Journal of refractive surgery最新文献

{"title":"Visual Outcomes, Quality of Vision, and Quality of Life After Bilateral Implantation of a Trifocal Intraocular Lens With Mini-monovision.","authors":"John S M Chang, Sylvia C T Liu, Toto K T Wong, Sam C M To, Jack C M Ng","doi":"10.3928/1081597X-20260728-04","DOIUrl":"https://doi.org/10.3928/1081597X-20260728-04","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate visual outcomes, quality of vision, and quality of life after bilateral implantation of a single-piece trifocal intraocular lens with mini-monovision.</p><p><strong>Methods: </strong>This retrospective case series included patients who underwent bilateral implantation of the AcrySof IQ Pan-Optix (Alcon Laboratories, Inc) multifocal intraocular lens with mini-monovision targeting -0.75 to -1.25 diopters in the non-dominant eye. Postoperative visual acuity, stereopsis, contrast sensitivity, dysphotopsia, satisfaction, and quality of life were evaluated.</p><p><strong>Results: </strong>Thirty-three patients were included. The mean binocular uncorrected visual acuity at distance, 60, 40, and 25 cm was 20/19, 20/22, 20/21, and 20/28, respectively. Vision loss was limited to one line for all eyes. Binocular defocus curves demonstrated that visual acuity of 20/25 or better was achieved from -3.50 to +0.50 diopters. The mean stereoacuity was 88 seconds of arc. Contrast sensitivity was comparable with that reported in previous studies of the same intraocular lens without any monovision. The mean scores for halos, glare, and starbursts were 2.3 ± 1.5, 0.3 ± 1.1, and 0.7 ± 1.4 (out of 5), respectively. The mean satisfaction score was 4.3 ± 0.5 (out of 5). Most patients (94%) reported total spectacle independence. The mean vision-targeted composite score of the National Eye Institute Visual Function Questionnaire was 95.77 ± 2.14 (out of 100).</p><p><strong>Conclusions: </strong>Trifocal intraocular lens implantation with mini-monovision offers an extended range of vision, particularly at very near distances, along with satisfactory visual outcomes and quality of vision and life. This approach represents a viable option for patients seeking high spectacle independence and functional vision across a wide range of daily activities.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e404-e415"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127927","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":"Anterior Capsule Polishing and the Capsule-IOL Complex.","authors":"Shraddha Sneha, Sridevi Nair, Manpreet Kaur, Rohit Saxena","doi":"10.3928/1081597X-20260813-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260813-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e511"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127947","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 Performance, Optical Quality, and Patient-Reported Outcomes After Trifocal Lens Implantation in Patients With Clear Lens or Early Cataract.","authors":"Alaa M Eldanasoury, Karim Ayesh, Ziad Zidan","doi":"10.3928/1081597X-20260803-02","DOIUrl":"https://doi.org/10.3928/1081597X-20260803-02","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate visual and refractive outcomes, visual quality, patient satisfaction, and spectacle independence after bilateral implantation of a diffractive trifocal intraocular lens (IOL).</p><p><strong>Methods: </strong>Thirty-three patients (66 eyes) underwent refractive lens exchange (54.5%) or cataract surgery (45.5%). Exclusion criteria included prior ocular surgery, corneal aberrations greater than 0.5 µm, and tear film instability. Refractive target was emmetropia. Toric IOLs were used for corneal astigmatism greater than 1.00 diopter (D). Objective optical quality metrics including Objective Scatter Index, modulation transfer function, Strehl ratio, and visual Strehl optical transfer function were measured before and after surgery. Patient-reported outcomes were assessed using the Catquest-9SF questionnaire.</p><p><strong>Results: </strong>At 3 months (follow-up rate: 90.9%), manifest refraction spherical equivalent was 0.09 ± 0.34 D. Binocular uncorrected distance visual acuity at 4 m and 66 and 40 cm was 0.02 ± 0.10, 0.10 ± 0.09, and 0.12 ± 0.09 logarithm of the minimum angle of resolution, respectively. Defocus curve showed peaks at 0.00 and -2.50 D. Objective depth of field weakly correlated with subjective depth of field. Objective Scatter Index decreased insignificantly after cataract surgery but significantly increased following refractive lens exchange. Strehl ratio, modulation transfer function, and visual Strehl optical transfer function improved in all eyes (<i>P</i> < .05). Most patients reported minimal difficulty across Catquest-9SF domains. Spectacle independence was 93% for distance and intermediate and 87% for near vision. Photic phenomena were infrequent and mild. All patients expressed satisfaction.