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Taiwan Journal of Ophthalmology 2024Lamellar surgeries with SMILE lenticules are an evolving field of refractive surgery. This chapter intends to discuss the reported clinical results of using SMILE...
PURPOSE
Lamellar surgeries with SMILE lenticules are an evolving field of refractive surgery. This chapter intends to discuss the reported clinical results of using SMILE derived lenticules in terms of feasibility, safety and predictability; or the potential management of hyperopia, keratoconus, SMILE ectasia and presbyopia.
MATERIALS AND METHODS
Donor SMILE lenticules were prepared under microscope tocreate doughnut shaped lenticules. For hyperopia, this tissue was then inserted into afemtosecond laser enabled pocket created using VisuMax FS Laser at a depth of 160µm. For ectasia induced by keratoconus and post refractive procedure (SMILE), 0.23% riboflavin dye was instilled into the interface and then lenticule was inserted followed by exposure to UV-A radiation with total energy of 6.3 J.
RESULTS
Spherical equivalent (S.E.) of within ± 0.5 D was observed in 50% (n=21) eyes and within 1 D was seen in 71% eyes treated for hyperopia. A significant increase in the K mean anterior, central corneal thickness, Q-value and corneal aberrations was seen 2 weeks post-op. Clinical improvement in terms of S.E. and uncorrected distance visual acuity in eyes treated for ectasia after keratoconus and post refractive procedure (SMILE) was seen.
CONCLUSION
With the ample availability of SMILE- derived lenticules, researchers are exploring the possibility of using this tissue for the treatment of various refractive and corneal conditions.
PubMed: 38654992
DOI: 10.4103/tjo.TJO-D-23-00171 -
Clinical Ophthalmology (Auckland, N.Z.) 2023To evaluate the clinical rationale of wavefront-shaping technology, describe how intraocular lenses (IOLs) using wavefront-shaping technology are differentiated from... (Review)
Review
PURPOSE
To evaluate the clinical rationale of wavefront-shaping technology, describe how intraocular lenses (IOLs) using wavefront-shaping technology are differentiated from refractive or diffractive optical presbyopia-correcting designs, and describe the mode of action of this technology.
METHODS
Extended depth of focus (EDoF) IOLs are the latest class of presbyopia-correcting IOLs addressing the growing demand of patients for reduced spectacle dependence. These use various optical technologies, including diffractive designs (eg, TECNIS Symfony ZXR00 and AT LARA 29 MP) and non-diffractive designs such as small aperture (eg, IC-8 IOL and XtraFocus Pinhole Implant), spherical aberration (eg, MINI WELL Ready and LuxSmart), and wavefront shaping (eg, AcrySof IQ Vivity DFT015 and Clareon Vivity CNWET0). Despite some improvement in visual acuity at intermediate and near distances, these technologies can still be associated with increased rate of visual disturbances or poorer distance vision compared with monofocal IOLs. One way to overcome such limitations is using a wavefront-shaping optical principle.
RESULTS
Clinical data show that wavefront-shaping technology results in a continuous EDoF compared with a monofocal IOL while exhibiting a minimal halo, similar to an aspheric monofocal IOL. Clinically, this translates to a lens that has proven to exceed the American National Standards Institute/American Academy of Ophthalmology criteria for an EDoF IOL.
CONCLUSION
The novel wavefront-shaping optic technology allows patients to achieve a continuous range of vision from distance to functional near with low levels of visual disturbances comparable with aspheric monofocal IOLs.
PubMed: 37614847
DOI: 10.2147/OPTH.S400083 -
BMC Ophthalmology Nov 2023Fuchs endothelial corneal dystrophy (FECD) is the leading indication for EK and may coexist with cataract and presbyopia. Notably, the outcomes of phacoemulsification in... (Review)
Review
Fuchs endothelial corneal dystrophy (FECD) is the leading indication for EK and may coexist with cataract and presbyopia. Notably, the outcomes of phacoemulsification in FECD patients are not as favorable as those in eyes without this condition. Historically, only monofocal intraocular lenses (IOLs) were recommended for these patients. However, recent reports have described the implantation of Premium-IOLs (such as Multifocal IOLs, Enhanced Depth of Focus IOLs, and Toric IOLs) in FECD eyes undergoing cataract surgery and Descemet membrane endothelial keratoplasty (DMEK). While the results are encouraging, they are not as optimal as those from unoperated eyes, especially when comparing simultaneous procedures to sequential ones. It's advised to perform the DMEK first to improve the accuracy of IOL calculations. Still, even successfully operated eyes may experience secondary graft failure or graft rejection after DMEK. The success rate of a secondary DMEK is typically lower than that of the initial procedure. Furthermore, if the postoperative thickness after DMEK is less than anticipated, laser enhancements might not be an option. There's a pressing need for more controlled and randomized clinical trials to ascertain the safety and effectiveness of Premium-IOLs for FECD eyes. This narrative review aims to collate evidence on the use of Premium IOL technologies in eyes receiving EK and to underscore key points for surgeons performing EK combined with cataract surgery.
