Journal of refractive surgery最新文献

{"title":"Clinical Outcomes and Safety of Customized Corneal Cross-linking for Keratoconus: A Systematic Review and Meta-analysis.","authors":"Jui-Hung Hsu, Tsung-Hsien Tsai, Tsai-Wei Lin","doi":"10.3928/1081597X-20260216-01","DOIUrl":"10.3928/1081597X-20260216-01","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical outcomes and safety of customized corneal cross-linking (cCXL) for the treatment of keratoconus.</p><p><strong>Methods: </strong>Electronic databases were searched through May 1, 2025, yielding 394 records. Primary outcomes were 12-month changes in maximum keratometry (Kmax), corrected distance visual acuity (CDVA), and thinnest corneal thickness (TCT). Secondary outcomes included additional keratometric indices, uncorrected distance visual acuity, spherical equivalent, higher order aberrations, endothelial cell density, and demarcation line depth. Nineteen studies were included in the systematic review, with 14 studies eligible for meta-analysis. Both single-arm analyses of cCXL and comparative analyses versus non-customized CXL were performed. Subgroup analyses were conducted according to epithelial status and irradiation pattern.</p><p><strong>Results: </strong>At 12 months, cCXL significantly reduced Kmax by -1.29 diopters [D] (95% CI: -1.55 to -1.03 D) and achieved greater Kmax flattening than non-customized CXL (additional -1.39 D; 95% CI: -1.82 to -0.95 D; <i>P</i> < .001). CDVA improved by -0.10 logarithm of the minimum angle of resolution (logMAR) (95% CI: -0.12 to -0.07; <i>P</i> < .001), exceeding the improvement with non-customized CXL (mean difference: -0.06 logMAR; <i>P</i> = .031). TCT decreased modestly (-4.42 μm; 95% CI: -7.24 to -1.60 μm; <i>P</i> = .006). Significant reductions were observed in total higher order aberrations (-0.24 μm; 95% CI: -0.37 to -0.11 μm; <i>P</i> = .016) and vertical coma (-0.25 μm; 95% CI: -0.49 to -0.00 μm; <i>P</i> = .049). Outcomes were comparable between epithelium-on and epithelium-off cCXL, and no significant endothelial cell loss or serious adverse events were reported.</p><p><strong>Conclusions: </strong>Customized CXL is a safe and effective treatment for keratoconus and provides superior topographic and visual outcomes compared with non-customized CXL through tailored energy delivery.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e496-e507"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874526","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: Additional Considerations for Interpreting SMILE Outcomes With the VisuMax 800 Platform.","authors":"Supriya Samak Sriganesh, Sri Ganesh","doi":"10.3928/1081597X-20260311-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260311-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e508-e509"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874619","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 Effective Optical Zone, Lenticule Decentration, and Corneal Aberrations Following KLEx Extraction Between the VisuMax 800 and VisuMax 500.","authors":"Yishan Qian, Junjie Yu, Jing Zhao, Xingtao Zhou","doi":"10.3928/1081597X-20260224-02","DOIUrl":"10.3928/1081597X-20260224-02","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the effective optical zone (EOZ), extent of lenticule decentration, and corneal higher order aberrations (HOAs) after keratorefractive lenticule extraction (KLEx) using the VisuMax 800 and 500 (Carl Zeiss Meditec AG).</p><p><strong>Methods: </strong>This was a prospective, matched case-control study controlled for programmed sphere (PS: ±0.25 diopters [D]), cylinder (PC: ±0.25 D), and optical zone (±0.1 mm). The EOZ and decentration values were obtained from the tangential topography difference map. The refractive outcomes and corneal HOAs were compared between the two platforms at the 3-month postoperative visit.</p><p><strong>Results: </strong>A total of 95 right eyes of 95 patients who underwent KLEx using the VisuMax 800 and 95 patients using the VisuMax 500 were included. Both platforms are effective and safe for the treatment of myopia and astigmatism. No significant difference was found in the percentage reduction of EOZ between the two platforms (16.52 ± 4.53% vs 16.42 ± 4.60%, <i>P</i> = .637). Multiple linear regression revealed that, for both platforms, PS and mean keratometry were negatively correlated with the percentage reduction in EOZ, whereas PC was positively correlated with the percentage reduction in EOZ. The absolute values of the vertical decentration were significantly lower for the VisuMax 800 (0.14 ± 0.10 vs 0.21 ± 0.14 mm, <i>P</i> < .001). No significant differences in postoperative total HOAs, horizontal and vertical coma, or spherical aberration were found between the two platforms (<i>P</i> > .05).</p><p><strong>Conclusions: </strong>Both platforms achieved good and comparable refractive, EOZ, and HOAs outcomes. The VisuMax 800 demonstrated higher centration accuracy.