Search Results (350)

Background and Objectives: Achieving a postoperative refractive outcome close to the target is crucial in cataract surgery, as residual refractive errors can affect visual quality and patient satisfaction. Methods: This study evaluates the relationship between preoperative target refraction, postoperative intraocular lens (IOL) shift, and refractive stability. Prospective, observational study conducted at the Clinical Hospital Centre Sestre Milosrdnice, Zagreb, Croatia, involving patients undergoing routine cataract surgery with monofocal IOL implantation. Ninety-four eyes undergoing phacoemulsification with implantation of one of three monofocal IOLs (PCB00, RayOne HA, Akreos Adapt) were included. Preoperative biometry assessed axial length, anterior chamber depth, central corneal thickness, and white-to-white distance. Target refraction was −0.75 to 0.00 D. IOL position and refraction were measured at 1 week, 1 month, and 6 months postoperatively. Patient satisfaction was evaluated at all three time points. Results: All three IOLs demonstrated comparable in-the-bag stability over 6 months, with minimal longitudinal shift (all p > 0.05). Postoperative refractive outcomes were generally comparable, but RayOne HA showed a slightly more myopic deviation, whereas PCB00 and Akreos Adapt remained closer to emmetropia. The differences reflect the extent of deviation from the intended postoperative refraction, with statistically significant intergroup differences at 1 month (p = 0.004) and 6 months (p = 0.045). Conclusions: All three IOLs provided stable positioning and excellent visual outcomes. However, small differences in refractive predictability suggest that IOL design may influence the accuracy of target refraction. Tailoring target refraction according to IOL type may improve the likelihood of achieving emmetropia and optimize patient satisfaction. Full article

Background/Objectives: High astigmatism remains challenging in keratorefractive lenticule extraction because small errors in centration or cyclotorsion may affect astigmatic correction. This study evaluated early refractive and astigmatic vector outcomes after small-incision lenticule extraction (SMILE) Pro using the VISUMAX 800 in eyes with high astigmatism. Methods: This prospective interventional cohort study was conducted at Cung Hong Son International Eye Hospital, Hanoi, Vietnam. Refractive outcomes, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, astigmatic vector analysis, and intraoperative and postoperative complications, were evaluated up to 3 months postoperatively. Results: A total of 160 eyes from 102 patients were included in the final analysis. The mean age was 23.7 ± 4.7 years, and 63.7% of participants were female. The mean preoperative spherical equivalent (SEQ) was −7.21 ± 2.03 D, and the mean preoperative refractive cylinder was −2.51 ± 0.56 D. Mean postoperative SEQ was −0.10 ± 0.38 D at 1 month and 0.02 ± 0.31 D at 3 months. At 3 months, 99% and 84% of eyes achieved UDVA of 0.8 decimal or better and 0.9 decimal or better, respectively. The mean residual refractive cylinder was −0.52 ± 0.28 D, with 69% and 98% of eyes achieving a residual cylinder ≤0.50 D and ≤1.00 D, respectively. All eyes had an angle of error within ±15°. The safety index was 1.01, and no eyes lost two or more lines of CDVA. Conclusions: SMILE Pro performed with the VISUMAX 800 provided favorable early 3-month refractive and astigmatic vector outcomes with a satisfactory safety profile in eyes with high astigmatism. Full article

