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Purpose: To determine tolerance to residual astigmatism and visual performance in eyes implanted with a monofocal intraocular lens (IOL) designed to extend the depth of focus (Tecnis Eyhance, DIB00; Johnson & Johnson Vision) compared to eyes implanted with a standard monofocal IOL (Tecnis ZCB00; Johnson & Johnson Vision). Methods: This prospective, observational study enrolled consecutive patients who underwent routine cataract surgery and implantation of either the DIB00 (n = 20) or ZCB00 (n = 20) IOL. Astigmatic defocus was induced with a plus cylinder from +0.50 to +2.00 diopters (D) in 0.50-D steps for each astigmatic orientation (against-the-rule [ATR], with-the-rule [WTR], and oblique). Outcome measures included the comparison of mean visual acuity at each step of defocus, astigmatic defocus curves, and near and intermediate visual acuity. Results: Eyes implanted with the DIB00 demonstrated greater astigmatic tolerance and were more likely to maintain 20/40 or better visual acuity with up to +2.00 D of induced ATR and oblique astigmatism than the ZCB00 IOLs. The DIB00 group showed 1.3 lines better visual acuity at 2.00 D of ATR astigmatic defocus and 1 line better than the ZCB00 group at 1.50 D of oblique astigmatic defocus. Although the distance visual acuity was comparable, near and intermediate visual acuities (both distance-corrected and uncorrected) were better for the DIB00 IOL than for the standard ZCB00 IOL. Conclusions: The monofocal IOL designed to extend the depth of focus (DIB00 group) showed greater tolerance to induced astigmatism in ATR and oblique orientations and superior uncorrected and distance-corrected near and intermediate visual acuity than the standard monofocal IOL of the same IOL platform. [ J Refract Surg . 2023;39(4):222–228.]

Purpose: To evaluate the prediction of postoperative anatomical lens position (ALP) using intraoperative spectral-domain optical coherence tomography (SD-OCT) lens anatomy metrics in patients who underwent femtosecond laser–assisted cataract surgery. Methods: Intraoperative SD-OCT (Catalys; Johnson & Johnson Vision) and postoperative optical biometry (IOLMaster 700; Carl Zeiss Meditec AG) were used to assess anterior segment landmarks, including lens thickness, lens volume, anterior chamber depth, lens meridian position (LMP), and measured ALP. LMP was defined as the distance from the corneal epithelium to the lens equator, and ALP was defined as the distance from the corneal epithelium to the IOL surface. Eyes were divided into groups according to axial length (> 22.5 mm, 22.5 to 24.5 mm, and > 24.5 mm) and IOL type (Tecnis ZCB00 [Johnson & Johnson Vision]; AcrySof SN-60WF [Alcon Laboratories, Inc], or enVista MX60E [Bausch & Lomb]) to further analyze the correlation between LMP and ALP. Theoretical effective lens position was back-calculated using a specific formula. Primary outcome was correlation between postoperative measured ALP and LMP. Results: A total of 97 eyes were included in this study. Linear regression analysis displayed a statistically significant correlation between intraoperative LMP and postoperative ALP ( R 2 = 0.522; P < .01). No statistically significant correlation was observed between LMP and lens thickness ( R 2 = 0.039; P = .06) or between ALP and lens thickness ( R 2 = 0.02; P = .992). The greatest predictor for ALP was LMP (β = 0.766, P < .001; R 2 = 0.523). Conclusions: Intraoperative SD-OCT–measured LMP correlated better than anterior chamber depth and axial length to postoperative ALP. Further studies are necessary to analyze the impact of preoperative or intraoperative LMP measurements on postoperative refractive outcomes. [ J Refract Surg . 2023;39(3):165–170.]

Larissa Gouvea,1,2 Kareem Sioufi,3 Colin E Brown,3 George Waring IV,4 Wallace Chamon,2 Karolinne Maia Rocha3 1Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, ON, Canada; 2Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil; 3Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA; 4Waring Vision Institute, Mount Pleasant, SC, USACorrespondence: Larissa Gouvea Toronto Western Hospital - 399 Bathurst Street, 6th Floor East Wing, Reception 1, Toronto, ON, M5T 2S8, CanadaTel +1 416 603-5401Fax +1 416 603-1993Email gouveaalarissa@gmail.comPurpose: To compare the refractive predictability of intraoperative aberrometry (IA, ORA, Alcon) and Barrett True-K/Universal II formulas for intraocular lens (IOL) power calculations in post-corneal refractive surgery and normal eyes.Methods: Retrospective study of normal and post-corneal refractive surgery eyes that underwent cataract surgery with IA at tertiary academic center. Preoperatively, IOL power calculations were performed using Barrett Universal II (normal eyes) or Barrett True-K (post-corneal refractive surgery eyes) formulas. Intraoperatively, aphakic IA measurements were used for IOL power calculations. Mean absolute refractive prediction error (MAE) and the percentage of eyes with prediction error within ± 0.50, ± 0.75 and ± 1.00 D were calculated. Refractive predictability was also evaluated in short, normal, and long eyes.Results: Two hundred and seventy-three eyes were included in the analysis. No statistically significant differences were observed between the MAE of preoperative formulas and IA for post-hyperopic laser vision correction (LVC), post-myopic LVC, post-radial keratotomy (RK) and normal eyes. For prediction error within ± 0.5 D in post-corneal refractive surgery eyes, range of agreement between Barrett True-K and IA ranged from 28% (7/25) of the time in post-RK eyes to 49% (40/81) of the time in post-hyperopic LVC; the corresponding value for Barrett Universal II/IA was 62% (64/103) in normal eyes. When there was disagreement, IA outperformed Barrett True-K in post-hyperopic LVC eyes and Barrett formula outperformed IA in post-myopic LVC, post-RK, and normal eyes.Conclusion: IA appears to be comparable to Barrett formulas for IOL power calculations in post-corneal refractive surgery and normal eyes. In post-hyperopic LVC, IA yields better results compared to Barrett True-K formula; in real-life scenarios, IA reveals statistical advantage over the Barrett True-K no history formula for eyes post-hyperopic LVC.Keywords: intraoperative aberrometry, eyes post refractive surgery, refractive outcomes, Barrett True-K formula

