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To compare the consistency between the actual diameter of capsulotomy (ADC) and the predicted diameter of capsulotomy (PDC) in femtosecond laser-assisted cataract surgery (FLACS) and analyze the factors that influence the deviation of the diameter of capsulotomy (DDC) between the actual and predicted.Aier Eye Hospital of Wuhan University, China.Retrospective observational case series.Patients who underwent FLACS from March 2020 to March 2021 were reviewed. The ADC in FLACS was measured and compared with the PDC. The effects of age, sex, and biometrics on DDC were analyzed.412 eyes of 336 patients were included. The mean age was 53.0 ± 0.91 years (range 3 to 91 years). When the PDC was set to 4.50 mm, the results showed that the ADC was 5.21 ± 0.21 mm with a significant difference between them ( Pamp;lt; .05). However, when the PDC was set to 5.2 mm, the ADC was 5.10 ± 0.38 mm without a significant difference between them ( Pamp;gt; .05). No correlation ( Pamp;gt; .05) was found between the DDC and the axial length, the DDC and the anterior chamber depth (ACD), and the DDC and the mean keratometry (Km), but a negative correlation was found between the DDC and the lens thickness (LT) ( r = -0.21; Pamp;lt; .05) and the DDC with age ( r = -0.70; Pamp;lt; .05). Using curvilinear regression analysis, a development of an age-depending correction formula was predicted: ADC = PDC + 1.23 - 0.30 ln (x) (x = age ≥3) ( R2 = 0.65; F = 752.39; P = .00).The consistency of the ADC and PDC was influenced by age and LT. For patients aged 40 years or younger, the younger the patient, the wider the DDC; for patients older than 40 years, the DDC was small. The thicker the LT, the smaller the DDC.

To evaluate the visual and refractive outcomes of laser corneal enhancement after trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic/hyperopic laser corneal refractive surgery (LCRS).Clinica Baviera-AIER-Eye Group, Spain.Retrospective comparative case series.Patients were divided by primary LCRS into myopic and hyperopic groups. The outcomes evaluated were uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuity (UNVA), and predictability, safety, efficacy, and satisfaction after implantation of 2 trifocal IOL models (Physiol-FineVision and Zeiss-ATLisa 839) and subsequent laser enhancement.186 eyes (89 myopic and 97 hyperopic eyes) from 146 patients were assessed. At the last visit, refractive outcomes were better in myopic than those in hyperopic eyes, with statistically significant differences for sphere ( P.001), cylinder ( P.001), manifest refraction spherical equivalent (MRSE) ( P = .003), CDVA ( P = .005), UDVA ( P = .047), and UNVA ( P = .003) but not for UIVA ( P = .580), binocular UIVA ( P = .660), or binocular UNVA ( P = .836). Predictability differences were nonsignificant between groups for a final MRSE of ±0.5 diopters (D) and ±1.0 D (P = .167 and .502, respectively). Efficacy and safety were similar in both groups ( P = .235 and P = .080). A greater myopic MRSE was present after trifocal implantation in myopic than in hyperopic eyes (MRSE = -0.93 vs -0.69 D, P = .013), and the statistically significant differences were maintained after enhancement between both groups (MRSE -0.00 vs 0.00 D, P = .003). Overall satisfaction was similar in both groups ( P.05 all items).Corneal laser enhancement after implantation of a trifocal IOL in eyes previously treated for myopia or hyperopia with LCRS was safe, effective, predictable, and highly satisfactory.

PURPOSE: To evaluate safety and efficacy in the management of flap displacement after laser in situ keratomileusis (LASIK) and subsequent complications. METHODS: This was a retrospective study performed using data recorded at the center's database from October 2002 to August 2021. Efficacy and safety were both converted to binary outcomes (loss of one or more lines and no change or gain in lines of visual acuity). The effects of time from surgery to complication and from complication to repair were assessed and the odds ratios and probabilities were calculated. The same procedure was applied to investigate the effect of these temporal variables on complications. RESULTS: A total of 66 eyes with late traumatic LASIK flap displacements were studied. Efficacy remained unchanged in 48 patients (64 eyes, 75%), and safety remained unchanged in 53 patients (59 eyes, 90%). Sixty-six patients (64 eyes, 100%) achieved visual acuity values of 20/40 and 45 patients (64 eyes, 70.3%) achieved values of 20/20. The flap displacement was resolved in the first 24 hours (SD ± 0.1 days). Surgery was performed in 58 patients (65 eyes, 90%). Epithelial ingrowth was the most frequent complication. Patients who underwent surgery tended not to lose lines ( P = .05). The risk of developing epithelial ingrowth increases with time after LASIK surgery until traumatic flap displacement (odds ratio: 1.001; P < .001). The prevalence of dislocation during the study period was 0.012%. CONCLUSIONS: Visual safety values were favorable after resolution of the flap complication. Immediate surgical management leads to better visual efficacy, and the time between LASIK and trauma increases the risk of epithelial ingrowth after flap displacement. [ J Refract Surg . 2022;38(4):270–276.]

PURPOSE To compare the visual outcomes in both eyes of patients who undergo phacoemulsification and trifocal intraocular lens (IOL) implantation and have asteroid hyalosis (AH) or synchysis scintillans (SS) in only 1 eye. METHODS This retrospective comparative cases series study evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction after implantation of the same model of trifocal IOL in both eyes (PhysIOL FineVision Pod-F and Micro-F and Rayner RayOne Trifocal). RESULTS A total of 164 eyes from 82 patients (41 females, 50%) met the inclusion criteria. There were no statistically significant differences in sphere, cylinder, spherical equivalent, UDVA, UIVA, and UNVA between the groups. Postoperative CDVA was slightly better in the control group (logMAR 0.03) than in the AH/SS group (logMAR 0.04) (p: 0.014). There were no statistically significant differences in predictability, safety index, and efficacy index between the groups. Overall subjective satisfaction was good (98.2%). CONCLUSIONS Visual outcomes and satisfaction are good after implantation of trifocal IOLs in eyes with AH or SS. Therefore, trifocal IOLs should not be ruled out in these patients when no other vitreoretinal disorder is present.

