Clinical ophthalmology (Auckland, N.Z.)最新文献

{"title":"XEN63 Gel Stent in Glaucoma: Narrative Review and Expert Perspectives on Patient Selection, Surgical Technique, and Perioperative Management.","authors":"Iqbal Ike K Ahmed, Jose Maria Martinez-De-La-Casa, Antonio Maria Fea, Karsten Klabe, Luis Abegão Pinto, Herbert A Reitsamer, Paramjit Singh, Ingeborg Stalmans, Vanessa Vera","doi":"10.2147/OPTH.S615868","DOIUrl":"https://doi.org/10.2147/OPTH.S615868","url":null,"abstract":"<p><p>The XEN gel stent (AbbVie Inc. North Chicago, IL, USA) is a minimally invasive bleb-forming surgical device designed to lower intraocular pressure (IOP). The 63 μm gel stent has a larger lumen than the 45 μm gel stent, creating lower outflow resistance, which may translate into greater IOP-lowering potential. However, the comparative evidence base remains limited, heterogeneous, and largely retrospective; the magnitude and durability of any advantage over the 45 μm device should be interpreted cautiously. This narrative review summarizes the currently available evidence and expert surgical perspectives on patient selection, pre- and intraoperative practices, implantation technique, and postoperative practices with the 63 μm gel implant. Particular attention is given to conjunctival and Tenon's tissue management, use of mitomycin C (MMC), management of postoperative IOP elevation, and recognition and treatment of hypotony. The article is based on a targeted review of the literature combined with unstructured expert input and was not conducted as a systematic review or formal Delphi consensus. Based on the available evidence and expert perspectives, the 63 μm gel stent may be a useful option for selected patients requiring IOP in the low- to mid-teens. However, outcomes depend heavily on patient factors, surgical technique, and postoperative care.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"615868"},"PeriodicalIF":0.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motugivatrep (SJP-0132) 0.3% Ophthalmic Suspension for Dry Eye Disease: A Randomized, Double-Masked, Placebo-Controlled, Multicenter, Phase 3 Trial.","authors":"Yuichi Hori, Tomoyuki Wada, Kazunori Omatsu","doi":"10.2147/OPTH.S615529","DOIUrl":"https://doi.org/10.2147/OPTH.S615529","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy and safety of motugivatrep (SJP-0132) 0.3% ophthalmic suspension, a novel therapy targeting subjective symptoms, in patients with dry eye disease.</p><p><strong>Patients and methods: </strong>This pivotal, multicenter, randomized, double-masked, placebo-controlled Phase 3 study was conducted in Japan. Outpatients with dry eye-related subjective symptoms and short tear break-up times (TBUT; ≤5 seconds in both eyes) were randomized 1:1 to receive motugivatrep 0.3% ophthalmic suspension or placebo four times daily for 8 weeks. The primary endpoint was the change from baseline in total Dry Eye-related Quality of Life Score (DEQS) at week 4.</p><p><strong>Results: </strong>A total of 535 patients were randomized to motugivatrep 0.3% (n=268) or placebo (n=267). The primary endpoint was met, with a significantly greater improvement in total DEQS at week 4 in the motugivatrep 0.3% group compared with placebo (least-squares mean [LSM] change from baseline -16.76 vs -14.36; LSM difference -2.40; 95% CI -4.72, -0.07; p=0.0433). Consistent improvements in total DEQS were observed with motugivatrep 0.3% vs placebo from week 1 through week 4 (all nominal p<0.05). Motugivatrep 0.3% also demonstrated early improvements in other subjective symptoms, with statistically significant improvements vs placebo in visual analog scale scores for eye dryness at weeks 1 and 4 (both nominal p<0.05).No significant differences were observed between groups in changes in TBUTs or corneal fluorescein staining (CFS) scores overall. A subgroup analysis suggested greater and increasing improvements in total CFS scores with motugivatrep 0.3% compared with placebo in patients with corneal epithelial disorder, indicating potential benefit in this population. Motugivatrep 0.3% was generally well tolerated, with no major safety concerns identified.</p><p><strong>Conclusion: </strong>Motugivatrep 0.3% ophthalmic suspension provided early improvements in subjective symptoms and quality of life and was well tolerated, representing a new therapeutic option for patients with dry eye disease.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"615529"},"PeriodicalIF":0.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Tomographic Outcomes of Long Arc-Length Intrastromal Corneal Ring Segment Implantation in Central Keratoconus.","authors":"Beatriz Costa Vieira, André Ferreira, João Ramalhão, Miguel Mesquita Neves, Miguel Gomes, Luís Oliveira","doi":"10.2147/OPTH.S603865","DOIUrl":"10.2147/OPTH.S603865","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the outcomes of implanting a long arc-length intrastromal corneal ring segment (ICRS) in central hyperprolate keratoconus (KC).