Topics: Humans; Lens Implantation, Intraocular; Descemet Membrane; Presbyopia; Visual Acuity; Lenses, Intraocular; Corneal Transplantation; Fuchs' Endothelial Dystrophy; Cataract; Descemet Stripping Endothelial Keratoplasty; Retrospective Studies
PubMed: 38007433
DOI: 10.1186/s12886-023-03240-5 -
Clinical Ophthalmology (Auckland, N.Z.) 2024To determine if the changes in stereoacuity and aniseikonia, following bilateral implantation of presbyopia correcting intraocular lenses could be predicted from...
Stereoacuity and Aniseikonia: Evaluation Before and After Bilateral Implantation of Three Types of Presbyopia-Correcting Intraocular Lenses in Uncomplicated Phacoemulsification with Due Consideration of Interocular Differences in Higher Order Aberrations, Axial Lengths, Refractive Errors, and...
PURPOSE
To determine if the changes in stereoacuity and aniseikonia, following bilateral implantation of presbyopia correcting intraocular lenses could be predicted from preoperative measurements of higher order aberrations (HOAs), axial lengths (AL), refractive errors (RE) and corrected visual acuities (CVAs).
PATIENTS AND METHODS
Stereoacuity (Randot tests, @6m & 40cm, in steps of 20 arcsecs") vertical and horizontal aniseikonia (Awaya test @6m, in steps of 1%) with best correction and HOAs (Shack-Hartmann aberrometer) were measured before, 3 and 6 months after uncomplicated bilateral phacoemulsification. Twenty patients (I) underwent a mix-and-match procedure (Tecnis MF, ZKB00 in one eye and ZLB00 in the other), 17 (II) were implanted with a trifocal (AT LISA 839 triMP) and 18 (III) with a one-piece diffractive (Synergy OU) intraocular lens. The resultant aniseikonia (A) of vertical and horizontal pairs of aniseikonia measurements was calculated using the Pythagorean theorem. Twenty untreated age/gender matched cases were recruited as controls (IV).
RESULTS
The key results (p < 0.001) were a) stereoacuity at distance (SAD) and near (SAN) improved, A reduced in groups I, II & III remaining unchanged in group IV; b) some significant intergroup differences in SAD, SAN & A were detected at postop; c) at 6 months postop, changes (Δ=pre- minus postoperative value) correlated with preoperative values (x). Linear regression revealed, I ΔSAD=0.66x-57.47 [0.832, ±66.4], ΔSAN=0.96x-34.59 [0.821, ±16.9], ΔA=0.93A-2.12 [0.795, ±1.4] II ΔSAD=0.79x-62.91 [0.916, ±38.1], ΔSAN=0.96x-31.49 [0.892, ±8.0], ΔA=0.91A-0.91 [0.839, ±1.3] III ΔSAD=0.67x-35.50 [0.991, ±23.7], ΔSAN=0.88x-38.51[0.988, ±10.6], ΔA=0.86A-0.96 [0.900, ±1.3]. Figures in parentheses are the corresponding and ±limits of agreement between actual and estimated values. Definitive overarching associations connecting interocular differences in HOAs, AL, RE, and CVAs with SAD, SAN and A were not found.
CONCLUSION
Changes in stereoacuity and aniseikonia can be predicted using preoperative values. ΔSAN can be predicted within ±1, and ΔA within ±2, scale divisions. In group III ΔSAD can be predicted within ±1, and in group I ±3, scale divisions.
