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PURPOSE: To evaluate the safety and efficacy of toric implantable Collamer lens (ICL) (STAAR Surgical) implanted at least 6 months after combined topography-guided photorefractive keratotomy (TG-PRK) and corneal cross-linking (CXL) in keratoconus. METHODS: This retrospective study included 46 eyes with keratoconus of 31 patients who underwent toric ICL implantation after previous TG-PRK+CXL. Patients were examined for uncorrected (UDVA) and corrected (CDVA) distance visual acuity, flat and steep keratometry, and manifest refraction spherical equivalent preoperatively and 12 months postoperatively. RESULTS: At 12 months postoperatively, there was a statistically significant improvement in visual and refractive outcomes (all P < .001). Mean UDVA improved to 0.17 ± 0.14 logMAR (vs 1.00 ± 0.38 logMAR preoperatively) and mean manifest refraction spherical equivalent improved to −0.32 ± 1.42 diopters (D) (vs −7.35 ± 5.20 D preoperatively). At 12 months, 63% of eyes achieved UDVA of 20/32 or better and 60.9% of eyes were within ±0.50 D of manifest refraction spherical equivalent. Mean refractive astigmatism improved from −2.90 ± 2.21 D preoperatively to −1.47 ± 1.46 D at postoperative 12 months ( P < .001), with 30.4% and 45.7% of eyes having a postoperative astigmatic error within ±0.50 and ±1.00 D, respectively. No complications were observed. CONCLUSIONS: Toric ICL implantation was found to be safe and effective for the correction of myopia and myopic astigmatism in patients with stable keratoconus who had undergone TG-PRK+CXL, as revealed by the statistically significant improvement in visual and refractive outcomes at 12 months after toric ICL implantation. [ J Refract Surg . 2021;37(12):824–829.]

PURPOSE: To evaluate the long-term refractive and visual stability and the risks related to the implantation of Implantable Collamer Lens (ICL; STAAR Surgical, Monrovia, CA) phakic intraocular lens (PIOL) for myopia. METHODS: This retrospective, consecutive, cumulative clinical study was performed in a group of 144 eyes implanted with ICL PIOL for myopia. Only the cases with clinical data available 12 years after the implantation were included in the series. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity, spherical equivalent, refractive astigmatism, endothelial cell density, ICL vaulting, and postoperative complications were analyzed. RESULTS: Mean spherical equivalent refraction was −16.90 ± 4.26 diopters (D) preoperatively and −1.77 ± 1.93 D 12 years postoperatively. Mean CDVA at the first and last visit were 0.31 ± 0.19 logMAR and 0.22 ± 0.22 logMAR, respectively (Mann–Whitney U test, P < .001). Twelve years postoperatively, 8.9% of eyes had lost more than two lines of CDVA. The incidence of clinically relevant cataracts (13.88%) was significantly linked to the use of the V3 model ICL (chi-square test, P = .007). During the follow-up period, a significant reduction in PIOL vaulting was observed (Kruskal–Wallis test, P < .05), and the mean endothelial cell density decreased by 19.75%. CONCLUSIONS: The ICL PIOL provided good refractive outcomes and stability in the long term. The incidence of cataracts is low when the latest models of this PIOL are used. [ J Refract Surg. 2015;31(8):548–556.]

PURPOSE: To investigate the effect of topical eye application of platelet-rich plasma (E-PRP) on the recovery of corneal sensitivity after LASIK and the anatomical recovery of the sub-basal corneal plexus as studied by confocal microscopy. METHODS: This was a randomized, consecutive, controlled, prospective and masked study on 108 myopic eyes receiving LASIK. The main variables of the study were the increase in corneal sensitivity (Cochet-Bonet aesthesiometer; Luneau, Paris, France) and the aspect of the sub-basal nerve plexus (confocal microscope). Additionally, a biomicroscopic study of the epithelial status of the cornea and a subjective questionnaire were completed. Each eye of each patient was assigned to one of two groups: 54 eyes treated with balanced saline solution and 54 fellow eyes receiving PRP drops for 3 months. RESULTS: No significant differences were detected when the corneal sensitivity thresholds were compared at any postoperative visit in both groups ( P > .05 for all comparisons). Almost identical sub-basal fiber densities were estimated for both groups before LASIK ( t test, P = .66). However, the type and severity of staining detected during the slit-lamp examinations at the first and third month postoperatively were significantly less evident in the E-PRP treatment group (Wilcoxon test, P < .05). CONCLUSIONS: PRP drops have beneficial effects for promoting epithelial status after LASIK but have no positive effect on recovery of corneal sensitivity, probably due to the limited bioavailability of growth factors in corneal stroma when the substance is topically administered.

PURPOSE: To compare visual, refractive, and clinical outcomes of foldable iris-fixated phakic intraocular lens (PIOL) implantation versus femtosecond laser–assisted LASIK for myopia between −6.00 and −9.00 diopters (D). METHODS: Forty-six myopic patients were randomized to undergo bilateral Artiflex (Ophtec BV) PIOL implantation or bilateral femtosecond laser–assisted conventional LASIK with the VISX S2 (Abbott Medical Optics). Refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, contrast sensitivity, corneal endothelial cell count, rate of retreatment, and complications were compared. RESULTS: Twelve months after surgery, no statistically significant differences were noted in spherical equivalent refraction ( P =.19) or UDVA ( P =.28), whereas CDVA was better in the PIOL group ( P P >.99). The percentage of eyes gaining lines of CDVA was significantly higher in the PIOL group (50.0% vs 8.7%; P P =.03) and 6 cpd ( P =.008). The LASIK eyes showed a mean endothelial cell count increase of 3.7%±2.8%, whereas PIOL eyes showed a mean decrease of 9.1%±2.0% ( P P =.37), and no serious complications occurred in either group. CONCLUSIONS: The Artiflex PIOL provided better CDVA and contrast sensitivity at high spatial frequencies than femtosecond laser–assisted conventional LASIK, suggesting that PIOL implantation is a reasonable option for myopia between −6.00 and −9.00 D.

