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PURPOSE To compare the long-term safety, efficacy, and complications of small-incision lenticule extraction (SMILE) and flexible iris-fixated anterior chamber phakic intraocular lens (pIOL) implantation for the treatment of high myopia. SETTING University of Health Science Turkey, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN Retrospective comparative case series. METHODS Data of patients who underwent SMILE or pIOL (Artiflex) implantation for myopia were retrospectively reviewed. Only patients with preoperative manifest refraction spherical equivalent from -6.00 to -10.00 diopters (D) were included in the study. RESULTS There were 47 eyes of 32 patients in the SMILE group and 52 eyes of 29 patients in the pIOL group. The mean postoperative follow-up was 63.75 ± 18.40 months in the SMILE group and 65.38 ± 16.22 months in the p-IOL group (P = .71). At 6 years postoperatively, refractive predictability was slightly better in the pIOL group, and the percentages of eyes within ±0.50 D of the attempted correction were 77% and 83% in the SMILE and pIOL groups, respectively. Although mean uncorrected distance visual acuity was comparable (SMILE, 0.12 ± 0.06 logarithm of the minimum angle of resolution [logMAR]; p-IOL, 0.09 ± 0.05 logMAR), the safety indices (1.08 ± 0.22 vs 1.11 ± 0.20; P = .02) and the efficacy indices (0.92 ± 0.24 vs 1.11 ± 0.22; P = .03) were statistically significantly higher after pIOL implantation. Despite a mean of 11.09% of the endothelial cell being lost at 6 years after pIOL implantation, no pIOL was explanted due to endothelial cell loss. CONCLUSIONS In this comparative and long-term study, iris-fixated anterior chamber pIOL implantation for high myopic correction showed slightly better safety and efficacy profiles but with statistically significant endothelial cell loss.

Attention is usually given to inferior steepening on corneal topography in the evaluation of a patient’s suitability for LASIK surgery. The aim of this study is to investigate long-term refractive results with superior steepening. Patients who underwent LASIK surgery between 2015 and 2019 in our refractive surgery department were retrospectively reviewed. The patients with a ≥ 1.0 D superior–inferior (S–I) quadrant difference in the tangential map, using a Scheimpflug camera with a Placido disc topographer (Sirius), were included in the study. Preoperative and postoperative best-corrected and uncorrected visual acuity (Snellen), cylindrical refraction values, and spherical equivalent (SE) values were compared. Adverse events were recorded. Fifty eyes of 28 patients participated in the study. The mean age of the patients was 27.5 ± 8.0 (19–59). Sixteen patients were female (57.1%), and 12 (42.8%) patients were male. The average follow-up time was 29.8 ± 11.1 months (12–61). Average central corneal thickness was 549.4 ± 26.0 (498–602) μm. Average minimal corneal thickness was 549.1 ± 26.9 (497–598) μm. Preoperative S–I quadrant difference (D) was 1.87 ± 0.7 (1.0–3.99). Posterior elevation (Kvb) was 11.2 ± 1.9 (9–17) μm. The preoperative SE value was − 1.7 ± 2.1 (− 6.25–3.25) and improved to − 0.3 ± 0.44 D (− 1.25–0.75) (p

Purpose To evaluate long-term clinical results of 2 different accelerated corneal crosslinking (CXL) protocols in pediatric patients with keratoconus. Setting Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. Design Retrospective case-control study. Methods Patients who were younger than 18 years were included in the study. Group 1 received 4 minutes of illumination at 30 mW/cm, and Group 2 received 5 minutes of illumination at 18 mW/cm. Uncorrected and corrected distance visual acuities, manifest refraction, corneal topographic parameters, and corneal higher-order aberrations (HOAs) were evaluated at baseline and during 1-, 3-, and 5-year follow-up visits. Results A total of 143 eyes from 86 patients were included in the study. There were 30 eyes in Group 1 and 113 eyes in Group 2. The mean follow-up time was 4.15 ± 0.99 years. Mean keratometry (K) and/or maximum K progressed ≥1.00 diopter (D) in 7 eyes (23.3%) in Group 1 and 19 eyes (16.8%) in Group 2 (P = .411). Mean K and/or maximum K decreased ≥2.00 D in 2 eyes (6.7%) in Group 1 and 24 eyes (21.2%) in Group 2 (P = .06). In Group 1, there were no statistically significant differences in topographic parameters during follow-up. In Group 2, there was a statistically significant reduction in total HOA and coma during the 5-year visit when compared with the preoperative visit (P = .005 and P = .045, respectively). Conclusions Accelerated CXL is beneficial in terms of halting the progression of keratoconus in pediatric patients throughout 5 years of follow-up examinations. An increased irradiance with a reduced application time reduces the topographic effects of CXL.