</p><p><strong>Conclusions: </strong>Bilateral implantation of a diffractive trifocal IOL provided good optical performance at far, intermediate, and near distances, high patient satisfaction, and spectacle independence at 3 months. Subjective and objective DOF measurements are not interchangeable.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e441-e451"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127904","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":"Epithelium-on Corneal Cross-linking Using a Modified Penetration Enhancer Without Supplemental Oxygen or Iontophoresis.","authors":"Farhad Hafezi, M Enes Aydemir, Mark Hillen, Léonard Kollros, Nikki L Hafezi, Nan-Ji Lu, Shady T Awwad, Shihao Chen, Emilio A Torres-Netto","doi":"10.3928/1081597X-20260802-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260802-01","url":null,"abstract":"<p><strong>Purpose: </strong>To present the 1-year results of a novel epitheliumon corneal cross-linking (epi-on CXL) protocol for the treatment of progressive keratoconus that does not require supplemental oxygen or iontophoresis and that involves the use of a modified penetration enhancer solution to enable riboflavin to saturate the corneal stroma transepithelially.</p><p><strong>Methods: </strong>Thirty-eight eyes from 29 patients with progressive keratoconus were included. Patients were treated with epi-on CXL using accelerated pulsed high-fluence ultraviolet-A irradiation. The main outcome measures included the thinnest corneal thickness, the anterior radius of curvature in the 3-mm zone centered on the thinnest location of the cornea (ARC3mm), demarcation line depth, the final deviation value D of the Belin/Ambrósio Enhanced Ectasia Display (D), maximum anterior keratometry (K_max), and the apical keratoscopy (K^f_max). The follow-up period was 1 month for the demarcation line depth and 1 year for all other parameters.</p><p><strong>Results: </strong>Differences before and after epi-on CXL were Δthinnest corneal thickness (-7.92 µm [445.29 µm, 437.37 μm], <i>P</i> = .28), ΔARC (-0.03 mm [6.80 mm, 6.77 mm], <i>P</i> = .57), demarcation line depth was 217.85 µm, ΔD (Belin/Ambrósio) (0.17 [9.96, 10.13], <i>P</i> = .68), ΔKmax (-0.01 D [56.12 D, 56.11 D], <i>P</i> = .99), ΔK^f_max (-1.41 D [57.64 D, 56.23 D], <i>P</i> = .24).</p><p><strong>Conclusions: </strong>This new epi-on CXL approach demonstrated 12-month topographic stability in progressive keratoconus without requiring supplemental oxygen or iontophoresis. This simplification holds the potential to enable a practical, office-based approach to epi-on cross-linking.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e425-e430"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128020","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":"Five-Year Follow-up of the ELZA-sub400 Protocol: Individualized Corneal Cross-linking With Riboflavin and UV-A in Ultrathin Keratoconic Corneas.","authors":"Emilio A Torres-Netto, Sabine Kling, Rüştü Emre Akcan, Léonard Kollros, M Enes Aydemir, Mark Hillen, Michalina Furrer, Jaloliddin Khurramov, Nikki L Hafezi, Nan-Ji Lu, Shady T Awwad, Boris Knyazer, Frank Blaser, Farhad Hafezi","doi":"10.3928/1081597X-20260728-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260728-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the 5-year safety and efficacy of the ELZA-sub400 protocol, an individualized stromal thickness-guided corneal cross-linking (CXL) technique, in eyes with progressive keratoconus and corneal stroma thickness of less than 400 µm.</p><p><strong>Methods: </strong>In this retrospective interventional case series, 39 eyes of 33 patients with progressive keratoconus or primary ectasia and stromal thickness between 214 and 398 µm underwent CXL using the ELZA-sub400 protocol. Following epithelial removal and riboflavin loading, ultraviolet-A irradiation at 3 mW/cm² was applied for durations tailored to stromal thickness, targeting a demarcation line (DL) 70 µm anterior to the corneal endothelium. Outcome measures included anterior radius of curvature over the central 3 mm (ARC3mm), maximum keratometry (Kmax), corrected distance visual acuity (CDVA), refractive error, stromal thickness, and corneal densitometry, assessed by Scheimpflug tomography (Pentacam HR; Oculus Optikgeräte GmbH) annually for 5 years. Mean follow-up was 3.6 ± 1.5 years (range: 1 to 5 years), with 18 of 39 eyes (46.2%) completing the 5-year follow-up.