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Acta Ophthalmologica Aug 2021To compare the outcomes of femtosecond astigmatic keratotomy (FSAK) and manual astigmatic keratotomy (AK) in treatment of postkeratoplasty astigmatism. (Comparative Study)
Comparative Study
PURPOSE
To compare the outcomes of femtosecond astigmatic keratotomy (FSAK) and manual astigmatic keratotomy (AK) in treatment of postkeratoplasty astigmatism.
METHODS
A retrospective, comparative, pairwise-matched case series including 150 patients who underwent either FSAK (n = 75) or manual AK (n = 75) for the treatment of astigmatism (>3.00 D) following penetrating keratoplasty or deep anterior lamellar keratoplasty. Pairwise matching for baseline variables (age, visual acuity and astigmatism) was performed.
RESULTS
Mean age was 57.5 ± 16.0 years. The FSAK group had significantly better postoperative best-corrected visual acuity (BCVA) (p = 0.010), uncorrected visual acuity (UCVA) (p = 0.049), corneal astigmatism (p = 0.020) and manifest astigmatism (p < 0.001) compared with the manual AK group. Gain of ≥3 lines in BCVA (logMAR) was seen in five eyes (6.7%) and 21 eyes (28.0%) in manual AK and FSAK, respectively (p = 0.005). Alpins vector analysis showed lower (closer to 0) index of success (0.50 ± 0.24 and 0.79 ± 0.48, p < 0.001) and higher (closer to 1) correction index (0.94 ± 0.45 and 0.74 ± 0.55, p = 0.020) in FSAK compared with manual AK. Corneal and manifest astigmatism improved significantly in both groups, while BCVA and UCVA improved significantly in FSAK only. Repeat AK rate was 32% (24 eyes) in manual AK and 4% (three eyes) in FSAK (p < 0.001). Overcorrection-related re-suturing rate was 0% in manual AK and 8% (six eyes) in FSAK (p = 0.037). There was one microperforation (1.3%) in FSAK, and there were no occurrences of graft dehiscence, infectious keratitis or graft rejection.
CONCLUSIONS
Both manual AK and FSAK were safe and effective in reducing postkeratoplasty astigmatism. FSAK had superior visual and keratometric outcomes compared with manual AK.
Topics: Astigmatism; Cornea; Corneal Diseases; Corneal Topography; Female; Humans; Keratoplasty, Penetrating; Keratotomy, Radial; Lasers, Excimer; Male; Middle Aged; Postoperative Complications; Refraction, Ocular; Reoperation; Retrospective Studies; Treatment Outcome; Visual Acuity
PubMed: 33124121
DOI: 10.1111/aos.14653 -
Journal of Cataract and Refractive... Sep 2018To compare corneal astigmatism and shape between male and female eyes in relationship to age. (Comparative Study)
Comparative Study
PURPOSE
To compare corneal astigmatism and shape between male and female eyes in relationship to age.
SETTING
Hayashi Eye Hospital, Fukuoka, Japan.
DESIGN
Prospective case series.
METHODS
Eyes of men and women in 5 age groups (40 to 49 years, 50 to 59 years, 60 to 69 years, 70 to 79 years, and ≥80 years) had videokeratographic evaluations using a Placido-Scheimpflug system. Corneal astigmatism decomposed to vertical-horizontal (J0) and oblique (J45) astigmatism components was compared between male and female eyes, and corneal shape changes were compared using videokeratography maps.
RESULTS
The study comprised 1000 eyes (100 eyes of male patients and 100 eyes of female patients in each of the 5 age groups). The mean J0 of the total and anterior cornea were significantly smaller in male eyes than in female eyes in all age groups (P ≤ .0269) with no significant difference in the J45 between sexes, indicating greater against-the-rule (ATR) astigmatism in male eyes. The mean J0 of the posterior cornea did not differ significantly between sexes except in the 50 to 59 years group (P = .0105). The ATR astigmatic change per decade did not differ significantly between men and women. Videokeratography maps revealed that the total and anterior corneal shape changed to ATR astigmatism with age in both sexes, and that this ATR change began at a younger age in male eyes than in female eyes. The posterior corneal shape did not differ between sexes at any age.
CONCLUSION
Against-the-rule corneal astigmatism was greater and the ATR astigmatic change with age began earlier in the male eyes than in the female eyes, suggesting that target astigmatism should be determined separately for men and women when performing astigmatism correction.