Summary Purpose To report anatomical and functional outcomes of pars plana vitrectomy (PPV) for recurrent retinal detachment (RD) after failed scleral buckling (SB) or primary PPV. Methods Retrospective analysis of 59 eyes with recurrent RD treated previously with SB or PPV was performed. All eyes underwent 23 gauge PPV. The primary outcome was single surgery success rate (SSSR) for retinal reattachment at the final visit. Secondary outcomes were visual acuity change and number of reoperations. Results SSSR was 77.4 % in the SB group and 67.9 % in the PPV group ( P = 0.41). The mean change in visual acuity was not significantly different between the two groups ( P = 0.35). The mean number of reoperations was 1.2 ± 0.5 and 1.4 ± 0.6 in the SB and PPV groups, respectively ( P = 0.38). Conclusion PPV was found to be an effective technique for the management of recurrent RD after SB and PPV surgeries. However, the small sample size and the retrospective design prevent any claims of advantages or disadvantages of one surgical technique over the other.

Purpose: To assess the role of inflammation in the pathogenesis of idiopathic epiretinal membrane (iERM) using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as indicators of inflammation and to compare these parameter levels between iERM and control subjects. Methods: We retrospectively analyzed the medical records of 36 patients who underwent vitrectomy-ERM peeling and 39 patients who had cataract surgery. We obtained blood samples from all individuals who participated in the study to investigate these parameters. Results: Seventy-five subjects were included in this study: 36 in the iERM group and 39 in the control group. The mean neutrophil and MPV levels were significantly higher in iERM subjects than in control subjects. The mean lymphocyte level was lower in the iERM group. The mean NLR, PLR, and MPV levels were higher in iERM subjects than in control subjects. Conclusion: The higher NLR, PLR, and MPV levels found in patients with iERM may indicate that subclinical systemic inflammation may associate with iERM.

Introduction: To evaluate the visual and refractiveoutcomes after implantation of a monofocal aspheric yellowchromophore intraocular lens (Eyecryl Plus ASHFY600, BiotechVision Care Pvt. Ltd., Ahmedabad, India).Methods: Medical records of patients, who underwentcataract surgery and had intraocular lens implantation,were retrospectively analyzed. One eye of each patient wasevaluated. Subjective manifest refraction and visual acuityresults at 1 week and 1, 3 and 6 months, and intraoperativeand postoperative complications were analyzed.Results: Forty-nine eyes (25 right and 24 left) of 49 patients(31 male and 18 female) were included in the study, Atpostoperative week 1, best corrected distance visual acuity(CDVA) was significantly increased and within an acceptablerange. Uncorrected distance visual acuity (UDVA) and bestCDVA were stabilized at the 1st month examination, and therewas no significant difference in visual acuity between the1st month and the 3rd and 6th month examinations. The bestCDVA and UDVA at 6th months were 20/25 or better in 93% and79% of patients, respectively. The spherical equivalent of themanifest refraction was within ± 1.00 D emmetropia in 96% ofthe patients. No complication occurred during or after surgery.Conclusion: CDVA and UDVA and postoperative refractiveresults were similar to non-chromophore lenses. Theimplantation of the Eyecryl Plus ASHFY600 intraocular lens hasbeen evaluated as effective and safe. Amaç: Sarı kromoforlu, mor ışığı kısmen filtre eden, asferik monofokal bir göz içi lensinin (Eyecryl Plus ASHFY600, Biotech Vision Care Pvt. Ltd., India) klinik sonuçlarını değerlendirmektir. Yöntemler: Katarakt cerrahisi geçirip cerrahi sonunda Eyecryl Plus ASHFY600 model intraoküler lens implantasyonu uygulanan hastaların dosyaları retrospektif olarak incelendi. Her hastanın bir gözü çalışma kapsamında değerlendirildi. Birinci hafta, 1. ay, 3. ay ve 6. ay muayenelerindeki subjektif manifest refraksiyon ve görme keskinliği sonuçları ile intraoperatif ve postoperatif komplikasyonlar analiz edildi. Bulgular: Kırk dokuz hastanın 49 gözü çalışma kapsamına alındı (25 sağ göz ve 24 sol göz, 31 erkek ve 18 kadın). Ameliyat sonrası 1. hafta muayenesinde en iyi düzeltilmiş uzak görme keskinliği anlamlı derecede artmış ve kabul edilebilir derecedeydi. Düzeltilmemiş ve en iyi düzeltilmiş görme keskinlikleri 1. ay muayenesinde stabilize olmuştu ve 1. ay muayenesi ile 3. ve 6. ay muayeneleri arasında görme keskinlikleri açısından anlamlı fark yoktu. Altıncı ayda düzeltilmemiş ve en iyi düzeltilmiş görme keskinlikleri hastaların sırasıyla %79 ve %93’ünde 20/25 veya daha iyiydi. Manifest refraksiyonun sferik eşdeğeri hastaların %96’sında ±1,00 D emetropi aralığındaydı. Hiçbir hastada ameliyat esnasında veya sonrasında komplikasyon gelişmedi. Sonuç: Düzeltilmiş ve düzeltilmemiş görme keskinlikleri ve ameliyat sonrası refraktif sonuçlar kromoforsuz lenslerle benzer olarak tespit edilmiştir. Eyecryl Plus ASHFY600 göz içi lensinin implantasyonu etkili ve güvenli olarak değerlendirilmiştir.