Background/Objectives: Schlemm canal-based minimally invasive glaucoma surgery (MIGS) can be combined with cataract surgery, but topical glaucoma therapy alone is not a sufficient indication for adding MIGS. This review addresses when cataract surgery alone may be sufficient, when combined cataract surgery and MIGS may be appropriate, and when filtration surgery should be considered. Methods: This narrative review used a targeted PubMed/MEDLINE search of English-language literature published from January 2000 to May 2026 to support source identification and reference selection. The review focused on cataract surgery combined with Schlemm canal- or trabecular meshwork-targeted MIGS, including stent-based Schlemm canal procedures and trabeculotomy/goniotomy-based procedures, medication burden, ocular surface disease, refractive and visual outcomes, corneal endothelial safety, complications, angle visibility, guideline-based decision-making, and patient selection. Final references were selected according to clinical relevance to cataract-surgeon decision-making and evidence priority, with emphasis on guidelines, systematic reviews or meta-analyses, randomized or prospective comparative studies, pivotal or long-term studies, large real-world or post-market studies, and clinically informative safety, refractive, endothelial, imaging, or complication-related studies. Results: Stent-based Schlemm canal procedures and trabeculotomy/goniotomy-based procedures can provide additional IOP and medication reduction compared with cataract surgery alone in selected eyes with mild-to-moderate open-angle glaucoma. Stent-based procedures generally have a lower hyphema risk, whereas trabeculotomy/goniotomy-based procedures may provide comparable or greater IOP reduction in selected eyes but are associated with more frequent hyphema. In normal-tension glaucoma or low-baseline-IOP eyes, the expected benefit is often medication reduction or modest IOP lowering rather than reliable achievement of very low target IOP. Available refractive evidence remains limited and procedure-specific, but suggests that major refractive instability is uncommon in appropriately selected eyes. Conclusions: The decision to combine Schlemm canal-based MIGS with cataract surgery should be goal-directed rather than based solely on the presence of topical therapy. Practical selection should integrate glaucoma subtype, disease stage, baseline and target IOP, expected phacoemulsification-only IOP reduction, medication burden, ocular surface status, adherence, angle visibility, endothelial reserve, refractive objectives, and future filtration surgery options. Full article

Tear film instability and dry eye disease (DED) are among the most common postoperative complaints after anterior segment surgery. Cataract surgery, corneal refractive procedures, keratoplasty, glaucoma filtration surgery, and pterygium excision can all disrupt ocular surface homeostasis through mechanisms that include corneal denervation, inflammation, goblet cell loss, and meibomian gland dysfunction. The severity and duration of postoperative dry eye vary substantially according to the surgical procedure performed. This review summarises current evidence on the pathophysiology, clinical manifestations, objective tear film changes, and recovery patterns following major anterior segment interventions. Particular emphasis is placed on standardised, non-invasive assessment methods, including tear breakup time, tear meniscus height, meibography, and validated symptom questionnaires. Procedure-specific recovery trajectories are compared to distinguish transient postoperative tear film instability from persistent chronic dry eye disease. Evidence-based management strategies, including preoperative risk stratification, intraoperative optimisation, and multimodal postoperative therapy, are also reviewed. Understanding these distinct recovery patterns may improve surgical planning, patient counselling, early intervention, visual outcomes, and patient satisfaction. Full article

Background and Objectives: The purpose of this study is to present the clinical results over a 12-month follow-up period in patients after simultaneous bilateral crystalline lens removal with implantation of a Tecnis Eyhance DIB00 monofocal plus lens. Materials and Methods: This is a single-center, 12-month, retrospective study involving 214 eyes of 107 patients operated on between 2021 and 2023. Measurements included uncorrected and best-corrected visual acuity at 30 cm, 70 cm, and distance vision under fixed lighting conditions, instead of focusing on patient-dependent factors, such as pupil size, which varies individually based on sympathetic and parasympathetic nervous systems balance, simulating visual performance in real-world conditions. Contrast sensitivity was also assessed at 6 and 12 months postoperatively. Patients filled out a questionnaire on quality of life after surgery. Results: Uncorrected and best-corrected visual acuity were, respectively, for a 30 cm distance UCVA 0.76/BCVA 0.18 LogMAR; for a 70 cm distance UCVA 0.03/BCVA −0.036 LogMAR; and for distance vision UCVA 0.05/BCVA 0.02. None of the patients reported adverse phenomena such as halo, glare, contrast decrease, or other phenomena after surgery. The average rating of patient satisfaction assessed in a special questionnaire was 8.54 out of 10 points. Conclusions: The Tecnis Eyhance DIB00 lens implanted during bilateral cataract surgery produced good results in terms of uncorrected visual acuity under various lighting conditions, which in our population was better than predicted by the lens manufacturer. Through the 12-month observation period, postoperative refractive values remained stable, with no deterioration of vision. Full article

