Journal of refractive surgery最新文献

{"title":"Objective Versus Subjective Depth of Focus Correlation in Pseudophakic Eyes.","authors":"Mayank A Nanavaty, Margarita Safir, Muhanned Alwindi","doi":"10.3928/1081597X-20250207-01","DOIUrl":"10.3928/1081597X-20250207-01","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a method for quantifying objective depth of focus (DOF) from the visual Strehl ratio based on the optical transfer function (VSOTF), measured on a ray-tracing aberrometer (iTrace; Tracey Technologies) and to compare it to the subjective clinical DOF in two groups of pseudophakic eyes with varying asphericity of the intraocular lenses (IOLs).</p><p><strong>Methods: </strong>In this cross-sectional study, two groups with negatively aspheric (Eyhance; Johnson & Johnson) and aspherically neutral (RayOne; Rayner) IOLs were assessed 3 to 9 months postoperatively. The patient assessments included: logarithm of the minimum angle of resolution visual acuity, refraction, defocus curves, and iTrace assessments. The primary outcome was to determine the threshold of VSOTF (%) corresponding to subjective DOF. Secondary outcomes were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, keratometry, and wavefront aberrometry. The specific threshold of VSOTF matching the subjective DOF was determined.</p><p><strong>Results: </strong>Forty-two eyes (21 patients in each IOL group) were analyzed. For the primary outcome, in the Eyhance versus the RayOne IOL group and all eyes together there was no significant difference between 25% (<i>P</i> = .10 vs .28; <i>P</i> = .07) and 30% (<i>P</i> = .55 vs .73; <i>P</i> = .58) VSOTF and subjective DOF, respectively. For secondary outcomes, UDVA was better in the Eyhance group (<i>P</i> = .02). There was no difference in CDVA, manifest refraction, and keratometry. There was a significant difference in total and internal spherical aberration between the two groups, although it was not clinically significant.</p><p><strong>Conclusions: </strong>This study showed that a 25% to 30% threshold of VSOTF values on iTrace measurements (Nanavaty Threshold) gives an objective DOF estimate, equivalent to clinical DOF derived from the defocus curve irrespective of the IOL's optical profiles. <b>[<i>J Refract Surg</i>. 2025;41(4):e310-e317.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e310-e317"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803415","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: To Dose or Not to Dose, Is That the Question?","authors":"Holger Lubatschowski, Jodhbir S Mehta","doi":"10.3928/1081597X-20250317-02","DOIUrl":"https://doi.org/10.3928/1081597X-20250317-02","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e410"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803497","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":"Changes in Corneal Densitometry Values of 50 Corneal Layers After Keratorefractive Lenticule Extraction (KLEx): A 6-Year Follow-Up.","authors":"Li Li, Wenjing Gao, Fuqi Deng, Huazheng Cao, Xiaomei Zhen, Yan Wang","doi":"10.3928/1081597X-20250305-01","DOIUrl":"10.3928/1081597X-20250305-01","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the changes in the corneal densitometry (CD) values after keratorefractive lenticule extraction (KLEx) and their influencing factors.</p><p><strong>Methods: </strong>CD values of 50 layers of the right corneas of the participants, measured using a Pentacam (Oculus Optikgeräte GmbH) at different points after KLEx, were obtained from a database and analyzed. Repeated-measures analysis of variance was used to compare CDs between postoperative time, regions, and corneal depths.</p><p><strong>Results: </strong>Fifty-two participants were included. At 1 week after surgery, CDs of the corneal center, para-center, and non-incised periphery increased by 24.23%, 24.49%, and 11.42% at the superior and inferior 20 μm and 14.54%, 13.39%, and 7.82% at the superior and inferior 40 μm of the junctions of the corneal cap and stromal bed, respectively, from their preoperative values. No significant differences were observed in maximum CD values between the corneal center, para-center, and non-incised periphery groups between preoperative and 6-year postoperative measurements (<i>P</i> = .07, .81, and .96, respectively).</p><p><strong>Conclusions: </strong>There was an initial significant increase in CD, particularly near the junctions of the corneal cap and stromal bed. Maximum CDs returned to preoperative values after 6 years. <b>[<i>J Refract Surg</i>. 