PURPOSE: To compare the area of the superficial foveal avascular zone (SFAZ) and deep foveal avascular zone (DFAZ) between patients with nanophthalmos and age matched controls. METHODS: This prospective and comparative study included 19 eyes from 11 patients with nanophthalmos (study group) and 19 eyes from 19 healthy subjects (control group). SFAZ and DFAZ were measured with optical coherence tomography angiography (OCT-A). All participants underwent a standardised ocular examination including best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT) anterior chamber depth (ACD), axial length (AL), and refractive error (RE) measurements. RESULTS: Mean SFAZ and DFAZ area in the nanophthalmic eyes and in the control eyes were 0.09 ± 0.12 mm(2), 0.10 ± 0.10 mm(2) and 0.37 ± 0.10 mm(2), 0.37 ± 0.10 mm(2) respectively (p

Objectives: To evaluate the real-world outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in neovascular age-related macular degeneration (nAMD) patients. Materials and Methods: Multicenter, retrospective, interventional, non-comparative study. The records of nAMD patients treated with an anti-VEGF agent on a pro re nata treatment regimen basis between January 2013 and December 2015 were reviewed. The patients who completed a follow-up period of 12 months were included. Primary outcome measures of this study were the visit and injection numbers during the first year. Results: Eight hundred eighty eyes of 783 patients met the inclusion criteria for the study. Mean number of visits at month 12 was 6.9±2.5 (range: 1-15). Mean number of injections at month 12 was 4.1±1.9 (range: 1-11). Mean visual acuity at baseline and months 3, 6, and 12 was 0.90±0.63 LogMAR (range: 0.0-3.0), 0.79±0.57 LogMAR (range: 0.0-3.0), 0.76±0.57 LogMAR (range: 0.0-3.0), and 0.79±0.59 LogMAR (range: 0.0-3.0), respectively. Mean central retinal thickness at baseline and months 6 and 12 was 395±153 μm (range: 91-1582), 330±115 μm (range: 99-975), and 332±114 μm (range: 106-1191), respectively. Conclusion: The numbers of visits and injections were much lower than ideal and were insufficient with the pro re nata treatment regimen.

Purpose: To compare the efficacy and complications associated with higher viscosity (5000-centistoke) versus lower viscosity (1000-centistoke) silicone oil in traumatic retinal detachment surgery. Material and methods: Patients who underwent 23-gauge pars plana vitrectomy using 1000- or 5000-centistoke silicone oil to treat retinal detachment associated with traumatic globe injury were retrospectively analysed. Anatomical and visual outcomes were compared. Results: Forty-four eyes of 44 patients were included in the study, which included 22 eyes in each group. Patients were significantly younger in the 5000-centistoke group compared to the 1000-centistoke group (median: 22 vs. 54 years old, respectively, p 5/200) at the final follow-up visit was more common in the 1000-centistoke group compared to the 5000-centistoke group (55% vs. 9%, respectively, p

Macular telangiectasia type 2 (Mac Tel 2) is a bilateral disease of unknown cause with characteristic changes of the retinal vasculature. To the best of our knowledge, we could not find any reported cases of Mac Tel 2 with retinal arterial macroaneurysm (RAM). Our aim is to report a case of Mac Tel 2 with RAM.

INTRODUCTION[|]The aim of the present study was to report the outcomes of pars plana lensectomy (PPL) combined with pars plana vitrectomy (PPV) in traumatic ectopia lentis performed at a tertiary eye hospital.[¤]METHODS[|]Patients who underwent PPL combined with PPV for surgical management of traumatic lens subluxation/dislocation in the clinic were retrospectively evaluated. Only patients with at least 6 months follow-up were included in the study.[¤]RESULTS[|]Sixteen eyes of 16 patients were included in the study. Of the total, 94% of the patients were male and 6% were female. The mean age of the patients was 41+-17 years. The mean length of follow-up was 9+-5 months. At presentation, 19% of the patients had intravitreal hemorrhage and 38% had retinal detachment. Preoperatively, 19% of the patients had 5/200 or better visual acuity. At the final visit, visual acuity was 'hand motion' or better in all patients, and 38% of the patients had 5/200 or better visual acuity. Visual acuity was stable or improved in all patients. Anatomical success was achieved in all patients who had retinal detachment preoperatively.[¤]DISCUSSION AND CONCLUSION[|]PPL combined with PPV is a safe and effective method of surgical management of traumatic ectopia lentis; however, the associated pathologies determine the final visual outcome and preoperative visual acuity is the most important prognostic factor.[¤]

