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Objective: To assess anterior segment changes, including iridocorneal angle and vault, after toric and non-toric implantable collamer lens (ICL) V4c (STAAR Surgical AG) implantation under different lighting conditions., Methods: Longitudinal, prospective, case series. Patients with high myopia (>6 dioptres) underwent toric and non-toric ICL V4c implantation. Optical coherence tomography measurements were taken under different lighting conditions preoperatively and at 1 week and 1, 6 and 12 months of follow-up., Results: Seventy-six eyes of 42 patients underwent ICL V4c implantation. Mean age was 27.4 years (±5.14 years, range 20 to 39 years). The average iridocorneal angle showed a statistically significant decrease (p<0.05) in all mesopic, scotopic and photopic conditions after 1 week of surgery compared with the preoperative measurements; in mesopic conditions, it decreased 14.1°, in photopic conditions 14.8° and scotopic conditions 13.2°. The angle measurement had a statistically significant change only in mesopic conditions (p=0.01) over the 1-year follow-up. The average vault under mesopic conditions was 0.661±0.21 mm at week 1. The vault measurement change was statistically significant over the 1-year follow-up in mesopic conditions (p=0.01). Refractive results showed a significant improvement in both uncorrected and corrected distance visual acuity (p<0.001)., Conclusion: There is a significant reduction in the iridocorneal angle after ICL V4c implantation. Furthermore, there is a change under mesopic conditions in both the iridocorneal angle and vault during long-term follow-up., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Purpose: To report visual, refractive, and topographic outcomes of sequential, same-day small-incision lenticule extraction and intrastromal corneal collagen crosslinking (CXL) in eyes with mild keratoconus., Setting: Institute of Ophthalmology Conde de Valenciana, Mexico City, Mexico., Design: Prospective interventional case series., Methods: Fifteen eyes with forme fruste keratoconus and/or irregular corneas, corrected distance visual acuity 20/40 or better, stable refraction of at least 1 year, age 18 years or older, and residual corneal thickness of greater tan 400 μm before performing collagen crosslinking were studied. Patients were treated with small-incision lenticule extraction followed by intrastromal injection of riboflavin inside the pocket. Ultraviolet A light with a wavelength of 370 nm to 3 mW/cm(2) was applied for 30 minutes. Follow-up was done at 1 day, at 1 week, and at 1, 3, 6, 12, 18, and 24 months., Results: Eight patients were included in the study. The mean age was 29.5 years ± 5.5 (SD) (range 20 to 36 years). Twenty-four months of follow-up were completed in 13 eyes, and 12 months were completed in 2 eyes. Preoperative uncorrected distance visual acuity improved from 1.6 ± 0.3 LogMAR (Snellen 20/796) to postoperative 0.12 ± 0.20 LogMAR (Snellen 20/26) and was statistically significant (P < .001). Best-corrected distance visual acuity did not change significantly (P = .186), from 0.006 ± 0.02 LogMAR (Snellen 20/20) preoperatively to 0.04 ± 0.05 LogMAR (Snellen 20/21) postoperatively, and spherical equivalent improved from -4.3 ± 1.02 preoperatively to 0.2 ± 0.66 (P < .001)., Conclusion: Although further follow-up and larger samples are needed to fully confirm these findings, the results suggest that combined small-incision lenticule extraction and intrastromal corneal collagen crosslinking are a promising treatment option for patients for whom conventional laser refractive surgery is contraindicated., Financial Disclosure: Drs. Ramirez-Miranda and Navas are consultants to Carl Zeiss Meditec. No other author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective To assess anterior segment changes, including iridocorneal angle and vault, after toric and non-toric implantable collamer lens (ICL) V4c (STAAR Surgical AG) implantation under different lighting conditions. Methods Longitudinal, prospective, case series. Patients with high myopia (>6 