Purpose To dynamically assess variations in pupil diameter induced by changes in brightness in myopic eyes implanted with an implantable collamer lens (ICL, STAAR Surgical) with a central port. Methods This prospective, observational single-center case series study comprised 65 eyes from 65 consecutive patients undergoing ICL implant. A modified commercially available swept-source Fourier-domain anterior segment optical coherence tomography (AS-OCT) device was used for imaging and performing dynamic pupillometry under changing light conditions before and after a mean follow-up interval of four months after surgery. Results Preoperative mean pupil size under photopic conditions was 3.38 ± 0.64 mm; after surgery, this increased to 3.48 ± 0.61 mm. Mean pupil size under scotopic light conditions was 5.72 ± 0.79 mm before surgery and 5.84 ± 0.77 mm postoperatively. The differences between preoperative and postoperative pupil diameter in miosis and mydriasis were 0.10 ± 0.44 mm (P = 0.078) and 0.12 ± 0.58 mm (P = 0.098), respectively. The scotopic pupil exceeded the optic zone of the implanted lens in 39 eyes (60%). The mean central vault value was 412 ± 177 μm under maximum miosis and 506 ± 190 μm under maximum mydriasis. We found a positive correlation between vault and differences in pupil diameter under all light conditions (P Conclusion Dynamic AS-OCT enables a very precise determination of the pupillary diameter in the iris plane. The changes in the pupil diameter under different light conditions after the implantation of an ICL are related to the postoperative vault.

Purpose: To observe the distribution characteristics of corneal higher-order aberrations (HOAs) in cataract patients, and analyze the relationship of HOAs with patients' age and ocular biometric parameters. Methods: This cross-sectional study review the patients undergoing cataract surgery in Wuhan Aier Eye Department from January to August 2022. Root mean square (RMS) of the total corneal HOA, spherical aberration (SA), coma and trefoil aberration for a corneal central region of 4mm and 6mm were measured by the Wavefront Aberrometer (OPD-Scan III; Nidek Inc, Tokyo, Japan). The biometric parameters were measured by swept source coherence laser interferometry (OA-2000; TOMEY Corp, Aichi, Japan). Subgroup analyses and multiple linear regression analyses were used to determine whether HOAs were associated with age and ocular biometric parameters. Results: A total of 976 patients (976 eyes) were included, averagely aged 65 years. The mean RMS of total corneal HOA at central 4mm and 6mm optic zone were respectively 0.20μm and 0.65μm, the RMS of SA were 0.06μm and 0.30μm. Total HOA decreased with age until 60 years and then started to increase afterwards. Total HOA, coma and trefoil aberration increased with corneal astigmatism. Total HOA, SA, and coma aberration differ among different AL groups, and emmetropes had the smallest aberration. Conclusions: With increasing age, the value of total HOA decrease first and started increasing at 60 years. The trends of corneal HOAs are consistent with corneal low-order aberrations. The values of total HOA, SA and coma aberration were the smallest in emmetropic eyes.

Purpose To evaluate the tolerance of refractive errors and visual outcomes of extended depth of focus intraocular lens (EDOF IOLs) in patients with previous corneal refractive surgery for myopia. Methods Patients from Wuhan Aier Eye Hospital with previous myopia excimer laser correction underwent cataract surgery and implantation of an EDOF IOL. The follow-up period was three months. The uncorrected distance, intermediate, and near visual acuities (UDVA, UIVA, UNVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), defocus curve, optical quality, including modulation transfer functions (MTF) and Strehl ratio (SR), National Eye Institute Visual Functioning Questionnaire-14 for Chinese people (VF-14-CN), spectacle independence, and dysphotopsia were assessed. Results At the final visit, UDVA, CDVA, UIVA, and UNVA (logMAR) were 0.07 ± 0.09, 0.01 ± 0.04, 0.10 ± 0.08, 0.20 ± 0.11, respectively. The mean spherical equivalent (SE) was ± 0.75 ± 0.49D, where 42% (21 eyes) were within ± 0.50D, 70% (35 eyes) were within ± 1.00D, and 98% (49 eyes) were within ± 1.50D. The defocus curve showed that visual acuity could reach 0.1 in the refractive range of 0 ~ -1.5D. SR and MTF values of 10, 15, 20, 35, and 30 c/d spatial frequency were measured with a 3 mm pupil diameter after removing the influence of low-order aberrations, which were all higher than the values before the operation. The mean VF-14-CN questionnaire score was 51.02 ± 2.95 out of 56. Conclusion The EDOF IOLs have a certain tolerance for refractive errors, and they are recommended for patients with prior myopia excimer laser surgery to achieve satisfactory visual performance.