PURPOSE: To evaluate an automated method for detecting the cone shape characteristics and to assess the cornea specialists' subjective variability of these measures using different maps. METHODS: Topographic images of the anterior and posterior surface of each eye were presented to 12 clinicians in two different types of map: tangential curvature and relative elevation to the best-fit sphere. They were asked to mark the cone center and its boundaries in the two maps without knowing that they belonged to the same patient. The results between the maps were compared to assess the subjective variability dependent on the map type and the automated method was compared against both estimations to assess its accuracy. RESULTS: Considering the results of anterior and posterior surfaces, there was low agreement between the cone center estimations using different types of maps for 10 of the 12 cases ( P < .05), whereas the comparison between the automated method and the two map estimations did not show differences in 11 of the 12 cases ( P > .05). There was high variability, up to 55%, among clinicians' estimations of the cone area. The results of the automated method were within the range of the expert's estimations. CONCLUSIONS: An objective, mathematically derived method of determining morphological dimensions of the cone was consistent with clinicians' evaluations. Although there was high variability among the experts' subjective estimates, which were highly influenced by the type of map, the objective method provided a reliable evaluation of the keratoconus shape independent of maps or color scale. [ J Refract Surg . 2021;37(6):414–421.]

PURPOSE To analyze factors affecting depth of focus (DOF) and near vision functionality in eyes implanted with aspheric monofocal intraocular lenses (IOLs). METHODS This prospective study included 111 eyes of 74 patients that underwent phacoemulsification with monofocal IOL implantation. Ninety-one normal eyes were randomized to receive aberration-free (n = 30) or negative-spherical aberration (SA) IOLs (n = 61). Twenty post-hyperopic femto-LASIK eyes received aberration-free IOLs. Corneal higher-order aberrations (SA, coma, trefoil, and corneal asphericity) for a 6 mm pupil were measured by Scheimpflug tomography. Ray-tracing metrics (visual Strehl optical transfer function [VSOTF], effective range of focus [EROF], sphere shift [SS], EROF-SS), pupil size measurements at far and near, and ocular and corneal SA were obtained using ray-tracing aberrometry. Distance-corrected near visual acuity (DCNVA) and subjective defocus curves up to ±4.0 diopters were evaluated. RESULTS Multivariable logistic regression found corneal profile and IOL type to be determinants of extended DOF with monofocal IOLs. The aberration-free IOL group showed significantly better DCNVA and higher total SA than the negative-SA group. Post-hyperopic LASIK eyes showed significantly better DCNVA; higher negative SA, coma, and Q value (P < .05), and smaller pupil size (P = .05) than normal eyes implanted with aberration-free IOLs. CONCLUSION Corneal profile and type of IOL implanted were the most important factors influencing near vision functionality with aspheric monofocal IOLs. Higher positive SA in the aberration-free group potentially led to better DCNVA than the negative-SA group in normal eyes. Hyperprolate corneas had better DOF curves and DCNVA than normal corneas. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

PURPOSE: To compare ray-tracing aberrometry, Hartmann-Shack wavefront analysis, automated refraction, and manifest refraction in patients with echelette diffractive intraocular lenses (IOLs) and patients with monofocal IOLs with negative spherical aberration. METHODS: Pseudophakic patients implanted with an echelette diffractive IOL (Tecnis ZXR00; Johnson & Johnson Vision) and a control group consisting of patients implanted with a negative spherical aberration monofocal IOL (Tecnis ZCBOO, Johnson & Johnson Vision) were included in this study. Ray-tracing aberrometry (iTrace; Tracey Technologies Corp.), Hartmann-Shack wavefront analysis (LADARWave; Alcon Laboratories, Inc.), automated refraction (Topcon KR-8800; Topcon Medical Systems, Inc.), and manifest refraction spherical equivalent were performed 1 to 3 months postoperatively. RESULTS: Thirty-two eyes implanted with a ZXR00 IOL and 30 eyes implanted with a ZCBOO IOL were enrolled in this study. The ZXR00 IOL group yielded more myopic results with automated refactions (−0.62 ± 0.41 diopters [D]), Hartmann-Shack wavefront analysis (−0.85 ± 0.40 D), and ray-tracing aberrometry (−0.45 ± 0.64 D), compared to manifest refraction (−0.12 ± 0.44 D) ( P < .001). Hartmann-Shack wavefront analysis showed a statistically significant myopic shift (−0.39 ± 0.47 D) in the ZCBOO group compared to ray-tracing aberrometry, automated refraction, and manifest refraction spherical equivalent (−0.14 ± 0.56, −0.14 ± 0.50, and −0.06 ± 0.44 D, respectively; P < .001). CONCLUSIONS: Manifest refraction techniques unique to echelette technology should be used to avoid over-minus end points. Autorefractors and aberrometers commonly use near-infrared light; thus, myopic results are expected with echelette achromatic technology. [ J Refract Surg . 2020;36(5):334–339.]

Jorge Selem Haddad,1,2 Eliza Barnwell,1 Karolinne Maia Rocha,1 Renato Ambrosio Jr,2,3 George O Waring IV4 1Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA; 2Universidade Federal de São Paulo, São Paulo, Brazil; 3Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; 4Waring Vision Institute, Mt. Pleasant, SC, USACorrespondence: Jorge Selem HaddadStorm Eye Institute, Medical University of South Carolina, 167 Ashley Ave, Charleston, SC 29425, USATel +1 843 327 7934Email jshaddad2@hotmail.comPurpose: To compare biometry measurements obtained by a partial interferometer biometer (IOLMaster 500) to the new Scheimpflug tomography with an integrated axial length biometer module (Pentacam AXL).Patients and Methods: Cataract patients who underwent biometric measurements with the IOL Master 500 and the Pentacam AXL from July to November 2017 were enrolled in this study. Comparisons were performed for axial length (AL), keratometry (K), and anterior chamber depth (ACD). The Pearson correlation coefficient and the 95% limits of agreement (LoA) were calculated. Paired Student’s t-tests and Bland-Altman plots were used to assess the differences between devices.Results: One hundred and sixty-six eyes of 92 patients were analyzed. There were no statistically significant differences in AL (p=0.558) or flat K (p=0.196) values between the IOL Master 500 and Pentacam AXL measurements. Statistically significant differences were found between the two devices with respect to steep K, ACD, and mean K measurements (p< 0.001).Conclusion: Both devices provided similar measurements of AL and flat K, though there were statistically significant differences in ACD, steep K, and mean K measurements.Keywords: anterior chamber depth, axial length, biometry, IOLMaster 500, partial coherence interferometry, pentacam AXL