2025;41(4):e365-e373.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e365-e373"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803232","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":"Analysis of Accommodation and Optical Quality After Myopia Surgery With Phakic Intraocular Lens Implantation.","authors":"Esther López-Artero, Nuria Garzón, Francisco Poyales, Blanca Poyales, Ricardo Pérez-Izquierdo, María García-Montero","doi":"10.3928/1081597X-20250221-01","DOIUrl":"10.3928/1081597X-20250221-01","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the accommodative function and optical quality in high and moderate myopia after the implantation of a phakic intraocular lens implantable collamer lens (ICL).</p><p><strong>Methods: </strong>This was a prospective observational study of 20 myopic patients undergoing bilateral ICL implantation with a mean spherical equivalent (SE) of -7.44 diopters (D) (range: -4.37 to -12.00 D). Amplitude of accommodation, subjective accommodative response, optical quality parameters including modulation transfer function cut-off, Objective Scatter Index, and Strehl ratio, and objective accommodative response with a double-pass system (HD Analyzer; Visiometrics SL) were assessed before surgery and 1 month postoperatively.</p><p><strong>Results: </strong>Mean residual refractive error improved to 0.20 ± 0.19 D (<i>P</i> < .001) at 1 month postoperatively compared to preoperatively. Amplitude of accommodation decreased significantly by 1.65 D (<i>P</i> < .001) from 7.65 ± 1.33 D at baseline to 6.00 ± 0.95 D at 1 month after ICL implantation. However, no significant changes were found in accommodative response or in the optical quality parameters of modulation transfer function cut-off, Objective Scatter Index, Strehl ratio, and objective accommodative response with HD Analyzer between preoperatively and 1-month postoperative follow-up (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>ICL implantation in healthy patients with moderate to high myopia does not significantly alter accommodative function, as measured by subjective or objective methods, or optical quality parameters, except for a non-clinically relevant decrease in amplitude of accommodation. <b>[<i>J Refract Surg</i>. 2025;41(4):e325-e332.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e325-e332"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803653","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":"Optical and Visual Outcomes of a New Refractive Extended Depth of Focus Intraocular Lens.","authors":"Belén Alfonso-Bartolozzi, Irene Martinez-Alberquilla, Luis Fernández-Vega-Cueto, Fátima Cuellar, Fidel Vega, María S Millán, David Madrid-Costa, José F Alfonso","doi":"10.3928/1081597X-20250221-02","DOIUrl":"10.3928/1081597X-20250221-02","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the optical design and analyze the optical quality and halo induced by the new extended depth of focus (EDOF) TECNIS PureSee intraocular lens (IOL) (Johnson & Johnson Surgical Vision) and to evaluate its clinical performance.</p><p><strong>Methods: </strong>The power profile of the TECNIS PureSee was measured with the NIMO TR1504 device (LAMBDA-X). The through-focus modulation transfer function area (TF-MTFa) metric from +2.00 to -4.00 diopters (D) and the halo induced by the IOL in the best focus plane for distance vision (0.00 D), were assessed for 2-, 3-, and 4.5-mm aperture diameters at the IOL plane. The clinical evaluation in a cohort of patients included postoperative refraction, visual acuities, defocus curve, and subjective symptomatology.</p><p><strong>Results: </strong>The power profile shows distinct zones that meet relatively smoothly. The largest power change occurs in the central zone of the lens. The TF-MTFa curves showed an increase in depth of focus for smaller pupils. Larger pupils resulted in smaller, lower-intensity halos. For 2-, 3-, and 4.5-mm pupils, halo sizes were 18.64, 14.73, and 13.23 arcmin, respectively, and normalized energies were 0.55, 0.46, and 0.42, respectively. Clinical assessment yielded excellent visual and refractive outcomes, a depth of field from +1.00 to -2.00 D with visual acuities better than 0.2 logarithm of the minimum angle of resolution, and with almost no dysphotopic symptoms.