Journal of cataract and refractive surgery最新文献

{"title":"Interexpert agreement on epithelial thickness mapping for refractive surgery screening: variability highlights need for standardization.","authors":"Niklas Mohr, Jorge L Alio Del Barrio, Martin Dirisamer, Alain Saad, Stefan Kassumeh, Wolfgang J Mayer, Siegfried G Priglinger, Nikolaus Luft","doi":"10.1097/j.jcrs.0000000000001928","DOIUrl":"10.1097/j.jcrs.0000000000001928","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate interexpert agreement on epithelial thickness map interpretation and its influence on eligibility decisions for keratorefractive surgery candidates.</p><p><strong>Setting: </strong>Multicenter international collaboration involving 4 experienced refractive surgeons.</p><p><strong>Design: </strong>Retrospective, masked case review study.</p><p><strong>Methods: </strong>A total of 103 cases were retrospectively evaluated, including patients with normal (n = 44), borderline (n = 44), and keratoconic (n = 15) corneal tomography, as defined by the Belin-Ambrosio display (BAD). 4 independent experts (M.D., J.L.A.d.B., A.S., and N.L.) first assessed surgical eligibility based on Scheimpflug tomography and subsequently re-evaluated the same cases with the addition of anterior segment optical coherence tomography-based epithelial thickness maps. To ensure comparability, a standardized questionnaire with 9 predefined epithelial thickness characteristics was used. Interrater agreement was quantified with Fleiss κ, and the relative impact of each imaging modality on decision-making was ranked.</p><p><strong>Results: </strong>Incorporating epithelial mapping changed the eligibility decision in 19% (77/412) of cases. Specifically, 9% (16/176) of normal, 20% (35/176) of borderline, and 3% (2/60) of keratoconic cases were reclassified as eligible, while 2% (3/176), 6% (10/176), and 3% (2/60), respectively, were deemed ineligible. Interrater agreement on eligibility was moderate before (κ = 0.46) and after (κ = 0.43) adding epithelial maps but remained poor in borderline cases (κ = 0.14 and 0.12, respectively). Agreement on epithelial profile features ranged from poor to fair (κ = -0.78 to 0.35). Corneal topography and BAD were ranked as most influential, followed by epithelial mapping.</p><p><strong>Conclusions: </strong>Epithelial mapping frequently shifted decisions toward eligibility. However, poor interexpert agreement highlights the need for standardized, safety-oriented interpretation to ensure consistent ectasia risk assessment before refractive surgery.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":"865-871"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147306193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual and refractive outcomes with intrascleral haptic fixation of the light adjustable lens.","authors":"Allison J Chen, Emily Grace Rodgers, Li Wang, Douglas D Koch, Christina Y Weng, Zaina N Al-Mohtaseb","doi":"10.1097/j.jcrs.0000000000001936","DOIUrl":"10.1097/j.jcrs.0000000000001936","url":null,"abstract":"<p><strong>Purpose: </strong>To describe refractive outcomes with intrascleral haptic fixation (ISHF) of the light adjustable lens (LAL).</p><p><strong>Setting: </strong>Baylor College of Medicine and 1 private practice in the United States.</p><p><strong>Design: </strong>Retrospective sequential cohort.</p><p><strong>Methods: </strong>All patients undergoing double-needle ISHF of the LAL were included in the study. Pretreatment and post-lock-in uncorrected distance visual acuity (UDVA) were recorded. Mean numerical errors, refractive prediction errors, and astigmatism outcomes were measured.</p><p><strong>Results: </strong>10 eyes were included. Initial pretreatment UDVA after surgery ranged from 20/25 to 20/150, and post-lock-in UDVA ranged from 20/12.5 to 20/40 (median UDVA 20/20; mean 0.01 logMAR [spherical equivalent 0.04]). Mean magnitude of refractive astigmatism was 0.70 diopters (D) (range 0.00 to 1.50 D) pretreatment and 0.25 D (range 0.0 to 0.75 D) after final lock-in. Pretreatment mean numerical error was +1.00 D (SD 0.94 D) and was reduced to -0.022 D (SD 0.28) after treatments and lock-in sessions. All eyes (10/10) achieved their full visual potential in UDVA.</p><p><strong>Conclusions: </strong>This study illustrates that with careful planning and patience, patients with poor or absent capsular support who previously did not have a customizable option can potentially achieve personalized visual outcomes with excellent refractive accuracy with scleral fixation of the LAL.