The term dysfunctional lens syndrome has gained acceptance in the field and encompasses natural changes due to aging of crystalline lens. The evolution of diagnostic devices has been a key factor in better staging, understanding and characterizing of these degenerative changes. Even with these technological advances and the use of subjective classifications, such as the classic Lens Opacities Classification System, an objective staging of early dysfunctional lens syndrome has yet to be established. Ocular wavefront aberrometry and objective scatter index, associated with Scheimpflug backscatter densitometry, have proven instrumental in detecting early dysfunctional lens syndrome. Staging of early dysfunctional lens syndrome has been proposed in the literature, but no classification has been recognized worldwide. The purpose of this literature review is to assess the current state of dysfunctional lens syndrome from a technological perspective and propose a new staging system to assist surgeons in making surgical decisions. RESUMO O termo “síndrome disfuncional do cristalino” tem sido mais aceito na área e engloba mudanças naturais devido ao envelhecimento do cristalino. A evolução dos dispositivos diagnósticos tem sido fator fundamental para melhor estadiamento, compreensão e caracterização dessas alterações. Mesmo com esses avanços tecnológicos e o uso de classificações subjetivas, como o Lens Opacities Classification System , um estadiamento objetivo da síndrome disfuncional do cristalino precoce ainda não foi estabelecido. A aberrometria ocular total e o índice de superfície ocular, associado à densitometria de Scheimpflug, mostraram-se instrumentais na detecção da síndrome disfuncional do cristalino precoce. Embora estadiamentos precoces de síndrome disfuncional do cristalino tenham sido propostos na literatura, nenhum foi reconhecido mundialmente até o momento. O objetivo desta revisão de literatura é avaliar o estado atual da síndrome disfuncional do cristalino a partir de uma perspectiva tecnológica, e propor um novo sistema de estadiamento para auxiliar os cirurgiões na tomada de decisões cirúrgicas.

Purpose To assess optical quality dynamics using a double-pass (DP) system in patients with dry eye disease (DED). Methods Seventy-six eyes with DED and 44 control subjects were enrolled in this study. Each patient underwent ocular surface evaluation including fluorescein corneal staining and Schirmer's II test. Ocular Surface Disease Index (OSDI) questionnaire was used to assess subjective symptoms. Optical quality dynamics and tear film instability was analyzed using a DP system (HD AnalyzerTM, Visiometrics, Spain). Mean objective scatter index (OSI), maximum and minimum OSI, difference between maximum and minimum OSI (ΔOSI) were recorded with 40 consecutive scans over 20 s. Results The DED group had pronounced impairment of optical quality compared to the control group. Mean OSI (4.29±4.07), minimum (3.22±3.51) and maximum (5.72±4.52) OSI, ΔOSI (2.50±1.96), OSDI score (36.94±16.55), and fluorescein corneal staining (0.79±0.96) were statistically significantly higher than controls (p

Purpose: To report clinical outcomes and surgical technique of flanged intrascleral intraocular lens fixation with double-needle combined with either penetrating keratoplasty (PKP) or ultrathin Descemet-stripping automated endothelial keratoplasty (UT-DSAEK). Observations: Five patients underwent combined flanged intrascleral intraocular lens fixation with double-needle technique and keratoplasty. Three patients underwent triple procedure (open sky intrascleral intraocular lens fixation with double-needle and PKP) secondary to ocular trauma or a failed corneal transplant. Two patients underwent combined UT-DSAEK and intrascleral intraocular lens fixation for pseudophakic bullous keratopathy (PBK) and anterior chamber intraocular lens (AC IOL). Conclusion: Flanged intrascleral intraocular lens fixation with double-needle technique combined with PKP or UT-DSAEK was shown to be a safe and effective method of visual rehabilitation without additional intraoperative complications. Keywords: Corneal transplant, Flanged intrascleral intraocular lens fixation, Cataract surgery

Purpose To study correlations of crystalline lens anatomy and position parameters obtained using intraoperative spectral-domain (SD) optical coherence tomography (OCT) in cataract patients. Methods This retrospective study evaluated biometry data from 600 eyes of 399 cataract patients (mean age: 69±8.4 years) using intraoperative anterior segment SD-OCT during femtosecond laser-assisted cataract surgery. Lens anatomy and position parameters (anterior chamber depth [ACD] - center of the anterior cornea to the anterior lens capsule, lens thickness [LT] - distance between anterior and posterior lens capsules, and lens meridian position [LMP] - distance from center of the anterior cornea to intersection of the anterior and posterior lens) obtained with intraoperative SD-OCT, were correlated among themselves and with noncontact axial length (AL). Equatorial plane position (EPP) (distance between the plane of the lens equator and anterior capsule) was also studied. Pearson's coefficients (r-values) were determined for all correlation pairs. Results There was a moderate correlation between AL and ACD (r=0.451; P

A 27-year-old woman had BrightOcular iris implants placed for cosmetic purposes that changed eye color from brown to blue bilaterally. Of note, BrightOcular implants are not approved by the U.S. Food and Drug Administration (FDA) for use in the United States and have been associated with severe ocular complications. In keeping with their design, they were placed in the anterior chamber (AC) in both eyes of this patient; surgery was performed outside the United States. As has been described previously and tragically in other cases, she developed chronic inflammation, intolerable glare, angle-closure glaucoma, corneal edema, and cataracts in both eyes. For medically unmanageable elevated intraocular pressure (IOP), she underwent diode laser cyclophotocoagulation (CPC) in both eyes, and eventually, an Ahmed tube shunt (New World Medical, Inc.) was placed in the right eye. Although she was advised and urged to have the iris implants removed, despite her ocular issues, she refused removal until intolerable glare and reduced vision ensued. Ultimately, both iris implants were extracted 5 years after implantation by a U.S. surgeon; the procedures resulted in corneal decompensation and progressive cataract development. Subsequent penetrating keratoplasty (PKP) was performed for the right eye, but it failed because of contact with the glaucoma tube shunt. She sought additional consultation and presented with the following findings: corrected distance visual acuity was 20/400 in the right eye and 20/40 in the left eye, IOP of 18 mm Hg in the right eye and 16 mm Hg in the left eye, pupils were nonreactive and fixed, and extraocular muscles and central visual field were normal. Pachymetry was 868 μm in the right eye and 653 μm in the left eye. Anterior segment examination in the right eye revealed a failed corneal graft with 3+ edema, peripheral anterior synechiae (PAS) for 360 degrees, shallow AC, Ahmed tube shunt at the 11 o'clock position and remnant iris adherent to the graft-host junction for 270 degrees, 3+ posterior subcapsular cataract, and 2+ cortical cataract (Figure 1JOURNAL/jcrs/04.03/02158034-202208000-00024/figure1/v/2022-08-01T210317Z/r/image-tiff). The sclera revealed multiple circular and circumferential atrophic blue spots consistent with high-energy transscleral CPC (Figure 2JOURNAL/jcrs/04.03/02158034-202208000-00024/figure2/v/2022-08-01T210317Z/r/image-tiff). In the left eye, she had remnant fixed dilated iris for 270 degrees, missing iris superiorly for 3 clock hours, an adequate AC, and 2+ cortical cataract (Figure 3JOURNAL/jcrs/04.03/02158034-202208000-00024/figure3/v/2022-08-01T210317Z/r/image-tiff). Posterior segment examination revealed a 0.5 cup-to-disc ratio in both eyes with normal vessels, macula, vitreous, and retinal periphery, bilaterally. Given this constellation of findings, how would you proceed?