To compare visual outcomes and patient satisfaction between unilateral and bilateral trifocal diffractive intraocular lens (IOL) implantation in emmetropic patients with presbyopia.Retrospective observational case series.This is a multicenter, multisurgeon study of emmetropic presbyopes who underwent refractive lens exchange (RLE) followed by an implantation of FineVision IOL (PhysIOL). Inclusion criteria were emmetropic eyes, with a sphere between -0.25 and +0.50 diopters (D), cylinder of less than 0.75 D and spherical equivalent (SE) between -0.25 and +0.25 D. In addition, uncorrected distance visual acuity (UDVA) had to be Snellen0.9 in each eye. A total of 171 eyes of 122 patients were evaluated. This sample was divided into 2 groups depending on whether they have been operated monocularly or binocularly. Visual and refractive performance, patient satisfaction, and spectacle independence were evaluated.UDVA and corrected distance visual acuity (CDVA) remained almost unchanged after monocular and binocular surgery. Binocular uncorrected intermediate (UIVA) and near visual acuity (UNVA) were better in those operated binocularly (0.3±0.12 vs 0.22±0.06, P .063, and 0.09±0.08 vs 0.04±0.05, P.027, respectively). Predictability and efficacy were higher in the binocular group, whereas safety was better in the monocular group. Visual dysphotopsia was worse and spectacle independence for all distances was higher in binocular group.Our research shows that RLE with binocular implantation of a trifocal diffractive IOL in presbyopic emmetropic patients is more successful in UNVA than monocular implantation. However, no significant differences were observed in UDVA, UIVA, and patient satisfaction.

Introduction Presbyopia is the progressive and irreversible loss of accommodation due to aging. It is one of the main causes of loss of quality of life in people from 45 years of age, due to the, often novel, dependence on spectacles. The eagerness to correct it by ophthalmologists driven by the desire of millions of people who suffer from it, has become one of the main drivers for the development of intraocular lens (IOL) technology over the last twenty years. Material and methods This review briefly presents the different alternatives that have allowed us to improve the crystalline lens surgical approach of presbyopia; from monofocal lenses and monovision technique, accommodation, refractive, and diffractive multifocal lenses, and finally the most recent focus or extended depth or focus/ field lenses known as EDOFs. Results Each IOL has its advantages, limitations and disadvantages. Furthermore, there is no single lens that suits the needs of all patients. Conclusions It is necessary to know the variety of lenses available, and to have an in-depth understanding of their optical properties, as well as the impact that these will have later on their clinical performance and on the visual quality of the patients. This should help us to select the best alternative for each of them.

Resumen Introduccion La presbicia es la perdida progresiva e irreversible de la acomodacion debido al envejecimiento. Es una de las principales causas de disminucion de la calidad de vida en personas a partir de los 45 anos derivada de la, muchas veces novedosa, dependencia de las gafas. El afan por corregirla por parte de los oftalmologos, impulsados por el deseo de millones de personas que la padecen, se ha convertido en uno de los principales motores de desarrollo de la tecnologia de las lentes intraoculares (LIO) durante los ultimos 20 anos. Material y metodos Esta revision repasa las distintas alternativas que han permitido ir mejorando el enfoque quirurgico cristaliniano de la presbicia; desde las lentes monofocales y la tecnica de la monovision, a las lentes acomodativas, pasando por las lentes multifocales refractivas y difractivas y terminando con las mas recientes lentes de foco o campo extendido conocidas como EDOF. Resultados Cada una de estas LIO tiene sus ventajas, limitaciones e inconvenientes; y ademas, no existe la lente que se adapte a las necesidades de todos los pacientes. Conclusiones Es necesario conocer la variedad de lentes disponibles, y comprender en profundidad tanto sus propiedades opticas como el impacto que estas van a tener luego en su rendimiento clinico y en la calidad visual de los pacientes. Esto nos deberia ayudar a poder seleccionar la mejor alternativa para cada uno de ellos.

Purpose Our objectives were to determine the anatomical and functional (visual and refractive) outcomes of corneal refractive surgery during breastfeeding and to compare the results with those of women who stopped breastfeeding at least 3 months before the procedure. We also evaluated predictability, safety, and efficacy indexes; number of retreatments; and adverse effects reported in babies. Methods We performed a multicenter, retrospective, interventional case series review of patients who were breastfeeding and who underwent laser in situ keratomileusis or surface ablation (photorefractive keratectomy) from September 11, 2002 to December 12, 2017 (group 1, n = 142 eyes in the case group). Patients were compared with women who stopped breastfeeding at least 3 months before the procedure from September 11, 2002 to December 12, 2017 (group 2, n = 95 eyes in the control group). A total of 168 women (237 eyes) were included. Patients were incorporated consecutively. Functional (visual and refractive) and anatomical outcomes are described. Results No significant intraoperative or postoperative complications were recorded. There were no significant differences between the groups in visual acuity, postoperative spherical equivalent, efficacy index, predictability, safety index, or retreatments. No infants experienced adverse effects. Conclusions In our experience, laser in situ keratomileusis and photorefractive keratectomy can be performed effectively and safely in breastfeeding women.

PURPOSE: To assess the effect of crystalline lens rise (CLR) on postoperative vault in eyes implanted with a phakic Visian Implantable Collamer Lens (ICL) (STAAR Surgical Company, Monrovia, CA) with a central port for myopic correction. METHODS: Non-invasive Fourier-domain swept-source anterior segment optical coherence tomography was used for dynamic assessment of the study eyes under changing light conditions. Phakic intraocular lens (IOL) vault, anterior chamber depth (ACD), and CLR were recorded after surgery, and intra-eye differences were analyzed under scotopic and photopic ambient light conditions. Inter-group analysis and regression analysis were performed to investigate any potential correlation between these biometric variables. RESULTS: This retrospective observational study comprised 111 eyes (65 patients) implanted with a myopic Visian ICL. The mean change in CLR from mydriasis to miosis was 59 ± 60 µm ( P < .001). The sample was further divided into four groups according to the CLR value in miosis: CLR < 0, 0 to 200, 201 to 350, and > 350 µm. A significant difference in central vault values was observed between the < 0 and > 350 µm groups, the 0 to 200 and 201 to 350 µm groups, and the 0 to 200 and > 350 µm groups ( P < .05). Eyes with a high vault value (> 750 µm in mydriasis) had lower CLR values ( P < .001) and higher ACD values ( P < .001) than eyes with a low vault value (< 100 µm in miosis). The linear correlation observed was negative between CLR and ACD, positive between postoperative vault and ACD, and negative between postoperative vault and CLR ( P < .001). CONCLUSIONS: CLR significantly affected anterior chamber depth and postoperative ICL vault. [ J Refract Surg . 2019;35(3):177–183.]