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":"885-889"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply : Accuracy of new-generation and traditional intraocular lens power calculation formulas in pediatric primary implantation.","authors":"Jiaxin Jin, Yanyu Shen, Yiwen Qu, Hui Chen, Xiaohang Wu, Ling Jin, Yizhi Liu, Haotian Lin, Zhenzhen Liu","doi":"10.1097/j.jcrs.0000000000002004","DOIUrl":"10.1097/j.jcrs.0000000000002004","url":null,"abstract":"","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":"953-954"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corneal nerve regeneration:where we are today.","authors":"Sathish Srinivasan","doi":"10.1097/j.jcrs.0000000000002024","DOIUrl":"10.1097/j.jcrs.0000000000002024","url":null,"abstract":"","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":"52 9","pages":"841-842"},"PeriodicalIF":3.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small-incision lenticule extraction with prophylactic crosslinking: systematic review and meta-analysis.","authors":"Kareem Sadek, Oreoluwapo Maxwell, Brendan K Tao, Isra M Hussein, Marko M Popovic, Clara C Chan","doi":"10.1097/j.jcrs.0000000000002046","DOIUrl":"10.1097/j.jcrs.0000000000002046","url":null,"abstract":"<p><strong>Topic: </strong>Keratorefractive lenticule extraction (KLEx) treats myopia and myopic astigmatism while preserving corneal biomechanics better than flap-based procedures. KLEx with prophylactic accelerated corneal crosslinking (KLEx-CXL) has been proposed for thinner corneas, higher myopia, or borderline tomography, but its incremental value remains uncertain.</p><p><strong>Clinical relevance: </strong>KLEx-CXL may reduce biomechanical instability but adds operative time, cost, and protocol variability. Comparative evidence is needed to determine whether it improves outcomes over KLEx alone.</p><p><strong>Methods: </strong>MEDLINE, Embase, Scopus, Web of Science, CENTRAL, and CINAHL were searched to July 2, 2026. Comparative adult studies with at least 6-month follow-up reporting refractive or visual outcomes were included. 2 reviewers extracted data, assessed risk of bias, and rated certainty using Grading of Recommendations, Assessment, Development, and Evaluation. Random-effects meta-analyses pooled mean differences (MDs).</p><p><strong>Results: </strong>9 studies included 730 eyes: 386 KLEx and 344 KLEx-CXL. Residual manifest refraction spherical equivalent was similar overall (MD 0.03 diopters [D]; 95% CI, -0.01 to 0.06; P = .17), with no consistent timepoint-specific difference. A small residual difference was confined to moderate-myopia cohorts (0.09 D; 95% CI, 0.04-0.15) and absent in high myopia. KLEx showed a 1-month advantage in uncorrected distance vision (MD -0.04 logMAR), safety index (MD 0.07), and efficacy index (MD 0.08), resolving by 12 months. Corrected vision was similar throughout. Biomechanical measures favored KLEx-CXL. Early haze was transient; no ectasia occurred. Certainty was low.</p><p><strong>Conclusions: </strong>KLEx and KLEx-CXL achieved similar residual refraction and corrected visual acuity. KLEx-CXL produced measurable biomechanical reinforcement but transiently delayed early uncorrected visual recovery. Current evidence supports reserving prophylactic crosslinking for higher-risk eyes.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photorefractive keratectomy in keratoconus: long-term outcomes from a precrosslinking era cohort.","authors":"Gustavo E Tamayo, Natalia Moros, Eduardo J Polania-Baron, Claudia Castell, Pilar Vargas","doi":"10.1097/j.jcrs.0000000000002047","DOIUrl":"10.1097/j.jcrs.0000000000002047","url":null,"abstract":"<p><strong>Purpose: </strong>To describe long-term visual, refractive, and topographic outcomes after photorefractive keratectomy (PRK) in patients with keratoconus treated before corneal crosslinking (CXL) became available.</p><p><strong>Setting: </strong>Single private ophthalmic center in Bogotá, Colombia.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>1532 archived paper charts from all patients at the practice between 1996 and 2004 were screened. Patients with keratoconus who underwent PRK using multiple excimer laser techniques, with adequate preoperative documentation and availability for re-evaluation after ≥20 years, were included. Outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refractive spherical equivalent, astigmatism, and keratometry.