Presbyopia affects 1.8 billion people worldwide. This reduction in distance corrected near visual acuity impacts quality of life, which prompts patients to seek treatment. Presbyopia is an early manifestation of the “crystalline lens optical dysfunction through aging,” or dysfunctional lens syndrome, and appropriate management of presbyopia is dependent on coexisting factors such as increased higher order aberrations, reduced contrast sensitivity, light scatter, and lenticular opacification. This review of published literature (PubMed and MEDLINE) is presented in narrative format and discusses medical and surgical treatments available to patients who experience presbyopia, while highlighting future therapies. Numerous strategies exist for the management of presbyopia. These strategies include pharmacological therapy, glasses and contact lenses, corneal, scleral, and lenticular procedures. This article discusses the role of several new and existing presbyopia treatments, as well as which patients are candidates for these novel therapies. Although no single treatment is ideal for all patients with presbyopia, new medical and surgical strategies increase the number of options available when addressing different stages of presbyopia and dysfunctional lens syndrome. [ J Refract Surg . 2021;37(6 Suppl):S28–S34.]

Purpose To report clinical outcomes of a patient with unilateral neurotrophic keratitis following penetrating keratoplasty for lattice dystrophy treated with topical recombinant human nerve growth factor. Observations A 75-year-old male with lattice dystrophy and history of herpes simplex keratitis, presented with recurrent neurotrophic ulceration in the right eye two years following penetrating keratoplasty. The patient was successfully treated with topical recombinant human nerve growth factor. Conclusion Neurotrophic keratitis is a rare chronic disorder that affects quality of life due to the risk of vision loss. Topical recombinant human nerve growth factor is a novel and effective treatment option that may help improve optical quality and patient's satisfaction as shown in this case of recurrent neurotrophic keratitis.

The endothelial cell is a critical structure within the cornea and is responsible for maintaining corneal clarity through its pump function. Endothelial cells are lost over time naturally but can be injured medically, surgically, or as a part of various dystrophies. Monitoring of endothelial cells can be performed clinically or more formally with specular microscopy. In cases of significant compromise, endothelial cells can be transplanted by various endothelial keratoplasty techniques. The future pipeline is bright for possible endothelial cell regeneration and rehabilitation. This article reviews these topics in depth to provide a comprehensive look at the structure and function of the endothelial cell, etiologies of endothelial cell damage, detailed review of iatrogenic causes of endothelial cell loss, and management strategies.

Purpose of review This review outlines ophthalmic diagnostic systems, which objectively evaluates the human visual system and its potential beyond that of Snellen acuity. Recent findings Advances in ophthalmic diagnostic systems have allowed for a deeper understanding of the optical principles of the human eye and have created the opportunity to evolve our current standards of vision assessment beyond Snellen acuity charts. Definitive comparative and validation trials will continue to be necessary in order for these advanced diagnostics to gain more widespread acceptance in the specialty, in addition to providing the guidance on the specific indications and utilities. Summary Advancements in wavefront analysis, light scatter measurements, and adaptive optics technologies can provide greater insight into an individual optical system's potential and irregularities. Modalities that test for anterior corneal surface and whole eye aberrations, light scatter and contrast sensitivity can be an excellent educational tool for our patients to help them better understand their visual dysfunction and can prove useful for medical or surgical decision-making.

Purpose Report a case of corneal melt in a patient with conjunctival intraepithelial neoplasia (CIN) treated with topical interferon (IFN) alpha-2B. Observations An 89-year-old man presented with gelatinous paralimbal lesions of the left eye extending onto the cornea with corneal neovascularization extending 5–6 clock hours. Nasally there was mild absence of the terminal vascular loops of the limbal palisades of Vogt and conjunctivalization. Diffuse punctate epithelial erosions were noted. The corneal graft displayed subepithelial and stromal edema. Anterior segment optical coherence tomography detected hyperreflectivity, sectional thickened epithelium, and abrupt transitions from normal to abnormal tissue. The patient was treated with excision of the corneal and conjunctival lesions with cryotherapy to the conjunctival borders. Excisional biopsy revealed CIN Grade 3 and carcinoma in situ of the cornea. Topical IFN alpha-2B four times daily was initiated postoperatively. Two months later, a central epithelial defect developed. The cornea progressively thinned and corneal melt ensued. The patient had several risk factors for corneal melt including neurotrophic cornea, early limbal stem cell deficiency, history of cryotherapy, keratoconjunctivitis sicca, and chronic use of glaucoma medications and steroid medications. Conclusions Interferon alpha-2B is an effective first line treatment for CIN with few side effects. It's side effects include punctate epithelial erosions, conjunctival hyperemia, and follicular conjunctivitis. We report a case of pre-existing keratoconjunctivitis sicca, early limbal stem cell deficiency, neurotrophic cornea, and newly diagnosed CIN Grade 3; it was treated with surgical excision, cryotherapy, and topical IFN alpha-2b with development of corneal melt 2 months later. Caution should be taken when using interferon alpha -2b in patients with pre-existing keratoconjunctivitis sicca, neurotrophic cornea, or limbal stem cell deficiency as it could exacerbate these conditions resulting in corneal melt.