Purpose: To report the impact on visual function and corneal aberrations during an epidemic of diffuse lamellar keratitis (DLK). Methods: A retrospective, comparative, and consecutive case-control study was performed, involving 418 eyes operated between March and October 2007 in the refractive surgery unit of one center. Eyes were separated into groups: group 1 (DLK group) included 209 eyes that presented with DLK after LASIK and group 2 (control group) included 209 unaffected, consecutive eyes operated from the beginning of the outbreak. Refractive variables and corneal aberrations were compared between the two groups. Results: Visual outcomes were significantly different when comparing control eyes and eyes with DLK grades 3 and 4, but not for eyes with DLK grades 1 and 2. Uncorrected distance visual acuity (UDVA) significantly improved from the third month after DLK was diagnosed (Kruskal-Wallis, P =.02). Corrected distance visual acuity (CDVA) did not decrease significantly with DLK grades 1 and 2 (preoperative CDVA vs 1, 3, and 6 months after diagnosis; Mann-Whitney, P >.05, respectively). At the end of follow-up, UDVA and CDVA were not significantly different between the two groups. Eyes suffering from DLK had significantly increased corneal aberrations, except for spherical and astigmatism aberrations, 3 months after being diagnosed (Kruskal-Wallis, P P >.05). Conclusions: The outbreak of DLK did not induce a significant decrease in global visual outcomes, except in severe cases, and postoperative corneal aberrations were not affected.

PURPOSE To report a patient with severe and progressive bilateral deafness who suffered recurrent episodes of diffuse lamellar keratitis (DLK) in both eyes ≥4 months after undergoing uneventful LASIK for myopia. METHODS Four months after LASIK, the patient presented with blurred vision in the left eye. Best spectacle-corrected visual acuity was 0.9. Slit-lamp examination revealed aggregates of white cells at the paracentral and mid-peripheral interface without affecting the visual axis. Diffuse lamellar keratitis stage II was diagnosed and intensive corticosteroid treatment was started. Uncorrected visual acuity (UCVA) in the right eye was 1.2 with no signs of DLK. RESULTS One week after initiating corticosteroid treatment, UCVA improved (1.2) in the left eye. Diffuse lamellar keratitis was diagnosed in the left eye again at 9 months and in the right eye at 15 months after LASIK. The patient was later diagnosed with atypical Cogan’s syndrome. CONCLUSIONS Recurrent and late-onset DLK may be due to other patient systemic conditions predisposing to interstitial keratitis, such as Cogan’s syndrome. [J Refract Surg. 2008;24:548-550.] ABOUT THE AUTHORS From the Department of Cornea and Refractive Surgery, VISSUM, Instituto Oftalmológico de Alicante, Miguel Hernández University School of Medicine, Alicante, Spain (Javaloy, Muñoz, Pérez-Santonja, Vidal, Alió); and Otorhino-Laringology Department, Fundación Hospital de Torrevieja, Torrevieja, Spain (Barrera). The authors have no proprietary interest in the materials presented herein. Correspondence: Jaime Javaloy, MD, PhD, Instituto Oftalmológico de Alicante, Avda Denia, sn. Edificio VISSUM, Alicante, Spain. Tel: 34 965 150 025; E-mail: jjavaloy@coma.es; rdioa@vissum.com Received: June 13, 2007 Accepted: November 7, 2007 Posted online: January 31, 2008

PURPOSE: To compute and compare anterior corneal aberration changes following hyperopic LASiK using two different excimer lasers: the VISX Star S2 and the AsclepionMeditec MEL 70 G Scan. METHODS: The right eyes of 43 patients with preoperative refraction ranging from +0.75 to +5.50 diopters (D) and astigmatism ranging from 0.00 to 1.00 D were randomly divided into two groups. The first group was operated with the Star S2, a broad -beam excimer laser (n=22), and the second group with the MEL 70, a flying-spot excimer laser (n=21). Total higher order aberrations (Z^sup i^^sub n^, n≥3), coma (Z^sup ±1^ 3 , Z^sup ±1^ 5 ), and spherical aberration (Z^sup o^ 4 ) values were computed from videokeratography using CTView software preoperatively and 6 months postoperatively, for 3.0- and 6.5-mm aperture diameters. RESULTS: Higher order aberrations, coma, and spherical aberration increased after hyperopic LASIK and were greater for larger pupil diameters in both groups. No statistically significant differences were found between the Star S 2 and MEL 70 excimer lasers in terms of aberrometric increase, mean postoperative visual acuity, and residual refraction. CONCLUSIONS: Anterior corneal aberrations increase after hyperopic LASIK. The type of laser (Star S2 versus MEL 70) seems to have no impact on the amount of anterior corneal aberrations induced after hyperopic LASIK. [J Refract Surg. 2006;22:34-42.]