dioptres) underwent toric and non-toric ICL V4c implantation. Optical coherence tomography measurements were taken under different lighting conditions preoperatively and at 1 week and 1, 6 and 12 months of follow-up. results Seventy-six eyes of 42 patients underwent ICL V4c implantation. Mean age was 27.4 years (±5.14 years, range 20 to 39 years). The average iridocorneal angle showed a statistically significant decrease (p<0.05) in all mesopic, scotopic and photopic conditions after 1 week of surgery compared with the preoperative measurements; in mesopic conditions, it decreased 14.1°, in photopic conditions 14.8° and scotopic conditions 13.2°. The angle measurement had a statistically significant change only in mesopic conditions (p=0.01) over the 1-year follow-up. The average vault under mesopic conditions was 0.661±0.21 mm at week 1. The vault measurement change was statistically significant over the 1-year follow-up in mesopic conditions (p=0.01). Refractive results showed a significant improvement in both uncorrected and corrected distance visual acuity (p<0.001). Conclusion There is a significant reduction in the iridocorneal angle after ICL V4c implantation. Furthermore, there is a change under mesopic conditions in both the iridocorneal angle and vault during long-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the performance of different nomograms and vault prediction formulas in predicting the optimal Implantable Collamer Lens (ICL; STAAR Surgical) size and vault. Methods: This retrospective study included 108 participants (214 eyes) who underwent ICL implantation. The efficacy of the manufacturer's nomogram, Parkhurst nomogram, NK formula, KS formula, Zhu formula, and ZZ formula was assessed by comparing the indicated ICL sizes to the postoperative vault measurements. Additionally, Bland-Altman plots and the Friedman test were used to assess the agreement and absolute error between the actual vault and predicted vault. Results: The proportions of the ideal ICL category recommended by the manufacturer's nomogram, Parkhurst nomogram, NK formula, KS formula, Zhu formula, and ZZ formula were 50.5%, 45.3%, 46.7%, 42.5%, 50.0%, and 28.5%, respectively. The mean differences between the actual vault and the predicted vault using the NK, KS, Zhu, and ZZ formulas were 144.1 ± 261.1, −19.3 ± 179.6, 70.8 ± 284.2, and 182.6 ± 361.5 μm, respectively. The predicted ICL vault tended to overestimate the actual ICL vault, particularly when choosing a larger ICL size. The KS formula shows the smallest deviation in prediction error and is least affected by variation in ICL size. Conclusions: White-to-white distance from the Pentacam (Oculus Optikgeräte GmbH) coupled with the manufacturer's nomogram performed well for ICL size selection. Four vault prediction formulas tended to overestimate the actual ICL vault, particularly when selecting a larger ICL size. The KS formula appeared to have the least bias of the formulas. Simultaneously, vault prediction formulas need to be modified according to the ICL size. [J Refract Surg. 2023;39(7):456–461.] [ABSTRACT FROM AUTHOR]

Purpose: To estimate the accommodative changes of the anterior segment and its impact on the central and peripheral vaults after Visian Implantable Collamer Lens (ICL) (STAAR Surgical) implantation. Methods: Eighty eyes of 40 consecutive patients (mean age: 28.05 years; range: 19 to 42 years) were examined 3 months after ICL implantation. Eyes were randomly divided into a mydriasis group and a miosis group. Anterior chamber depth (ACD) to crystalline lens (ACD-L), anterior chamber depth to ICL (ACD-ICL), central distance from endothelium to sulcus to sulcus (ASL), central distance from sulcus to sulcus to crystalline lens (STS-L), central distance from ICL to sulcus to sulcus (STS-ICL), and central (cICL-L), midperipheral (mICL-L), and peripheral (pICL-L) vaults were measured by ultrasound biomicroscopy at baseline and after induction with tropicamide or pilocarpine. Results: After tropicamide treatment, cICL-L, mICL-L, and pICL-L decreased from 0.531 ± 0.200, 0.419 ± 0.173, and 0.362 ± 0.150 mm to 