Purpose To characterize crystalline lens dimensions derived from in vivo spectral-domain optical coherence tomography (SD-OCT) and identify associations among these parameters, ocular biometry, and age. Methods In this retrospective study, lens thickness (LT), lens diameter (LD), and lens volume (LV) were measured intraoperatively using SD-OCT in 293 eyes undergoing lens surgery. Correlations among LT, LD, LV, age, axial length (AL), and anterior chamber depth (ACD) were analyzed. Multiple regression analysis was performed to determine whether a combination of biometric data could predict LD and LV. Results Wide variations were observed in LT (3.6-5.7 mm), LD (7.5-11.9 mm), and LV (119.9-312.4 mm3) of aging eyes. Correlations among the 3 lens dimensions were statistically significant (LV-LT: r = 0.785; P 1 standard deviation (SD) above and that 5.2% had LD Conclusions Dimensions of the aging lens vary considerably and are most accurately characterized by direct measurement of LT, LD, and LV, rather than making assumptions based on AL. These findings challenge historically proposed relationships between LD and AL and represent a normative dataset of contemporary geometric features of the aging lens, possibly aiding in surgical decision making and future developments in lens surgery.

To characterize the dysfunctional lens syndrome and review the literature on the topic. Diagnostic devices may be used to objectively evaluate the aging changes of the crystalline lens in order to better characterize the entity. Opportunities exist for future evaluation of this emerging concept. The term dysfunctional lens syndrome is gaining acceptance in our field. Objective diagnostic evaluation of aging crystalline lenses has been demonstrated to be useful in identification and characterization of the dysfunctional lens.

Presbyopia corrections traditionally have been approached with attempts to exchange power, either at the cornea or the lens planes, inducing multifocality, or altering asphericity to impact the optical system. Treatments that affect the visual axis, such as spectacle and contact lens correction, refractive surgeries, corneal onlays and inlays, and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye. Their aim is instead to enhance ‘pseudoaccommodation’ by facilitating an extended depth-of-focus for which vision is sufficient. There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution, rather than a ‘vision correction’ solution that compromises other components of the optical system. Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia. While the theoretical justification of scleral surgical procedures remains controversial, there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia. Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s, and this remains an active area of research. In this article, we discuss the historic scleral surgical procedures, the two scleral procedures currently available, as well as an outlook of the future for the scleral surgical space for treating presbyopia.

The purpose of this study is to report the preliminary findings and the retrospective clinical impressions of the integrated corneal tomography and corneal deformation parameters with a dynamic ultra-high-speed Scheimpflug camera equipped with a noncontact tonometer. Twelve eyes of six patients were evaluated by the Scheimpflug imaging system of the Pentacam HR and Corvis ST (OCULUS Optikgeräte GmbH, Wetzlar, Germany) devices. The parameters used were the Belin/Ambrósio deviation (BAD-D) and Corvis biomechanical index (CBI), as well as the recently published tomographic and biomechanical index (TBI), combined with a detailed clinical data and evaluation of normal eyes and patients with different stages of corneal ectasia. How to cite this article Haddad JS, Barnwell E, Rocha KM, Waring IV GO, Ambrosio Jr R. First Clinical Impressions on the Integrated Corneal Tomography and Corneal Deformation with Scheimpflug Imaging. Int J Kerat Ect Cor Dis 2017;6(2):101-109.

Purpose: The purpose of this study was to objectively assess the optical vision quality of patients before and after Nd:YAG capsulotomy for posterior capsular opacification using a double-pass retinal imaging system. Methods: We retrospectively analyzed the data from 26 pseudophakic eyes with posterior capsular opacification that underwent Nd:YAG capsulotomy. The objective scatter indices, modulation transfer function cutoff frequencies, Strehl ratios, and logMAR corrected distance visual acuities were assessed before and after YAG capsulotomy with a double-pass retinal imaging system (OQAS II, Visiometrics, Spain). We also analyzed data from a subgroup of 10 patients with pre-YAG corrected distance visual acuity of 0.10 logMAR (20/25) or better. Results: Vision quality indices improved in all 26 eyes, resulting in a statistically significant improvement in the corrected distance visual acuity (p=0.007), objective scatter index (p=0.001), modulation transfer function cutoff frequency (p=0.001), and Strehl ratio (p=0.020). The overall mean improvements included 0.12 ± 0.04 logMAR for corrected distance visual acuity, 2.84 ± 0.76 for objective scatter index, 12.29 ± 2.77 for modulation transfer function cutoff frequency, and 0.06 ± 0.03 for Strehl ratio. Our sub-analysis of 10 eyes with 0.10 logMAR (20/25) corrected distance visual acuity or better also showed a statistically significant improvement in the mean objective scatter index (0.76 ± 16; p=0.001), resulting in approximately 35% decrease in intraocular light scatter. Conclusions: The objective vision quality measurements as assessed by the double-pass retinal imaging system showed a significant improvement after YAG capsulotomy. This suggests that the objective scatter index improves after YAG capsulotomy, even in eyes with pre-YAG 0.10 logMAR (Snellen 20/25) corrected distance visual acuity or better. RESUMO Objetivo: Avaliar objetivamente a qualidade da visão óptica antes e depois da capsulotomia com Nd: YAG, obtida por imagem pelo metodo de dupla passagem de luz em pacientes com opacificação capsular posterior. Método: Análise retrospectiva de 26 olhos pseudofácicos com opacificação capsular posterior visualmente significativa, que foram submetidos à capsulotomia de Nd: YAG. O índice de dispersão objetiva, a função de transferência de modulação, a relação de Strehl e a acuidade visual à distância corrigida foram avaliados antes e após a capsulotomia com YAG usando o dupla passagem de luz (OQAS II, Visiometrics, Espanha). Também foi analisado um subgrupo de pacientes com acuidade visual à distância corrigida pré-YAG de 0,10 logMAR (20/25) ou melhor. Resultados: Os índices de qualidade da visão melhoraram em todos os 26 olhos, resultando em uma melhora estatisticamente significativa na acuidade visual à distância corrigida (p=0,007), índice de dispersão objetiva (p=0,001), função de transferência de modulação (p=0,001) e relação de Strehl (p=0,020). A melhora média na acuidade visual à distância corrigida foi de 0,12 ± 0,04 logMAR, no índice de dispersão objetiva foi de 2,84 ± 0,76, no função de transferência de modulação foi de 12,29 ± 2,77 e na razão de Strehl foi de 0,06 ± 0,03 em todos os olhos. Sub-análise de 10 olhos com 0.10 logMAR (20/25) acuidade visual à distância corrigida ou melhor também mostrou uma melhora estatisticamente significativa no índice de dispersão objetiva (p=0,001). A melhora média no OSI foi de 0,76 ± 16, uma diminuição de 35% na dispersão da luz intraocular. Conclusões: A qualidade da visão avaliada pelo dupla passagem de luz mostra uma melhora significativa nas medidas objetivas da qualidade da visão após a capsulotomia do YAG. O índice de dispersão objetiva melhora após a capsulotomia YAG, mesmo em olhos com acuidade visual à distância corrigida pré-YAG de 0,10 logMAR (Snellen 20/25) ou melhor.

