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Purpose: The main objective was to develop a prediction model based on machine learning to calculate the postoperative vault as well as the ideal implantable collamer lens (ICL) size, considering for the first time the implantation orientation in a Caucasian population., Setting: Arruzafa Ophthalmological Hospital (Cordoba, Spain) and Barraquer Ophthalmology Center (Barcelona, Spain)., Design: Multicenter, randomized, retrospective study., Methods: Anterior segment biometric data from 235 eyes of patients who underwent ICL lens implantation surgery were collected using the anterior segment optical coherence tomography (AS-OCT) CASIA II, to train and validate five types of multiple regression models based on advanced machine learning techniques. To perform an external validation a dataset of 45 observations was used., Results: The Pearson correlation coefficient between observed and predicted values was similar in the five models in the external validation, with least absolute shrinkage and selection operator (LASSO) regression being the highest (r = 0.62, p < 0.001), followed by random forest regression model (r = 0.60, p < 0.001) and backward stepwise regression (r = 0.58, ρ < 0.001). In addition, the predictions generated by the different models showed closer agreement with the actual vault compared with the Nakamura formulas. Using the new methods, about 70% of the observations had a prediction error below 150 µm., Conclusions: Advanced forms of regressions models based on machine learning allow satisfactory calculation of the ideal lens size, offering greater precision to surgeons customizing surgery according to implant orientation., (Copyright © 2025 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Objective: This study aimed to evaluate the initial clinical outcomes of and patient satisfaction with the newly introduced extended monofocal Evolux™ intraocular lens following cataract surgery. Methods: A retrospective study was conducted, involving 18 patients (36 eyes) who received Evolux™ lenses bilaterally. The inclusion criteria comprised individuals over 40 years old with no active eye diseases, excluding cataracts, and no postoperative complications. Various parameters were evaluated, including distance, intermediate, and near visual acuity; refraction; defocus curves; dependency on spectacles; and patient satisfaction. Patient satisfaction and visual quality of life were measured using the Catquest-9SF and QOV questionnaires. Results: The average age of the patients was 72.7 years, with the majority being women (77.8%). The results demonstrated excellent postoperative visual acuity at different distances. The mean logMAR values for uncorrected visual acuity were -0.04 for distance vision, 0.15 for intermediate vision, and 0.35 for near vision. The defocus curve indicated good tolerance, with visual acuity exceeding 20/20 in significant defocus ranges. Most patients expressed high satisfaction with their vision without spectacles, particularly for distance and intermediate vision. The need for spectacles for near vision was notably reduced. Furthermore, there was a low incidence of photic phenomena like halos and glare, contributing to the overall high patient satisfaction. Conclusions: Evolux™ lenses were found to be an effective choice for cataract surgery, providing excellent visual acuity at various distances and high patient satisfaction.

Purpose: The aim of this study was to describe our technique for performing femtosecond laser (FSL)-assisted mushroom configuration in deep anterior lamellar keratoplasty (DALK)., Methods: We describe our surgical technique for a mushroom-configuration DALK using a femtosecond laser (FSL) both to prepare the graft and to perform a precut of the recipient cornea, as well as the steps for the dissection of the recipient cornea and for donor cornea implantation. Moreover, we show the parameters of energy and spot separation and the external and internal diameters as well as the thickness of the external and internal keratotomy., Results: We performed a retrospective case series study of 20 patients with a mean follow-up of 4.36 ± 2.54 years. The indication for surgery was leukoma in 15 cases (75%), keratoconus in 4 cases (20%), and stromal corneal dystrophy in 1 case (5%). Four cases had