0.488 ± 0.171, 0.373 ± 0.153, and 0.311 ± 0.131 mm, respectively. The values decreased from 0.540 ± 0.185, 0.445 ± 0.172, and 0.388 ± 0.149 mm to 0.464 ± 0.199, 0.378 ± 0.156, and 0.324 ± 0.137 mm after pilocarpine administration, respectively. The ASL and STS showed a significant increase in the mydriasis group (all P ≤.038), but a decrease in the miosis group (all P <.001). The ACD-L increased and STS-L decreased in the mydriasis group (all P <.001), indicating the backward shift of the crystalline lens, whereas crystalline lens forward shift was observed in the miosis group. Additionally, the STS-ICL decreased in both groups (all P ≤.021), suggesting the ICL backward shift. Conclusions: Both central and peripheral vaults decreased during the pharmacological accommodation process, and the ciliaris-iris-lens complex contributed to the changes. [J Refract Surg. 2023;39(6):414–420.] [ABSTRACT FROM AUTHOR]

Purpose: To establish and validate the accuracy of implantable collamer lens (ICL) vault size prediction formula based on preoperative biometric factors and lens parameters. Methods: This study included 300 patients (300 eyes) with Visian ICL V4c (STAAR Surgical) implantation. They were randomly divided into the formula establishment group and formula validation group. Anterior segment measurements, ICL V4c size and power, and vault 1 week postoperatively were collected from all patients. Multiple linear regression analysis was performed to establish the prediction formula. Mean absolute error (MAE), median absolute error (MedAE), root mean square error (RMSE), and Bland-Altman diagrams were used to evaluate the prediction formula. Results: Anterior chamber depth (ACD) had the greatest influence on vault 1 week after ICL V4c implantation, followed by ICL V4c size and angle-to-angle distance (ATA). The prediction formula was obtained according to the partial regression coefficient, which was vault (mm) = −1.279 + 0.291 × ACD (mm) + 0.210 × ICL V4c size (mm) – 0.144 × ATA (mm) (R2 = 0.661). In the formula validation group, the mean predictive vault, MAE, MedAE, and RMSE were 628.10, 135.09, 130.42, and 150.46 µm, respectively. The Bland-Altman diagram showed the predictive vault was in good agreement with the actual vault. Conclusions: A novel ICL V4c vault prediction formula was developed and shown to be an effective method for predicting the vault to reduce surgical complications. [J Refract Surg. 2023;39(5):332–339.] [ABSTRACT FROM AUTHOR]

Purpose: To assess whether the postoperative outcomes of the implantation of an EVO + implantable collamer lens (ICL) in one eye can be used as a predictor of the vault of the fellow eye, and to evaluate the vault changes of the implantation in both eyes during the postoperative period. Methods: A prospective study including 40 eyes of 20 patients with a bilateral EVO + ICL implantation was performed. Subjects were evaluated before the surgery and 1 day, 1 week and 1, 3 and 6 months postoperatively. Central vault was assessed using spectral-domain optical coherence tomography. The inter-eye and follow-up analyses were performed using lineal models and the Bland–Altman method. Results: The vault of the first implanted eye at the 1-day visit highly predicts the vault of the second eye (R2 =.87; P <.001); the mean inter-eye difference was − 0.95 μm, and the superior and inferior limits of agreement were −50.27 μm and 148.37 μm, respectively. This relationship was maintained during the medium-term follow-up, not finding differences in the slopes among visits (P ≥.09). A progressive decrease of vault was found during the follow-up (P <.001). Larger vault change 6 months after the surgery was associated with higher vault 1 day after the ICL implantation (R2 =.19;P =.005). Conclusion: One-day postoperative vault in the first eye can help to predict the optimal ICL sizing in the second eye. Vault tends to decrease during the first 6 months after EVO + ICL implantation. Eyes with higher initial vaults will also show larger reductions during the medium-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To investigate how vault and other biometric variations affect postoperative refractive error of implantable collamer lenses (ICLs) by integrating artificial intelligence and modified vergence formula., Setting: Eye and ENT Hospital of Fudan University, Shanghai, China., Design: Artificial intelligence and big data-based prediction model., Methods: 2845 eyes that underwent uneventful spherical ICL or toric ICL implantation and with manifest refraction results 1 month postoperatively were included. 