</p><p><strong>Results: </strong>At 5 years after CXL, 84.6% of eyes (33/39) remained stable or flattened (Kmax change ≤1.00 diopters [D]). Kmax decreased significantly from baseline (mean: -2.74 ± 2.65 D, <i>P</i> < .001). ARC3mm-derived dioptric power decreased significantly over 5 years (-1.29 D, <i>P</i> = .014). Median CDVA was unchanged (0.40 logMAR, <i>P</i> = .572). No significant change was observed in spherical (<i>P</i> = .211) or cylindrical (<i>P</i> = .280) refractive error. DL depth averaged 275 ± 61 µm; no endothelial decompensation occurred. Minimum corneal thickness declined modestly (median -10 µm, <i>P</i> = .049). Anterior densitometry increased slightly (+2.40 grayscale units, <i>P</i> = .007), remaining within mild clinical ranges.</p><p><strong>Conclusions: </strong>The ELZA-sub400 protocol safely stabilized keratoconus in 84.6% of ultrathin corneas over 5 years, with no signs of endothelial damage. Individualized fluence enabled effective treatment of corneas previously ineligible for standard CXL.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e416-e424"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127975","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":"Risk Factors Associated With ICL Decentration After ICL Surgery.","authors":"Junfeng Li, Yichen Xiao, Rui Xiong, Chang Liu, Ziyi Guo, Zhuotong Wu, Xingtao Zhou, Shengtao Liu","doi":"10.3928/1081597X-20260804-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260804-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the magnitude and direction of Implantable Collamer Lens (ICL V4c; STAAR Surgical) decentration at 1 month after implantation and to identify associated preoperative biometric factors.</p><p><strong>Methods: </strong>This prospective observational study included 52 patients (104 eyes) receiving ICL V4c implantation. Preoperative measurements included corneal curvature, anterior chamber depth, white-to-white distance, axial length, and angle alpha and angle kappa. One month postoperatively, total, horizontal, and vertical decentrations of the ICL center relative to the visual axis were measured using the OPD-Scan III (Nidek). Generalized estimating equations (GEEs) were used to analyze relationships between decentration and biometric variables while accounting for inter-eye correlation.</p><p><strong>Results: </strong>The mean total decentration was 0.43 ± 0.19 mm and was predominantly temporal; mean horizontal and vertical decentrations were -0.24 ± 0.32 and 0.05 ± 0.24 mm, respectively. GEE analysis showed that the magnitude of angle alpha was significantly correlated with total decentration (coefficient = 0.669, β = 0.422; adjusted <i>R</i>^<i>2</i> = 0.159; <i>P</i> < .001), that horizontal decentration was related to the horizontal components of angles alpha and kappa (adjusted <i>R</i>^<i>2</i> = 0.415), and that vertical decentration was related to the vertical component of angle kappa (adjusted <i>R</i>^<i>2</i> = 0.075). Eyes with angle alpha greater than 0.50 mm exhibited greater decentration.</p><p><strong>Conclusions: </strong>ICL decentration after surgery is generally small but varies between individuals; angle alpha is the main predictor of decentration, and preoperative measurement of angles alpha and kappa helps identify patients at higher risk.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e452-e457"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127431","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":"Reframing Anterior Segment Depth: A Scoping Review of Virtual ACD and Related Biometric Parameters for ELP Prediction.","authors":"Jose Galvez-Olortegui, Isabel Silva-Ocas, Carmen Burgueño-Montañes, Tomas Galvez-Olortegui, Belen Alfonso-Bartolozzi, Jose F Alfonso Md","doi":"10.3928/1081597X-20260708-02","DOIUrl":"10.3928/1081597X-20260708-02","url":null,"abstract":"<p><strong>Purpose: </strong>To map and standardize the terminology used to describe anterior segment biometric parameters related to postoperative anterior chamber depth (ACD)/effective lens position (ELP) prediction and intraocular lens (IOL) position.