to be converted to penetrating keratoplasty. The overall results were as follows: The mean preoperative corrected distance visual acuity increased from 0.11 ± 0.09 (0.01-0.30) to 0.78 ± 0.22 (0.30-1.0) with spectacles and to 0.92 ± 0.13 (0.5-1.0) with a gas permeable contact lens. The mean final cylinder was 3.90 ± 1.86 (1.25-7.0). The mean endothelial cell count at 6 months was 2033.83 ± 570.53 cells/mm 2 (930-3207), and the mean final spherical equivalent was -4.67 ± 2.91 (-0.25 to -9.00)., Conclusions: FSL-assisted technology is useful to achieve a predictable and safe procedure when using mushroom configuration to perform DALK. Our conversion rate from DALK to penetrating keratoplasty was similar to or even lower than that reported in the literature. In the successful DALK cases, the visual and refractive results were similar to those reported in other studies using FSL-assisted DALK (with a standard or mushroom configuration)., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To evaluate the clinical outcomes of the Visian implantable collamer lens (ICL) in eyes with ≥17 years of follow-up., Setting: Single-center., Design: Retrospective observational study., Methods: 70 eyes from 38 patients who underwent surgery between 2002 and 2006 with V4 ICL implantation were analyzed. Preintervention data included corrected distance visual acuity (CDVA), refraction, and intraocular pressure (IOP). At the 19-year mark, CDVA, refraction, IOP, endothelial count, and vault were measured using Tomey Casia 2 anterior pole tomography, along with recording long-term events., Results: The operated patients had a spherical correction between -4 diopters (D) and -21 D and a cylinder up to 7.5 D. The mean CDVA (decimal) at the 17-year check-up was 0.89 ± 0.18, with a spherical equivalent of -1.05 ± 1.36 D. IOP has remained stable because mean measurements before surgery and currently were 15.16 ± 2.54 mm Hg and 16.19 ± 3.29 mm Hg, respectively. The endothelial cell count showed values of 2191 ± 386 cells/mm2, with a maximum of 2804 cells and a minimum of 1125 cells. Finally, the vault obtained was 348.53 ± 234.58 mm. Over the years, 2 eyes developed angle-closure glaucoma and 9 eyes were operated on for the development of anterior subcapsular cataracts., Conclusions: Visian ICL implantation demonstrated long-term visual and refractive stability, indicating it as a low-risk procedure. The ICL V4 model yielded satisfactory results for myopia and astigmatism correction after 17 years., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Background/Objectives : To evaluate the clinical and patient-reported outcomes (PROMs) obtained with an optimized version of a previously investigated trifocal IOL. Methods : Prospective non-comparative single-center study enrolling 29 patients (55-71 years) undergoing bilateral cataract surgery with implantation of the trifocal diffractive IOL Liberty 677CMY (Medicontur Medical Engineering Ltd., Zsámbék, Hungary). Visual and refractive outcomes as well as PROMs were evaluated during a 3-month follow-up: measurement of uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, DCIVA) and near visual acuities (UNVA, DCNVA), defocus curve, patient satisfaction, photic phenomena perception, spectacle independence, and difficulty in performing some vision-related activities. Results : A total of 100%, 92%, and 80% of patients achieved a postoperative binocular UDVA, UIVA, and UNVA of 20/25 or better, respectively. Likewise, 100%, 80%, and 84% of patients achieved a postoperative binocular CDVA, DCIVA, and DCNVA of 20/25 or better, respectively. In the defocus curve, all mean visual acuity values were better than 0.15 logMAR for all defocus levels. A total of 95.8%, 95.8%, and 91.7% of patients referred to be satisfied with their distance, intermediate, and near visual vision, respectively. Mean overall Catquest Rasch calibrated score was -3.12 ± 0.98. Most of the patients were spectacle independent: far (95.8%), intermediate (95.8%) or near vision (91.7%). No bothersome or minimal to moderately bothersome halo, starburst, and glare was perceived by 83.3%, 83.4%, and 83.3% of patients, respectively. Conclusions : The trifocal IOL evaluated provides a visual acuity improvement, with high levels of spectacle independence, patient satisfaction, and perceived visual quality associated.

