Journal of refractive surgery最新文献

{"title":"The Achieved Central Corneal Stromal Thickness Reduction Less Than the Planned in SMILE: A Retrospective Study.","authors":"Yunpeng Li, Shimin Tan, Xindi Wang, Nan Li, Yimeng Fan, Zhao Liu, Shengjian Mi","doi":"10.3928/1081597X-20250409-02","DOIUrl":"https://doi.org/10.3928/1081597X-20250409-02","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the differences between the planned and achieved central corneal thickness (CT) reduction after small incision lenticule extraction (SMILE).</p><p><strong>Methods: </strong>This retrospective study included 426 eyes (426 patients) treated with SMILE. The central CT and corneal epithelial thickness (CET) were measured using the RTVue XR 100 optical coherence tomography device preoperatively and more than 6 months postoperatively. The central corneal stromal thickness (CST) was obtained by central (CT - CET). The planned and achieved thickness reductions were compared and the difference was defined as the planned-achieved difference (PAD).</p><p><strong>Results: </strong>The achieved central CT reduction was 75.80 ± 16.24 µm, which was smaller than the planned (100.20 ± 20.46 µm, <i>P</i> < 0.001). Similarly, the central CST reduction, which excluded the influence of corneal epithelial proliferation, was overestimated by 19.91 ± 6.53 µm. Furthermore, the PAD of central CST reduction showed a positive correlation with preoperative manifest refraction spherical equivalent (MRSE) and with planned central CST reduction (<i>R</i>² = 0.906, <i>P</i> < .001). However, the PAD of central CST reduction did not influence postoperative visual acuity. When removing the nomogram adjustment, the overall overestimation of central CST reduction was narrowed to 12.09 ± 8.09 µm.</p><p><strong>Conclusions: </strong>Over 6 months postoperatively, the achieved central CT reduction after SMILE was less than the planned reduction. The difference was due to the overestimation of CST reduction, rather than corneal epithelial proliferation. Moreover, there was a greater disparity between the planned and achieved central CST reduction with higher MRSE, attesting to the safety of SMILE for patients with relatively high MRSE. <b>[<i>J Refract Surg</i>. 2025;41(5):e501-e509.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 5","pages":"e501-e509"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144013010","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":"Evaluation of Dynamic Intraocular Lens Movement Using Anterior Segment Optical Coherence Tomography Movie Analysis.","authors":"Ryo Ohira, Yoichiro Masuda, Sachiyo Okude, Masanobu Iida, Kosuke Ichihara, Koji Komatsu, Takuya Shiba, Hisaharu Iwaki, Kotaro Oki, Tadashi Nakano","doi":"10.3928/1081597X-20250307-02","DOIUrl":"https://doi.org/10.3928/1081597X-20250307-02","url":null,"abstract":"<p><strong>Purpose: </strong>To introduce a method to quantitatively assess dynamic intraocular lens (IOL) positioning using anterior segment optical coherence tomography (AS-OCT).</p><p><strong>Methods: </strong>This retrospective observational study analyzed 13 eyes with in-the-bag IOL fixation between May and December 2023 at the Ophthalmology Department of The Jikei University School of Medicine Hospital in Tokyo. Using ASOCT imaging during horizontal eye movements, dynamic IOL and iris movement angles were quantitatively assessed, compared with conventional static IOL tilt and decentration, and their interrelations were examined.</p><p><strong>Results: </strong>Static measurements revealed an average IOL tilt of 4.1 ± 1.3 degrees (range: 1.9 to 5.9 degrees) and decentration of 0.17 ± 0.10 mm (range: 0.02 to 0.38 mm). Dynamic analysis showed IOL movement angles of 2.6 ± 2.1 degrees (range: 0.3 to 7.3 degrees) and iris movement angles of 4.1 ± 3.4 degrees (range: 0.3 to 10.3 degrees). No correlation was found between the dynamic IOL movement angle and static IOL tilt and decentration, with some cases showing discrepancies (Spearman's rank correlation, <i>P</i> > .05). However, a strong positive correlation was observed between the dynamic IOL and iris movement angles (Spearman's rank correlation, <i>R</i> = 0.83, <i>P</i> < .05).</p><p><strong>Conclusions: </strong>Although the static IOL tilt and decentration were within normal ranges, significant oscillations in IOL positioning were detected, highlighting the importance of dynamic assessment for evaluating IOL stability during daily activities. This study underscores the potential value of dynamic evaluation of IOL position in routine clinical practice. <b>[<i>J Refract Surg</i>. 