliable intraocular pressure measurements due to prior LASIK surgery. Cataract extraction, pars plana vitrectomy, and Ahmed valve implantation were performed, with only partial recovery of visual acuity. This case illustrates that HSV-1 uveitis can mimic or transition into a UAIT-like syndrome, possibly due to steroid use without concurrent antiviral treatment, which may exacerbate viral replication and damage to the iris pigment epithelium. Aqueous PCR testing aids in differential diagnosis, but indicative medical history and clinical findings should remain instrumental. Clinicians should maintain a high index of suspicion for herpetic etiology in anterior uveitis cases and initiate prompt antiviral treatment to prevent potentially sight-threatening complications. Full article

Background: To assess the accuracy of ChatGPT-4o and OpenAI-o1 in answering refractive surgery questions from the AAO BCSC Self-Assessment Program and to evaluate whether their performance could meaningfully support clinical decision making, we compared the models with 1983 ophthalmology residents and clinicians. Methods: A randomized, questionnaire-based study was conducted with 228 text-only questions from the Refractive Surgery section of the BCSC Self-Assessment Program. Each model received the prompt, “Please provide an answer to the following questions.” Accuracy was measured as the proportion of correct answers and reported with 95 percent confidence intervals. Differences between groups were assessed with the chi-squared test for independence and pairwise comparisons. Results: OpenAI-o1 achieved the highest score (91.2%, 95% CI 87.6–95.0%), followed by ChatGPT-4o (86.4%, 95% CI 81.9–90.9%) and the average score from 1983 users of the Refractive Surgery section of the BCSC Self-Assessment Program (77%, 95% CI 75.2–78.8%). Both language models significantly outperformed human users. The five-point margin of OpenAI-o1 over ChatGPT-4o did not reach statistical significance (p = 0.1045) but could represent one additional correct decision in twenty clinically relevant scenarios. Conclusions: Both ChatGPT-4o and OpenAI-o1 significantly outperformed BCSC Program users, demonstrating a level of accuracy that could augment medical decision making. Although OpenAI-o1 scored higher than ChatGPT-4o, the difference did not reach statistical significance. These findings indicate that the “advanced reasoning” architecture of OpenAI-o1 offers only incremental gains and underscores the need for prospective studies linking LLM recommendations to concrete clinical outcomes before routine deployment in refractive-surgery practice. Full article

Background: Personalized precision medicine has become a prevailing trend and applies to the selection of intraocular lenses (IOLs) for cataract surgery based on the unique corneal morphology of each person. The choice of presbyopia-correcting IOLs for post-laser-assisted in situ keratomileusis (LASIK) cataract surgery is a significant concern. However, few direct comparison studies exist between eyes with and without LASIK history. We analyzed the performance of extended depth of focus (EDOF) IOL implantation in these two groups. Methods: In this retrospective single-center study, we included patients with or without previous LASIK who underwent cataract surgery and EDOF Symfony IOL implantation, with ≥1 follow up. All patients underwent optical biometry using the IOLMaster. IOL power was calculated using the Sanders Retzslaff Kraff/theoretical and Haigis-L formulas for patients without and with LASIK, respectively. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), refraction, and corneal tomography were recorded. The prediction error was the absolute difference between the postoperative sphere and target refraction. The right eyes of patients who met the inclusion criteria were selected for analysis. Results: Among the 321 recruited eyes, 18 underwent previous LASIK. After 1:3 age/sex matching, 17 LASIK and 49 non-LASIK eyes from 66 patients were analyzed. No significant preoperative differences existed in target refraction, spherical equivalent, or best-corrected visual acuity. All surgical procedures were uneventful. LASIK exhibited non-inferiority to non-LASIK for predictive refraction error and UNVA. An age/sex-matched regression analysis indicated no UDVA superiority between the two groups. Conclusions: Previous LASIK may have no discernible effect on the visual performance of presbyopia-correcting EDOF IOLs with respect to the absolute refractive error, UNVA, and UDVA. Longer follow-up and larger-scale studies are required to further validate these results. Full article