1 eye of each patient was randomly included. Random forest was used to calculate the postoperative sphere, cylinder, and spherical equivalent by inputting variable ocular parameters. The influence of predicted vault and modified Holladay formula on predicting postoperative refractive error was analyzed. Subgroup analysis of ideal vault (0.25 to 0.75 mm) and extreme vault (<0.25 mm or >0.75 mm) was performed., Results: In the test set of both ICLs, all the random forest-based models significantly improved the accuracy of predicting postoperative sphere compared with the Online Calculation & Ordering System calculator ( P < .001). For ideal vault, the combination of modified Holladay formula in spherical ICL exhibited highest accuracy ( R = 0.606). For extreme vault, the combination of predicted vault in spherical ICL enhanced R values ( R = 0.864). The combination of predicted vault and modified Holladay formula was most optimal for toric ICL in all ranges of vault (ideal vault: R = 0.516, extreme vault: R = 0.334)., Conclusions: The random forest-based calculator, considering vault and variable ocular parameters, illustrated superiority over the existing calculator on the study datasets. Choosing an appropriate lens size to control the vault within the ideal range was helpful to avoid refractive surprises., (Copyright © 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: This study aims to investigate the influence of anterior chamber depth (ACD) and vault on the anterior chamber angle (ACA) morphology in myopic individuals implanted with posterior chamber phakic intraocular lenses., Methods: This retrospective case series involved 231 eyes receiving a 13.2-mm implantable collamer lens (ICL). Preoperative anterior chamber anatomy was assessed using anterior segment optical coherence tomography (AS-OCT) and optical tomography, while postoperative evaluation employed AS-OCT. ACA morphology was characterized pre- and postoperatively through trabecular iris angle (TIA 750 ), ACA distance opening (AOD 750 ) and trabecular iris space area (TISA 750 ). The influence of ACD and vault was examined by categorizing the sample into ACD (shallow, average and deep) and vault (low, optimal and high) groups., Results: Preoperative ACA morphology varied based on ACD, with shallower ACDs exhibiting narrower TIA 750 , smaller AOD 750 and TISA 750 . ICL implantation induced greater ACA narrowing more in the deep ACD group (TIA 750  = 20.1 degrees; AOD 750  = 0.82 mm and TISA 750  = 0.44 mm 2 ) compared to the shallow ACD group (TIA 750  = 15.2 degrees; AOD 750  = 0.44 mm and TISA 750  = 0.21 mm 2 ). Postoperatively, deeper ACDs showed larger ACAs. Increasing vault magnitude led to increased ACA narrowing, with the low vault group exhibiting smaller closure (TIA 750  = 14.3 degrees; AOD 750  = 0.56 mm and TISA 750  = 0.29 mm 2 ) compared to the high vault group (TIA 750  = 20.8 degrees; AOD 750  = 0.73 mm and TISA 750  = 0.36 mm 2 ). The magnitude of ACA narrowing associated with the vault had a consistent effect across different ACD groups., Conclusions: Posterior chamber intraocular lens implantation results in ACA narrowing, the extent of which is contingent upon preoperative anterior chamber and ACA morphology, with additional influence from vault magnitude., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: The aim of the study was to evaluate efficacy and safety outcomes after implantation of the Visian Implantable Collamer Lens (ICL V4c) in myopia patients with shallow anterior chamber depth (ACD). Methods: This retrospective study followed 163 eyes of 94 patients for at least 24 months. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intraocular pressure (IOP), manifest refraction, vault, endothelial cell density (ECD), anterior chamber angle (ACA), anterior chamber volume, and the distance from the corneal endothelium to the central ICL (C-ICL) were measured during follow-ups. Spearman's correlation and logistic regression were used to identify variables correlated with changes in ECD and potential risk factors for ineffective outcomes, respectively. Results: All surgeries were performed safely. High IOP of 9 eyes and anterior capsular opacity of 5 eyes were observed. The last follow-up ACA had a significant difference between the high and normal IOP groups (p = 0.0003). The mean ECD and vault were 2,855.76 ± 270.82 cells/mm2 and 388.01 ± 135.28 μm at the last follow-up, respectively. The vault and C-ICL were significantly associated with ΔECD (all p < 0.05). Furthermore, the vault was most responsible for the ECD loss. Twenty-two eyes had unsatisfactory postoperative UDVA, and the low vault at the last follow-up was a significant risk factor for this ineffective outcome (p < 0.001, OR = 14.739). Conclusions: ICL V4c implantation in patients with shallow ACD achieved stable visual outcomes. The vault is related to postoperative visual acuity and ECD loss, which needs to be paid attention during follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To determine the influence of implantable collamer lenses (ICL) geometry, i.e. spherical and toric on the vault, and report the refractive and visual outcomes of patients bilaterally implanted with the two ICL geometries.Methods: This retrospective case series analysed 41 patients implanted with a spherical ICL (sICL) in one eye and an equal sized toric ICL (tICL) in the fellow eye. The anatomical and ICL-related parameters were assessed using anterior-segment optical coherence tomography (AS-OCT Visante, Zeiss Meditec AG) and optical tomography (Pentacam, OCULUS). The influence of the anatomical and ICL-related parameters on the vault was determined using generalised estimating equations (GEE) to incorporate inter-eye correlations.Results: Postoperative spherical equivalent was within ± 0.50D in 66% and 83% of the eyes, respectively implanted with sICL and tICL. The efficacy index in the sICL group was 1.06 and 1.14 in the tICL group. The mean inter-eye vault difference was -1.46 µm, anatomical and ICL-related parameters showed similar associations with the vault for sICL and tICL. The GEE identified the ICL size minus the anterior chamber width, the ICL spherical power and ICL central thickness as significant factors influencing the vault.Conclusions: Spherical and toric ICL showed good efficacy for the correction of myopia and astigmatism. Patients implanted bilaterally with sICL and tICL tend to present similar vaults. The vault produced by both types of ICL was mainly regulated by the oversizing of the ICL. This suggests that the ICL geometry (spherical vs toric) is a factor with limited influence on the vault, thus the sizing method of a sICL and tICL should be similar. [ABSTRACT FROM AUTHOR]

Background: This study investigated the early outcomes of anterior segment parameters after implanting an implantable collamer lens with a central hole (ICL V4c) in patients with myopia and determined the earliest follow-up time for detecting potential complications.Methods: Sixty-two patients were included, and the following parameters were measured at baseline (preoperative), 1 day, 1 week, and 1, 3, and 6 months after the operation: intraocular pressure (IOP), endothelial cell density (ECD), central anterior chamber depth (CACD), anterior chamber volume (ACV), nasal and temporal anterior chamber angle (n-ACA and t-ACA), horizontal corneal diameter (white-to-white, WTW), and axial length (AL). The vault was measured at each post-operative timepoint.Results: The postoperative IOP and ECD at the 6 months were both statistically similar to the baseline. The post-operative CACD and ACV were significantly less at all timepoints compared with the baseline (P < 0.001) and stayed stable from 1 day and 1 month after