</p><p><strong>Methods: </strong>Retrospective study enrolling patients with moderate to advanced hyperprolate KC that were submitted to long arc-length ICRS implantation (Ferrara™ or Keraring®). The clinical measurements taken included manifest refraction, spectacle corrected distance visual acuity (CDVA, logMAR scale), and corneal tomographic analysis (Oculus Pentacam HR (OCULUS Optikgerate GmbH, Wetzlar, Germany). Clinical and tomographic changes were assessed. All examinations were performed before and after surgery.</p><p><strong>Results: </strong>Thirty-five eyes of 31 patients (71.0% men, n=22) with a mean±SD age of 28.25±11.42 years were enrolled. Median (IQR) follow-up was 19.3 (9.93-23.03) months. Twenty-five Keraring® and ten Ferrara™ ICRS, including 16 (45.7%) with progressive thickness, were successfully implanted, with no intraoperative or postoperative complications. CDVA improved from 0.70±0.40 to 0.38±0.32 logMAR (p < 0.001) and the spherical equivalent decreased from -1.94±2.81 to -0.16±1.93D (p < 0.001). Overall, 82.8% gained at least one line; no patient lost lines postoperatively. All anterior but not posterior keratometric parameters decreased significantly. Maximum elevation of both corneal surfaces, asphericity, vertical Coma-like aberration and the total higher-order aberrations decreased significantly with the procedure (all p < 0.05). The 6-month safety index (ratio of postoperative to preoperative CDVA) was 2.85. No complications occurred during or after the procedure.</p><p><strong>Conclusions: </strong>These results suggest that implanting a long arc-length ICRS is a well-tolerated and effective procedure associated to improvement of visual and tomographic outcomes in patients with central hyperprolate keratoconus.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"603865"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Squint ASSIST: A Novel Application Program for Detecting Strabismus and Measuring Angle of Deviation.","authors":"Nichakant Srisaenpang, Nutta Homdee, Yosanan Yospaiboon, Sirinya Suwannaraj","doi":"10.2147/OPTH.S578342","DOIUrl":"10.2147/OPTH.S578342","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate Squint ASSIST (Squint Automatic Strabismus Sizing using Image Sensing Technology), an application program for strabismus detection and angle measurement, using corneal light reflex deviation in eye photographs.</p><p><strong>Methods: </strong>This prospective cross‑sectional clinic‑based study enrolled 136 patients and 1384 photographs. Two analytic methods were evaluated: Method 1 (inter-ocular comparison; comparing corneal light reflex positions between both eyes in one image) and Method 2 (intra‑ocular comparison; comparing the same eye in a straight vs deviated image). Photographs were processed with standardized processing images. The participants' angles of deviation were measured using this program, which converts the light reflex deviation to misaligned angles in prism diopters. The main outcome was the sensitivity, specificity, and accuracy of the program for detecting strabismus. The agreement between the angles measured by the program and those measured by pediatric ophthalmologists using the Krimsky test and the Alternate Prism Cover Test (APCT) was analyzed using the Bland-Altman plot. Intra-observer and inter-observer reproducibility were also evaluated.</p><p><strong>Results: </strong>Of those 136 patients with strabismus, eighty‑seven patients had esotropia, 43 had exotropia, and six had orthophoria after strabismic surgery. The mean age was 12.8 (1-69) years. Squint ASSIST detected strabismus with high performance. Method 1: sensitivity 96.39%, specificity 94.34%, accuracy 95.59%; Method 2: sensitivity 96.83%, specificity 90.48%, accuracy 94.29%. Pearson <i>r</i> versus clinician measures were 0.962 (Method 1) and 0.955 (Method 2) (P < 0.001). When compared the program with ophthalmologists, the Bland-Altman analysis showed that the mean biases were small (Method 1: -1.23 PD; Method 2: -2.00 PD), but the 95% limits of agreement were wide (-29 to +27 PD overall). Repeatability and inter-observer reproducibility was strong.</p><p><strong>Conclusions: </strong>The Squint ASSIST offers a reliable method for detecting and measuring strabismic angles in clinical settings. The small mean bias and strong intra-observer and inter-observer consistency support substantial clinical utility for screening, standardized photographic documentation, and telemedicine follow‑up. However, due to its wide limits of agreement for absolute angle estimates, pediatric ophthalmologists remain the reference for situations that demand maximal precision such as pre‑surgical planning.