</p><p><strong>Conclusions: </strong>The TECNIS PureSee IOL provided good distance optical and visual quality and an extended depth of field of approximately 2.00 D. The depth of focus increased for smaller pupils. The halo induced by the lens was of low size and energy. <b>[<i>J Refract Surg</i>. 2025;41(4):e333-e341.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e333-e341"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803346","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":"One-Year Outcomes of the Phase III Clinical Study on the Lumina Accommodative Intraocular Lens.","authors":"Jorge L Alió, Antonio Martínez-Abad, Jorge L Alió Del Barrio, Ana B Plaza-Puche MSc, Pilar Yebana","doi":"10.3928/1081597X-20250305-02","DOIUrl":"10.3928/1081597X-20250305-02","url":null,"abstract":"<p><strong>Purpose: </strong>To report the outcomes of a Phase III Clinical Study with the sulcus-based Lumina accommodative intraocular lens (IOL) (Akkolens, Clinical BV) with 12 months of postoperative follow-up.</p><p><strong>Methods: </strong>This was a prospective, interventional, non-comparative, longitudinal and consecutive study developed at the Cornea, Cataract, and Refractive Surgery Unit at Vissum, Grupo Miranza, Alicante, Spain. It was composed of 25 patients who were bilaterally implanted with the Lumina accommodative IOL and had undergone a 12-month postoperative evaluation including visual and refractive variables, defocus curve, objective accommodation, contrast sensitivity function, retinal optical quality assessment, and patient-reported outcome measures (PROMs). The Wilcoxon test was applied for all longitudinal comparisons.</p><p><strong>Results: </strong>All distance and near visual acuities improved after the surgery (<i>P</i> < .05). Distance and near mean postoperative uncorrected visual acuities were 0.06 ± 0.15 and 0.27 ± 0.15 logarithm of the minimum angle of resolution (logMAR), respectively. The defocus curve exhibited a corrected vision of -0.01 ± 0.06 at distance, 0.18 ± 0.11 at intermediate, and 0.38 ± 0.13 at near vision. The subjective depth of focus, as determined from the defocus curve, was 1.37 ± 0.74, 2.05 ± 0.75, and 3.63 ± 0.68 diopters (D) for visual acuities of 0.10, 0.20, and 0.40 logMAR. The mean objective accommodation was -0.65 ± 0.69 D. The contrast sensitivity function exhibited better results than normal values and the optical quality revealed a mean point spread function of 0.23 μm. In the PROMs, more than 87% of patients reported mild or no difficulties in uncorrected near vision. The complication rate was low; only posterior capsule opacity and epithelial type were common but being successfully treated by laser capsulotomy improved the uncorrected near vision (<i>P</i> = .018). PROMs also revealed a perceived good functional result in far and near vision performance, with minimal or negative abnormal light visual phenomena.</p><p><strong>Conclusions: </strong>The Lumina sulcus-based accommodative IOL provides generally good distance vision maintaining a suitable contrast sensitivity and optical quality. Near vision also was restored conveniently. The lens demonstrated both accommodative and pseudoaccommodative functions. The lack of complications other than posterior capsular opacity confirms the adequate performance of this implant and the preservation of accommodation after capsulotomy. <b>[<i>J Refract Surg</i>. 2025;41(4):e374-e381.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e374-e381"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803344","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":"Flap Loss in More Than 1 Million LASIK Procedures: Incidence, Management, and Visual Outcomes.","authors":"Julio Ortega-Usobiaga, Rafael Bilbao-Calabuig, Fernando Mayordomo-Cerda, Andrea Llovet-Rausell, Jaime Beltrán-Sanz, Kangjun Li, Julio Baviera-Sabater, Fernando Llovet-Osuna","doi":"10.3928/1081597X-20250219-01","DOIUrl":"10.3928/1081597X-20250219-01","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the incidence of flap loss in laser in situ keratomileusis (LASIK), management of this complication, and visual outcomes.</p><p><strong>Methods: </strong>This multicenter, multisurgeon, single-protocol, retrospective case series study enrolled patients who had undergone LASIK and experienced flap loss. Patients were operated on using a Moria LSKONE or a Moria One-Use-Plus-SBK microkeratome (Microtech Inc, Moria Ophthalmic Instruments). The study assessed uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), predictability (accuracy to the intended target), safety (change in Snellen lines of CDVA), and efficacy (difference between UDVA and CDVA). A control group was created to compare refractive outcomes, predictability, safety, and efficacy for eyes with flap loss and patients whose LASIK procedure was free of complications.