Diffusion is an important mechanism of transport for nutrients and drugs throughout the avascular corneal stroma. The purpose of this study was to investigate the depth- and direction-dependent changes in stromal transport properties and their relationship to changes in collagen structure following ultraviolet A (UVA)-riboflavin induced corneal collagen cross-linking (CXL). After cross-linking in ex vivo porcine eyes, fluorescence recovery after photobleaching (FRAP) was performed to measure fluorescein diffusion in the nasal-temporal (NT) and anterior-posterior (AP) directions at corneal depths of 100, 200, and 300 μm. Second harmonic generation (SHG) imaging was also performed at these three corneal depths to quantify fiber alignment. For additional confirmation, an electrical conductivity method was employed to quantify ion permeability in the AP direction in corneal buttons and immunohistochemistry (IHC) was used to image collagen structure. Cross-linked corneas were compared to a control treatment that received the riboflavin solution without UVA light (SHAM). The results of FRAP revealed that fluorescein diffusivity decreased from 23.39 ± 11.60 μm2/s in the SHAM group to 19.87 ± 10.10 μm2/s in the CXL group. This change was dependent on depth and direction: the decrease was more pronounced in the 100 μm depth (P = 0.0005) and AP direction (P = 0.001) when compared to the effect in deeper locations and in the NT direction, respectively. Conductivity experiments confirmed a decrease in solute transport in the AP direction (P

Since the introduction of femtosecond laser (FS) systems for corneal flap creation in laser-assisted in-situ keratomileusis there have been numerous applications for FS laser in corneal surgery. This manuscript details the utility of FS lasers in corneal surgical procedures including refractive laser surgeries, intracorneal ring segment tunnels, presbyopic treatments, and FS-assisted keratoplasty. We also review the role of FS lasers in diagnostic procedures such as two photon excitation fluorescence and second harmonic generation.

PURPOSE: To measure retinal image quality using point spread function (PSF) analysis by double-pass retina point imaging in patients with keratoconus and to correlate visual quality with disease severity. METHODS: Patients diagnosed as having keratoconus by clinical examination, topography, and tomography and normal eyes were included in this study. A commercially available double-pass retina point imaging instrument (OQAS 108 II AcuTarget HD; Visiometrics S.L., Terrassa, Spain) was used to collect Objective Scatter Index (OSI) values in 21 keratoconic and 22 normal eyes. Eyes were also subjected to corneal topography and tomography, and staged using the Keratoconus Severity Score (KSS) and Amsler–Krumeich (AK) scales. RESULTS: The OSI was increased in keratoconic eyes (5.85 ± 0.98) versus control eyes (0.83 ± 0.12; mean ± SEM), in AK stages 1 to 4, and KSS stages 3 and 4. Receiver-operator characteristic analysis obtained an area under the curve (AUC) of 0.859 when evaluating the OSI as a unimodal diagnostic indicator for any KSS stage and 0.993 for KSS stages 3 and higher. An AUC of 0.949 was obtained in comparing eyes with lower severity topographic aberrations (KSS 1 and 2) versus mild to moderate keratoconus (KSS 3 and 4). Increasing corneal steepening patterns on tomography and topography were associated with PSF broadening and increased OSI. CONCLUSIONS: Double-pass retina point imaging is useful in correlating retinal image quality with keratoconus severity. The OSI may represent a clinically significant parameter for staging keratoconus with a unique ability to directly evaluate quality of vision in this population. [ J Refract Surg. 2016;32(11):760–765.]

Purpose of review This review outlines concepts in intraocular lens (IOL) optics and aberrations important both for current IOLs and for new IOLs in development. Recent findings Optical aberrations make a significant impact on the laboratory and clinical performance of IOLs, especially under mesopic and low-contrast conditions. Minimizing or correcting these aberrations can potentially improve visual function. Strategic management of aberrations can have clinical utility for extended depth of focus and presbyopia correction. Summary All IOLs affect ocular aberrations in some manner. It is important for clinicians and researchers to understand the implications how any residual aberrations could affect visual quality, visual side-effects, and depth of focus.

To assess changes in Ocular Response Analyzer (ORA) waveforms after UVA/riboflavin corneal collagen cross-linking (CXL) using investigator-derived and manufacturer-supplied morphometric variables in patients with keratoconus (KC) and postrefractive surgery ectasia.Prospective randomized trial of a standard epithelium-off CXL protocol.Patients with progressive KC (24 eyes of 21 patients) or postrefractive surgery ectasia (27 eyes of 23 patients) were enrolled.Replicate ORA measurements were obtained before and 3 months after CXL. Pretreatment and posttreatment waveform variables were analyzed for differences by paired Student t tests using measurements with the highest waveform scores.Corneal hysteresis, corneal resistance factor, 37-s generation manufacturer-supplied ORA variables, and 15 investigator-derived ORA variables.No variables were significantly different 3 months after CXL in the KC group, and no manufacturer-supplied variables changed significantly in the postrefractive surgery ectasia group. Four custom variables (ApplanationOnsetTime, P1P2avg, Impulse, and Pmax) increased by small but statistically significant margins after CXL in the postrefractive surgery ectasia group.Changes in a small subset of investigator-derived variables suggested an increase in corneal bending resistance after CXL. However, the magnitudes of these changes were low and not commensurate with the degree of clinical improvement or prior computational estimates of corneal stiffening in the same cohort over the same period. Available air-puff-derived measures of the corneal deformation response underestimate the biomechanical changes produced by CXL.