Background/Objectives: Intermediate vision has become increasingly important after cataract surgery because many daily activities require functional visual performance beyond distance vision alone. Enhanced monofocal intraocular lenses may improve intermediate visual function while maintaining good distance visual acuity. The aim of this study was to compare binocular distance and intermediate visual outcomes after bilateral implantation of Clareon and TECNIS Eyhance intraocular lenses. Methods: This was a single-center, non-randomized comparative observational study with assessment of postoperative visual outcomes. Eighty-six patients who had previously undergone uncomplicated bilateral age-related cataract surgery with implantation of the same IOL model in both eyes were included. Forty-two patients received Clareon IOLs and forty-four patients received TECNIS Eyhance IOLs. Postoperative assessment was performed at least 12 weeks after surgery of the second eye. Binocular corrected distance visual acuity (CDVA) and distance-corrected intermediate visual acuity (DCIVA) were measured using ETDRS charts at 4 m and 66 cm. Results: Baseline biometric and clinical parameters were comparable between groups. Mean postoperative DCIVA was 0.23 ± 0.09 logMAR in the Clareon group and 0.21 ± 0.08 logMAR in the Eyhance group. The mean between-group difference, calculated as Clareon minus Eyhance, was 0.02 logMAR, with a 95% confidence interval from −0.02 to 0.06 logMAR. Mean binocular CDVA was 0.02 ± 0.02 logMAR in the Clareon group and 0.02 ± 0.03 logMAR in the Eyhance group, with a 95% confidence interval for the between-group difference from −0.01 to 0.01 logMAR. Mean postoperative manifest refraction spherical equivalent was −0.27 ± 0.42 D in the Clareon group and −0.29 ± 0.37 D in the Eyhance group. Conclusions: Both Clareon and TECNIS Eyhance IOLs provided good binocular distance and intermediate visual acuity after bilateral implantation. Intermediate visual performance after Clareon implantation was comparable to that achieved with TECNIS Eyhance, while distance visual acuity remained similarly high in both groups. These findings suggest that both IOL models may represent useful options for patients undergoing cataract surgery who expect good distance vision and functional intermediate visual performance. Full article

Background/Objectives: Rhegmatogenous retinal detachment is a vision-threatening condition often treated with combined cataract surgery and vitrectomy, but accurate postoperative refractive prediction may be difficult when ocular anatomy is altered by preoperative hypotony. This retrospective comparative study evaluated the effect of preoperative ocular hypotony on refractive predictability and visual outcomes after combined phacovitrectomy for rhegmatogenous retinal detachment. Materials and Methods: Electronic medical records from Nagasaki University Hospital from 2010 to 2022 were reviewed. Among 731 eyes that underwent combined phacovitrectomy with sulfur hexafluoride gas tamponade for rhegmatogenous retinal detachment, 17 eyes with preoperative ocular hypotony (intraocular pressure ≤ 7 mmHg) that met the inclusion criteria were identified. Thirty-four eyes with normal intraocular pressure were selected as controls in a 1:2 ratio. Refractive outcomes were assessed through spherical equivalent and mean absolute error, and visual outcomes were evaluated through best-corrected visual acuity at baseline and 6 months postoperatively. Results: Mean absolute error was significantly higher in eyes with hypotony than in normotonic eyes (1.46 ± 0.95 diopters vs. 0.70 ± 0.81 diopters; p = 0.002; mean difference, 0.76 D; 95% CI, 0.21–1.31; Hedges’ g = 0.87). Target postoperative refraction within ±0.5 diopters was achieved in 23.5% of hypotonic eyes and 50.0% of normotonic eyes (p = 0.07), the corresponding proportions within ±1.0 D were 35.3% and 76.5%, respectively (p = 0.006). Best-corrected visual acuity improved significantly in both groups, but final visual acuity at 6 months was worse in hypotonic eyes (0.35 ± 0.31 vs. 0.09 ± 0.17 logarithm of the minimum angle of resolution; p < 0.001). Conclusions: Preoperative ocular hypotony in rhegmatogenous retinal detachment was associated with greater refractive prediction error and worse visual outcomes after phacovitrectomy. Full article