Topics: Adult; Aged; Aged, 80 and over; Aging; Astigmatism; Cornea; Corneal Topography; Female; Humans; Male; Middle Aged; Prospective Studies; Refraction, Ocular; Sex Factors; Visual Acuity
PubMed: 30077353
DOI: 10.1016/j.jcrs.2018.06.020 -
Acta Ophthalmologica Dec 2017To investigate the central and paracentral astigmatism and the significance of centration and measurement zone diameter compared to a 3-mm pupil-centred measurement zone... (Comparative Study)
Comparative Study
PURPOSE
To investigate the central and paracentral astigmatism and the significance of centration and measurement zone diameter compared to a 3-mm pupil-centred measurement zone in keratoconus and in healthy eyes.
METHODS
Twenty-eight right eyes from 28 KC patients with an inferotemporal cone were selected according to specified criteria based on Oculus Pentacam HR measurements and were matched with healthy control eyes. The flat (K1) and steep (K2) keratometry readings were registered from the 'Total Corneal Refractive Power' (TCRP) display as well as the anterior and posterior corneal astigmatism displays (ACA and PCA, respectively). Astigmatic power vectors KP0 and KP45 were calculated and analysed for a 6-mm and two 3-mm zones centred on the corneal apex and the pupil, and for 8 paracentral 3-mm zones.
RESULTS
The astigmatism was generally higher in KC. Many astigmatic values in KC differed between the 3-mm pupil-centred and the 3- and 6-mm apex-centred zones in KC. In the controls, no corresponding differences between measurement zones were seen, apart from PCA, which differed. The magnitude and direction of KP0 and KP45 varied greatly between the paracentral measurements in KC.
CONCLUSION
Centration and measurement zone diameter have great impacts on the astigmatic values in KC. A small pupil-centred measurement zone should be considered when evaluating the astigmatism in KC.
Topics: Astigmatism; Cornea; Corneal Topography; Female; Follow-Up Studies; Humans; Keratoconus; Male; Refraction, Ocular; Retrospective Studies; Time Factors; Visual Acuity; Young Adult
PubMed: 28692136
DOI: 10.1111/aos.13517 -
Indian Journal of Ophthalmology Jan 2022Since the introduction of the first toric intraocular lens (IOLs) in the early 1990s, these lenses have become the preferred choice for surgeons across the globe to... (Review)
Review
Since the introduction of the first toric intraocular lens (IOLs) in the early 1990s, these lenses have become the preferred choice for surgeons across the globe to correct corneal astigmatism during cataract surgery. These lenses allow patients to enjoy distortion-free distance vision with excellent outcomes. They also have their own set of challenges. Inappropriate keratometry measurement, underestimating the posterior corneal astigmatism, intraoperative IOL misalignment, postoperative rotation of these lenses, and IOL decentration after YAG-laser capsulotomy may result in residual cylindrical errors and poor uncorrected visual acuity resulting in patient dissatisfaction. This review provides a broad overview of a few important considerations, which include appropriate patient selection, precise biometry, understanding the design and science behind these lenses, knowledge of intraoperative surgical technique with emphasis on how to achieve proper alignment manually and with image-recognition devices, and successful management of postoperative complications.
Topics: Astigmatism; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Phacoemulsification; Refraction, Ocular
PubMed: 34937203
DOI: 10.4103/ijo.IJO_1785_21 -
BMC Ophthalmology Feb 2023To examine the astigmatism characteristics and surgical outcomes in patients with unilateral severe congenital ptosis following frontalis suspension surgery.
BACKGROUND
To examine the astigmatism characteristics and surgical outcomes in patients with unilateral severe congenital ptosis following frontalis suspension surgery.
METHODS
We included 53 congenital ptosis patients who underwent frontalis suspension surgery in Hunan Children's Hospital. Each patient underwent a refractive examination before and after surgery to assess astigmatism. We also evaluated the effects and complications associated with the procedure.
RESULTS
Degree of astigmatism in ptotic and fellow eyes was - 1.45 ± 0.59 D and - 0.66 ± 0.51 D before surgery. Ratio of severe astigmatism in ptotic and fellow eyes was 51.3 and 12.8%. The fellow eyes presented with with-the-rule astigmatism (WR; 71.8%) and against-the-rule astigmatism (AR; 20.5%) types, with no cases of oblique astigmatism (OA). Ptotic eyes demonstrated higher frequencies of AR (59.0%) and OA (10.2%) than did fellow eyes. Furthermore, the former showed increased astigmatism, followed by a gradual decrease at the 6-month, before significantly decreasing at the 1-year postoperatively. The ratio of postoperative AR and OA astigmatism cases in ptotic eyes decreased to 35.9 and 7.7% 1 month postoperatively. However, there was a postoperative increase in the WR ratio from 30.8 to 56.4% after 1 month. Kaplan-Meier survival analysis showed a success rate of 81.4% at 6 months and 62.9% at 12 months which was influenced by the following complications: suture reaction, epithelial keratopathy, infection and granuloma, lid lag, and recurrence.