Purpose: To evaluate the effect on visual outcomes of a diffractive trifocal intraocular lens (IOL) in pars plana vitrectomy (PPV) for removal of epiretinal membrane (ERM) in pseudophakic eyes. Methods: This is retrospective case-series study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Other outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE). Results: Mean corrected distance visual acuity (CDVA) was 0.03±0.03 logMAR after phacoemulsification; this worsened to 0.23±0.10 logMAR with ERM, improving to 0.10±0.04 log MAR 12 months after PPV (p=0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62±0.51 after lensectomy. This worsened to Jaeger 5.46±1.67 with ERM and improved to the initial Jaeger 2.69±0.84 after PPV (p=0.005). CMT decreased significantly, from 380.15 ±60.50 µm with the ERM to 313.70 ±36.98 µm after PPV. Mean SE after lensectomy was -0.18 ±0.38 D, which minimally changed to – 0.18±0.47 D after PPV (p=0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV. Conclusion: PPV for ERM in eyes with this trifocal IOL is safe and effective, and allows recovery of the loss of UNVA.

Background The purpose of this study was to evaluate the ocular biometric parameters in adult cataract patients from China and create an anterior chamber depth (ACD) regression model. Methods The ocular biometric records of 28,709 right eyes of cataract surgery candidates who were treated at Aier Eye Hospitals in nine cities from 2018 to 2019 were retrospectively analyzed. All measurements were taken with IOLMaster 700. We included patients who were at least 40 years old and were diagnosed with cataract. Results The mean age of the patients was 68.6 ± 11.0 years. The mean values recorded were as follows: axial length (AL), 24.17 ± 2.47 mm; mean keratometry (Km) value, 44.26 ± 1.70 D; corneal astigmatism (CA), 1.06 ± 0.96 D; ACD, 3.02 ± 0.45 mm; lens thickness (LT), 4.52 ± 0.45 mm; central corneal thickness (CCT), 0.534 ± 0.04 mm; and white to white (WTW) corneal diameter, 11.64 ± 0.46 mm. ACD correlated positively with AL (Spearman coefficient, 0.544) and WTW (0.300), but negatively with LT (-0.660) and age (-0.285) (all P R2 = 0.641. Conclusions Cataract patients with longer AL and wider WTW have deeper ACD. With increasing age and lens thickening ACD becomes shallower. Based on the standardized coefficients of ACD multivariate regression analysis from the study, LT is the main factor that affects ACD, and is followed by AL.

Purpose: To evaluate the visual and refractive outcomes of trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic and hyperopic corneal refractive laser surgery. Setting: Clinica Baviera-AIER-Eye group, Spain. Design: Retrospective comparative case series. Methods: The series was divided into 2 groups according to the type of corneal laser refraction (myopic and hyperopic). The main visual and refractive outcome measures included corrected distance visual acuity (CDVA) and uncorrected distance and near visual acuity, safety, efficacy, and predictability. The secondary outcome measures were percentage of enhancement and Nd:YAG capsulotomy and influence of prelaser magnitude of myopia and hyperopia on the outcome of trifocal IOL implantation. Results: The sample comprised 868 eyes (543 patients): myopic, n = 319 eyes (36.7%); and hyperopic, n = 549 eyes (63.2%). Three months postoperatively, visual outcomes were poorer in the hyperopic group than those in the myopic group for mean CDVA (0.06 ± 0.05 vs 0.04 ± 0.04, P < .01) and safety (21% vs 12% of CDVA line loss, P < .05) outcomes. However, precision outcomes were worse in the myopic group than those in the hyperopic group, with amean spherical equivalent of 0.38 ± 0.3 vs 0.17 ± 0.3 (P < .01). Stratification by magnitude of primary laser treatment revealed poorer visual and safety results in the high hyperopia subgroup (>+3.0 diopters [D]) and poorer precision in the high myopia subgroup (< 5.0 D). Conclusions: Trifocal IOL implantation after photorefractive surgery in eyes previously treated with myopic ablation achieved good visual outcomes but less predictability in the high myopia subgroup. However, eyes with a previous hyperopic corneal ablation achieved excellent precision but worse visual and safety outcomes in the high hyperopia subgroup. pre-print 601 KB

Purpose To assess long-term crystalline lens transparency in eyes implanted with phakic collamer intraocular lens (pIOL) with a central port and low postoperative vault for correction of myopia. Setting Clinica Baviera, Madrid, Spain. Design Retrospective cross-sectional single-center study. Methods Using a noninvasive Fourier-domain swept-source anterior segment optical coherence tomography system, shifts in myopic and astigmatic myopic eyes implanted with a pIOL with vaulting lower than 100 μm in miosis and more than 4 years of follow-up were dynamically evaluated. Main outcome measures were pIOL dynamic vault (vault interval and vault range [VR]), crystalline lens density, and anterior subcapsular lens opacities. Crystalline lenses were examined under slitlamp microscopy, and lens density was evaluated using quantitative Scheimpflug images. Scheimpflug images were compared with those of a control group comprising eyes that were candidates for pIOL implantation. Results The study population comprised 24 eyes from 16 patients previously implanted with a pIOL (5.82 ± 0.9 years) with central vault lower than 100 μm under photopically induced miosis. The mean vault value was 52 ± 19 µm under photopic light conditions and 113 ± 37 µm under scotopic conditions. The mean VR was 58 ± 24 μm. Anterior subcapsular lens opacities were found in only 1 eye (4.17%). The mean lens density was 7.94 ± 0.43, and no statistically significant differences were observed compared with the control group. Conclusions Long-term low vaulting in eyes implanted with a pIOL with a central port for correction of myopia was associated with a low risk for developing anterior crystalline lens opacities.