Purpose: To report intraoperative safety and postoperative complications after small-incision lenticule extraction using the 2 MHz femtosecond platform (SMILE Pro; VisuMax 800) in routine practice. Methods: Retrospective consecutive case series at a single center. All planned SMILE Pro procedures were analyzed (916 eyes from 482 patients). Outcomes included completion rate, intraoperative events, postoperative complications stratified as <3 and >3 months, and retreatment rate. Results: Baseline age was 32.9 ± 6.9 years; average preoperative refraction was −3.60 ± 1.90/−0.87 ± 0.76 D (sphere/cylinder) with best corrected visual acuity of −0.08 ± 0.07 logMAR. Procedures were completed in 911 of 916 eyes (99.45%). Suction loss occurred in six eyes (0.66%); one was completed after redocking, four were converted (two ICL, two femtosecond LASIK) and one did not receive a second procedure. No failed lenticule separations occurred. Retreatment was performed in 14 eyes (1.54%): 11 re-LASIK, 2 ICL, and 1 cataract extraction. Early postoperative events (<3 months) were mainly superficial punctate keratitis (3.51%) and dry eye (1.32%); beyond 3 months, events remained uncommon (dry eye 1.65%, photopsia/halo/glare 0.88%). No severe or sight-threatening complications were observed. Conclusions: SMILE Pro on the VisuMax 800 showed a high completion rate, rare intraoperative disruption, low retreatment, and rare, mostly mild postoperative events. These findings support a favorable early safety profile in routine practice; longer-term follow-up is warranted. Full article

Purpose: To investigate whether the season in which photorefractive keratectomy (PRK) with mitomycin C (MMC) is performed influences postoperative corneal transparency considering seasonal variations in ultraviolet (UV) exposure. Methods: This retrospective study included 100 eyes of 50 patients who underwent MMC-assisted PRK for myopic refractive error. Patients were divided into two groups based on the season of surgery: winter (November–April, low UV exposure) and summer (May–October, high UV exposure). All patients were evaluated preoperatively and at 12 months postoperatively. Corneal transparency was objectively assessed using Scheimpflug-based corneal densitometry obtained with the Pentacam system, focusing on the central (0–2 mm) and paracentral (2–6 mm) zones. Postoperative densitometry values were compared between seasonal groups. Results: Corneal densitometry values showed a significant reduction postoperatively compared with preoperative measurements in both central and paracentral zones. When comparing seasonal groups, no statistically significant differences were observed in postoperative densitometry values between eyes operated on during summer and winter months. No clinically detectable corneal haze was observed in any patient throughout the follow-up period. Conclusions: Surgical season did not significantly influence postoperative corneal densitometry or clinically detectable haze formation after MMC-assisted PRK for low-to-moderate myopia, suggesting that deferral during high-UV months may not be necessary with standard postoperative UV protection. Full article

Background/Objectives: The goal of this study was to show the consistency between the inflammatory and anti-inflammatory response in the early postoperative period after corneal refractive surgery (LASIK and PRK), represented by the levels of specific cytokines in the tear film. Materials/Methods: A total of 68 myopic eyes (31 in the LASIK and 37 in the PRK group) had 3 samples of tear film taken, one before surgery (t₀), another 1 h after surgery (t₁) and the third 24 h after surgery (t₂). The tear samples were then analyzed by flow cytometry in order to determine the levels of pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IFN-γ, TNF-α) and the levels of anti-inflammatory cytokines (IL-4, IL-10). Results: A statistically significant positive correlation was found between the concentrations of all pro-inflammatory cytokines (IL-1β, IL-6, IL-8, IFN-γ, TNF-α) and all anti-inflammatory cytokines (IL-4, IL-10), respectively, for both t₁ and t₂ in the group of eyes that underwent LASIK. In the PRK group, there was a statistically significant positive correlation for all cytokines (pro-inflammatory and anti-inflammatory) at t₁; however at t_2, there was no correlation between IL-1β and IL-10, IL-6 and IL-10, IL-8 and IL-10, and IFN-γ and IL-10. In contrast, for other correlations between pro-inflammatory and anti-inflammatory cytokines in the same observation time (t₂), a positive correlation was observed. Conclusions: There is a consistency between the inflammatory and anti-inflammatory responses in the early postoperative period after refractive surgery, which persists longer after LASIK compared to PRK. This difference may explain the different clinical courses in patients after undergoing these procedures. Full article