CONCLUSION
Monocular congenital ptosis could develop severe astigmatism and higher frequency of AR or OA, early surgery may ameliorate astigmatic amblyopia.
Topics: Child; Humans; Astigmatism; Amblyopia; Blepharoptosis; Refraction, Ocular; Treatment Outcome; Retrospective Studies; Oculomotor Muscles
PubMed: 36750792
DOI: 10.1186/s12886-023-02804-9 -
BMC Ophthalmology Jul 2022Chalazion may affect visual acuity. This study aimed to evaluate refractive status of chalazia and effect of different sites, sizes, and numbers of chalazion on...
BACKGROUND
Chalazion may affect visual acuity. This study aimed to evaluate refractive status of chalazia and effect of different sites, sizes, and numbers of chalazion on astigmatism.
METHODS
Three hundred ninety-eight patients aged 0.5-6 years were divided into the chalazion group (491 eyes) and the control group (305 eyes). Chalazia were classified according to the site, size, and number. Refractive status was analyzed through the comparison of incidence, type, mean value and vector analysis.
RESULTS
The incidence, type, refractive mean and of astigmatism in the chalazion group were higher than those in the control group, and the difference was statistically significant (P < 0.05). For comparison of the incidence, the middle-upper eyelid (50%) was highest, followed by 41.77% in the medial-upper eyelid, both higher than that in the control group (P < 0.05). In medium (54.55%) and large groups (54.76%) were higher than that in the control group (27.21%) (P < 0.05). In multiple chalazia, the astigmatism incidence for chalazion with two masses was highest (56%), much higher than that in the control group (P < 0.05). However, this difference was not significant in chalazion with ≥3 masses (P > 0.05). For comparison of the refractive mean,the medial-upper eyelid, middle-upper eyelid and medial-lower eyelid were higher than the control group (P < 0.05) (P < 0.05). The 3-5 mm and >5 mm group were higher than those in the control group and <3 mm group(P < 0.05), and the>5 mm group was larger than the 3-5 mm group,suggesting that the risk of astigmatism was higher when the size of masses > 5 mm. Astigmatism vector analysis can intuitively show the differences between groups, the results are the same as refractive astigmatism.
CONCLUSION
Chalazia in children can easily lead to astigmatism, especially AR and OBL. Chalazia in the middle-upper eyelid, size ≥3 mm, and multiple chalazia (especially two masses) are risk factors of astigmatism. Invasive treatment should be performed promptly if conservative treatment cannot avoid further harm to the visual acuity due to astigmatism.
Topics: Astigmatism; Chalazion; Child; Eyelids; Humans; Multivariate Analysis; Refraction, Ocular
PubMed: 35842622
DOI: 10.1186/s12886-022-02529-1 -
Indian Journal of Ophthalmology Nov 2022The prevalence of blindness in India is 14.9 per 1000. Cataract causes 80% of this blindness. Most of these blinds are in the rural areas while the surgical service...
The prevalence of blindness in India is 14.9 per 1000. Cataract causes 80% of this blindness. Most of these blinds are in the rural areas while the surgical service delivery channels are concentrated in the urban areas. This situation has many social impacts like loss of productivity, breakdown of interpersonal relationships, depressive manifestations, loss of self-esteem, and isolated humiliating life. Manual small-incision cataract surgery (MSICS; also SICS) is a low-cost, small-incision, high-valued cataract surgery that is principally employed in the developing world. In poor settings, MSICS also has several distinct advantages over phacoemulsification, including shorter operative time, less need for technology, and lower cost. Ranjan MSICS Marker is a tool which enables MSICS to be done under topical anesthesia easily with more precise and safe incision making along with more control on surgery induced astigmatism.
Topics: Humans; Cataract Extraction; Astigmatism; Phacoemulsification; Cataract; Blindness
PubMed: 36308169
DOI: 10.4103/ijo.IJO_1696_22 -
Indian Journal of Ophthalmology Nov 2022Cataract remains a major cause of visual impairment worldwide including in India. The sutureless manual small-incision cataract surgery (MSICS) as an alternative to... (Review)
Review
Cataract remains a major cause of visual impairment worldwide including in India. The sutureless manual small-incision cataract surgery (MSICS) as an alternative to phacoemulsification, gives equivalent visual results at lower expenses. Still the procedure is often discredited for higher astigmatism due to the larger size of the incision. High astigmatism is an important cause of poor uncorrected visual acuity after cataract surgery. However, there are enough studies in the literature to prove that surgically induced astigmatism (SIA) can be minimized and also eliminated by adopting appropriate wound construction techniques during surgery. Even pre-existing astigmatism if any can be neutralized by changing wound architecture during surgery. Here, we review the various techniques of scleral tunnel construction described in the literature to care for postoperative astigmatism in MSICS.