the operation, respectively. Postoperative n-ACA and t-ACA decreased significantly at 1 day and 1 week compared with the baseline (P < 0.001), while tended to stabilization at 1, 3, and 6 months. The vault kept decreasing significantly at 1 day, 1 week, and 1 month, but stayed stable at 3 and 6 months. The postoperative n-ACA and t-ACA positively correlated with the baseline ACA, CACD, and ACV.Conclusions: The anterior chamber parameters tended to stabilization early after the operation. Thus, it is essential to evaluate patients' anterior segment status at earlier timepoints and prevent complications with prompt and non-invasive intervention. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate clinical outcome during 24 months follow-up between small incision lenticule extraction combined with cross-linking (SMILE Xtra) and small incision lenticule extraction (SMILE) only. Setting. Ophthalmology Division of San Rossore Medical Center, Pisa, Italy. Design. Retrospective comparative case series. Methods. The study comprised 70 eyes (35 patients); 40 eyes were corrected using SMILE and 30 eyes were corrected using SMILE Xtra using a low energy protocol. The outcomes were compared at 1, 6, 12, and 24 months postoperatively. Results. The mean spherical equivalent (SEQ) reduced from −7.18 ± 1.21 D to −0.01 ± 0.09 D in the SMILE group and from −6.20 ± 2.99 D to −0.04 ± 0.1 D postoperatively in SMILE Xtra (p < 0.05). At 24 months the mean SEQs were −0.01 ± 0.24 D for SMILE and −0.15 ± 0.33 D for SMILE Xtra (p > 0.05). At 1, 6, 12, and 24 months, there were no statistically significant differences between the SMILE and SMILE Xtra groups in logarithm of the minimum angle of resolution (logMAR) uncorrected distance visual acuity (UDVA), safety, and efficacy index (p > 0.05). The mean average keratometry (K-avg) at 1, 6, 12, and 24 months after surgery did not shown any statistically significant difference between SMILE and SMILE Xtra group (p > 0.05). The mean maximum keratometry (K-max) readings at 1, 6, 12, and 24 months were not statistically significant between SMILE and SMILE Xtra group (p > 0.05). The preoperative mean thinnest point pachymetry (TTP) was 543.90 ± 22.85 μm in the SMILE group and 523.40 ± 37.01 μm in the SMILE Xtra group (p < 0.05). At 1, 6, 12, and 24 months the mean TTP was not statistically significant between the SMILE and SMILE Xtra groups (p > 0.05). At 24 months, the TTP was 408.29 ± 38.75 μm for the SMILE group and 402.22 ± 37 μm for the SMILE Xtra group (p > 0.05). In the preoperative period, the mean maximum posterior elevation (MPE) was 8.63 ± 4.35 μm for SMILE and 8.13 ± 2.54 μm for SMILE Xtra (p > 0.05). After the surgical procedure, both groups showed a statistically significant increase of the MPE (p < 0.05). At 24 months, the MPE was 11.00 ± 4.72 μm for SMILE Xtra and 10.14 ± 3.85 μm for the SMILE group (p > 0.05). In the preoperative period, the means of the root mean square (RMS) of high-order aberration (HOA) were 0.08 ± 0.03 μm for the SMILE group and 0.08 ± 0.03 μm for the SMILE Xtra group (p > 0.05). At 24 months, the RMS of HOA was 0.13 ± 0.07 μm for the SMILE group and 0.14 ± 0.07 μm for the SMILE Xtra group (p > 0.05). In the preoperative period, the root mean square of coma aberration (RMS-Coma) aberration was 0.06 ± 0.09 μm for the SMILE group and 0.04 ± 0.03 μm for the SMILE Xtra group (p > 0.05). At 24 months, the coma aberration of SMILE group was 0.12 ± 0.21 μm and 0.16 ± 0.25 μm for SMILE Xtra group (p > 0.05). Conclusions. SMILE Xtra procedure is a safe and simple procedure that can be offered to patients with high corneal ectasia risk because there were no differences in the indices of ectasia compared to the group treated only with SMILE which has a low corneal ectatic risk. [ABSTRACT FROM AUTHOR]