AIM: To compare two different anti-vascular endothelial growth factor (anti-VEGF) treatment regimens'-a priori pro re nata (PRN) and PRN regimen following the loading phase-anatomical and functional results in neovascular age-related macular degeneration (nAMD) patients. METHODS: Totally 544 nAMD patients followed and treated with aflibercept (n=135) and ranibizumab (n=409) at 9 different centers between 2013 and 2015 were enrolled into this retrospective multicenter study. Patients with initial best corrected visual acuity (BCVA) interval of 1.3-0.3 (logMAR) and a minimum follow-up of 12mo were included. Patients under two different regimens-a priori pro re nata (1+PRN) or 3 consecutive intravitreal injections followed by a PRN regimen (3+PRN)-were compared in BCVA at 3(th), 6(th) and 12(th) months, and in central macular thickness (CMT) at 6(th) and 12(th) months. The total study group, intravitreal ranibizumab (IVR) and intravitreal aflibercept (IVA) groups were evaluated separately. RESULTS: The mean CMT decreased in the 1+PRN (n=101) regimen from 407 to 358 and 340 µm and in the 3+PRN (n=443) group from 398 to 318 and finally to 310 µm at months 6 and 12, respectively. Anatomically, the CMT reduction at 6(th) month (48.5 vs 76.4; P

Polypoidal choroidal vasculopathy (PCV) is seen with polypoidal lesions and branching vascular networks (BVNs) (Spaide et al. in Retina 15(2):100-110, 1995; Yannuzzi et al. in Retina 10(1):1-8, 1990). There are reports about laser photocoagulation for PCV (Yuzawa et al. in Japan J Ophthalmol 47(4):379-384, 2003; Lee et al. in Eye 23(1):145-148, 2009); however, all these reports are about final vision and frequent relapses. Therefore, this treatment merits rigorous scrutiny using optical coherence tomography angiography (OCTA).

INTRODUCTION[|]The aim of this study was to describe clinical findings as well as spectral-domain optical coherence tomography (SD-OCT), fundus fluorescein angiography (FA), and indocyanine green angiography (ICGA) findings of polypoidal choroidal vasculopathy (PCV).[¤]METHODS[|]This retrospective, observational case series included 144 eyes of 103 patients who were diagnosed with PCV between January 2014 and August 2016. Best corrected visual acuity, 90-diopter lens slit-lamp fundus biomicroscopy examination findings, color fundus photography, SD-OCT, FA, and ICGA findings were evaluated at the time of diagnosis.[¤]RESULTS[|]Sixty-six patients (93 eyes, 64.1%) were male and 37 (51 eyes, 35.9%) were female. Sixty-two (60.2%) patients had unilateral involvement. The most common SD-OCT finding was retinal pigment epithelial detachment (PED). Red-orange subretinal lesions were seen in 20 eyes (13.9%). There was a single polyp in 21 (14.6%) eyes, and more than 1 polyp in 123 (85.4%) eyes observed with ICGA imaging. The polyps were located in the peripapillary area in 10 (6.9%) eyes, the macular area in 91 (63.2%) eyes, and the extramacular area in 1 (0.7%) eye. A significant branching vascular network was seen in the ICGA images of 112 (77.8%) eyes.[¤]DISCUSSION AND CONCLUSION[|]In this study, the majority of patients were male, with unilateral macular polyps. A serous PED and an exudative pattern were the most common clinical manifestations. SD-OCT showed specific findings for PCV, but ICGA was the most useful test for diagnosis.[¤]

Small-incision lenticule extraction (SMILE) is an alternative to laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) for the correction of myopia and myopic astigmatism. SMILE can be performed for the treatment of myopia ≤-12 D and astigmatism ≤5 D. The technology is currently only available in the VisuMax femtosecond laser platform. It offers several advantages over LASIK and PRK; however, hyperopia treatment, topography-guided treatment, and cyclotorsion control are not available in the current platform. The working principles, potential advantages, and disadvantages are discussed in this review.

PURPOSE: To compare the refractive outcomes of small incision lenticule extraction (SMILE) with photorefractive keratectomy (PRK) using an aberration-free ablation profile. METHODS: One eye of patients diagnosed as having myopia for bilateral refractive correction was randomly allocated to either PRK or SMILE. The primary outcome measures included refractive efficacy, predictability, safety, stability, corneal aberrations, and adverse events. Patients were followed up for 1 year postoperatively; postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, and corneal aberrations were recorded and compared with preoperative data. RESULTS: Thirty-nine patients in the PRK group and 35 patients in the SMILE group completed the study. The mean preoperative spherical equivalent refractions were −3.27 ± 0.62 diopters (D) for the PRK group and −3.56 ± 1.12 D for the SMILE group. The average postoperative spherical equivalent refractions were −0.26 ± 0.29 and −0.43 ± 0.38 D for the PRK and SMILE groups, respectively ( P = .06). Total higher order aberrations in the 6-mm central corneal zone were significantly higher in the SMILE group (0.21 ± 0.10 µ m) than in the PRK group (0.09 ± 0.03 µ m) ( P = .01) 12 months postoperatively. However, no statistically significant differences were found among spherical, trefoil, and coma aberrations between the groups. CONCLUSIONS: The refractive results of PRK with aberration-free aspheric ablation are similar to those of SMILE in eyes with low myopia. The induction of coma, spherical, and trefoil aberrations did not statistically differ after both surgeries, but the total higher order aberrations after SMILE were significantly higher than PRK with aberration-free aspheric ablation. [ J Refract Surg. 2016;32(9):604–610.]