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e453-e460"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874491","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 Imaging Considerations After Cosmetic Femtosecond Laser-Assisted Keratopigmentation.","authors":"Alireza Yazdani-Abyaneh","doi":"10.3928/1081597X-20260301-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260301-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e510"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874531","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":"Management of Patient Dissatisfaction After Presbyopia-Correcting Intraocular Lens Implantation.","authors":"Bianca N Susanna, Nasrine Anais El Salloukh, Bassel Hammoud, Nitesh Mohan, Tanner J Ferguson, Claudia Perez-Straziota, J Bradley Randleman","doi":"10.3928/1081597X-20260220-02","DOIUrl":"10.3928/1081597X-20260220-02","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the success rate of different treatments for dissatisfaction after presbyopia-correcting intraocular lens (PrC-IOL) surgery and propose a management decision tree to maximize patient satisfaction.</p><p><strong>Methods: </strong>This was a retrospective evaluation of patients who were dissatisfied following PrC-IOL implantation. Evaluated outcomes included nature of visual complaints, treatment modalities employed for each type of complaint, and treatment success for each intervention.</p><p><strong>Results: </strong>There were 140 eyes of 93 patients evaluated. PrCIOLs included trifocal (PanOptix), diffractive extended depth of focus (EDOF), and non-diffractive EDOF IOLs. Main drivers of dissatisfaction were blurred corrected vision (67.1%) and photic phenomena (48.6%). Interventions leading to the highest rates of improvement were IOL exchange (94%) and laser vision correction (LVC) (72%), whereas Nd:YAG capsulotomy (18.3%), spectacle correction (15.1%), and dry eye treatment (5.2%) were less successful interventions. Among the eyes that underwent IOL exchange, the cohort with intact posterior capsules had more eyes with ≥1 lines of CDVA gained (83.3% vs 0%, <i>P</i> < .001) and fewer eyes with ≥1 lines of CDVA lost (8.3% vs 55.6%, <i>P</i> = .04).</p><p><strong>Conclusions: </strong>The most effective treatments for patient dissatisfaction after PrC-IOL implantation were IOL exchange followed by laser vision correction, whereas glasses, Nd:YAG capsulotomy, and dry eye treatment alone were not effective. Although successful outcomes can be achieved following IOL exchange in eyes with open posterior capsules, eyes with intact capsules had better outcomes. Therefore, Nd:YAG capsulotomy should be delayed in the setting of PrC-IOL dissatisfaction until all other potential causes for dissatisfaction have been eliminated.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e427-e434"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874511","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: Corneal Imaging Considerations After Cosmetic Femtosecond Laser-Assisted Keratopigmentation.","authors":"Diego Castanera-Gratacós","doi":"10.3928/1081597X-20260305-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260305-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e510-e511"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874588","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":"Pinhole Pupilloplasty for Higher Order Aberrations in Patients With Scarred Cornea.","authors":"Dhivya Ashok Kumar, Priya Narang, Amar Agarwal, Soosan Jacob, Jack Holladay, Jayapratha Selvaraj, Ashvin Agarwal, Soundari Sivangnanam, Rhea Narang","doi":"10.3928/1081597X-20260320-04","DOIUrl":"10.3928/1081597X-20260320-04","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the clinical outcomes of pinhole pupilloplasty (PPP) in eyes with higher order aberrations (HOAs) due to scarred cornea.</p><p><strong>Methods: </strong>In this prospective, interventional series, eyes with central or paracentral localized corneal opacity (partial or full thickness) with adjacent clear corneal zone with or without cataract were included. Phacoemulsification with posterior chamber intraocular lens (IOL) implantation was performed followed by PPP. HOAs were assessed with the Pentacam HR (Oculus Optikgeräte GmbH) and optimum pupil size was determined by placing the pinhole template and recording the pinhole size that enabled patients to see distinctly. Postoperative visual outcomes, patient satisfaction score, change in HOAs, and pupil size were documented.</p><p><strong>Results: </strong>Overall, 25 eyes of 24 patients underwent the procedure. The mean size of the corneal scar was 4.5 ± 2.4 mm (2 to 12 mm) (linear [n = 5] and non-linear [n = 20]) and the mean depth was 462.4 ± 108.6 μm (range: 158 to 600 μm). PPP was combined with phacoemulsification and posterior chamber IOL in 23 eyes and with glued IOL in 2 eyes. Postoperatively, there was significant improvement in uncorrected (<i>P</i> < .001) and corrected (<i>P</i> < .001) distance visual acuity. There was significant reduction in pupil size (<i>P</i> < .001) and optimum pinhole (<i>P</i> = .071) size was attained for all eyes. There was no significant difference in the postoperative period for HOA root mean square values (<i>P</i> = .118) except one case that underwent corneal suture removal. No change in corneal topography (<i>P</i> = .249) was observed. A negative correlation was observed between reduction of pupil size and improvement in corrected distance visual acuity; however, it was not statistically significant (<i>r</i> = -0.136, <i>P</i> = .517). Seventy-five percent of the patients reported being highly satisfied (score 3) and 25% of the patients were satisfied (score 2) with the surgical outcomes.