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"578342"},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Effectiveness of a Gel Stent in Refractory Glaucoma in China: Real-World Evidence at 12 Months.","authors":"Yuanbo Liang, Yihua Zhu, Ningli Wang, Hong Zhang, Haijun Li, Jia Qu, Zhixuan Chen, Bill Bunnell, Sherry Zhao, Daisy Yuan, Susan S Lee, Michael R Robinson","doi":"10.2147/OPTH.S598092","DOIUrl":"10.2147/OPTH.S598092","url":null,"abstract":"<p><strong>Purpose: </strong>The XEN gel stent (XEN Glaucoma Treatment System®; AbbVie Inc., North Chicago, IL, USA) is a minimally invasive bleb-forming device implanted ab-interno to lower intraocular pressure. The gel stent is approved to treat refractory glaucoma in China since 2020, based on interim real-world study data from patients at Hainan Boao Super Hospital. Final study data on the gel stent's effectiveness and safety in those patients are presented.</p><p><strong>Patients and methods: </strong>The single-center, single-arm, open-label, phase 3b Hainan study collected data from Chinese patients with refractory glaucoma (ie, failed surgical treatment or primary open-angle/pseudoexfoliative/pigmentary glaucoma unresponsive to medical therapy) who underwent ab-interno gel stent implantation. This study was designed for both retrospective and prospective collection of real-world data.</p><p><strong>Primary effectiveness outcome: </strong>Proportion of study eyes at 12 months achieving ≥20% intraocular pressure (IOP) reduction from baseline without increasing the number of IOP-lowering medications and without secondary surgical intervention. Secondary effectiveness outcomes: mean IOP and mean number of IOP-lowering medications used over time. Safety outcomes: intraoperative complications and postoperative treatment-emergent adverse events (TEAEs), postoperative needling, and ophthalmic safety assessments.</p><p><strong>Results: </strong>Fifty-nine patients were enrolled that composed the effectiveness (n=59 eyes) and safety (n=62 eyes) populations. Among the 59 study eyes, 53 (89.8%) completed the 12-month visit. Mean IOP decreased from 23.7 mmHg on 3.3 IOP-lowering medications at baseline (47.5% of patients requiring ≥4 medications; 59.3% with prior glaucoma surgery) to 17.4 mmHg on 1.0 IOP-lowering medication at month 12. 49.0% (95% CI: 34.8-63.4) of the study eyes achieved the primary effectiveness outcome based on observed data. Among study eyes with baseline IOP ≥20 mmHg (n=31/59; 52.5%), IOP decreased from 30.4 mmHg on 3.4 medications (baseline) to 17.2 mmHg on 0.6 medications (month 12), and 17/28 (60.7%) achieved the primary outcome. No intraoperative complications or ocular TEAEs leading to study discontinuation were reported. Excluding expected inflammatory TEAEs following filtration surgery, IOP decreased (8.1%) and IOP increased (33.9%) were the most common TEAEs ≤7 and >7 days after surgery, respectively.</p><p><strong>Conclusions: </strong>The gel stent effectively lowered IOP and IOP-lowering medication burden in Chinese patients with refractory glaucoma, with no new unexpected safety findings, supporting its use as a minimally invasive bleb-forming surgical option in this population. Future considerations may include larger, prospective, comparative studies.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"598092"},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Preoperative Ocular Surface Optimization on Biometric Accuracy and Refractive Outcomes After Cataract Surgery: A Systematic Review with Narrative and Exploratory Quantitative Synthesis.","authors":"Shaker O Alreshidi, Sultan Abdulrahman A Alhassan, Raneem Meshal F Alshunaif Almehlse, Renad Ali I Assiri, Riam Ahmed I Alghannam, Kawthar Mubarak M Hanif, Manar Makki A Almuntashri, Abdulaziz Abdulhamid B Alaskar, Nouf Saleh F AlBlaihed, Ghadah Mohammed Almutairi, Asma A AlFarraj","doi":"10.2147/OPTH.S642583","DOIUrl":"10.2147/OPTH.S642583","url":null,"abstract":"<p><strong>Background: </strong>The ocular surface and tear-film instability can affect keratometry and biometry before cataract surgery. This review evaluated whether preoperative ocular surface optimization improves biometric accuracy, keratometric repeatability, intraocular lens (IOL) power prediction, and postoperative refractive outcomes.</p><p><strong>Methods: </strong>PubMed/MEDLINE was searched on 24 June 2026 and Cochrane CENTRAL on 1 July 2026 without language, study-type, age, or date filters. One reviewer screened records in Rayyan and the exported CENTRAL trial list, assessed full texts against prespecified eligibility criteria, and extracted study data; screening and extraction were not independently duplicated. The primary synthesis was narrative because study designs and outcome reporting were heterogeneous, with exploratory random-effects sensitivity analyses performed only for sufficiently compatible datasets.