</p><p><strong>Methods: </strong>A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping review (PRISMA-ScR) guidelines. Studies reporting definitions, preoperative and postoperative changes, or estimation models of anterior segment biometric parameters related to postoperative ACD or IOL position were included. Parameters were classified according to their anatomical reference into axial, horizontal, and combined measurements. Changes from preoperative to postoperative measures were entered into a standardized evidence table. A qualitative comparative synthesis was used to identify standardized terminology, highlighting consistent findings across definitions.</p><p><strong>Results: </strong>One hundred fourteen records were selected for full text review; 72 articles were excluded, 22 articles were considered for definitions, and 20 articles were considered for definitions and/or data extraction. Substantial heterogeneity in terminology was identified, with multiple definitions describing the same anatomical construct and different measurements sharing identical definitions. Conventional ACD showed marked postoperative deepening, whereas deep anterior segment parameters demonstrated minimal postoperative change, highlighting a different anatomical behavior that may be relevant for IOL positioning.</p><p><strong>Conclusions: </strong>Anterior segment biometric terminology related to postoperative ACD estimation is highly heterogeneous. Virtual anterior chamber depth (ACD) may represent one possible conceptual synthesis and anatomically grounded framework, among other landmark-based approaches, for standardizing existing measurements without introducing additional terminology.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e485-e496"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128032","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":"Anterior Stromal Melt Following Implantation of a Large Size Corneal Allogenic Intrastromal Ring Segment (CAIRS).","authors":"Karen E Asfar, Soosan Jacob, Jad F Assaf, Farhad Hafezi, Shady T Awwad","doi":"10.3928/1081597X-20260807-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260807-01","url":null,"abstract":"<p><strong>Purpose: </strong>To report delayed anterior stromal melt following corneal allogenic intrastromal ring segment (CAIRS) implantation in a patient without known systemic or ocular risk factors.</p><p><strong>Methods: </strong>A 62-year-old man with advanced bilateral keratoconus underwent femtosecond laser-assisted CAIRS implantation at 260 µm depth (900 µm tunnel width). Three months postoperatively, CDVA improved from 20/150- and 20/400 to 20/80 bilaterally and Kmax improved from 59.67 and 67.56 diopters (D) to 54.39 and 64.72 D in the right and left eyes, respectively. Optical coherence tomography (OCT) measured the segment at 624 µm in the right eye.</p><p><strong>Results: </strong>Ten months postoperatively, the right eye demonstrated focal epithelial thinning with fluorescein staining and melt localized over the inferotemporal segment; overlying stromal thickness decreased from 133 µm (week 1) to 7 µm on OCT. The left eye remained unaffected. Topical loteprednol, lubrication, and systemic doxycycline were initiated. Nineteen months postoperatively, OCT and topography demonstrated stromal stability. Despite astigmatic regression, CDVA remained better than baseline, and the CAIRS was retained.</p><p><strong>Conclusions: </strong>The large segment size placed superficially may have contributed to localized biomechanical stress, particularly in eyes with advanced keratoconus. Safe thresholds for segment/tunnel sizes, depth, and location warrant further studies.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e506-e510"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127952","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":"The Future of Eye Surgery.","authors":"Abel Vera Paterna","doi":"10.3928/1081597X-20260910-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260910-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e387"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127694","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":"What Is Normal Topography?","authors":"J Bradley Randleman","doi":"10.3928/1081597X-20260903-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260903-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 10","pages":"e388-e394"},"PeriodicalIF":2.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127935","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}