PURPOSE: To evaluate changes in corneal epithelial and stromal thickness after corneal collagen cross-linking (CXL) in eyes with keratoconus and postoperative corneal ectasia using spectral-domain optical coherence tomography (SD-OCT). METHODS: Anterior segment SD-OCT (RTVue-100; Optovue, Inc., Fremont, CA) was used to compare regional corneal epithelial and stromal thickness in eyes with keratoconus and ectasia before CXL and 1 and 3 months after CXL. The anterior surface of the cornea, epithelium–Bowman’s layer interface, and posterior reflective surface were used as anatomical landmarks to measure epithelial and stromal thickness, respectively. Regional thickness was assessed centrally and at 21 points 0.5 mm apart across the central 6 mm of the corneal vertex in the horizontal and vertical meridians. RESULTS: Thirty-one eyes from 30 patients were evaluated, including 17 eyes (17 patients) with keratoconus and 14 eyes (13 patients) with ectasia. Preoperatively, a highly irregular epithelial thickness profile and distribution was observed in both groups. After CXL, epithelial thickness was significantly thinner 2.5 and 2 mm below and 1.5 mm above the corneal apex (49.26 ± 5.69 μ m; range: 43 to 62 μ m), and 2.5 and 1 mm nasal and 2 mm temporal to the corneal apex (46.66 ± 4.53 μ m; range: 39 to 57 μ m) compared to preoperative values ( P < .05 for all measurements). Epithelial thickness standard deviations were significantly lower (by 3 to 6 μ m) 3 months after CXL, compared to ranges before CXL in both the vertical and horizontal meridians for keratoconus and ectasia ( P = .048). No significant differences were found between epithelial remodeling in keratoconus and corneal ectasia ( P = .98). No significant or consistent stromal changes were found for either group. CONCLUSIONS: Significant epithelial remodeling occurs after CXL in eyes with keratoconus and corneal ectasia, creating a similar, more regularized thickness profile in all meridians in the early postoperative period. This pattern of remodeling may facilitate interpretation of corneal curvature and thickness changes after CXL and may be related to visual acuity after CXL. [ J Refract Surg. 2014;30(2):122–127.]

PURPOSE: To evaluate and compare biomechanical properties in normal and keratoconic eyes using a dynamic ultra-high-speed Scheimpflug camera equipped with a non-contact tonometer (Corvis ST; Oculus Optikgeräte GmbH, Wetzlar, Germany). METHODS: This retrospective study evaluated 89 eyes (47 normal, 42 keratoconic) and a validation arm of 72 eyes (33 normal, 39 keratoconic) using the Corvis ST. A diagnosis of keratoconus was established by clinical findings confirmed by topography and tomography. Dynamic corneal response parameters collected by the Corvis ST (A1 velocity, deformation amplitude [DA], DA Ratio Max 1mm, and Max Inverse Radius) and a stiffness parameter at first applanation (SP-A1) were incorporated into a novel logistic regression equation (DCR index). Area under the receiver operating curve (AUC) was used to assess the sensitivity and specificity of the DCR index. RESULTS: DA, DA Ratio Max 1mm, Max Inverse Radius, and SP-A1 were each found to be statistically significantly different between normal and keratoconic eyes (Mann–Whitney test [independent samples]; P = .0077, < .0001, < .0001, and < .0001, respectively; significance level: P < .05). DCR index demonstrated high sensitivity, specificity, and overall correct detection rate (92.9%, 95.7%, and 94.4%, respectively; AUC = 98.5). The sensitivity and overall correct detection rate improved when eyes with Topographical Keratoconus Classification grades (TKC) greater than 0 were reevaluated (from 92.9% to 96.6% and from 94.4% to 96.1%, respectively). CONCLUSIONS: Combining multiple biomechanical parameters (A1 velocity, DA, DA Ratio Max 1mm, Max Inverse Radius, and SP-A1) into a logistic regression equation allows for high sensitivity and specificity for distinguishing keratoconic from normal eyes. [ J Refract Surg. 2017;33(9):625–631.]

Despite the surgical challenges during the endothelial keratoplasty (EK) procedures, postoperative management is of utmost importance for graft survival. One of the most important aspects of postoperative care is the management of topical steroid dosage, since sudden discontinuation of treatment has been identified as the main cause of graft failure in several reports. There are also potential challenges that can present to the surgeon both in the early and late postoperative period, such as fluid in the interface and graft detachment; or immunologic rejection or graft failure, respectively. In the initial portion of this chapter, routine management of an uncomplicated graft is described, followed by the description and management of several scenarios that could present along the postoperative period.

To compare central (CCT) and peripheral corneal thickness (PCT) using Scheimpflug imaging (Pentacam), high-speed optical coherence tomography (Visante OCT), and ultrasound (US) pachymetry (Sonogage Corneo-Gage Plus) in normal, keratoconus-suspect, and post-laser in situ keratomileusis (LASIK) eyes.Department of Refractive Surgery, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.The CCT and PCT were retrospectively measured using US pachymetry, Scheimpflug imaging, and high-speed OCT from January 2006 to March 2008. The influence of age and absolute magnitude of corneal thickness were also analyzed. Analysis was by multivariate generalized estimating equations, multivariate linear regression, and linear regression plots.One hundred sixty-three eyes were analyzed. Ultrasound pachymetry CCT measurements were consistently higher than Scheimpflug and OCT measurements (mean difference 6.5 microm +/- 1.8 [SD] and 7.5 +/- 1.4 microm, respectively) (both P.0005) in normal eyes; the difference was statistically similar and not greater with keratoconus suspicion, age, or absolute magnitude of corneal thickness (P.05). Scheimpflug measurements were significantly lower than US pachymetry in post-LASIK eyes (P.0005). There was no statistically significant difference (mean 0.9 +/- 1.4 microm) in Scheimpflug and OCT CCT measurements (P.5), although Scheimpflug measurements were significantly lower in post-LASIK eyes (P.0005). Scheimpflug PCT measurements were higher than OCT measurements, showing more agreement with increasing age (P = .017).Scheimpflug and OCT CCT measurements were reproducible but always thinner than US pachymetry in normal and keratoconus-suspect eyes. In post-LASIK eyes, OCT pachymetry maps were more accurate than Scheimpflug maps. The influence of age on PCT requires further study.