Purpose: To compare 2 techniques to correct low astigmatism during implantable collamer lens (ICL) surgery: astigmatic opposite clear corneal incisions (OCCIs) and toric ICL (T-ICL)., Setting: Arruzafa Ophthalmological Hospital, Cordoba, Spain., Design: Randomized prospective comparative study., Methods: The study comprised 152 myopic eyes undergoing ICL surgery. Patients were separated into 2 groups: Group 1 (57 patients; 76 eyes) received a spherical ICL with OCCIs and Group 2 (53 patients; 76 eyes) received a T-ICL. The inclusion criteria were refractive astigmatism up to 1.50 diopters (D), regular corneal astigmatism up to 2.00 D (Sim K, Pentacam), and agreement between the refractive and topographic corneal cylinders (discrepancies less than 30 degrees axis or 0.50 D). The outcomes were evaluated after a 1-month follow-up., Results: The T-ICL group achieved a mean postoperative spherical equivalent refraction and refractive astigmatism of -0.04 ± 0.17 D and -0.03 ± 0.12 D, respectively, vs -0.14 ± 0.33 D and -0.20 ± 0.36 D, in the OCCI group ( P < .001). Postoperative refractive astigmatism of less than 0.25 D was achieved in 94.74% of cases in the T-ICL group vs 73.68% in the OCCI group. Undercorrection of corneal astigmatism occurred in the OCCI group with a surgically induced astigmatism of 0.48 ± 0.24 D and correction index = 0.46., Conclusions: Both the T-ICL and OCCI techniques provided excellent results in terms of safety and efficacy. T-ICL surgery was shown to be more predictable and accurate for correcting low astigmatism with a lower postoperative spherical equivalent and less residual astigmatism compared to incisional management., (Copyright © 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

(1) Purpose: The aim was to analyze the outcomes of Descemet's membrane endothelial keratoplasty (DMEK) and Descemet stripping only (DSO) surgeries using a glasses-assisted NGENUITY ® 3D visualization system (Alcon Laboratories, Fort Worth, TX, USA). (2) Methods: Five consecutive cases of DMEK surgery and four consecutive cases of DSO were performed using the NGENUITY ® system in this prospective study carried out at the Arruzafa Hospital, Córdoba, Spain. Only one eye from each patient received surgery. Best corrected distance visual acuity (CDVA) using EDTRS charts, central corneal thickness using the Casia II optical coherence tomograph (Tomey Co., Nagoya, Japan), and endothelial cell count using the Tomey EM-4000 (Tomey Co., Nagoya, Japan) for DMEK cases or the Nidek CEM-530 (Nidek Co., Ltd., Gamagori, Japan) specular microscopes for DSO cases were recorded preoperatively and at 1 and 3 months postsurgery. (3) Results: DMEK cases included one male and four female subjects, with a mean age of 73.6 ± 9.5 years. Average improvement in CDVA 3 months after surgery was 0.46 ± 0.16 decimal. Average change in cell count between 1 and 3 months postsurgery was 360.75 ± 289.38 cells/mm 2 . DSO cases included four female subjects, with a mean age of 64.2 ± 9.7 years. The average improvement in CDVA 3 months after surgery was 0.09 ± 0.17 decimal. All cases also had phacoemulsification carried out. He average change in cell count between 1 and 3 months after surgery was 460 ± 515.69 cells/mm 2 . There were no associated complications during surgery or the follow-up period in any of the cases. (4) Conclusions: In addition to the known benefits of the use of a 3D visualization system during surgery, the present study shows that the system can be successfully used in both DMEK and DSO procedures with a very short learning curve for the surgeon.

Purpose: This study is to describe the clinical outcome of penetrating keratoplasty combined with implantation of a novel intraocular lens with an artificial iris, aided by continuous vitreous chamber infusion, in patients with severe aniridia and corneal alterations., Methods: This was a prospective single-center case series study involving five patients with corneal alterations and aniridia. All subjects underwent simultaneous penetrating keratoplasty and implantation of a new intraocular lens with an artificial iris with the assistance of infusion into the vitreous chamber to regulate intraocular pressure during the surgical procedure. Visual acuity, corneal endothelial cell density, and intraocular pressure assessments were performed in the postoperative period. The final cosmetic outcome of the iris prosthesis placement was also evaluated., Results: In all cases, increased visual acuity and a good aesthetic result were observed in all affected eyes except one in which, despite the excellent aesthetic outcome, the eye was very hypotonic as it had high myopia and had undergone several previous surgeries., Conclusion: The single surgical procedure combining implantation of an intraocular lens-iris prosthesis with penetrating keratoplasty is an effective technique for the simultaneous treatment of aphakia and aniridia. However, larger series with longer-term follow-up are needed to definitively establish the benefits of this technique., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To compare two aspheric ablation profiles in myopic refractive surgery using different asphericity targets., Methods: Patients underwent laser in situ keratomileusis (LASIK) with the WaveLight EX500 laser platform (Alcon, WaveLight Laser Technologie). Asymmetric surgery was performed, programming the wavefront-optimized (WFO) ablation profile in one eye and the custom-Q (CQ) profile in the contralateral eye. The patients were divided into two groups following a systematic randomization method. The Q-target programmed for the preoperative Q group was equal to the preoperative asphericity of the CQ profile, and for the -0.6 Q-target group, the Q-target was set to -0.6., Results: The study included 100 patients (200 eyes). Both groups had comparable safety and efficacy indexes greater than 1. A similar oblate shift in postoperative asphericity was seen in both groups regardless of the ablation profile and programmed Q-target. Asphericity was 0.33 ± 0.34 and 0.35 ± 0.29 ( P = .18) in the preoperative Q group and 0.26 ± 0.28 and 0.26 ± 0.27 ( P = .89) in the -0.6 Q-target group for WFO and CQ, respectively. A lower spherical aberration was found with CQ compared to WFO when the Q-target was set to -0.6: 0.211 ± 0.121 versus 0.144 ± 0.114 ( P < .01). However, no statistically significant differences were found when the preoperative Q-target was used., Conclusions: WFO and CQ treatments are similar in terms of refractive and visual outcomes. CQ offers greater control over the increase in positive spherical aberration after myopic refractive surgery, but it does not represent an advantage over WFO in the oblate shift in postoperative asphericity regardless of the Q-target programmed. [ J Refract Surg . 2022;38(11):698-707.] .

