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Sheetal Brar, Sri Ganesh, Raghavender Reddy Arra, Smith Snehal Sute Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bangalore, Karnataka, IndiaCorrespondence: Sheetal BrarNethradhama Super Speciality Eye Hospital, 256/14, Kanakapura Main Road, 7th Block, Jayanagar, Bengaluru, Karnataka, 560070, IndiaTel +91 9591002092Email brar_sheetal@yahoo.co.inTitle: Visual and refractive outcomes and patient satisfaction following implantation of monofocal intraocular lens in one eye and ERV intraocular lens in the contralateral eye with mini-monovision.Purpose: To evaluate the outcomes following implantation of monofocal intraocular lens in one eye and ERV intraocular lens in the contralateral eye with mini-monovision.Methods: Twenty-five subjects underwent bilateral cataract surgery, wherein the dominant eye received monofocal Tecnis-1 IOL, while in the contralateral eye received the Tecnis Symphony ERV IOL. The dominant eye was targeted for emmetropia and the non-dominant eye for myopia of − 0.50 to − 0.75D. Binocular uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, CIVA), and near (UNVA, DCNVA) visual acuity; reading speeds, defocus curve and contrast sensitivity were studied at 6 months post-operatively.Results: At 6 months post-operatively the mean binocular UDVA, CDVA, UNVA and DCNVA were 0.007± 0.07, − 0.13± 0.06, 0.26± 0.09 and 0.44± 0.10 LogMAR, respectively. Binocular UIVA and DCIVA at 60 cm were 0.22± 0.10 and 0.18± 0.08 LogMAR and at 80 cm was 0.16± 0.11 and 0.15± 0.10 LogMAR, respectively. Mean uncorrected reading speeds evaluated with SRD at 40, 60 and 80 cm were 114.4± 6.9, 126.4± 7.9 and 123.16± 5.8 words per minute. Contrast sensitivity values did not show significant difference for any spatial frequency tested. At 6 months, only 12% (3 patients) reported mild halos. Spectacle independence satisfaction scores were 96%, 100% and 88% for distance, intermediate and near.Conclusion: Implantation of monofocal intraocular lens in one eye and ERV intraocular lens in the contralateral with mini-monovision resulted in good outcomes for far and intermediate, and satisfactory outcomes for near vision, with good tolerance to mini-monovision at the end of 6 months.Keywords: hybrid monovision, extended range of vision IOL, monofocal IOL

Purpose To compare the safety, efficacy, and predictability of femtosecond laser-enabled anterior penetrating and intrastromal arcuate incisions for the correction of preoperative astigmatism at the time of cataract surgery. Setting Nethradhama Super Speciality Eye Hospital, Bangalore, India. Design Prospective randomized comparison study. Methods This study included 50 eyes of 50 patients who had femtosecond laser-assisted cataract surgery with the CATALYS Precision System (Johnson & Johnson Vision Care, Inc.). Twenty-five eyes received anterior penetrating and 25 eyes received intrastromal arcuate incisions for the correction of corneal astigmatism in the range of 0.75 to 2.00 diopters (D). Six months postoperatively, vector analysis of astigmatism was performed using the Alpins method with the ASSORT software. Results The mean preoperative keratometric astigmatism and target-induced astigmatism were 1.07 D and 1.16 D in the anterior penetrating group and 1.23 D and 1.50 D in the intrastromal group, respectively. There was no statistically significant difference between the postoperative keratometric astigmatism (anterior penetrating = 0.65, intrastromal = 0.90, P value = .13) and surgically induced astigmatism (anterior penetrating = 1.23, intrastromal = 1.08, P value = .55) at 6 months postoperatively. The correction index was 0.95 in the anterior penetrating group and 0.55 in the intrastromal group, signifying an undercorrection of 5% and 45% of eyes in the anterior penetrating and intrastromal group, respectively. Eighty percent of eyes in the anterior penetrating group and 72% of eyes in the intrastromal group were within ±0.5 D of refractive astigmatism. Conclusions Both anterior penetrating and intrastromal incisions were effective in reducing preoperative astigmatism using the femtosecond laser technology. However, the anterior penetrating incisions showed comparatively better correction, whereas the intrastromal incisions resulted in significant undercorrection at 6 months.

PURPOSE: To describe a new intraoperative sign called the “gas bubble escape” (GBE) sign to predict the ease of dissection and immediate postoperative quality of vision after small incision lenticule extraction (SMILE). METHODS: The term GBE sign refers to the escape of gas bubbles followed by an immediate clarity of the interface on delineation of the lenticule planes in SMILE. This sign may indicate an optimized laser energy, which may facilitate an easy dissection of lenticule, potentially resulting in good quality of vision immediately postoperatively. This prospective study included 100 eyes of 50 patients undergoing bilateral myopic SMILE, wherein a randomly selected 32 (29 patients) of 68 eyes showing the GBE sign intraoperatively were compared with 32 eyes (20 patients) that did not show this sign. A single surgeon performed all surgeries using the same technique and energy parameters (150 nJ energy, 4.5 µm spot spacing). At postoperative 1 day and 1 month, uncorrected distance visual acuity (UDVA), Objective Scatter Index (OSI) score, and modulation transfer function (MTF) cut-off were compared between the two groups using a double-pass system. RESULTS: On day 1, the mean OSI score was significantly lower (0.78 ± 0.32) in the GBE group compared to the no GBE group (1.11 ± 0.90) ( P = .03). The mean UDVA was also significantly better in the GBE group ( P = .001). MTF cut-off was comparable between both groups. However, at 1 month all of the above parameters were comparable between the two study groups ( P > .05). CONCLUSIONS: The gas bubble escape sign may be a useful indicator of energy optimization, potentially resulting in good visual outcomes in the immediate postoperative period following SMILE. [ J Refract Surg. 2019;35(7):467–472.]