</p><p><strong>Results: </strong>68 patients with keratoconus treated with PRK were identified; 16 patients (29 eyes) with available long-term follow-up were included (mean follow-up of 22 years). UDVA improved from 0.81 ± 0.50 to 0.46 ± 0.36 logMAR ( P = .005) and CDVA from 0.14 ± 0.17 to 0.08 ± 0.11 logMAR ( P = .02), although not significant after excluding eyes that later required keratoplasty. Spherical equivalent decreased by 1.51 diopters (D) ( P = .001) and astigmatism by 0.82 D ( P = .03). Maximum keratometry showed no significant change ( P = .19). 4 eyes (13.8%) required keratoplasty, including 3 of 7 (43%) with advanced disease. The remaining 25 eyes (86.2%) did not require keratoplasty, although some required additional interventions.</p><p><strong>Conclusions: </strong>In this small pre-CXL cohort, mild-to-moderate keratoconus eyes had visual and refractive improvement, while keratoplasty was required mainly in advanced cases. These findings offer historical observational context rather than evidence of safety or efficacy.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic injection in cataract surgery and risk of endophthalmitis: Bayesian meta-analysis.","authors":"Marcelo Ramos, Lucas M Barbosa, Sofia de Melo Ramos, Luisa de Melo Ramos, Jhonattan Rodrigues Garcia Costa, João Vítor de Mattos, Wilson Takashi Hida","doi":"10.1097/j.jcrs.0000000000002045","DOIUrl":"10.1097/j.jcrs.0000000000002045","url":null,"abstract":"<p><strong>Topic: </strong>Cataract surgery is the most performed surgical procedure worldwide, with more than 28 million cases annually. Traditional postoperative care relies on topical eyedrops for infection prevention and inflammation control; however, challenges such as patient noncompliance and cost limitations persist. The dropless cataract surgery approach, involving intracameral or subconjunctival administration of antibiotics and corticosteroids during surgery, has gained attention as an alternative to improve adherence, simplify care, and potentially reduce postoperative complications, including endophthalmitis.</p><p><strong>Clinical relevance: </strong>To evaluate the risk of postoperative endophthalmitis associated with antibiotic injection during cataract surgery in comparison with the standard eye drop regimen.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and the Cochrane Library for studies evaluating the safety of antibiotic injections in cataract surgery compared with conventional postoperative regimens. Bayesian random-effects meta-analysis was used for marginal posterior distributions for the overall and between-study heterogeneity, expressed as odds ratios (ORs) with 95% credible intervals (CrIs). Risk of bias was assessed with Risk of Bias in Nonrandomized Studies-of Interventions or Risk of Bias Tool for Assessing Bias in Randomized Controlled Trials. All statistical analyses were performed using R v. 4.5.0.</p><p><strong>Results: </strong>54 studies were included, encompassing 6 867 422 surgeries of which 3 501 802 received antibiotic injection therapy. Antibiotic injection was associated with a reduction in the risk of postoperative endophthalmitis (OR 0.208; 95% CrI: 0.161-0.268), with a 100% posterior probability of clinically meaningful benefit (OR <0.80) and a 99.1% likelihood that future studies would confirm these findings. Sensitivity analyses corroborated the general findings.</p><p><strong>Conclusions: </strong>The use of antibiotic injection was associated with a significant reduction in the risk of postoperative endophthalmitis.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of visual field outcomes after monofocal, bifocal, and trifocal intraocular lens implantation.","authors":"Shuangqing Yao, Fengjie Li, Jianing Shi, Xiaowei Zhong, Ranyi Ding, Mengdi Niu, Ying Zhang, Jijun Sun, Li Pei, Xiaozhen He, Jincong Wang, Mengqiu Zeng, Weiyun Shi, Ting Wang, Can Zhao","doi":"10.1097/j.jcrs.0000000000002041","DOIUrl":"10.1097/j.jcrs.0000000000002041","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the visual field (VF) outcomes after implantation of monofocal, bifocal, and trifocal intraocular lenses (IOLs) from the same manufacturer platform.</p><p><strong>Setting: </strong>Shandong Eye Hospital, Jinan, China.</p><p><strong>Design: </strong>Prospective, nonrandomized, controlled study.