</p><p><strong>Results: </strong>PubMed identified 179 records and CENTRAL identified 44 trial records. PubMed screening selected 23 records for full-text review. CENTRAL added two completed published studies and identified five registry-only records awaiting results. Overall, 25 completed published studies were included, while five registry-only records were tracked but not synthesized. Heterogeneity in interventions, comparators, and outcomes limited quantitative pooling.</p><p><strong>Conclusions: </strong>Preoperative ocular-surface optimization may improve the stability of cataract measurements and refractive prediction in selected patients, particularly when dry eye disease, meibomian gland dysfunction, tear-film instability, or ocular-surface irregularity is present. Heterogeneity and predominantly nonrandomized evidence preclude a definitive pooled treatment effect. Final biometry should be performed after clinically significant ocular-surface disease has been treated and the surface is reasonably stable.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"642583"},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13618311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Overestimation of Uveoscleral Outflow from Goldmann Tonometry Bias.","authors":"Sean McCafferty","doi":"10.2147/OPTH.S638576","DOIUrl":"10.2147/OPTH.S638576","url":null,"abstract":"<p><p>In living humans, uveoscleral outflow (Fu) is calculated, not measured. Except in rare tracer studies it is the residual of the modified Goldmann equation, Fu = F - C(IOP - Pev), which treats Fu as pressure-independent and assigns all pressure-dependent outflow to facility (C). Goldmann applanation tonometry (GAT) underestimates manometric IOP by about 4-5 mmHg. Because F, C, and Pev are measured independently of GAT, that low IOP input understates C(IOP - Pev) and overstates the residual reported as pressure-independent uveoscleral outflow. With representative values, GAT 15.5 mmHg yields Fu of about 50% of flow; manometric 20 mmHg yields about 9%, in line with human tracer data. A pressure-dependent uveoscleral component, if present, already sits inside C and cannot be separated by this method. The same bias has likely overstated the pressure-independent effect of prostaglandin analogs.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"638576"},"PeriodicalIF":0.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149083231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Year Outcomes of Repeat XEN Gel Stent Implantation for Prior XEN Failure: A Retrospective Study.","authors":"Arkadiy Yadgarov, Savannah Wegemer","doi":"10.2147/OPTH.S625088","DOIUrl":"10.2147/OPTH.S625088","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the 12-month outcomes of repeat XEN gel stent implantation in eyes with prior XEN failure.</p><p><strong>Patients and methods: </strong>This single-center retrospective chart review included 24 eyes of 24 patients with a previously failed XEN stent, who underwent repeat XEN gel stent implantation between April 2019 and June 2023. Outcome measures included changes in mean intraocular pressure (IOP) and number of IOP-lowering medications from baseline (prior to repeat XEN) to postoperative 12 months, assessment of surgical success defined as achieving IOP ≤18 mmHg without medications (complete success)/on the same or fewer medications (qualified success), without secondary surgical intervention (SSI), and a morphologically functional bleb.</p><p><strong>Results: </strong>The mean age of patients was 65.3 ± 10.9 years. The study population was predominantly African American (79.2%). Among the eyes not requiring SSI, there was a 43.5% reduction in mean IOP from baseline to postoperative 12 months, which was statistically significant (23.50 ± 5.58 mmHg at baseline to 13.28 ± 3.54 mmHg at 12 months (p <0.001). The postoperative 12-month complete success rate was 16.7%, and the qualified success rate was 66.7%. The mean number of IOP-lowering medications also declined significantly from 3.00 ± 1.37 to 1.28 ± 1.13 (p = 0.002), revealing a 57% reduction from baseline to 12 months. No vision-threatening complications were reported.</p><p><strong>Conclusions: </strong>Repeat XEN gel stent implantation may be a viable surgical option for prior XEN failure, providing meaningful reductions in IOP and medication burden in majority of patients. These findings support consideration of a second XEN stent before transitioning to more invasive filtering surgeries.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"625088"},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distance Visual Outcomes of Trifocal Intraocular Lenses in Highly Myopic Eyes Without Myopic Maculopathy.","authors":"Álvaro Fernández-Vega González, Irene Martínez-Alberquilla, María Isabel López-Gálvez, Nicolás Sánchez-Maluf, Luis Fernández-Vega-Cueto-Felgueroso, David Madrid-Costa, José F Alfonso","doi":"10.2147/OPTH.S630115","DOIUrl":"10.2147/OPTH.S630115","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the refractive and visual distance outcomes of trifocal intraocular lens (IOL) implantation in highly myopic patients and to investigate potential preoperative factors predictors of postoperative vision.