Topics: Humans; Astigmatism; Cataract Extraction; Phacoemulsification; Lens Implantation, Intraocular; Cataract; Vision Disorders; Surgical Wound
PubMed: 36308097
DOI: 10.4103/ijo.IJO_1627_22 -
Investigative Ophthalmology & Visual... Sep 2022The purpose of this study was to investigate the short-term effect of imposing astigmatism on the refractive states of young adults.
PURPOSE
The purpose of this study was to investigate the short-term effect of imposing astigmatism on the refractive states of young adults.
METHODS
Nineteen visually healthy low-astigmatic young adults (age = 20.94 ± 0.37 years; spherical-equivalent errors [M] = -1.47 ± 0.23 diopters [D]; cylindrical errors = -0.32 ± 0.05 D) were recruited. They were asked to wear a trial frame with treated and control lenses while watching a video for an hour. In three separate visits, the treated eye was exposed to one of three defocused conditions in random sequence: (1) with-the-rule (WTR) astigmatism = +3.00 DC × 180 degrees; (2) against-the-rule (ATR) astigmatism = +3.00 DC × 90 degrees; and (3) spherical defocus (SPH) = +3.00 DS. The control eye was fully corrected optically. Before and after watching the video, non-cycloplegic autorefraction was performed over the trial lenses. Refractive errors were decomposed into M, J0, and J45 astigmatism. Interocular differences in refractions (treated eye - control eye) were analyzed.
RESULTS
After participants watched the video with monocular astigmatic defocus for an hour, the magnitude of the J0 astigmatism was significantly reduced by 0.25 ± 0.10 D in both WTR (from +1.53 ± 0.07 D to +1.28 ± 0.09 D) and 0.39 ± 0.15 D in ATR conditions (from -1.33 ± 0.06 D to -0.94 ± 0.18 D), suggesting an active compensation. In contrast, changes in J0 astigmatism were not significant in the SPH condition. No compensatory changes in J45 astigmatism or M were found under any conditions.
CONCLUSIONS
Watching a video for an hour with astigmatic defocus induced bidirectional, compensatory changes in astigmatic components, suggesting that refractive components of young adults are moldable to compensate for orientation-specific astigmatic blur over a short period.
Topics: Astigmatism; Humans; Lens, Crystalline; Refraction, Ocular; Refractive Errors; Vision Tests; Young Adult
PubMed: 36155745
DOI: 10.1167/iovs.63.10.15 -
Indian Journal of Ophthalmology Nov 2022: The study was conducted to calculate and compare the surgically induced astigmatism (SIA) in chevron, frown, and straight incisions in manual small-incision cataract...
PURPOSE
: The study was conducted to calculate and compare the surgically induced astigmatism (SIA) in chevron, frown, and straight incisions in manual small-incision cataract surgery (MSICS).
METHODS
A prospective, hospital-based study was conducted on 90 patients aged 50 years and above with nuclear sclerosis of grade 4 or more. Each group had 30 patients, divided into Group V (chevron incision), Group S (straight incision), and Group F (frown incision). Patients who had with-the-rule (WTR) astigmatism were operated on through a chevron or straight incision superiorly, while patients who had against-the-rule (ATR) astigmatism underwent MSICS through a temporal frown incision. The patients were followed up post-operatively on days 1, 7, 6 weeks, and 12 weeks, and at each visit, the uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and SIA were calculated and compared.
RESULTS
The mean age of all the patients was 66.22 ± 8.05 years. BCVA of at least 6/18 or better at 12 weeks post-operatively was achieved in 29 patients (97%) in Group V, 28 patients (93%) in Group F, and 29 patients (97%) in Group S. The mean SIA in Group V was 0.34D ± 0.22D, in Group S was 0.97D ± 0.29D, and in Group F was 0.575D ± 0.25D.
CONCLUSION
SIA by chevron incision is the least followed by the frown incision and straight incision. The superiorly placed chevron incision in WTR astigmatism provided optimal results for the best UCVA and minimal SIA. The temporal frown incision in ATR astigmatism also had good results.
Topics: Humans; Middle Aged; Aged; Astigmatism; Prospective Studies; Cornea; Cataract Extraction; Cataract; Surgical Wound; Phacoemulsification
PubMed: 36308115
DOI: 10.4103/ijo.IJO_1589_22