In the present paper, extracts from pomace after cherry wine production were used as biocomponents of antioxidant packages. In the study, the highest concentrations of polyphenolic compounds were obtained when a 50% ethanol solution was used as the extraction solution. The addition of extracts provided statistically significant (p < 0.05) changes in water vapor transmission for the films obtained. The WVTR results are at a very low level, as values ranging from 7.96 ± 0.33 [g/m² d] (sample 2) to 10.95 ± 0.33 [g/m² d] (sample 1) were obtained. The addition of extract also affected the oxygen barrier. Samples without extract addition showed an OTR value of 2.42 ± 0.23 [cm³/m² d 0.1 MPa]. A statistically significant (p < 0.05) reduction in this parameter was affected by the addition of extract to the matrix. Oxygen barrier properties ranged from 0.50 ± 0.05 (sample 3) to 0.94 ± 0.04 (sample 1), indicating high barrier properties of the packaging material. The addition of extracts caused an increase in opacity: films 3 and 4 were characterized by the highest value of the parameter, which was, respectively: 18.14 ± 27.02 and 18.97 ± 29.83 [%]. The research carried out in this study allows us to conclude that bioactive films with high application potential have been achieved and, in addition, represent a natural and ecological alternative to the materials currently used. 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

Objectives: Corneal refractive surgery aims to correct refractive errors. Proper corneal alignment is crucial. Eye-tracking technologies, specifically designed to address cyclotorsion using iris registration, help reduce the effects of cyclotorsion during surgery. The timing of iris registration can influence the efficacy of these technologies. This study compared cyclotorsion measurements before and after flap elevation/epithelium removal in FemtoLASIK and alcohol-assisted (aa) PRK. Methods: This retrospective cohort study was conducted at Einaim Medical Centers, Israel, and included patients who underwent refractive surgery using the VISX Star S4 IR excimer laser. Cyclotorsion measurements were obtained pre- and post-flap elevation or removal using the Wavescan™ and VISX Star S4 iris registration systems. Patients’ data were collected and analyzed retrospectively. Results: Overall, 152 eyes of 86 patients were included. In the FemtoLASIK group, 73 eyes from 45 patients were analyzed. For pre-flap lift, 34.2% had incyclotorsion and 65.8% had excyclotorsion, with a mean cyclotorsion of 2.3 ± 1.5 degrees. For post-flap lift, the mean cyclotorsion was 2.8 ± 1.9 degrees, showing a significant difference (p = 0.01). In the aa-PRK group, 79 eyes from 41 patients were analyzed. For pre-flap removal, 45.6% had incyclotorsion and 53.2% had excyclotorsion, with a mean cyclotorsion of 2.6 ± 1.8 degrees. For post-flap removal, the mean cyclotorsion was 2.5 ± 2.1 degrees, with no significant difference (p = 0.47) and a mean change of 1.6 ± 1.2 degrees. A total of 15.2% of eyes in the aa-PRK group and 13.6% in the LASIK group exhibited more than 3 degrees of cyclotorsional difference before and after flap lift or epithelial removal. Conclusions: Cyclotorsion occurs after flap lift/removal. To minimize residual astigmatism, iris registration should be performed post-flap elevation. Full article