2025;41(5):e444-e450.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 5","pages":"e444-e450"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009521","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":"Accelerated Epithelium-off Corneal Cross-linking With Preservation of a Central Epithelial Island in the Management of Paracentral Progressive Keratoconus: A Comparative Clinical Trial.","authors":"Ahmad S Khalil, Marwa A M Khedr, Ahmed A M Gad, Ali Goda Ali","doi":"10.3928/1081597X-20250409-01","DOIUrl":"https://doi.org/10.3928/1081597X-20250409-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy and safety of accelerated corneal cross-linking (A-CXL) while preserving the epithelium over the central 3 mm of the cornea compared to epithelium removal CXL in cases of paracentral keratoconus.</p><p><strong>Methods: </strong>In this prospective comparative study, 140 eyes of 77 patients were randomized to receive either A-CXL with preservation of the central 3 mm of corneal epithelium or A-CXL with removal of whole corneal epithelium over a central disk area with a diameter of 9 mm. Patients were observed regularly for 1 year after the procedure. The primary outcome measures were to compare early uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), corneal haze, pain, and discomfort in the first week between the two groups. The secondary outcome measure was keratoconus progression after 12 months of follow-up, measured by the maximum keratometry (Kmax) value.</p><p><strong>Results: </strong>A significant difference was found between the two groups regarding early postoperative CDVA, corneal haze, pain, and discomfort, with more favorable results in the ACXL with preservation of the central 3 mm of corneal epithelium group. At 12 months of follow-up, a significant improvement in UDVA, CDVA, and Kmax was noticed among patients of the same group, with better final vision and a reduction in Kmax as compared to the preoperative values.</p><p><strong>Conclusions: </strong>Preserving the epithelium over the central 3 mm of the cornea during A-CXL in cases with paracentral keratoconus can provide the benefits of immediate early postoperative visual rehabilitation, less corneal haze, less pain, good efficacy, and prevention of keratoconus progression. <b>[<i>J Refract Surg</i>. 2025;41(5):e492-e500.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 5","pages":"e492-e500"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988356","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":"First Discoveries.","authors":"Raquel Ruiz Birlanga","doi":"10.3928/1081597X-20250305-03","DOIUrl":"https://doi.org/10.3928/1081597X-20250305-03","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"290"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803239","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 Acuity Outcomes of Enhanced Monofocal Versus Standard Monofocal Intraocular Lenses from a Randomized, Multicenter, Active-Controlled Trial.","authors":"Robert Edward T Ang, Ramin Khoramnia, Harvey S Uy, Peter Hoffmann, Robert D Anello, Dominik Zalewski, Kai Januschowski, Pablo de Arriba Palomero, Daniel Böhringer, Marta Ibarz Barberá, Eckart Bertelmann, Slawomir Cisiecki, H Burkhard Dick, Katrin Lorenz, Gerd U Auffarth, Ramón Ruiz-Mesa, Alvin S Relucio","doi":"10.3928/1081597X-20250218-01","DOIUrl":"10.3928/1081597X-20250218-01","url":null,"abstract":"<p><strong>Purpose: </strong>To compare visual performance of the Vivinex Impress enhanced monofocal intraocular lens (IOL) (HOYA Surgical Optics) with the Acrysof IQ monofocal IOL (Alcon Laboratories, Inc).</p><p><strong>Methods: </strong>In this multicenter, active-controlled trial, participants were randomized 2:1 to bilateral implantation with the enhanced monofocal (test) or standard monofocal (control) IOL and examined through 12 months postoperatively for visual acuities, refractive outcomes, defocus curves, and pupil diameters.