Background/Objectives: Refractive corneal surgery alters corneal biomechanics and thickness, affecting the accuracy of intraocular pressure (IOP) measurements. This systematic review and meta-analysis aimed to quantify the postoperative underestimation of IOP following such procedures. Methods: This systematic review and meta-analysis, conducted based on PRISMA guidelines, evaluated pre- and postoperative IOP changes following LASIK and PRK using GAT, ORA, and CORVIS ST, based on studies identified through PubMed, Scopus, Cochrane Library, and ScienceDirect up to 31 December 2025, with results synthesized using random-effects models and reported as mean differences (MD) with 95% confidence intervals (CI). Results: Of the 1796 articles identified, 54 studies met the inclusion criteria, encompassing a total of 4730 eyes. After LASIK, a statistically significant underestimation of IOP was observed with all methods: GAT (MD: 3.23 mmHg, 95% CI: 2.77–3.69, p < 0.001), ORA (MD: 2.13 mmHg, 95% CI: 1.56–2.70, p < 0.001), and CORVIS ST (MD: 1.39 mmHg, 95% CI: 0.53–2.24, p = 0.001). Similarly, after PRK, a significant reduction in IOP was recorded with GAT (MD: 2.04 mmHg, 95% CI: 1.24–2.84, p < 0.001) and ORA (MD: 2.46 mmHg, 95% CI: 0.62–4.29, p < 0.01), while the difference measured by CORVIS ST was not statistically significant. Conclusions: LASIK and PRK result in systematic underestimation of IOP, most pronounced with GAT and less evident with ORA and CORVIS ST, highlighting the importance of selecting appropriate tonometry methods for accurate monitoring, especially in patients at risk of glaucoma or elevated IOP. Full article

Ocular biomechanics may contribute to the variability of structural and functional outcomes in highly myopic eyes, but their role in myopic maculopathy remains unclear. This retrospective cohort study investigated whether in vivo corneal biomechanical parameters are associated with macular structural phenotypes and longitudinal functional changes. Fifty-four eyes with high myopia (≤−6 D; mean SE −15.6 ± 6.6 D) were evaluated at baseline and after 5.0 ± 0.1 years. Biomechanics were assessed with Corvis Scheimpflug Technology^®, macular structure was assessed with SD-OCT (6 × 6 mm), and function was assessed with Microperimeter MP-3 (CPS, dB). Foveoschisis was associated with higher A2 deformation amplitude (0.371 vs. 0.333 mm, p = 0.014) and SSI (0.986 vs. 0.827, p = 0.035). Staphyloma showed changes in the highest concavity radius (7.13 vs. 6.17 mm, p = 0.002), A1 deformation amplitude (0.150 vs. 0.132 mm, p = 0.001), and maximum deflection amplitude (1.03 vs. 1.19 mm, p = 0.013). Softer corneal parameters correlated with less functional loss, while stiffer parameters correlated with greater decline; similar trends were observed for fixation stability. These findings suggest that biomechanical profiles may vary across macular phenotypes and could be associated with functional evolution in highly myopic eyes. Full article