Summary Purpose To investigate retinal nerve fiber layer (RNFL) thickness, anterior lamina cribrosa depth (ALD) and laminar thickness (LT) in eyes with angioid streaks (AS) in comparison with healthy eyes. Methods Patients with AS ( n = 32 eyes) and age-matched healthy subjects (n = 42 eyes) underwent enhanced depth imaging with spectral domain optical coherence tomography of the optic nerve head. RNFL thickness was obtained automatically by using the Heidelberg software. The ALD was defined as the vertical distance between the Bruch's membrane openings as reference plane and the anterior border of the lamina cribrosa. The LT was measured as the distance between the anterior and posterior borders of the lamina cribrosa. RNFL thickness, ALD and LT were compared between the AS and healthy eyes adjusting for axial length. Results The mean age was 51.7 ± 8.0 years for AS patients and 53.8 ± 10.2 years for control subjects (P = 0.34). The mean RNFL thickness was 88.6 ± 17.6 μm in AS eyes and 102.1 ± 8.3 μm in control eyes; the difference between the groups was significantly significant. ALD was 350.9 ± 70.8 μm in AS eyes and 432.5 ± 82.1 μm in control eyes, while LT was 166.3 ± 41.0 μm in AS eyes and 241.3 ± 43.2 μm in control eyes. ALD and LT were also significantly thinner in AS eyes than control eyes (P = 0.003, P Conclusion Enhanced depth imaging revealed that eyes with AS demonstrate thinner RNFL, ALD and LT compared with normal eyes. Further studies with a larger sample size are needed to understand the relationship between these findings and the morphologic changes and pathogenesis of AS.

Purpose. To compare refractive stability, central endothelial cell density (ECD), and complications between Verisyse (Abbott Medical Optics, Netherlands) and Veriflex (Abbott Medical Optics, Netherlands) phakic intraocular lenses (pIOL) over five years.Methods. We retrospectively reviewed the medical records of patients who underwent Verisyse or Veriflex pIOL implantation for surgical correction of myopia. Patients with a 5-year follow-up period were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent of manifest refraction (SE), and ECD were compared between the groups preoperatively and 1, 3, and 5 years postoperatively.Results. The study included 47 eyes in the Verisyse group and 50 eyes in the Veriflex group. There was no significant difference in mean SE, UDVA, CDVA, and ECD preoperatively or postoperatively. In both groups, there was a statistically significant myopic shift between 1-year and 5-year visits (−0.25 ± 0.30 D and −0.23 ± 0.48 D in the Verisyse and Veriflex groups, respectively). There was no significant difference between the groups in terms of efficacy and safety indexes at 5 years. ECD loss was highest during the first year (3.9% loss in the Verisyse group and 3.9% loss in the Veriflex group,p=0.670). At 5 years, the mean cumulative ECD losses in the Verisyse and Veriflex groups were 7.42% and 7.64%, respectively (p=0.709). Cataracts developed in 2.1% of the eyes in the Verisyse group and in 2.0% of those in the Veriflex group. No sight-threatening complications were observed.Conclusion. Verisyse and Veriflex pIOLs are highly effective for treating high myopia up to 5 years after surgery. Longitudinal studies with longer follow-up periods are necessary to determine the endothelial safety profile.

Purpose To report long-term efficacy and safety of small-incision lenticule extraction (SMILE) in patients with mild-to-moderate myopia. Setting Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. Design Retrospective case series. Methods Medical records of patients who had SMILE for surgical correction of myopia or myopic astigmatism were retrospectively reviewed. Patients with a preoperative spherical equivalent (SE) of manifest refraction of 6.00 D or less and a 5-year follow-up period were included in the study. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities and SE were analyzed preoperatively and at 1 year, 3 years, and 5 years postoperatively. Results The study comprised 54 eyes (34 patients). The mean SE of the intended correction was −4.11 diopters (D) ± 0.98 (SD) and ranged from −1.38 to −5.88 D. The mean preoperative UDVA and CDVA were 1.08 ± 0.29 logarithm of the minimum angle of resolution (logMAR) and 0.02 ± 0.08 logMAR, respectively. At the 5-year follow-up, the mean difference between the intended and achieved SE was −0.13 ± 0.29 D. The mean postoperative UDVA and CDVA were 0.04 ± 0.09 logMAR and 0.00 ± 0.04 logMAR, respectively. At the 5-year follow-up, the SE was within ±0.50 D of the intended correction in 32 (93%) of the 34 patients and within ±1.00 D of intended correction in all patients. The SE at the 5-year follow-up was within ±0.50 D of the 1-year visit in 33 (98%) of all patients. No patient lost CDVA lines, and no vision-threatening events occurred during the surgery or the postoperative period. Conclusions SMILE in mild-to-moderate myopia offers predictable correction of SE refractive error. Refractive results were stable at the long-term follow-up.