</p><p><strong>Results: </strong>Ninety-eight test and 46 control participants completed testing for the first implanted eye. The test arm demonstrated a statistically significant benefit in monocular distance-corrected intermediate visual acuity (DCIVA) (photopic: 1.2 lines, <i>P</i> < .001; mesopic: 0.7 lines, <i>P</i> = .01) and uncorrected intermediate visual acuity (0.8 lines; <i>P</i> < .001) but no significant difference in monocular corrected distance visual acuity (<i>P</i> = .07). Using a stepwise regression analysis for DCIVA, the final model (adjusted R-square, 0.31) identified three significant predictor variables (age, pupil diameter, and treatment arm). Photopic defocus curves showed the test arm produced better monocular visual acuity from -1.00 through -2.50 D than the control arm. The intermediate vision benefit of the test IOL is independent of pupil size and axial length. Cumulative and persistent adverse events for the test IOL did not exceed the Safety and Performance Endpoint rates per International Organization for Standardization 11979-7.</p><p><strong>Conclusions: </strong>Compared to a standard monofocal IOL, the Vivinex Impress enhanced monofocal IOL offers an extended range of vision, with significant improvements in intermediate vision and a DCIVA benefit unaffected by pupil size and axial length. This IOL is safe and effective for patients seeking improved intermediate vision following cataract surgery. <b>[<i>J Refract Surg</i>. 2025;41(4):e300-e309.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e300-e309"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803235","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":"To Dose or Not to Dose, Is That the Question?","authors":"Kishore Raj Pradhan, Victor Derhartunian, Samuel Arba-Mosquera","doi":"10.3928/1081597X-20250306-01","DOIUrl":"https://doi.org/10.3928/1081597X-20250306-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e409-e410"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803507","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":"Using 3D Convolutional Neural Network and Corvis ST Corneal Dynamic Video for Detecting Forme Fruste Keratoconus.","authors":"Hua Rong, Guihua Liu, Yanling Wang, Jiamei Hu, Ziwen Sun, Nan Gao, Chea-Su Kee, Bei Du, Ruihua Wei","doi":"10.3928/1081597X-20250226-01","DOIUrl":"10.3928/1081597X-20250226-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the performance of a three-dimensional convolutional neural network (3D CNN) in detecting forme fruste keratoconus (FFKC).</p><p><strong>Methods: </strong>A total of 415 anonymized corneal dynamic videos were collected for this study. The video dataset consisted of 150 patients with FFKC (150 videos) and 265 normal patients (265 videos). These patients underwent comprehensive ocular examinations, including slit lamp, Pentacam (Oculus Optikgeräte GmbH), and Corvis ST (Oculus Optikgeräte GmbH), and were classified by corneal experts. A 3D CNN-based algorithm was developed to establish a FFKC detection model. The performance of the model was evaluated using metrics such as accuracy, area under the receiver operating characteristic curve (AUC), confusion matrices, and F1 score. Gradient-weighted class activation mapping (Grad-CAM) was used to observe the regions that the model attended to.</p><p><strong>Results: </strong>In the test dataset, the model achieved an accuracy of 87.95% in identifying FFKC. The ResNet3D-AUC was 0.95 with a cut-off value of 0.49, and the F1 value was 0.85. The sensitivity was 83.33% and the specificity was 90.57%.</p><p><strong>Conclusions: </strong>Combining 3D CNN with Corvis ST corneal dynamic videos provides a new method for distinguishing between FFKC and normal corneas. This could offer valuable clinical insights and recommendations for detecting FFKC. Nevertheless, the generalizability of the model is still a concern, and external validation is required prior to its clinical implementation. <b>[<i>J Refract Surg</i>. 2025;41(4):e356-e364.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e356-e364"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803519","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":"Prospective Fellow-Eye Comparison of a Spherical Monofocal and an Enhanced Monofocal Intraocular Lens in Intermediate and Near Vision.","authors":"Victor Danzinger, Daniel Schartmüller, Marcus Lisy, Markus Schranz, Claudette Abela-Formanek, Rupert Menapace, Christina Leydolt","doi":"10.3928/1081597X-20250307-01","DOIUrl":"10.3928/1081597X-20250307-01","url":null,"abstract":"<p><strong>Purpose: </strong>To compare monocular visual performance of a spherical and an enhanced monofocal intraocular lens (IOL) after combined implantation.</p><p><strong>Methods: </strong>This prospective study comprised 50 patients (100 eyes) with bilateral cataract surgery and implantation of the spherical Sensar AAB00 IOL (Johnson & Johnson Vision) in the dominant eye and the enhanced monofocal Eyhance ICB00 IOL (Johnson & Johnson Vision) in the non-dominant eye. Postoperative assessment compared monocular CDVA, CNVA, DCIVA, DCNVA, low contrast visual acuities, defocus curves, wavefront aberrometry, decentration, tilt, and the 7-item Visual Function Index (VF-7) questionnaire.