Purpose: To report our first clinical and patient-reported outcomes in the early postoperative period with a new model of trifocal diffractive intraocular lens (IOL)., Methods: Pilot prospective analysis of the results of 26 eyes of 13 patients (age, 44-79 years) undergoing cataract surgery with implantation of the trifocal diffractive IOL Liberty 677MY (Medicontur Medical Engineering Ltd., Zsámbék, Hungary). The following clinical outcomes were evaluated during the first postoperative month: measurement of distance, intermediate and near visual acuity, binocular defocus curve, and level of spectacle independence, patient satisfaction, perception of photic phenomena, and difficulty in performing several vision-related daily tasks by means of a questionnaire., Results: Mean binocular LogMAR uncorrected distance, intermediate and near visual acuities were -0.03 ± 0.13, 0.21 ± 0.16, and 0.16 ± 0.09, respectively. Furthermore, 100.0%, 84.6% and 92.3% of patients achieved a binocular corrected distance, distance-corrected intermediate and distance-corrected near visual acuity of 20/32 or better, respectively. In the defocus curve, visual acuities were better than 0.2 logMAR for defocus levels between +1.00 and -3.00 D. Spectacle independence was referred by all patients, with any of them reporting dissatisfaction with the outcome of the surgery. The postoperative vision did not lead to difficulties in the daily life in 92.3% of patients. Bothersome halos, glare or starbursts were only reported by only 7.7% of patients., Conclusions: The trifocal IOL evaluated provides a successful visual rehabilitation with minimal photic phenomena associated, leading to high levels of spectacle independence and patient satisfaction.

The main objective was to evaluate distance, intermediate, and near vision in patients who have undergone cataract extraction with bilateral implantation of a new trifocal diffractive intraocular lens (IOL), along with patient-reported outcomes (PRO). A total of 50 eyes from 25 patients after Asqelio TM Trifocal IOL (AST Products, Inc., Billerica MA, USA) implantation were assessed in this study. At 3 months after surgery, the photopic visual acuity (VA) at distance, intermediate, and near distances was measured. Binocular photopic defocus curves were also obtained. Three questionnaires to assess patients' visual satisfaction and spectacle dependence, among other items, were completed: the Catquest-9SF, the patient-reported spectacle independence questionnaire (PRSIQ), and the patient-reported visual symptoms questionnaire (PRVSQ). The average spherical equivalent was 0.21 ± 0.37 D at 3 months post-operation, and the average absolute tolerance to defocus was 3.64 ± 0.70 D. The mean binocular uncorrected VAs for distance, intermediate, and near vision were -0.02 ± 0.09, 0.06 ± 0.08, and 0.11 ± 0.07 logMAR, respectively. The best-corrected VA was better than 0.1 logMAR for the whole range from distance to near. PROs revealed spectacle independence and general satisfaction with vision, and the incidence of photic phenomena were low. This study shows that the new bi-aspheric diffractive trifocal IOL provides a good visual performance at different distances under photopic conditions, accompanied by patient satisfaction and spectacle independence.