Purpose. We report the clinical characteristics, prognostic factors, and surgical outcomes for 23-gauge pars plana vitrectomy (23-G PPV) in pediatric cases of traumatic retinal detachment (RD). Methods. Medical records of pediatric patients who underwent 23-G PPV to treat traumatic retinal detachment were retrospectively reviewed. These patients underwent a follow-up examination at least 1 year following surgery. Associations between various preoperative factors and anatomical and visual outcomes were analyzed. An Ocular Trauma Score (OTS) and a Pediatric Ocular Trauma Score (POTS) were calculated for each patient. Raw scores were converted to their corresponding OTS and POTS categories. Final visual acuities by categories were compared with those in the OTS and POTS studies. Results. The mean age of the patients was 9 ± 4 years, and the male-to-female ratio was 4.7 : 1. The mean follow-up time was 23 ± 14 months. Anatomical success was achieved in 72% of the eyes, and functional success (>5/200) was achieved in 37% of the eyes. Functional success was less common among patients with visual acuities less than hand motion, macula-off retinal detachment, proliferative vitreoretinopathy at presentation, and recurrent retinal detachment during follow-up. When we compared the categorical distribution of final visual acuities in all categories, our results were significantly different than those suggested by OTS and POTS. Conclusions. Visual outcomes are poorer compared to anatomical outcomes. OTS and POTS do not provide reliable prognostic information if the patient has RD. Presenting visual acuity, the presence of macula-off RD, and PVR are all important predictors of final visual acuity.

PURPOSE: To compare postoperative corneal nerve fiber regeneration after small incision lenticule extraction (SMILE) and femtosecond laser-assisted LASIK (FS-LASIK). METHODS: The medical records of patients who underwent SMILE were retrospectively reviewed. Patients with SMILE in one eye (the SMILE group) and FS-LASIK in the fellow eye (the FS-LASIK group) and who had undergone a confocal microscopy study were retrospectively identified. Subbasal nerve fiber density was measured and compared between the groups preoperatively and at 1 week and 1, 3, and 6 months postoperatively. RESULTS: Thirty eyes of 15 patients were included in the study. Preoperative characteristics of the eyes were similar between the groups. However, there was a statistically significant difference in subbasal nerve fiber density between the groups at 1 month (SMILE group: 1,505 ± 627 µ m/mm 2 [range: 625 to 2,540 µ m/mm 2 ], FS-LASIK group: 1,107 ± 509 µ m/mm 2 [range: 595 to 2,313 µ m/mm 2 ], P = .003) and 3 months (SMILE group: 1,534 ± 503 µ m/mm 2 [range: 650 to 2,255 µ m/mm 2 ], FS-LASIK group: 1,194 ± 485 µ m/mm 2 [range: 530 to 1,695 µ m/mm 2 ], P = .004) postoperatively. No statistically significant difference was detected at 1 week and 6 months postoperatively. CONCLUSION: Eyes treated with SMILE have a higher density of subbasal nerve fibers than eyes treated with FS-LASIK in the early postoperative period (1 week to 3 months) but the two procedures are equivalent by 6 months postoperatively. [ J Refract Surg. 2015;31(9):594–598.]

Purpose. To report long-term visual and refractive results of small-incision lenticule extraction (SMILE) in treatment of high myopia. Materials and Methods. Medical records of patients who underwent SMILE for surgical correction of myopia or myopic astigmatism were retrospectively reviewed. Only patients with a preoperative spherical equivalent of subjective manifest refraction (SE) ≥ 6 D and a postoperative follow-up of 5 years were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and SE were analyzed preoperatively and at 1-, 3-, and 5-year postoperative periods. Results. Thirty-seven eyes of 37 patients were included in the study. The mean attempted SE was −7.47 ± 1.10 D (range −6.00 to −10.00 D). At the 5-year visit, the mean difference between achieved and attempted SE was −0.43 ± 0.47 (0.50 to −1.25 D). Mean postoperative UDVA and CDVA were 0.20 ± 0.18 and 0.06 ± 0.08 logMAR, respectively. At the 1-year visit, 70% and 97% of the eyes were within ±0.50 D and ±1.00 D of the intended correction. At the 5-year follow-up, 59% and 92% percent of the eyes were within ±0.50 D and ±1.00 D of the intended SE, respectively. At the 5-year visit, the efficacy index was 0.89 ± 0.26 and the safety index was 1.16 ± 0.20. Fifty-four percent of the eyes gained one or more lines of CDVA. Conclusion. SMILE with an intended correction of up to a spherical equivalent of 10 D is safe and effective. However, there is regression of the refractive effect over extended follow-up.