</p><p><strong>Methods: </strong>This retrospective study included eyes with axial length (AL) between 26 mm and 31mm without signs of pathological myopia and a preoperative corrected distance visual acuity (CDVA) equal or better than 0.1 logMAR who underwent diffractive trifocal IOL implantation (AT LISA tri or FineVision). Visual and refractive measurements, as well as biometric values (AL, anterior chamber depth, keratometry, white-to-white) were recorded both preoperatively and postoperatively. Comparisons were performed between eyes achieving predefined CDVA (0.0 logMAR or better) and uncorrected distance visual acuity (UDVA) (0.2 logMAR or better) thresholds and those that did not. Multivariable logistic regression analysis was performed to identify preoperative factors associated with these thresholds.</p><p><strong>Results: </strong>The study included 361 eyes with a mean preoperative CDVA of 0.03±0.04 logMAR, which significantly improved to 0.01±0.03 logMAR postoperatively (p<0.001). The mean postoperative spherical equivalent was -0.26 ± 0.40 D, with 80.1% of the eyes within ± 0.50 D range. Overall, 19.9% and 18.9% of eyes did not achieve 0.0 logMAR CDVA and 0.2 logMAR UDVA, respectively, and 8% required postoperative corneal refractive enhancement. Besides subtle differences, no determinant preoperative biometric parameters were significantly associated with postoperative distance vision outcomes.</p><p><strong>Conclusions: </strong>Trifocal IOLs performed satisfactorily in terms of distance vision in highly myopic eyes without signs of pathological myopia; however nearly one-fifth of eyes did not achieve the expected visual acuity, highlighting the importance of careful patient selection and appropriate preoperative counselling.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"630115"},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Postoperative Corneal Higher-Order Aberrations, Asphericity, Densitometry, and Optical Quality Between SMILE Pro and LASIK: A Retrospective Cohort Study.","authors":"Xiaodong Zheng, Tomoko Goto","doi":"10.2147/OPTH.S638148","DOIUrl":"10.2147/OPTH.S638148","url":null,"abstract":"<p><strong>Purpose: </strong>To compare postoperative changes in corneal higher-order aberrations (HOAs), densitometry, and optical quality following SMILE Pro and laser in situ keratomileusis (LASIK), and to investigate the relationship between corneal densitometry and postoperative optical quality.</p><p><strong>Patients and methods: </strong>This retrospective matched cohort study included 60 eyes of 30 patients who underwent SMILE Pro and 60 eyes of 30 age-, sex-, and preoperative spherical equivalent-matched patients who underwent LASIK for myopia at Hanamizuki Eye Clinic between July 2025 and March 2026. Anterior, posterior, and real corneal HOAs, spherical aberration (SA), coma, anterior corneal Q value, and central (0-4 mm) corneal densitometry were evaluated using anterior segment optical coherence tomography (CASIA2). Optical quality was assessed using the modulation transfer function (MTF) Area Ratio (Total and HO) obtained with the OPD-Scan III. Longitudinal comparisons were analyzed using linear mixed-effects models, and correlations were evaluated using Spearman's rank correlation coefficient.</p><p><strong>Results: </strong>Compared with LASIK, the SMILE Pro group showed significantly lower posterior corneal coma at 1 week, lower anterior and real SA at 1 month, and lower anterior and real SA as well as real corneal coma at 3 months (all P<0.05). Q values were significantly lower at 1 and 3 months. Corneal densitometry was significantly higher in the SMILE Pro group at 1 week, 1 month, and 3 months (all P<0.05), whereas the 3-month MTF Area Ratio Total was significantly lower (P=0.004). Within the SMILE Pro group, corneal densitometry at 1 week, 1 month, and 3 months was significantly negatively correlated with the 3-month MTF Area Ratio HO (all P<0.05), whereas no significant correlations were observed in the LASIK group.</p><p><strong>Conclusion: </strong>Compared with LASIK, SMILE Pro was associated with fewer postoperative corneal HOAs and better preservation of corneal asphericity. Although higher-order optical quality was comparable between the two procedures, postoperative corneal densitometry was associated with higher-order optical quality only after SMILE Pro. These findings suggest that anterior segment OCT-derived corneal densitometry may provide additional noninvasive information on postoperative stromal interface healing and its relationship with optical quality following SMILE Pro.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"638148"},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149077112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}