</p><p><strong>Conclusions: </strong>PPP leads to satisfactory visual outcomes and can be considered as an alternative in eyes with central or paracentral corneal scar with residual clear cornea.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e477-e483"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874573","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":"Sutureless Scleral Fixation of the Carlevale IOL: A 5-Year Retrospective Study.","authors":"Agostino S Vaiano, Antonio Greco, Maria Marenco, Fabio Garavelli, Alessandro De Filippis, Gerardo Deplano, Claudio Campa, Gugliemo Parisi, Giuseppe Giannaccare, Michele Reibaldi","doi":"10.3928/1081597X-20260218-01","DOIUrl":"10.3928/1081597X-20260218-01","url":null,"abstract":"<p><strong>Purpose: </strong>To report the surgical and refractive outcomes over a 5-year follow-up period in patients who underwent sutureless scleral fixation of a one-piece intraocular lens (IOL).</p><p><strong>Methods: </strong>A retrospective study was conducted at one single center involving consecutive patients undergoing sutureless scleral fixation of one-piece IOL implantation, between September 2016 and May 2020. Visual acuity, refractive outcomes, and complications were assessed over a minimum 60-month follow-up period.</p><p><strong>Results: </strong>The study included 28 eyes of 28 patients (7 women and 21 men; mean age 61.0 ± 19.4 years [95% CI: 53.4 to 68.5]). Five years after surgery, mean corrected distance visual acuity significantly improved from 1.1 ± 0.6 logarithm of the minimum angle of resolution (95% CI: 0.9 to 1.3) to 0.5 ± 0.6 (95% CI: 0.3 to 0.8 logarithm of the minimum angle of resolution) (<i>P</i> < .001) with a mean refractive prediction error of -0.04 ± 1.30 diopters (95% CI: -0.53 to +0.45 diopters). After surgery mean endothelial cell count significantly decreased from 2,037 ± 455 cells/mm² (95% CI: 1,861 to 2,213 cells/mm²) to 1,704 ± 483 cells/mm² (95% CI: 1,517 to 1,891 cells/mm²) (<i>P</i> < .001), with a mean loss of 16.9%. A mean IOL tilting of 2.7 ± 0.9 degrees (95% CI: 2.3 to 3 degrees) was found at 60 months postoperatively. The most common postoperative complication were corneal edema in the early course (2 eyes, 7.2%) and localized scleral thinning over the haptic in the late course (9 eyes, 32.1%). At 5 years postoperatively, anterior segment optical coherence tomography showed preserved scleral thickness 199.3 ± 72.7 μm (95% CI: 172.4 to 226.2 μm).</p><p><strong>Conclusions: </strong>Sutureless intrascleral fixation of the one-piece IOL demonstrated satisfactory long-term outcomes with good visual acuity and a low rate of complications.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e397-e404"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874583","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":"Ocular Residual Astigmatism, Posterior Corneal Astigmatism, and Anterior Corneal Irregularities in Virgin Eyes Undergoing Topography-guided LASIK.","authors":"Yan Zhang, Yimeng Fan, Xindi Wang, Linjuan Yang, Shimin Tan, Yu Zhang, Qianrong Hu, Yan Cai, Jingni Yu, Zhao Liu, Qianyan Kang, Shengjian Mi","doi":"10.3928/1081597X-20260224-01","DOIUrl":"10.3928/1081597X-20260224-01","url":null,"abstract":"<p><strong>Purpose: </strong>To identify the factors that contribute to the arithmetic difference between refractive astigmatism (RA) and anterior corneal astigmatism (ACA), particularly the potential roles of ocular residual astigmatism (ORA), posterior corneal astigmatism (PCA), and anterior corneal irregularities (ACI).</p><p><strong>Methods: </strong>This retrospective study included 360 eyes of 360 consecutive patients undergoing topography-guided LASIK. Preoperative examinations included refraction, topography, and aberrometry. Preoperative corrected distance visual acuity (CDVA) was collected. RA was obtained through manifest refraction. Total corneal astigmatism (TCA), PCA, and ACA were collected from the SIRIUS device (CSO). Patients were grouped into those who met the U.S. Food and Drug Administration (FDA) criteria (FDA+ group) and those who did not (FDA- group) based on the RA-ACA discrepancy. ORA was calculated as the vectorial difference between RA and ACA. ACI was assessed using higher order aberrations and para-central zone astigmatism.</p><p><strong>Results: </strong>Patients were grouped as FDA+ (140 eyes) or FDA- (220 eyes). The FDA+ group exhibited significantly higher RA but lower ORA values than the FDA- group. No significant differences were observed in the corneal astigmatisms (TCA, ACA, PCA) between groups. The ACI difference, assessed by higher order aberrations and paracentral zone astigmatism, was minimal between the two groups.</p><p><strong>Conclusions: </strong>ORA, defined as the vectorial difference between RA and ACA, was the primary contributor to the RA- ACA discrepancy preoperatively, whereas PCA and ACI made minimal contributions.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e444-e452"},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874463","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":"A Magic Eye.","authors":"Valeria Martinez","doi":"10.3928/1081597X-20260316-01","DOIUrl":"https://doi.org/10.3928/1081597X-20260316-01","url":null,"abstract":"","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"42 5","pages":"e388"},"PeriodicalIF":3.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874653","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}