Purpose: This study aimed to assess the efficacy of for PODEYE TORIC intraocular lenses (IOL). Methods: This study was a retrospective, non-randomized, interventional case series. Inclusion criteria comprised diagnosis of an age-related cataract and a corneal astigmatism equal to or higher than 0.9 D and undergoing implantation of toric IOLs (TIOL). A single toric lens model (PodEye Toric, BVI) was used in all cases. Results: The study includes 51 eyes of 35 patients with TIOL implantation with a mean follow-up time of 45.7 (±36.5) days. Fourteen patients were targeted for mono-vision. Eight eyes had previously undergone refractive surgery (five post Myopic Lasik/PRK, two post RK/AK and one post RK). The mean postoperative adjusted spherical equivalent (SEQ) was −0.57 D ± 0.31 and the residual postoperative refractive astigmatism was −0.49 D ± 0.50. Only 2% of patients had a preoperative subjective astigmatism lower than 1.0 D whereas postoperatively, 94% of the patients had a residual astigmatism of 1.0 D or lower. The average deviation from the planned axis was 2.66 ± 0.26 degrees. None of the IOLs rotated to 10° or higher and 88% remained at 5° or less on the intended IOL axis. Twenty-six (63%) of IOL rotations were counterclockwise. Conclusions: PODEYE TORIC intraocular lenses provide exceptional refractive precision, reliable rotational stability, and consistently strong postoperative vision outcomes. Full article

Diquafosol sodium is a purinergic P2Y₂ receptor agonist that is garnering much interest for its potential therapeutic benefits in ocular surface management. This review provides a comprehensive analysis of diquafosol’s pharmacology, clinical effectiveness, and role in the evolving landscape of ocular surface management. Future research should focus on optimising formulations, treatment duration, and exploring potential combination therapies to maximise therapeutic outcomes. By targeting underlying pathophysiological mechanisms, diquafosol represents a significant advancement in ocular surface management and a valuable addition to existing therapies. Full article

Background: We evaluate the accuracy of intraocular lens (IOL) power calculation in the following formulas—Barrett True-K No History (BTKNH), EVO 2.0 Post-Hyperopic LASIK/PRK (EVO 2.0), Haigis-L, Pearl-DGS, and Shammas (SF)—with patients who have undergone cataract surgery at the Eye Unit of University of Campania Luigi Vanvitelli, Naples, Italy, and had prior hyperopic laser refractive surgery. Methods: A monocentric, retrospective, comparative study, including the charts of patients who had undergone cataract surgery and previous hyperopic laser refractive surgery, was retrospectively reviewed. Patients with no other ocular or systemic disease which might interfere with visual acuity results and no operative complications or combined surgery were enrolled. The mean absolute prediction error (MAE) was calculated for each formula and compared. Subgroup analysis based on the axial length and mean keratometry was performed. Results: A total of 107 patients (107 eyes) were included. The MAE calculated with SF provided less accurate (p < 0.05) results when compared to both BTKNH and EVO 2.0 formulas. The MAE obtained using Haigis-L, EVO 2.0, Pearl-DGS, and BTKNH showed no significant differences. Conclusions: The analysis of the accuracy of the selected formulas shows no clear advantage in using one specific formula in standard cases, but in eyes where it is mandatory to reach the target refraction, SF should be avoided. Full article

Background/Objectives: To evaluate the postoperative outcomes between the second-generation keratorefractive lenticule extraction (KLEx) surgery and femtosecond laser in situ keratomileusis (FS-LASIK). Methods: A retrospective cohort study was conducted and subjects received second-generation KLEx and FS-LASIK surgeries were enrolled. A total of 124 and 102 eyes were selected into the second-generation KLEx and FS-LASIK groups after exclusion. The primary outcomes were the postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE), amount of astigmatism, and best-correct visual acuity (BCVA). The independent t-test was applied to compare the primary outcomes between groups. Results: The mean UDVA three months postoperatively showed insignificant differences between the two groups (p = 0.999). At the final visit, there were 113 (91.12%) and 96 (94.12%) subjects who reached UDVA 20/20 in the FS-LASIK and second-generation KLEx groups and the difference was statistically insignificant (p = 0.455), and the second-generation KLEx group illustrated a higher UDVA improvement (p = 0.046). The SE three months postoperatively showed insignificant difference between groups, whether the absolute value or the ratio of SE within ±0.50 D or ±1.00 D (all p > 0.05). The vector analysis indicated that the difference vector (DV) was significantly lower in the second-generation KLEx group (p = 0.033). The ratio of loss of more than 1 line BCVA showed insignificant differences between the two groups (all p > 0.05). In addition, the risk of postoperative dry eye disease (DED) was significantly higher in the FS-LASIK group (p = 0.031). Conclusions: The efficiency and predictability between second-generation KLEx and FS-LASIK surgeries are similar, while more DED occurred after FS-LASIK surgery. Full article