Purpose To compare distance-corrected, near, and intermediate visual acuities as a measurement of depth of focus and spherical aberration of eyes implanted with aspheric and spherical intraocular lenses (IOLs). Design Randomized prospective study. Participants One hundred twenty eyes of 60 patients with bilateral cataract implanted with 3 IOL models (AcrySof IQ, AcrySof SN60AT [Alcon Laboratories, Fort Worth, TX], and Sensar AR40 [Allergan Surgical, Irvine, CA]). Methods Pupil diameter was analyzed by using a Colvard pupillometer (OASIS Medical, Inc., Glendora, CA) under photopic, mesopic, and scotopic conditions. Distance (6 m), intermediate (1 m), and near (0.33 m) visual acuities were measured with distance correction in place 90 days after surgery. Wavefront analysis (LadarWave; Alcon Laboratories) was performed using 5-mm and measured photopic pupil diameter at 30 and 90 days after surgery. Main Outcome Measures To evaluate spherical aberration and depth of focus (by means of distance-corrected near and intermediate visual acuity) in patients implanted with aspheric and spherical IOLs. Results Photopic pupil sizes in each group were similar at 30 days after surgery. At 90 days after surgery, mean logarithm of the minimum angle of resolution distance-corrected near visual acuity (±standard deviation [SD]) was 0.50±0.20 in the AcrySof IQ group, 0.38±0.17 in the AcrySof SN60AT group, and 0.45±0.16 in Sensar AR40 group. Mean spherical aberration values (±SD) were 0.03±0.05 μm in the AcrySof IQ group, 0.24±0.04 μm in the AcrySof SN60AT group, and 0.14±0.07 μm in the Sensar AR40 group. The AcrySof IQ group showed a statistically significant lower induction of spherical aberration and worse distance-corrected near visual acuity. The AcrySof SN60AT group showed statistically significant higher mean spherical aberration values and better distance-corrected near and intermediate visual acuity. Conclusions The reduction of total spherical aberration after aspheric IOL implantation may degrade distance-corrected near and intermediate visual acuity.

To analyze higher-order aberrations induced by different types of lenticular opacities.Federal University of São Paulo, São Paulo, Brazil.One hundred thirty-eyes of 65 patients with bilateral cataract, classified according to the Lens Opacities Classification System III (LOCS III), had complete ophthalmic examinations, corneal topography (EyeSys Technologies), and wavefront analysis (LADARWave, Alcon Laboratories). Patients with cataracts that could not be measured by a Hartmann-Shack sensor or those with coexisting ocular disease were excluded. Higher-order aberrations were compared between the nuclear, cortical, and posterior subcapsular groups for statistical significance.One hundred five eyes of 65 patients were assessed. Twenty-eight eyes (23.33%) had predominantly nuclear opacification (NO1-NO6 and C1-2), and 13 (10.83%) had mainly cortical opacification (C1-4). Sixty-four eyes (65.83%) had a mixed pattern of LOCS III classification, which hindered the establishment of a correlation between the aberrometry and cataract type. Eighteen eyes that presented with dense posterior subcapsular cataract (P4-5) and 7 eyes with cortical C5 LOCS III classification were excluded. In eyes with nuclear opacification, the mean spherical aberration with a 6.0 mm pupil was 0.45 microm +/- 0.17 (SD) and the mean coma was 0.29 +/- 0.13 microm. In eyes with predominantly cortical cataract, the mean spherical aberration was 0.12 +/- 0.10 microm and the mean coma was 0.49 +/- 0.23 microm. The cortical cataract group had statistically significantly higher coma than the other groups (P.001). The nuclear cataract group had statistically significantly higher spherical aberrations than the other groups (P.001).Different types of early lenticular opacities induced different wavefront aberration profiles. Coma predominated in the cortical cataract group, and spherical aberration predominated in the nuclear cataract group.

To evaluate the clinical outcome of children with traumatic hyphema treated on an outpatient basis.A prospective cases series. Thirty-five children with traumatic hyphema were treated as outpatients for the ocular injury from February 2002 to February 2003. Data regarding initial and final visual acuity, slit-lamp biomicroscopy, hyphema size,ophthalmoscopy, intraocular pressure, rebleeding, clearance time, and medical and surgical intervention were recorded.Thirty (85.7%) children were male, and the major cause of traumatic hyphema was domestic tools (14 cases, 40.0%). Twenty-four patients (68.6%) presented low grades of hyphema. Seventeen patients (48.6%) had intraocular pressures higher than 24 mm Hg. The most common lesions associated with traumatic hyphema were corneal injuries (16 cases, 45.7%). The median final visual acuity was 20/25. Unsatisfactory final visual acuity (worse than 20/30) was statistically associated with ocular posterior segment lesions (P = 0.009) and grade of hyphema (P = 0.004). The grade of hyphema was also related to intraocular hypertension (P = 0.018) and time for hemorrhage absorption (P0.001). Nine patients (25.7%) underwent surgical intervention. Rebleeding occurred in three patients (8.6%).Outpatient management is a feasible option for children with hyphema. Associated posterior ocular segment injuries and hyphema of greater magnitude were related to the worst final visual acuities.

Infectious keratitis is rare following laser vision correction. We present a case of aggressive fungal keratitis caused by Aspergillus flavus, following laser in situ keratomileusis (LASIK) in the setting of a unique environmental risk factor. We describe the key features of the acute case presentation, which guided empirical medical and surgical treatment, resulting in the most favorable outcome found in the literature, to date.

PURPOSE: To assess the corneal architecture and reproducibility of LASIK flap thickness created by the Amadeus II mechanical microkeratome (Ziemer Ophthalmic Systems AG) using Fourier-domain optical coherence tomography (OCT; Optovue Inc). METHODS: Anterior segment Fourier-domain OCT was used to analyze the morphology of 58 LASIK flaps from 30 patients created with the Amadeus II microkeratome 140-μm head and ML7090CLB blades (Med-Logics Inc) at 2 weeks postoperatively. Flap thickness was assessed at 10 points across the central 6 mm of the cornea (horizontal and vertical meridians). Postoperative central corneal flap thickness measured by Fourier-domain OCT was compared with intraoperative ultrasound pachymetry measurements. RESULTS: No significant difference was noted between central flap thickness measured by intraoperative pachymetry (107.2±14 μm) and postoperative OCT (111.7±11 μm; P =.07, correlation coefficient=0.86). Fourier-domain OCT measurements demonstrated functionally planar flap architecture (standard deviation [SD] of thickness across the flap=4.9 μm, SD range across the flap=2 to 9 μm) for the microkeratome flaps. CONCLUSIONS: The Amadeus II microkeratome with Med-Logics blades created thin, reproducible, functionally planar flaps as measured by Fourier-domain OCT. Central flap thickness measured by intraoperative ultrasound pachymetry was equivalent to that measured 2 weeks postoperatively by OCT.