Journal of refractive surgery最新文献

{"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":"Influence of Corneal Higher Order Aberrations on Visual Performance With a Multifocal Intraocular Lens.","authors":"Joaquín Fernández, Noemí Burguera, Marina Rodríguez Calvo-de-Mora, Carlos Rocha-de-Lossada, Manuel Rodríguez-Vallejo","doi":"10.3928/1081597X-20250213-01","DOIUrl":"10.3928/1081597X-20250213-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of corneal aberrations on the visual performance of patients who received a multifocal intraocular lens (MIOL) implant.</p><p><strong>Methods: </strong>Two hundred seventy patients who underwent cataract or refractive lens exchange and were implanted with an apodized diffractive MIOL were included in the analysis. Relationships between total higher order aberrations (HOAs), coma, trefoil, and spherical aberration (SA) measured with a Scheimpflug topographer at 4 mm versus visual acuity and contrast sensitivity areas under the defocus curves (AUC) were evaluated. Relationships between other demographic and biometric variables with total AUCs were also explored.</p><p><strong>Results: </strong>Eyes rarely showed coma and trefoil aberrations exceeding 0.2 μm, 0.1 μm for SA, and 0.3 μm for the total HOAs. The total HOAs showed correlations with age (rho = 0.32, <i>P</i> < .0005) and anterior chamber depth (rho = -0.21, <i>P</i> = .001). The mesopic pupil size, age, and chart luminance, in the following order, were mainly correlated with total AUCs. A correction by mesopic pupil was required to unmask weak correlations of AUCs with the corneal aberrations. These were found particularly for total HOAs and total and near AUCs (<i>P</i> < .05).</p><p><strong>Conclusions: </strong>Values below 0.3 μm for total HOAs, 0.2 μm for coma and trefoil, and 0.1 μm for SA at 4 mm are safe for the study IOL. Higher values are rare but still can be safe, and the 0.5 μm cut-off at 4 mm for contraindication merits further research with this and other IOLs. <b>[<i>J Refract Surg</i>. 2025;41(4):e291-e299.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e291-e299"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803252","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}

{"title":"Reply: Clarifying Laser Dose Terminology in Ophthalmology.","authors":"Holger Lubatschowski, Jodhbir S Mehta","doi":"10.3928/1081597X-20250303-01","DOIUrl":"https://doi.org/10.3928/1081597X-20250303-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e404-e406"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803478","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":"\"Dose\" in Femtosecond Lasers: A Matter of Context and Clarity.","authors":"David S Y Kang, Byunghoon Chung, Dan Z Reinstein, Timothy J Archer, Ivan Gabriç","doi":"10.3928/1081597X-20250306-02","DOIUrl":"https://doi.org/10.3928/1081597X-20250306-02","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 4","pages":"e407"},"PeriodicalIF":2.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803647","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":"Postoperative Keratometry Prediction Model in Children Undergoing Bilateral Cataract Surgery With Primary Intraocular Lens Implantation.","authors":"Larissa Gouvea, M Edward Wilson, Rupal H Trivedi, Antonio Carlos Lottelli","doi":"10.3928/1081597X-20250123-02","DOIUrl":"10.3928/1081597X-20250123-02","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a model for predicting postoperative keratometry in children undergoing cataract surgery with primary intraocular lens (IOL) implantation.</p><p><strong>Methods: </strong>The longitudinal retrospective study included all children who underwent bilateral cataract surgery and had available intraoperative and postoperative keratometry data. Variables that could influence postoperative keratometry were analyzed, and a generalized estimating equation regression model was used to predict postoperative keratometry.</p><p><strong>Results: </strong>One hundred twenty eyes of 60 children were included. The mean age at surgery was 2.95 ± 2.78 years (range: 0.12 to 10.95 years), the mean age at the last follow-up was 7.25 ± 4.61 years (range: 0.50 to 20.41 years), and the mean follow-up was 2.40 ± 2.33 years (range: 0.25 to 10.37 years). Keratometry measurements were obtained in both eyes during 510 postoperative visits. The mean keratometry values before surgery and at the last follow-up were 45.32 ± 2.57 diopters (D) (range: 40.75 to 53.88 D) and 44.62 ± 2.25 D (range: 40.63 to 51.25 D), respectively. Preoperative mean keratometry, age at cataract surgery, and age at follow-up were statistically significant predictors of postoperative keratometry. The model to predict postoperative keratometry = 3.1304 + 0.9388 × (baseline keratometry) + 1.8294 × Log10 (baseline age), -1.1336 × Log10 (age at follow-up), -0.7045 × Log10 (baseline age) × Log10 (age at follow-up) was determined. The correlation between measured and estimated keratometry was <i>R</i> = 0.92. Using this model, a hypothetical patient who had surgery at 1 year of age with a mean keratometry value of 44.00 D would be estimated to have a keratometry value of 42.94 D at 21 years of age.</p><p><strong>Conclusions: </strong>The model is a good predictor for future keratometry after bilateral pediatric cataract surgery with an IOL implant. <b>[<i>J Refract Surg</i>. 2025;41(3):e207-e212.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 3","pages":"e207-e212"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605231","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":"I Think That I Think Too Much (Selfie).","authors":"Manuel Adrianzén Gonzales","doi":"10.3928/1081597X-20250123-03","DOIUrl":"https://doi.org/10.3928/1081597X-20250123-03","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 3","pages":"188"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605286","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":"Automated Detection of Keratorefractive Laser Surgeries on Optical Coherence Tomography Using Deep Learning.","authors":"Jad F Assaf, Hady Yazbeck, Dan Z Reinstein, Timothy J Archer, Roland Assaf, Diego de Ortueta, Juan Arbelaez, Maria Clara Arbelaez, Shady T Awwad","doi":"10.3928/1081597X-20250204-04","DOIUrl":"10.3928/1081597X-20250204-04","url":null,"abstract":"<p><strong>Purpose: </strong>To report a deep learning neural network on anterior segment optical coherence tomography (AS-OCT) for automated detection of different keratorefractive laser surgeries-including laser in situ keratomileusis with femtosecond microkeratome (femto-LASIK), LASIK with mechanical microkeratome, photorefractive keratectomy (PRK), keratorefractive lenticule extraction (KLEx), and non-operated eyes-while also distinguishing between myopic and hyperopic treatments within these procedures.</p><p><strong>Methods: </strong>A total of 14,948 eye scans from 2,278 eyes of 1,166 patients were used to develop a deep learning neural network algorithm with an 80/10/10 patient distribution for training, validation, and testing phases, respectively. The algorithm was evaluated for its accuracy, F1 scores, area under precision-recall curve (AUPRC), and area under receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>On the test dataset, the neural network was able to detect the different surgical classes with an accuracy of 96%, a weighted-average F1 score of 96%, and a macro-average F1 score of 96%. The neural network was further able to detect hyperopic and myopic subclasses within each surgical class, with an accuracy of 90%, weighted-average F1 score of 90%, and macro-average F1 score of 83%.</p><p><strong>Conclusions: </strong>Neural networks can accurately classify a patient's keratorefractive laser history from AS-OCT scans, which may support treatment planning, intraocular lens calculations, and ectasia assessment, particularly in cases where electronic health records are incomplete. This represents a step toward transforming OCT from a diagnostic to a more comprehensive screening tool in refractive clinics. <b>[<i>J Refract Surg</i>. 2025;41(3):e248-e256.]</b>.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 3","pages":"e248-e256"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605282","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}