Purpose: To create a nomogram including the translational speed of the microkeratome blade, microkeratome head size and precut tissue thickness to predict the postcut thickness for Descemet stripping automated endothelial keratoplasty to obtain the thinnest possible graft., Methods: This prospective study incorporated 48 grafts for DSAEK from March 2017 to June 2020. Corneal tissue for DSAEK was prepared by 3 experienced physicians using the Moria Evolution 3E (Moria Inc, Antony, France) microkeratome with 400, 450 and 500 μm head sizes. Precut central corneal thickness was measured with a DGH 550 handheld pachymeter (Pachette 2), taking an average of 3 readings. The microkeratome head was selected according to precut tissue thickness. The selected microkeratome head size was 150 μm less than the donor cornea thickness. Two translational speeds were used for the microkeratome cuts. One month after surgery, the central lenticular thickness was measured with a Visante® Optical Coherence Tomography caliper (Carl Zeiss Meditec Inc, Germany). A descriptive analysis was performed., Results: Forty-eight donor grafts were prepared. Mean graft thickness was 97.58 ± 29.84 μm (range 39-176 μm). Of the 48 samples, central graft thickness was < 120 µm (81.3%) in 39, < 100 µm (58.3%) in 28 and < 80 µm (37.5%) in 18 at 1-month follow-up. There were no statically significant differences between translational speeds., Conclusions: A nomogram with an automated microkeratome to obtain thin grafts for DSAEK provided good graft thickness results without donor waste., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To analyze the target induced astigmatism (TIA), surgically induced astigmatism (SIA), difference vector (DV), and correction index (CI) in the correction of astigmatism with phakic lenses, and its influence on visual acuity, and to analyze the safety and efficacy indexes of the correction of high and low power astigmatism with toric phakic lenses., Design: Retrospective comparative study., Methods: The medical records of patients that were operated on at the research center during the period were analyzed. Results were divided into Low Astigmatism Group - LAG (33 eyes) and High Astigmatism Group - HAG (93 eyes) according to the implanted toric ICL lens power. Preoperative refraction and resultant postoperative refraction were analyzed by vector analysis. Visual acuity pre and postop, with and without optical correction, were compared., Results: A total of 126 eyes were studied. The average preop refraction was -5.02 D sphere with -2.61 D cylinder. The average ICL lens power implanted was -8.31 D sphere +2.77 D cylinder. Refractive remaining was -0.01 ± 0.11 D sphere -0.15 ± 0.28 D cylinder. The arithmetic average angle of error in the astigmatism correction was 1.08°. The resultant cylinder was -0.03 ± 0.12 D and -0.19 ± 0.30 D in the low and high astigmatism groups, respectively, with a mean UDVA -0.01 ± 0.10 and 0.01 ± 0.16 and CDVA -0.03 ± 0.08 and -0.01 ± 0.17 for each group. The safety and efficacy indexes for the low astigmatism group were 1.09 ± 0.16 and 1.05 ± 0.17, respectively, with 1.11 ± 0.17 and 1.06 ± 0.16 for the high astigmatism group., Conclusions: The correction of astigmatism by the implantation of toric phakic lenses of the posterior chamber is safe and effective, independently of the amount of cylinder corrected.

Purpose: To assess the safety, aberrometric and keratometric changes, and stability of trans-epithelial topography-guided phototherapeutic keratectomy (TE-TG-PTK) with mitomycin C (MMC) using the ALLEGRO Topolyzer platform for the treatment of irregular astigmatism., Methods: This is a retrospective case series including 57 eyes that underwent TE-TG-PTK + MMC using the ALLEGRO Topolyzer platform for the treatment of irregular astigmatism. CDVA, manifest refraction (MR), keratometry readings, and aberrometry readings were analyzed at 1, 3, 6, and 12 months., Results: Causes of corneal irregularity included non-infectious leucoma (n=23), infectious leucoma (n=7), adenoviral keratitis (n=20), corneal haze (n=2), post-penetrant keratoplasty (PKP) (n=1), and others (n=4). Overall, 76% of the eyes (n=40) gained lines of vision; patients gained 1, and 2 or more lines of vision in 76%, and 38% of cases, respectively. Only 1 patient (2%) lost 5 lines of vision. Mean preoperative CDVA (LogMAR) was 0.37 ±0.31 and improved to 0.14 ±0.18 (p<0.001) at final follow-up (12 months). CDVA remained unchanged in 10 eyes (21%). No significant changes were observed in mean keratometry (Kmean) and keratometric astigmatism readings. Regarding aberrometry, only changes in coma proved to be significant 6 months after surgery (P<0.01). No intraoperative/postoperative complications were reported., Conclusion: At final follow-up, significant improvements were observed in CDVA and coma. TE-TG-PTK + MMC proved to be an effective and safe procedure for the treatment of corneal irregular astigmatism due to several causes., Competing Interests: The authors declare no potential conflicts of interest in this work., (© 2021 Cano-Ortiz et al.)