Purpose To investigate visual outcomes, spectacle independence, and patient satisfaction after trifocal intraocular lens implantation. Methods A retrospective study conducted on 5186 patients who underwent phacoemulsification and were implanted with a diffractive trifocal intraocular lens (FineVision Micro F, PhysIOL SA, Liege, Belgium). Results The mean pre-operative keratometry was 43.61 ± 1.55 D, and mean keratometric cylinder was −0.86 ± 0.66 D. At 3 months post-operatively, values changed to 43.59 ± 1.56 and −0.71 ± 0.46 D, respectively. Mean sphere varied from 2.04 ± 2.60 to 0.14 ± 0.38 D, and mean spherical equivalent from 1.64 ± 2.61 to −0.05 ± 0.36 D. More than 60% of the patients achieved better corrected distance visual acuity. The majority had a final residual refractive error (predictability) lower than 1 D (99.1%), with 14.3% needing optical adjustment (bioptics). Posterior capsulotomy was performed in 2.2%, and the lens was replaced in 5 patients. A high percentage of patients were satisfied in terms of vision and spectacle independence at all distances. Although 2% referred to worsening of night vision quality, only 2% were not very satisfied and 20 patients were dissatisfied. The causes were: blurred vision (7 cases), spectacle dependence (10), dysphotopsia (7), and dry eye (4). Conclusions The implantation of this model provided good visual performance in all distances, as well as high levels of spectacle independence and satisfaction.

Resumen Objetivo Evaluar los resultados visuales, la independencia de gafas y la satisfaccion tras el implante de una lente intraocular trifocal. Metodos Estudio retrospectivo de 5.186 sujetos intervenidos de facoemulsificacion con implante de la lente trifocal difractiva FineVision Micro F12 (PhysIOL, Liege, Belgica). Resultados La queratometria media preoperatoria fue 43,61 ± 1,55 D y el cilindro queratometrico medio −0,86 ± 0,66 D. A los 3 meses, cambiaron a 43,59 ± 1,56 y −0,71 ± 0,46 D respectivamente. La esfera media paso de 2,04 ± 2,60 a 0,14 ± 0,38 D y el equivalente esferico medio de 1,64 ± 2,61 a −0,05 ± 0,36 D. Mas del 60% alcanzaron una mejor agudeza visual corregida de lejos. La mayoria presento un defecto residual final (predictibilidad) menor de 1 D (99,1%). El 14,3% preciso un ajuste refractivo, el 2,2% capsulotomia posterior y se recoloco la lente intraocular en 5 casos. Un porcentaje elevado estaba satisfecho en terminos de vision e independencia de gafas en todas las distancias. Aunque un 2% refirio un empeoramiento en la vision nocturna, unicamente un 2% estaba poco satisfecho y 20 pacientes insatisfechos. Las causas fueron: vision borrosa (7 casos), necesidad de gafas (10), disfotopsias (7) y sequedad ocular (4). Conclusiones La implantacion de esta lente permite obtener buenos resultados visuales en las 3 distancias asi como un alto grado de independencia de gafas y de satisfaccion.

Purpose To assess visual outcomes of retreatment after laser in situ keratomileusis (LASIK) by lifting the flap or performing photorefractive keratectomy (PRK) on the flap, as well as to establish whether there was an increased risk of epithelial ingrowth (EIG) when LASIK and lifting of the flap are separated by a long time interval and to determine the incidence of corneal haze after PRK. Methods Retrospective study of 4077 patients (5468 eyes) who underwent LASIK and subsequent retreatment were reviewed in order to study their visual results and identify cases of EIG and corneal haze. Results Enhancements included 5196 eyes from 3876 patients that were retreated by lifting the flap, and 272 eyes from 201 patients that were retreated by PRK on the flap. No statistically significant differences were found between the retreatments in terms of predictability, efficacy, and safety. A total of 704 cases of EIG were found after lifting the flap, for which surgical cleansing was necessary in 70. Surgical cleansing decreased the efficacy index when compared with patients with EIG who did not need cleansing ( p = 0.01). Differences in terms of safety and predictability were not statistically significant. The incidence of corneal haze after ablation of the surface of the previous flap was 14.34%, although none of these cases were clinically relevant. Conclusions Visual outcomes were similar between patients who were retreated by lifting the flap and those who underwent PRK. The incidence of EIG when the flap was lifted was 13.55%. The incidence of EIG increases with the time elapsed between the primary procedure and retreatment.