Purpose. To evaluate the visual, refractive, and topographic outcomes after simultaneous topography-guided transepithelial photorefractive keratectomy (transepithelial TG-PRK) using the Amaris Excimer laser platform and accelerated corneal cross-linking (CXL) in eyes with keratoconus.Materials and Methods. Patients with 2 years of follow-up were included in this retrospective case series. Manifest refraction (MR), uncorrected (UDVA) and corrected (CDVA) distance visual acuity, corneal topography, and pachymetry were evaluated at 1, 3, 6, 12, and 24 months after surgery. The root-mean-square of total higher-order aberrations (total HOA-RMS), coma (Coma-RMS), and spherical aberration (SA-RMS) were calculated for 4- and 6-mm diameters.Results. Forty-six eyes of 46 patients were included in the study. Stromal ablation was ≤50μin all patients. MR was −3.78±3.26 preoperatively and −1.39±1.82 postoperatively. Significant improvements were seen in the UDVA and Coma-RMS values at 1 month, CDVA and total HOA-RMS values at 3 months, and SA-RMS values at 1 year compared to preoperative levels. UDVA values further improved after 2 years, compared to the 1-year values. No patient lost two or more lines and keratoconus progression was not observed in any patient.Conclusion. Simultaneous transepithelial TG-PRK and accelerated CXL resulted in significant gains in CDVA without compromising CXL efficacy.

Purpose To compare postoperative visual acuity and higher-order aberrations (HOAs) after femtosecond lenticule extraction (FLEX) and after small-incision lenticule extraction (SMILE). Methods Medical records of refractive lenticule extraction patients were retrospectively reviewed. Twenty patients were treated with FLEX. A comparable group of 20 SMILE patients were retrospectively identified. Only one eye of each patient was randomly chosen for the study. Visual acuity, subjective manifest refraction and corneal topography before and 6 months after the surgery were analyzed for both groups. Total HOAs, spherical aberrations, coma and trefoil were calculated from topography data over the 4- and 6-mm-diameter central corneal zone. Results The mean preoperative SE was −4.03 ± 1.61 in the SMILE group and −4.46 ± 1.61 in the FLEX group. One year after surgery, the mean SE was −0.33 ± 0.25 in the SMILE group and −0.31 ± 0.41 in the FLEX group (p = 0.86). In the SMILE group a greater number of eyes were within ±0.50 D of the target refraction (95% versus 75%); however, the difference was not statistically significant (p = 0.18). Furthermore, 80% of FLEX eyes and 95% of SMILE eyes had an uncorrected distance visual acuity of 20/25 or better (p = 0.34). Total HOAs, spherical aberration, coma and trefoil increased postoperatively in both groups. However, there was no statistically significant difference between the groups preoperatively and postoperatively. Conclusion FLEX and SMILE result in comparable refractive results. In addition, corneal aberrations induced by different techniques of lenticule extraction seemed similar to each other.

Purpose. To compare the efficacy of intravitreal bevacizumab versus ranibizumab in the treatment of neovascular age-related macular degeneration (nAMD). Methods. Retrospective, comparative study. The newly diagnosed nAMD patients who were treated with intravitreal bevacizumab or ranibizumab on an as-needed treatment regimen were included in the study. Main outcome measures were the change in best corrected visual acuity (BCVA), and central retinal thickness (CRT). Secondary outcome measures were the number of injections, and complications. Results. A total of 154 patients were included in the study. Bevacizumab group consisted of 79 patients, and ranibizumab group consisted of 74 patients. Mean follow-up time was 18.9 months, and 18.3 months in the bevacizumab and ranibizumab groups, respectively. There was not a significant difference between the two groups regarding the change in BCVA and CRT at all time points (P>0.05 for all). The mean number of injections at month 12 was 4.8 and 4.7 in bevacizumab and ranibizumab groups, respectively (P>0.05). No serious complications were detected in any of the groups. Conclusion. Both of the bevacizumab and ranibizumab found to be effective in the treatment of nAMD in regards of functional and anatomical outcomes with similar number of treatments and similar side effects.

AIM: To evaluate the increase in corrected distance visual acuity (CDVA) after laser in situ keratomileusis (LASIK) in adults with anisometropic amblyopia.METHODS: The medical records of consecutive patients diagnosed with anisometropic amblyopia at the time of refractive evaluation who underwent LASIK were retrospectively reviewed. Patients with at least a two-line difference of visual acuity (VA) between the eyes with a spherical refractive error difference of at least 3.00 diopters (D) or an astigmatic difference of at least 2.00D were included. Patients with any other possible reason for amblyopia other than anisometropia or those who had undergone previous amblyopia treatment were excluded. Amblyopic eyes with myopia or myopic astigmatism were considered as group 1, hypermetropia or hypermetropic astigmatism constituted group 2, and mixed astigmatism patients comprised group 3. Uncorrected distance visual acuity (UDVA), subjective manifest refraction, and CDVA were analyzed at 1 week and 1 month, 3, and 6 months. RESULTS: The study included 57 eyes of 57 patients. There were 33 eyes in group 1, 12 eyes in group 2, and 12 eyes in group 3. The preoperative mean values for spherical equivalent of subjective manifest refraction (SE) in groups 1, 2, and 3 were (-4.66±1.97)D, (4.40±1.00)D, and (0.15±1.05)D, respectively. Mean CDVA improved 0.1 log units (1 line LogMAR) at 6 months (P0.05). Moreover, age, the amount of preoperative refractive error, and the levels of preoperative corrected and UDVA had no effect on postoperative CDVA improvement (P>0.05).CONCLUSION: Correction of refractive errors with LASIK produced significant CDVA improvement in adult patients with anisometropic amblyopia and no previous amblyopia treatment.