</p><p><strong>Methods: </strong>102 patients (123 eyes) with age-related cataract were divided into monofocal, bifocal, and trifocal IOL groups. Corrected distance visual acuity (CDVA), refraction, Humphrey 30-2 standard automated perimetry (SAP), and defocus curve were assessed preoperatively and 3 months postoperatively. Outcome measures included visual field index (VFI), mean deviation (MD), and pattern standard deviation (PSD), as well as regional mean sensitivity (MS) in 3 predefined VF regions: central (0 to 5 degrees, zone I), paracentral (6 to 15 degrees, zone II), and peripheral (16 to 30 degrees, zone III).</p><p><strong>Results: </strong>All 3 IOL groups showed significant postoperative improvements in CDVA, VFI, MD, PSD, and MS in all zones ( P < .05). Postoperative MS did not differ significantly among groups in zone I. In zone II, MS was higher in the bifocal and trifocal groups than in the monofocal group, with no significant difference between bifocal and trifocal IOLs. In zone III, MS was highest in the trifocal group, followed by the bifocal and monofocal groups ( P < .05). Intergroup differences in ΔMS were not significant in zone I but were greater in zone II for bifocal and trifocal IOLs. For zone III, ΔMS was significantly larger in the trifocal group than in the monofocal group.</p><p><strong>Conclusions: </strong>Postoperative VF sensitivity improved after all 3 IOL types. Central MS did not differ significantly among groups, whereas multifocal IOLs, particularly trifocal IOLs, showed higher MS in paracentral and peripheral zones.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subjective patient perceptions of cataract and refractive surgery in an online forum.","authors":"Rita Vought, Victoria Vought, John D Gelles, Frances Lai, Adam Zaki, Steven A Greenstein, Peter S Hersh","doi":"10.1097/j.jcrs.0000000000002039","DOIUrl":"10.1097/j.jcrs.0000000000002039","url":null,"abstract":"","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From earlier to updated quadrifocal intraocular lens designs: objective optical metrology analysis.","authors":"Eun Ah Jeong, Seung Pil Bang, Seth Pantanelli, Sujin Kang, Sonia H Yoo","doi":"10.1097/j.jcrs.0000000000002042","DOIUrl":"10.1097/j.jcrs.0000000000002042","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the optical performance of the Clareon PanOptix and Clareon PanOptix Pro intraocular lenses (IOLs) using interferometric metrology and identify measurable optical differences.</p><p><strong>Setting: </strong>Physiological Optics Laboratory, Daegu, South Korea.</p><p><strong>Design: </strong>Experimental optical-bench investigation.</p><p><strong>Methods: </strong>3 +20.0-diopter samples each of the PanOptix and PanOptix Pro IOLs were analyzed using a Mach-Zehnder interferometer in a model eye incorporating +0.27 μm corneal spherical aberration (SA). Microscopic imaging, wavefront reconstruction with Zernike analysis, diffractive-step profile reconstruction, point-spread function (PSF)-based retinal image simulation, halo analysis, and through-focus modulation transfer function (MTF) analysis were performed.</p><p><strong>Results: </strong>Both IOLs showed broadly similar diffractive architecture and SA profiles. Peak-to-valley step-profile amplitudes were comparable, although the PanOptix Pro showed localized differences in the reconstructed step-height contour. PSF-based analyses showed broadly similar focal behavior, but the PanOptix Pro demonstrated clearer Sloan F contour preservation and more evident central PSF-core brightness at the far-intermediate position. In through-focus average MTF (aMTF) profiles, the PanOptix Pro showed a modestly higher far-focus peak and a less pronounced post-peak dip, particularly at 4.5 and 3.0 mm pupils. MTF50 analysis showed a similar overall pattern, with greater variability and more apparent intermodel differences at larger pupil sizes.</p><p><strong>Conclusions: </strong>The PanOptix Pro preserves the fundamental design and SA profile of the original PanOptix while showing localized diffractive step-height modifications. Together with clearer far-intermediate F-image preservation, sustained central PSF-core brightness, and a shallower post-peak aMTF dip, these findings are consistent with a relative redistribution of optical energy toward the far-intermediate region, supporting greater far-intermediate optical continuity without substantial changes in nominal add power or overall focal structure.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}