Purpose To investigate refractive and visual acuity outcomes, patient satisfaction, and spectacle independence at 3 months of 2 diffractive (non-toric) trifocal intraocular lenses (IOLs) in a large series of patients. Design Multicenter, retrospective, nonrandomized clinical study. Methods Patients underwent lens phacoemulsification and were implanted bilaterally with a diffractive trifocal IOL: FineVision Micro F (PhysIOL SA, Liege, Belgium) or AT Lisa tri 839MP (Carl Zeiss AG, Jena, Germany). Surgeries were performed between 2011 and 2015 with at least 3 months of follow-up. Visual and refractive performance, patient satisfaction, and spectacle independence were evaluated. Results A total of 10 084 trifocal IOLs were bilaterally implanted (5802 FineVision in 2901 patients and 4282 AT Lisa in 2141 patients). Three-month mean (± standard deviation) acuity: AT Lisa, binocular uncorrected distance visual acuity (UDVA), −0.01 logMAR ± 0.06; monocular distance corrected visual acuity (CDVA), 0.02 logMAR ± 0.06; binocular uncorrected near visual acuity (UNVA) at 40 cm, 0.05 logMAR ± 0.08; binocular uncorrected intermediate visual acuity (UIVA) at 80 cm, −0.05 logMAR ± 0.14; postoperative spherical equivalent, 0.26 D ± 0.47; cylinder −0.34 D ± 0.38; FineVision Micro F, binocular UDVA, 0.01 logMAR ± 0.05; monocular CDVA, 0.03 logMAR ± 0.06; binocular UNVA, 0.05 logMAR ± 0.08; binocular UIVA, −0.05 logMAR ± 0.12; spherical equivalent, 0.34 D ± 0.50; cylinder −0.39 D ± 0.40. The IOLs were equivalent in achieving spectacle independence; 98% were “satisfied” to “very satisfied” with their IOL performance. Conclusions In this retrospective study with over 5000 patients, implantation of both trifocal IOL models provided good functional distance, intermediate, and near visual acuity, resulting in high levels of both spectacle independence and patient satisfaction.

Cases Two cases are reported in which implantation of a collagen copolymer phakic intraocular lens (implantable collamer lens) corrected refractive errors in eyes with corneal scarring. A previous accident, in both cases, resulted in a central linear scar on the surface of the cornea of one eye. In the first patient, a corneal scar was visible in the left eye. The distance corrected visual acuity was 0.3 (–7.75 to 4 × 160°). An uncorrected distance visual acuity of 0.25 was obtained by implanting an implantable collamer lens. In the second patient an oblique corneal scar was visible in the right eye. The distance corrected visual acuity was 0.25 (–8.75 to 1.25 × 8°), and after implantation of the implantable collamer lens, uncorrected distance visual acuity was 0.25. Discussion The indications of the implantable collamer lens should be reviewed and possibly expanded.

Purpose To compare the incidence of corneal epithelial ingrowth (EIG) and the visual outcomes of enhancement with laser in situ keratomileusis (LASIK) by flap lift when a bandage soft contact lens (CL) was fitted after the procedure and when it was not. Methods This is a multicenter, retrospective, interventional case series in which all patients who underwent LASIK enhancement from January 2005 to January 2015 were included consecutively. Patients were grouped depending on whether a bandage CL was fitted after re-treatment by flap lift (group 1) or not (group 2). Results A total of 16,702 eyes from 12,485 patients were included. There were statistically significant differences between the groups regarding corrected distance visual acuity (better in group 1) and safety index (better in group 2) although these were not clinically relevant. The incidence of EIG was 0.58% in group 1 and 0.55% in group 2 although, again, the difference was not statistically different. Conclusions We found no relevant differences in LASIK enhancement between patients who received a bandage CL and those who did not regarding the incidence of EIG and visual outcomes.

Resumen Objetivo Determinar los resultados anatomicos y funcionales de los pacientes intervenidos con cirugia refractiva corneal que estaban en tratamiento con amiodarona, la cual ha sido considerada como una posible contraindicacion en estas intervenciones. Material y metodos Se ha realizado un estudio observacional retrospectivo. Los pacientes se incluyeron consecutivamente. Se incluyo a todos los pacientes que tomaban amiodarona y fueron operados mediante LASIK o ablacion de superficie entre enero de 2003 y diciembre de 2014. Se pretenden describir los resultados funcionales (visuales y refractivos). Resultados Se incluyo a un total de 20 pacientes (33 ojos). No se encontraron complicaciones intraoperatorias o postoperatorias significativas. Conclusiones En nuestra experiencia los pacientes tratados con amiodarona e intervenidos mediante LASIK o ablacion de superficie no presentaron complicaciones clinicas significativas. La contraindicacion absoluta por tomar determinadas medicaciones sistemicas deberia ser reconsiderada.

Mohammad Reza Djodeyre,1 Jaime Beltran,2 Julio Ortega-Usobiaga,3 Felix Gonzalez-Lopez,4 Ana Isabel Ruiz-Rizaldos,1 Julio Baviera2 1Department of Refractive Surgery, Clinica Baviera, Zaragoza, 2Department of Refractive Surgery, Clinica Baviera, Valencia, 3Department of Research and Development, Clinica Baviera, Bilbao, 4Department of Refractive Surgery, Clinica Baviera, Madrid, Spain Purpose: To study long-term refractive and visual outcomes of laser in situ keratomileusis (LASIK) in eyes with a postoperative thin central cornea. Methods: In this retrospective observational case series, we studied 282 myopic eyes with a normal preoperative topographic pattern and postoperative thin corneas (275 µm. Keywords: LASIK, thin, cornea, ectasia, myopia, pachymetry, topography

To determine the functional outcomes of laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in patients taking isotretinoin, which is contraindicated for these procedures.Multicenter, retrospective, interventional case series.All patients taking isotretinoin who underwent LASIK or PRK from January 2003 to September 2017 were included (Group 1). Patients were compared with those undergoing LASIK or PRK who had taken isotretinoin previously but not in the previous 6 months (Group 2). Patients were included consecutively.A total of 113 patients (219 eyes) were included. No significant intraoperative or postoperative complications were found. There were no significant differences between the groups in terms of visual acuity, postoperative spherical equivalent, efficacy index, predictability, or safety index. When only PRK patients were taken into account, the efficacy index (P = .017), postoperative sphere (P = .041), and postoperative astigmatism (P.001) were better in Group 2, although the difference was not clinically relevant.In our experience, LASIK and PRK can be performed effectively and safely in selected patients taking isotretinoin. The absolute exclusion of certain systemic medications should be reconsidered.