To evaluate the possible changes in the microvascular structure of the choroid by measuring choroidal thickness (CT) in four different body mass index (BMI) groups of healthy individuals.One hundred and sixty eyes of 160 healthy individuals (70 females and 90 males) were included in this cross-sectional study. Healthy individuals were divided into 4 groups according to their BMIs. Cases with BMI ≤ 18.50 formed Group 1, cases with BMI between 18.50 and 24.99 formed Group 2, cases with BMI between 25.00 and 29.99 formed Group 3, and cases with BMI between 30.00 and 34.99 formed Group 4. The CT was measured by the enhanced depth imaging technique of the spectral domain optical coherence tomography. The CT was measured at subfoveal area and at 500-μm intervals to the nasal and temporal to the fovea up to 2,000 μm. The measurements were then statistically compared among the four groups.The mean ages were 26.5 ± 6.9 years (range: 18-39 years) in Group 1, 27.2 ± 5.0 (range: 21-38 years) in Group 2, 28.5 ± 5.9 (range: 20-40 years) in Group 3, and 29.25 ± 5.6 (range: 20-40 years) in Group 4. The mean subfoveal CT (in micrometers) was 378 ± 86 (range: 189-563) in Group 1, 384 ± 102 (range: 225-643) in Group 2, 314 ± 66 (range: 160-455) in Group 3, and 317 ± 63 (range: 220-411) in Group 4. There was a statistically significant difference among the 4 groups in regard to CT in all locations (P0.05).We have demonstrated that BMI may have an influence on the CT of healthy persons. Individuals in both Group 3 and Group 4 have thinner choroids than the individuals in both Group 1 and Group 2.

Purpose: To evaluate the results of Artisan iris-supported phakic anterior chamber intraocular lens (pIOL) implantation in patients with high myopia. Methods: Medical records of patients who underwent Artisan pIOL implantation for surgical correction of myopia were retrospectively reviewed. Only patients with at least a twoyear follow-up were included. Spherical equivalent of manifest refractive error (SE), uncorrected visual acuity (UDVA), distance corrected visual acuity (CDVA), and endothelial cell density (ECD) were analyzed at six months, one year, and two years after surgery. Results: Sixty-two eyes of 42 patients were included in the study. All patients had a minimum anterior chamber depth of 3.0 mm from the endothelium. At two years, 68% of the patients were within ±0.50 D. Mean ECD was 2723 ± 311 cells/mm 2 preoperatively and 2630 ± 291 cells/mm 2 at six months postoperatively (3.4% loss, p = 0.001). ECD loss from six months postoperatively to two years postoperatively was not statistically significantly different. In three eyes (4.8%) of two patients, a temporary, steroid-induced increase in intraocular pressure (IOP) was detected. Conclusion: Artisan pIOL implantation is a safe and highly effective procedure for surgical correction of high myopia. ECD loss stabilizes in the early postoperative period.

PURPOSE: To compare the postoperative corneal hysteresis (CH) and corneal resistance factor (CRF) of eyes implanted with a small aperture corneal inlay versus fellow eyes. METHODS: Medical records of patients who underwent small aperture corneal inlay (KAMRA; AcuFocus, Inc., Irvine, CA) implantation were retrospectively reviewed. There were two groups: the implanted and non-implanted. Main outcome measures were CH, CRF, Goldmann-correlated intraocular pressure (IOP g ), corneal-compensated IOP (IOP cc ), and Goldmann applanation tonometry measurements performed preoperatively and at postoperative week 1 and months 1, 3, and 6. RESULTS: The study included 68 eyes of 34 patients. CH was higher in the implanted group when compared with the non-implanted group at postoperative week 1 (12.2 ± 3.1 vs 10.9 ± 1.7 mm Hg; P = .007) and month 1 (12.3 ± 2.5 vs 10.9 ± 1.8 mm Hg; P = .001). CRF was higher in the implanted group when compared with the non-implanted group at postoperative week 1 (11.9 ± 2.9 vs 10.7 ± 1.6 mm Hg; P = .003) and month 1 (12.5 ± 2.5 vs 10.4 ± 1.8 mm Hg; P < .001). IOP cc was higher in the implanted group when compared with the non-implanted group at only the first postoperative month (17.1 ± 3.5 vs 14.3 ± 2.9 mm Hg; P < .001). There were no statistically significant differences in Goldmann applanation tonometry or IOP g measurements between the two groups ( P > .05). At the 3-month postoperative visit, all parameters had returned to baseline and there was no change at the 6-month visit. CONCLUSIONS: Implantation of the KAMRA corneal inlay does not induce a permanent change in CH or CRF. A transient increase in both was seen in the early postoperative period. [ J Refract Surg . 2014;30(12):831–836.]