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PURPOSE: To evaluate the long-term visual outcome and intraocular (IOL) position parameters with a single-optic accommodating IOL after 5.5- or 6.0-mm femtosecond laser capsulotomy. METHODS: This prospective, randomized, pilot study comprised 17 eyes from 11 patients (7 men) with a mean age of 65.82±10.64 years (range: 51 to 79 years). All patients received a Crystalens AT-50AO (Bausch & Lomb) accommodating IOL after femtosecond laser refractive cataract surgery using either a 5.5-mm capsulotomy (5.5-mm group; 9 eyes) or 6.0-mm capsulotomy (6.0-mm group; 8 eyes). Near and distance visual acuities, manifest refraction spherical equivalent (MRSE), and IOL tilt and decentration were evaluated 1 year postoperatively. RESULTS: No significant differences were noted between groups for postoperative uncorrected distance visual acuity, uncorrected near visual acuity, distance-corrected near visual acuity, and MRSE. Vertical and horizontal tilt were significantly higher in the 6.0-mm group than in the 5.5-mm group ( P =.014 and P =.015, respectively). No significant difference was observed between groups regarding IOL decentration. CONCLUSIONS: A 5.5-mm capsulotomy created with a femtosecond laser is associated with less IOL tilt and therefore may be superior to a 6.0-mm capsulotomy when implanting a single-optic accommodating IOL.

PURPOSE: To evaluate corneal changes after corneal cross-linking (CXL) in progressive keratoconus with Scheimpflug imaging. METHODS: This prospective analysis included 40 eyes from 22 patients with progressive keratoconus. Corneal CXL was performed in 25 eyes (CXL group) and 15 fellow eyes served as controls (control group). Uncorrected (UDVA) and corrected distance visual acuity (CDVA), thinnest corneal thickness (ThCT), posterior elevation, and Holladay equivalent keratometry values (K1, K2) were determined with Pentacam (Oculus Optikgeräte GmbH) before and 1 year after CXL. Area under the receiver operator characteristic (ROC) curve and multivariable general estimating equation models were used to determine the most sensitive parameters of corneal changes. RESULTS: Manifest sphere (−2.55±3.21 to −1.48±2.39 diopters [D], P =.02), UDVA (0.23±0.25 to 0.31±0.25, P P =.019) improved significantly in the CXL group. Significant decreases were found in ThCT (472.53±33.18 to 440.53±38.67 μm, P P P P P >.05). According to ROC analysis, posterior elevation change was the most characteristic parameter of corneal change after CXL (area under the curve=0.99). General estimating equation model showed that CXL ( P =.001) and initial ThCT ( P =.007) were significant predictors of decrease in posterior elevation with a significant negative interaction of initial ThCT on CXL effect ( P =.005). CONCLUSIONS: Posterior elevation is a sensitive parameter to monitor corneal remodeling after CXL. Corneal CXL showed augmented effect on corneal protrusion in eyes with thinner corneas.

PURPOSE: To compare the effect of conventional phacoemulsification and femtosecond laser–assisted cataract surgery on the cornea using Scheimpflug imaging and noncontact specular microscopy. METHODS: In each group, 38 eyes (38 patients) underwent cataract surgery using either femtosecond laser–assisted (Alcon LenSx laser) (femtolaser group) or conventional phacoemulsification (phaco group). Central corneal thickness, 3-mm corneal volume, and Pentacam Nucleus Staging (PNS) were determined by a rotating Scheimpflug camera (Pentacam HR, Oculus Optikgeräte GmbH), and the volume stress index was calculated at 1 day and 1 month postoperatively. Endothelial cell count was measured by noncontact specular microscopy preoperatively, 1 day, 1 week, and 1 month postoperatively. RESULTS: Central corneal thickness was significantly higher in the phaco group (607±91 μm) than in the femtolaser group (580±42 μm) on day 1, but did not differ significantly preoperatively and at 1 week and 1 month. Volume stress index at day 1 was significantly lower in the femtolaser group than in the phaco group ( P CONCLUSIONS: Femtosecond laser–assisted cataract surgery causes less corneal swelling in the early postoperative period and may cause less trauma to corneal endothelial cells than manual phacoemulsification.

PURPOSE: To compare ocular and internal aberrations after femtosecond laser anterior capsulotomy and continuous curvilinear capsulorrhexis in cataract surgery. METHODS: In this prospective study, anterior capsulotomy was performed during cataract surgery with an intraocular femtosecond (FS) laser (Alcon LenSx Inc) in 48 eyes. As a control group, continuous curvilinear capsulorrhexis (CCC) was performed in 51 eyes. Wavefront aberrometry, corneal topography, and objective visual quality were measured using the OPD-Scan (NIDEK Co Ltd). Vertical and horizontal tilt, coma, and visual quality metrics were evaluated separately to determine whether the source of aberrations was ocular or internal. Main outcome measures included postoperative residual refraction, uncorrected and corrected visual acuities, ocular and internal aberrations, Strehl ratio, and modulation transfer function (MTF). RESULTS: No statistically significant differences were noted between the FS and CCC groups, respectively, in postoperative sphere (−0.60±1.50 vs −0.50±1.40 diopters [D]), postoperative cylinder (1.30±1.01 vs 1.10±1.10 D), uncorrected distance visual acuity (0.86±0.15 vs 0.88±0.08), or corrected distance visual acuity (0.97±0.08 vs 0.97±0.06). The FS group had significantly lower values of intraocular vertical tilt (−0.05±0.36 vs 0.27±0.57) and coma (−0.003±0.11 vs 0.1±0.15), and significantly higher Strehl ratios (0.02±0.02 vs 0.01±0.01) and MTF values at all measured cycles per degree, compared to the CCC group. CONCLUSIONS: Capsulotomy performed with an intraocular FS laser induced significantly less internal aberrations measured by the NIDEK OPD-Scan aberrometer compared to eyes that underwent CCC, which may result in better optical quality after the procedure.

PURPOSE: To measure and compare sizing and positioning parameters of femtosecond laser capsulotomy with manual continuous curvilinear capsulorrhexis (CCC). METHODS: Femtosecond capsulotomies (Alcon-LenSx Lasers Inc) and CCC were carried out in 20 eyes of 20 patients, respectively. Intraocular lens (IOL) decentration, circularity, vertical and horizontal diameters of capsulotomies, and capsule overlap were measured with Adobe Photoshop (Adobe Systems Inc) 1 week, 1 month, and 1 year after surgery. Between-group differences of parameters and predictors of IOL decentration were determined with repeated measures analysis of variance, chi-square test, and logistic regression analyses. RESULTS: Vertical diameter of CCC was statistically significantly higher in the first week and month. Significantly higher values of capsule overlap over 1 year and circularity in the first week showed more regular femtosecond capsulotomies. Horizontal IOL decentration was statistically significantly higher in the CCC group over 1 year. A significant difference was noted between the two groups in dichotomized horizontal decentration values at 0.4 mm with chi-square test after 1 week and 1 year ( P =.035 and P =.016, respectively). In univariable general estimating equation models, type of capsulorrhexis ( P P =.002) were significant predictors of horizontal decentration. Vertical diameter showed significant correlation to the overlap in the CCC group (1 week: r=−0.91; 1 month: r=−0.76, P P P >.05). CONCLUSIONS: More precise capsulotomy sizing and centering can be achieved with femtosecond laser. Properly sized, shaped, and centered femtosecond laser capsulotomies resulted in better overlap parameters that help maintain proper positioning of the IOL.