</p><p><strong>Results: </strong>The analysis included 1,008,849 eyes. Flap loss occurred in 16 eyes from 16 patients. Patients received topical mitomycin C (MMC) after flap loss in 9 cases (7 did not receive MMC). A bandage contact lens was applied in all 9 cases. Mean UDVA was significantly worse in the group of patients with a flap loss (<i>P</i> = .013), although the difference in CDVA was not (<i>P</i> = .077). Both the mean efficacy index and the mean safety index were significantly worse in patients with flap loss (<i>P</i> = .004 and .02, respectively).</p><p><strong>Conclusions: </strong>Flap loss is an extremely rare complication after LASIK. It can be managed with MMC and a bandage contact lens, with a reasonable safety index and visual outcomes. <b>[<i>J Refract Surg</i>. 2025;41(4):e318-e324.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e318-e324"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803193","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":"Laser in Situ Keratomileusis Outcomes and Complications: 2016 to 2023.","authors":"Bianca N Susanna, Nitesh Mohan, Marcony R Santhiago, J Bradley Randleman","doi":"10.3928/1081597X-20250312-01","DOIUrl":"10.3928/1081597X-20250312-01","url":null,"abstract":"<p><strong>Purpose: </strong>To review current clinical outcomes, complications, and patient satisfaction of laser in situ keratomileusis (LASIK) from studies published between 2016 and 2023, with a specific focus on refractive outcomes and topography-guided LASIK (TG-LASIK).</p><p><strong>Methods: </strong>A literature review was conducted using PubMed and Scopus, identifying studies reporting LASIK outcomes, complications, and patient satisfaction. Inclusion criteria required studies to report aggregate clinical data, using validated metrics for subjective outcomes. Studies on re-treatment, specific corneal/systemic disorders, or follow-up shorter than 1 month were excluded. Separate analyses were performed for TG-LASIK and other LASIK treatments.</p><p><strong>Results: </strong>Ninety-five studies met the final inclusion criteria. Myopic treatment achieved better outcomes than hyperopic treatment, with 88.3% and 69.2% reaching an uncorrected distance visual acuity (UDVA) of 20/20, respectively. TG-LASIK demonstrated superior refractive outcomes to LASIK myopic treatment, with 91.8% having 20/20 or better UDVA, and 95% and 100% of eyes achieving refractive accuracy within ±0.50 and ±1.00 diopters, respectively. Complication rates were low, with the most common being flap folds (0.73%). Sight-threatening complications occurred in 0.07% of the eyes. Patient satisfaction remained high, with 92.6% reporting satisfaction with surgery, and 99% would recommend the procedure to a friend.</p><p><strong>Conclusions: </strong>LASIK remains a safe, effective, and highly satisfying refractive surgery, with TG-LASIK demonstrating superior outcomes compared to other LASIK treatments. Complications were infrequent, and subjective visual symptoms generally improved postoperatively. Future research should use standardized methods for assessing and reporting subjective outcomes, including preoperative and postoperative comparisons, to provide a more comprehensive understanding of LASIK outcomes. <b>[<i>J Refract Surg</i>. 2025;41(4):e391-e403.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e391-e403"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803409","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":"Erratum for \"Outcomes of LASIK for Myopic Astigmatism Using a 1,050-HZ Excimer LASER and Seven-Dimensional Eye Tracker\".","authors":"","doi":"10.3928/1081597X-20250324-01","DOIUrl":"https://doi.org/10.3928/1081597X-20250324-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e411"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803237","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: \"Dose\" in Femtosecond Lasers: A Matter of Context and Clarity.","authors":"Holger Lubatschowski, Jodhbir S Mehta","doi":"10.3928/1081597X-20250317-01","DOIUrl":"https://doi.org/10.3928/1081597X-20250317-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e407-e408"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803432","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}