To assess the incidence, culture results, and visual outcomes of infectious keratitis after laser in situ keratomileusis (LASIK) and surface ablation when topical moxifloxacin was added to postoperative prophylaxis with tobramycin.Clínica Baviera, Instituto Oftalmológico Europeo, Bilbao, Spain.Retrospective case series review.The medical records of 55 255 patients (108 014 eyes) who had LASIK and surface ablation were reviewed to identify cases of infectious keratitis. The incidence, risk factors, clinical course, days to diagnosis, treatment, and final visual outcomes were recorded. These data were compared with previously published data of 221 437 eyes that received postoperative tobramycin alone.Post-LASIK infectious keratitis was diagnosed in 10 eyes (9 patients) and post-surface ablation infectious keratitis in 11 eyes (10 patients). The onset of infection was early in 40.00% of cases after LASIK and in 36.36% after surface ablation. Cultures were positive in 2 cases after surface ablation. Immediate flap lifting and irrigation with antibiotics were performed in all eyes after LASIK. The final corrected distance visual acuity was 20/20 or better in 7 cases after LASIK (70.00%) and 7 cases after surface ablation (63.64%) and 20/40 or better in all cases after LASIK or surface ablation.The incidence of infectious keratitis decreased from 0.025% to 0.011% (P.001) per procedure after LASIK and from 0.200% to 0.066% (P.001) after surface ablation. Infectious keratitis was less frequent after LASIK than after surface ablation. The frequency of infection, mainly early-onset infection, was lower when the postoperative treatment was tobramycin and moxifloxacin rather than tobramycin alone.No author has a financial or proprietary interest in any material or method mentioned.

Objectives A study is made on the incidence of corneal ectasia after laser in situ keratomi-leusis (LASIK) in patients with large differences in mean keratometry (MK) readings between both eyes (OU). Visual outcomes were also evaluated. Methods The medical records of 164,603 patients (315,259 eyes) who underwent LASIK from January 2003 to December 2011 were reviewed in order to identify patients with a difference in MK of ≥1.25 D between OU. The main outcome measures were incidence of ectasia after LASIK, and visual outcome. Results A total of 35 eyes that met the inclusion criteria were found. Functional and visual results were those expected for myopia studies. After a minimum follow-up of 2 years, no corneal ectasia was found in 3 eyes (2 patients). Conclusions The possibility of finding a patient with an asymmetry in MK and normal topography is low (0.021%), and it does not seem to be a contraindication of LASIK. Although no corneal ectasia was found in this case series, and as it is a potentially sight-threatening complication, patients with very different MK between OU should be studied carefully before undergoing LASIK.

Purpose To compare long-term refractive and visual outcomes of laser in situ keratomileusis (LASIK) and laser surface ablation in eyes with corneas thinner than 470 μm. Setting Private clinics, Spain. Design Comparative case series. Methods The study comprised eyes with myopic error and corneas thinner than 470 μm that had at least 2.9 years of postoperative follow-up between September 2001 and June 2007. The main outcome measures were safety, efficacy, predictability, and complications. Results The mean central corneal thickness was 462.0 μm (range 440 to 469 μm) in the LASIK group (n = 40) and 458.1 μm (range 420 to 469 μm) in the laser surface ablation group (n = 88). All eyes had normal preoperative topography. In the LASIK group after a mean follow-up of 5.1 years ± 1.5 (SD), the safety index was 1.07, efficacy was 0.99, and predictability (±1.00 diopter [D]) was 0.93. In the laser surface ablation group after a mean follow-up of 4.8 ± 1.3 years, the safety index was 1.01, efficacy was 0.93, and predictability (±1.00 D) was 0.92. The mean residual corneal bed thickness in all eyes was 345 ± 25 μm (range 270 to 399 μm). No major complications occurred. The safety index was better in the LASIK group than in the laser surface ablation group. Conclusion Both techniques were effective, safe, and predictable in eyes with corneas thinner than 470 μm, normal preoperative topography, and a residual corneal bed thickness greater than 250 μm. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Resumen Objetivo Estudiar la incidencia de queratitis infecciosas (QI) tras laser in situ keratomileusis (LASIK), el diagnostico, la actitud terapeutica adoptada, el manejo y los resultados. Material y metodo Hemos realizado un estudio retrospectivo, entre los 262.191 ojos intervenidos consecutivamente con LASIK, en nuestros 20 centros, durante el periodo comprendido entre septiembre de 2002 y diciembre de 2009, de todos aquellos casos susceptibles de ser diagnosticados como QI, tanto por la clinica, como por los hallazgos biologicos. Resultado Han sido recogidos un total de 82 casos de queratitis infecciosas, lo que supone una incidencia del 0,031%. Se presenta la distribucion por sexo, la edad media de los pacientes, la media de dias transcurridos desde la cirugia, el cuadro clinico, los factores predisponentes, la actitud terapeutica, las complicaciones, la filiacion del germen causal, y la perdida de lineas de vision. Conclusiones La queratitis infecciosa tras LASIK es una complicacion poco frecuente. El diagnostico temprano y el manejo del proceso son determinantes a la hora de establecer un pronostico. En nuestra casuistica todos los casos se resolvieron sin causar otras complicaciones de gravedad.