Background/Objectives: To describe the progression of axial and segmental ocular biometric lengths and refractive status in adolescents and study independent associations between these changes and baseline ocular biomechanics. Methods: Prospective cohort of 126 eyes from 63 individuals followed for 2.5 years. Data from general health and lifestyle were collected through a validated questionnaire. Data from ocular biometry (IOL MASTER 700^®), objective refraction, and ocular biomechanics (Corvis ST^®) were collected at baseline and the end of follow-up timepoints. Biomechanical parameters were correlated with the variation in axial length (d_AL), vitreous cavity length (d_VCL), and spherical equivalent (d_SE). Multivariable linear regression models (one eye randomly assigned) adjusted for age, SE, and AL were developed to identify independent associations between baseline biomechanics and d_AL, d_VCL, and d_SE. Results: The cohort of the present work had a mean age of 14.1 ± 2.6 years at baseline. Variations of 0.122 ± 0.17 mm, 0.092 ± 0.17 mm, and −0.32 ± 0.9 D were found in AL, VCL, and SE at follow-up, respectively. Within the multivariable regression models, the biomechanical parameters found to be independently associated with d_AL (model 1), d_VCL (model 2), and d_SE (model 3) were as follows: Model 1—Biomechanically corrected IOP (bIOP), Integrated Radius (IR), and A2 Deflection Area (A2DArea); Model 2—bIOP, IR, and A2DArea; and Model 3—IR and WholeEyeMovementMAxTime (MaxWEMT). Conclusions: The study of ocular biomechanical behavior may play a pivotal role in the risk assessment of ocular elongation and myopic progression. This work found independent associations between ocular biomechanical behavior at baseline and axial and segmental ocular elongation and refractive myopization, mainly including bIOP, IR, and MaxWEMT. Full article

Background/Objectives: The purpose of this study was to investigate the variation in subjective manifest refraction measures in a patient cohort screened for myopic refractive surgery. Methods: In this retrospective non-randomised cross-sectional single-centre study, we evaluated a dataset containing sequences of three refraction measurements performed by four experienced optometrists in 175 eyes screened for refractive corneal or lens surgery for myopia or myopic astigmatism. Refraction was converted from sphere (SPH), cylinder (CYL) and axis to power vector components (spherical equivalent SEQ and cylinder projections C0 and C45). The mean power vectors of the three repeat measurements (MEAN) and the deviations (DEV) of the repeat measurements from the MEAN were evaluated. Results: MEAN values for SPH/CYL/SEQ/C0/C45 were −5.93/0.99/−5.44/−0.47/0.02 D and the corresponding standard deviations were 0.20/0.16/0.17/0.17/0.16 D. DEV of both SEQ and CYL correlated significantly with patient age (Spearman R = 0.16 and 0.20). DEV of CYL correlated with mean (myopic) SEQ (R = −0.22) and CYL (R = 0.27) whereas DEV of SEQ showed no significant correlation with mean SEQ or CYL. Conclusions: The variation in subjective manifest refraction with repeat measurements is in a range of ±0.16 to ±0.20 D for SPH, CYL and the power vector components SEQ, C0 and C45. If reliable subjective refraction measurements are mandatory, e.g., for planning refractive surgery procedures or for formula constant optimisation, repeat refractometry measures could help to ensure representative data and to estimate the intraindividual variations. Full article

Background/Objectives: To evaluate the monocular and binocular visual outcomes for patients who underwent PRESBYOND Laser Blended Vision (LBV) surgery. Methods: A total of 46 patients participated in this study (mean age 47.5 yrs ± 4.7) with various refractive errors. Patients were treated using the MEL 90 excimer laser to correct their refractive errors. The patients were asked to attend follow-up sessions at intervals of 1, 3, and 6 months. A self-developed binary (Yes/No) satisfaction survey was then conducted at the end of the 6-month visit. Results: The mean preoperative spherical equivalent for the distance eyes was −0.42 ± 1.53, and for the near eyes was −0.4 ± 1.76. The mean logMAR for the uncorrected distance visual acuity after treatment and follow-up at one month, three months, and six months was 0.016, 0.037, and 0.028 (20/20 to 20/22 range), respectively. After treatment, 81% of patients achieved 20/22.5 vision or better, and 94% achieved 20/25 vision or better. For near vision, 100% of patients reached J2 print. After treatment, 97% of patients achieved 20/25 or better at distance and J2 or better at near. Patient satisfaction was 92%, with only 8% of patients reporting dissatisfaction. Conclusions: This protocol has demonstrated stable, well-tolerated, effective, and acceptable results in patients with presbyopia. The safety and efficacy of the procedure were demonstrated, with strong outcomes. Full article