</p><p><strong>Results: </strong>Monocular DCIVA at 66 cm (spherical: 0.33 ± 0.13 vs enhanced monofocal: 0.37 ± 0.13 logarithm of the minimum angle of resolution (logMAR), <i>P</i> = .007), DCIVA at 80 cm (spherical: 0.24 ± 0.12 vs enhanced monofocal: 0.31 ± 0.11 logMAR, <i>P</i> < .001), and DCNVA at 40 cm (spherical: 0.49 ± 0.17 vs enhanced monofocal: 0.56 ± 0.13, <i>P</i> = .003) increased significantly with the enhanced monofocal IOL. Similarly, monocular low contrast intermediate (<i>P</i> = .048) and corrected (<i>P</i> = .006) near vision were better in the enhanced monofocal group. Defocus curves from -0.25 to -1.50 D (<i>P</i> < .05) and internal spherical aberrations Z(4,0) (<i>P</i> < .001) differed between the two IOLs. CDVA, decentration, and tilt were comparable (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>This fellow-eye study demonstrated significant differences between the enhanced monofocal IOL and the spherical IOL. Visual improvements with the enhanced monofocal IOL were modest for both intermediate and near vision. There was no significant difference in distance vision, decentration, or tilt, and higher order aberrations were low. <b>[<i>J Refract Surg</i>. 2025;41(4):e382-e390.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e382-e390"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803350","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 Segment Characteristics Changes After Implantable Collamer Lens V4c in Low Anterior Chamber Depth Eyes: An Optical Coherence Tomography Study.","authors":"Zhanyu Su, Shanshan Wang, Siya Li, Ruiwen Wang, Yaxin Li, Shuli Di, Yaqian Xu, Jinwei Hu, Julio Ortega-Usobiaga, Zheng Wang, Ming X Wang, Kangjun Li","doi":"10.3928/1081597X-20250225-01","DOIUrl":"10.3928/1081597X-20250225-01","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate anterior segment changes after implantable collamer lens V4c (ICL-V4c; STAAR Surgical) implantation in eyes with low anterior chamber depth (ACD) and compare them with eyes with normal ACD.</p><p><strong>Methods: </strong>This prospective, interventional case-control study included 96 eyes of 48 patients with a low ACD (< 2.8 mm) and 44 eyes of 22 patients with normal ACD (≥ 2.8 mm) receiving a 12.1-mm ICL. All patients underwent follow-up and comprehensive ophthalmic examinations preoperatively and at 1, 3, and 6 months after surgery. Anterior segment parameters, including ACD, anterior chamber width, crystalline lens rise, anterior chamber angle, trabecular-iris angle (TIA), angle opening distance, trabecular-iris space area, the distance from cornea to ICL, and vault were all conducted by optical coherence tomography. These parameters from the last follow-up (6 months postoperatively) were used for statistical analysis to assess changes in anterior segment structure and their relationship with vault height.</p><p><strong>Results: </strong>The mean safety and efficacy index in eyes with low ACD were 1.23 ± 0.22 and 1.21 ± 0.08 respectively. In both groups, anterior chamber structure parameters become narrower compared to preoperatively (all <i>P</i> < .05). Preoperative ACD and C-ICL demonstrated significant correlations with ICL vault in eyes with low ACD (<i>P</i> < .001). Compared with eyes with normal ACD preoperatively, eyes with low ACD are more prone to have low vault (<i>P</i> < .01). There is a correlation between normal vault and corneal horizontal white-to-white distance (<i>P</i> = .032), ACD (<i>P</i> = .046), and temporal TIA₅₀₀ (<i>P</i> = .016).</p><p><strong>Conclusions: </strong>ICL-V4c surgery in eyes with low ACD is safe and efficacious. In patients with low ACD, the normal vault could be better anticipated by considering preoperative anterior chamber angle, white-to-white distance, and ACD. <b>[<i>J Refract Surg</i>. 2025;41(4):e342-e355.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e342-e355"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803697","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":"Clarifying Laser Dose Terminology in Ophthalmology.","authors":"Juan Arbelaez, Maria C Arbelaez","doi":"10.3928/1081597X-20250211-01","DOIUrl":"https://doi.org/10.3928/1081597X-20250211-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e404"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803234","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}