Objective To determine the anatomical and functional outcomes of corneal refractive surgery in patients on amiodarone, a drug listed as being contraindicated in patients undergoing this procedure. Material and methods A retrospective observational study was conducted on all consecutive patients who took amiodarone and who underwent LASIK or surface ablation from January 2003 to December 2014. Functional (visual and refractive) outcomes are described. Results A total of 20 patients (33 eyes) were included. No significant intraoperative or postoperative complications were found. Conclusions In our experience, LASIK and surface ablation did not produce significant clinical complications in selected patients taking amiodarone. The absolute exclusion of certain systemic medications should be reconsidered.

This chapter focuses on early postoperative LASIK complications such as sterile inflammation (e.g. diffuse lamellar keratitis, DLK), infectious keratitis, epithelial or flap folds, epithelial ingrowth (EIG) and dry eye. By definition early postoperative complication is manifestation within 3 months after the procedure. These early postoperative complications can occur after uneventful surgery and differ significantly in their clinical impact on the postoperative outcome and are therefor introduced separately.

Every patient who wants to go in for refractive surgery should be asked about their general clinical history. Every medical or surgical event in the past could be crucially important in the case they undergo refractive surgery. The data about diseases, medications, surgeries and allergies should be collected. Some of these may affect the postoperative period of the patients [1].

PURPOSE Interface fluid syndrome is an unusual complication after laser in situ keratomileusis (LASIK). We present a case of interface fluid syndrome after cataract surgery in a patient who had previous LASIK surgery. METHODS A 62-year-old man underwent routine cataract surgery on the left eye 10 years after LASIK on both eyes. The day after surgery, the intraocular pressure (IOP) was 21 mm Hg and a pocket of fluid was present in the interface LASIK wound. The patient was treated with 0.50% timolol eye drops twice daily. RESULTS The problem resolved within 1.5 months. Two months later, the patient underwent routine cataract surgery of the right eye. The next day, the IOP was 11 mm Hg and LASIK interface fluid was present. The patient was treated with 0.5% timolol eye drops twice daily. Two months after the surgery, the problem had completely resolved. CONCLUSIONS Ocular hypertension and traumatic endothelial cell damage could have been the causes of the syndrome. Although the IOP was not very high, previous LASIK could have led us to underestimate the IOP.

Purpose: To evaluate the surgical results obtained in patients with psychiatric disorders who underwent myopic laser in situ keratomileusis. (LASIK). Methods: Retrospective study of 156 eyes of 82 patients who underwent LASIK to correct a myopic spherical equivalent (SE) at Cl´onica Baviera-Instituto Oftalmologico Europeo, Bilbao, Spain. All procedures were performed with the Technolas Keracor 217 Z excimer laser. Patients had a preoperative diagnosis of bipolar disorder (79 eyes of 42 patients), schizophrenia (61 eyes of 32 patients), or obsessive-compulsive disorder (16 eyes of 8 patients). Before surgery, the average sphere of the series was 23.92 6 2.24 D in the first group, 23.45 6 2.03 D in the second group, and 23.39 6 1.97 D in the third group. We surveyed the patients to analyze subjective assessment from the patient's perspective. Results: At the last available visit after treatment, we obtained an SE of 60.50 D in 85.71% of eyes with bipolar disorder, 88.52% of eyes with schizophrenia, and 93.75% of eyes with obsessive-compulsive disorder. The efficacy index was 1.00 6 0.20 in the first group, 1.03 6 0.21 in the second group, and 1.00 6 0.07 in the third group. No eye lost 2 lines or more of best spectacle-corrected visual acuity. Conclusions: We found that patients with compensated psychiatric disorders, of which the surgeon was aware, achieved excellent results after surgery, with no remarkable complications. Patients tolerated the procedures well and were satisfied. The aim of this study was to evaluate the results of surgery in patients with psychiatric disorders who underwent LASIK. The hypothesis was that patients with psychological illnesses would report lower levels of VA, poorer outcome, and more perioperative complications. The results are intended to provide general guidance for the refractive surgeon treating patients with psychiatric disorders.

To evaluate the incidence, culture results, risk factors, treatment strategies, and visual outcomes of infectious keratitis after surface ablation.Multicenter study in Spain.Case series.The medical records of patients who had surface ablation between January 2003 and December 2009 were reviewed to identify cases of infectious keratitis. The incidence, risk factors, clinical course, days to diagnosis, medical and surgical treatment, and visual outcome were recorded. Main outcome measures were incidence of infectious keratitis after surface ablation, culture results, response to treatment, and visual outcomes.The study reviewed the records of 9794 patients (18,651 eyes). Infectious keratitis after surface ablation was diagnosed in 39 eyes of 38 patients. The onset of infection was early (within 7 days after surgery) in 28 cases (71.79%). Cultures were positive in 13 of 27 cases in which samples were taken. The most frequently isolated microorganism was Staphylococcus species (9 cases). The final corrected distance visual acuity (CDVA) was 20/20 or better in 23 cases (58.97%), 20/40 or better in 36 cases (92.30%), and worse than 20/40 in 3 cases (7.69%).The incidence of infectious keratitis after surface ablation was 0.20%. Infectious keratitis is a potentially vision-threatening complication. Prompt and aggressive management with an intensive regimen of fortified antibiotic agents is strongly recommended. Proper management can preserve useful vision in most cases.No author has a financial or proprietary interest in any material or method mentioned.