Investigation and evaluation of the first clinical results of the new ablative solid-state laser (AQUARIUZ) regarding clinical outcome, inclusively higher-order aberration and safety. In this case report, three hyperopic patients with six eyes were treated with the new ablative solid-state laser (AQUARIUZ). The LASIK incisions are cut with the Ziemer LDV Z8. All patients were followed for 6 months postoperatively. The treated hyperopia ranged from +0.5 D to +2.75 D. Emmetropia of 0 D was found in four eyes after 6 months. In two eyes there was a slight myopia of −0.25 D each, which is also considered emmetropia according to the definition. The aspherically optimized profile of the ablative solid-state laser did not induce a higher-order aberration or spherical aberration in any eye. No eye lost CDVA or UDVA lines after the follow-up period. The safety index was 1 in five eyes and 1.25 in one eye. The findings demonstrate a high level of precision and treatment safety with the new ablative solid-state laser. Full article

Objectives: Anterior Segment Optical coherence tomography (AS–OCT) can help in the diagnosis and treatment of infectious keratitis, but it has not been studied in cases occurring after corneal refractive surgery procedures such as femtosecond laser in situ keratomileusis (FS–LASIK) and keratorefractive lenticule extraction (KLEx). In these procedures, a surgical interface is created, where infections usually start, thus determining a different AS–OCT pattern compared to non–surgical infections, which begin on the corneal surface. Methods: We retrospectively reviewed 22,756 eyes of 13,564 patients who underwent FS–LASIK and KLEx at our surgical center. Results: Four cases of post–refractive surgery infectious keratitis were included (two after FS–LASIK and two after KLEx), in which the AS–OCT identified an initial infiltrate in the interface, followed by interface inflammation. In one case, after FS–LASIK, interface fluid accumulation occurred. In one case, after KLEx, diffuse interface inflammation led to stromal reabsorption, later compensated by stromal reformation and epithelial hyperplasia, well documented by OCT. Conclusions: AS–OCT represents a useful tool for assessing corneal infections after refractive surgery, guiding the treatment, and evaluating the healing process and residual corneal scarring. Full article

Purpose: refractive surgery, such as LASIK and SMILE, induces a wound healing response that leads to significant corneal stromal remodeling. We have shown that the protein profile in the stroma changes dramatically immediately post-surgery. However, the methylation status of the DNA post-refractive surgery remains unknown. Design/Participants: DNA methylation study. Refractive surgery (SMILE/LASIK) performed on donor eye globes. Method: we investigated the epigenetic changes post-surgery in relation to long term ECM remodeling in an experimental ex vivo study design. Donor globes (n = 19) were obtained from the eye bank. Three globes served as non-surgical controls while SMILE (-6DS) and LASIK surgery (-6DS) were performed on eight globes each and incubated for 3 days and 2 weeks (n = 4 per group per time point). Here, we compared the DNA methylation landscapes of LASIK and SMILE stroma using the Illumina Infinium Human Methylation 850 EPIC array (HM850). Results: significant changes in DNA methylation patterns were observed post-operatively in both LASIK and SMILE groups. Specific genes involved in the activation of actin cytoskeleton and inflammation (smad3, prkca and ssh2) showed hypomethylation in LASIK after 2 weeks and LASIK SMILE after 3 days, respectively, suggesting their active role in corneal repair. The genes (gaa, gstm1, mgat1, galnt9 and galnt5) involved in sphingolipid metabolism and mucin biosynthesis showed hypomethylation in SMILE after 3 days. Conclusions: our results suggest that altered DNA methylation patterns may have relevance to the development of complications of haze post-refractive surgery. It also presents the opportunity to utilize drugs that regulate chromatin remodeling for optimal outcomes. Full article