PubMed: 38855012
DOI: 10.2147/OPTH.S459684 -
Community Eye Health 2024
PubMed: 38827967
DOI: No ID Found -
Arquivos Brasileiros de Oftalmologia 2023
Topics: Humans; Presbyopia; Accommodation, Ocular
PubMed: 37878949
DOI: 10.5935/0004-2749.2023-0196 -
American Journal of Ophthalmology Sep 2023To evaluate the safety, efficacy, and pharmacokinetics of pilocarpine hydrochloride 1.25% (Pilo hereafter) compared with vehicle when administered bilaterally, twice... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate the safety, efficacy, and pharmacokinetics of pilocarpine hydrochloride 1.25% (Pilo hereafter) compared with vehicle when administered bilaterally, twice daily (6 hours apart) for 14 days in participants with presbyopia.
DESIGN
Phase 3, randomized (1:1), controlled, double-masked, multicenter study.
METHODS
Participants (40-55 years of age) had objective and subjective evidence of presbyopia affecting daily activities with mesopic, high-contrast, binocular distance-corrected near visual acuity (DCNVA) of 20/40 to 20/100. The primary/key secondary endpoint was the proportion of participants gaining ≥3 lines in mesopic/photopic, high-contrast, binocular DCNVA on day 14 (last study visit), hour 9 (3 hours after the second dose), with no more than a 5-letter loss in mesopic/photopic corrected distance visual acuity with the same refractive correction. Key safety measures included treatment-emergent adverse events (TEAEs) and some ocular measurements. Pilocarpine plasma levels were assessed in approximately 10% of enrolled participants.
RESULTS
Overall, 230 participants were randomized to Pilo twice daily (N = 114) and vehicle (N = 116). The proportion of participants achieving the primary and key secondary efficacy endpoints was statistically significantly greater with Pilo twice daily than vehicle, with between-treatment differences of 27.3% (95% CI = 17.3, 37.4) and 26.4% (95% CI = 16.8, 36.0), respectively. The most common TEAE was headache, reported in 10 participants (8.8%, Pilo group) and 4 participants (3.4%, vehicle group). Pilocarpine's accumulation index on day 14 was ≤1.11 after the second dose.
CONCLUSIONS
Near-vision improvements were statistically greater with Pilo twice daily than with vehicle, without compromising distance acuity. The safety profile of Pilo twice daily was consistent with that of Pilo once daily, and systemic accumulation was minimal, supporting twice daily administration.
Topics: Humans; Pilocarpine; Presbyopia; Visual Acuity; Refraction, Ocular; Double-Blind Method
PubMed: 37149245
DOI: 10.1016/j.ajo.2023.05.008 -
Eye and Vision (London, England) Aug 2023This study aims to detect alterations in the spatio-chromatic pseudophakic vision produced by multifocal diffractive intraocular lenses (IOLs) and provides a physical...
BACKGROUND
This study aims to detect alterations in the spatio-chromatic pseudophakic vision produced by multifocal diffractive intraocular lenses (IOLs) and provides a physical interpretation.
METHODS
In vitro characterization of the imaging performance of two diffractive IOLs: AT LISA Tri (Zeiss) and FineVision (PhysIOL) in on-bench model eye illuminated with red (R, 625 nm), green (G, 530 nm) and blue (B, 455 nm) lights. We used the metrics: energy efficiency (EE), area under the modulation transfer function, longitudinal chromatic aberration (LCA), and halo intensity. Through-focus (TF) analysis and calculation of the expected defocus curve under white (W) daylight were included. In vivo visual acuity (VA) of 50 pseudophakics (60 eyes) was assessed under W, R, G, B lights at far and near. Two clinical experiments evaluated LCA and R, G, B TF-EE effects on pseudophakic vision and their relative importance.
RESULTS
Clinical mean VA values under W light agreed with the predicted values at far and near for both IOLs. LCA measurements and R, G, B TF-EE curves were consistent with their lens design based on the 0th and 1st diffraction orders operative for far and near vision, respectively. LCA effects were compensated at near but noticed at far (- 0.75 D under B light). We detected strong asymmetry in visual resolution depending on the object distance and the illuminating wavelength-red predominance at far, blue predominance at near-in consistency with the TF-EE measurements.
CONCLUSIONS
Diffractive multifocal IOL designs produce asymmetries in the spatio-chromatic vision of pseudophakics beyond the alterations strictly due to LCA. VA asymmetry for far/near object distance under R and B illumination is clinically detectable in subjects implanted with IOLs with 0th and 1st diffraction orders for far and near vision, respectively. Such VA asymmetry cannot be explained solely from the influence of defocus, as would be derived from a chromatic difference of power, but mainly from the wavelength dependence of the EE.
PubMed: 37525263
DOI: 10.1186/s40662-023-00350-5