Purpose. To study the corneal morphology and biomechanics in cases of small incision lenticule extraction with prophylactic accelerated collagen cross-linking (SMILE Xtra). Methods. This study was a retrospective study. 28 eyes of 14 patients with moderate-high risk of postoperative ectasia according to the Randleman scoring system underwent SMILE Xtra procedure. Outcome data were recorded including uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), surface regularity index (SRI), surface asymmetry index (SAI), simulated keratometry (SimK), posterior axial curvature (PAC), anterior and posterior corneal elevations (ACE and PCE), central corneal thickness (CCT), corneal resistance factor (CRF), corneal hysteresis (CH), and cornea-compensated intraocular pressure (IOPcc). The follow-up period was 12 months. Results. There were 28, 26, 22, 12, and 10 eyes enrolled at postoperative 1st day and 1st, 3rd, 6th, and 12th months, respectively. The UDVA improved from 1.27 ± 0.18 logMAR preoperatively to -0.06 ± 0.04 logMAR postoperatively (P < 0.05). The MRSE improved from -5.05 ± 1.15 D preoperatively to -0.14 ± 0.30 D postoperatively (P < 0.05). SAI, SimK, PAC, PCE, and CCT all changed significantly at 1st month postoperatively (P < 0.05) and stabilized during the remainder of the follow-up (P > 0.05). There was no significant change in SRI or ACE before and after surgery (P > 0.05). CRF, CH, and IOPcc all decreased significantly at 1st month postoperatively (P < 0.05) and remained stable afterwards (P > 0.05). Conclusions. The changes in the corneal morphology and biomechanics remained stable after SMILE Xtra, and there was no sign of postoperative ectasia or refractive regression. Combined with the improvement of visual and refractive results, SMILE Xtra may be a promising method for corneal refractive surgeries in patients at risk. [ABSTRACT FROM AUTHOR]

Purpose. To compare the long-term safety, efficacy, predictability, and refractive stability following SMILE versus SMILE combined with accelerated cross-linking (SMILE XTRA), and to specifically study the regression patterns following the two procedures. Methods. This retrospective study included 54 eyes of SMILE and 54 eyes of SMILE XTRA treated for normal and borderline cases of myopia/myopic astigmatism, respectively, based on certain predefined topographic features and risk factors. Patients in both the groups were matched for age and refractive error. The mean postoperative follow-up for the SMILE group was 22.18 ± 10.41 months and the SMILE XTRA group was 21.81 ± 10.19 months. Results. At the end of follow-up, the mean sphere, cylinder, and SE reduced to −0.03, −0.09, and −0.08 D in the SMILE group and −0.06, −0.15, and −0.13 D in the SMILE XTRA group. 96% and 93% eyes remained within ±0.50 D in SMILE and SMILE XTRA groups, respectively, and 94% eyes maintained an UDVA of 20/20 or better in the SMILE as well as SMILE XTRA groups. Safety and efficacy indices for the SMILE group were 1.03 and 1.00. For the SMILE XTRA group, the safety and efficacy indices were 1.00 and 0.99. No eye in either group had postoperative ectasia or enhancement performed for significant residual refractive error. Conclusion. Both the SMILE and SMILE XTRA groups exhibited comparable visual outcomes, safety, and efficacy. Contrary to the belief, combination of prophylactic CXL with SMILE did not result in a hyperopic shift in the long term. No eye in either group encountered postoperative ectasia; however, further follow-up is suggested to establish the long-term effects on refractive and corneal stability following SMILE XTRA, as all the eyes treated in this group were borderline. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively compare the refractive outcomes between two groups of small-incision lenticule extraction (SMILE), one with a single incision and the second one with dual-incisions. Setting: Ebsar Eye Center, Benha, Qalyopia, Egypt. Design: A retrospective cohort study. Methods: This study was made up of two groups (162 eyes each): all eyes in group 1 had one SMILE cut at 120°, and all eyes in group 2 had double SMILE incisions, the first incision at 120° and the second one at 270°. Refractive outcomes between the two groups were compared at 3, 6, and 12 months after surgery. Results: The mean preoperative refractive spherical equivalent (MRSE) was − 5.75 ± 2.59 D and − 6.38 ± 2.18 D in group 1 and 2, respectively (P = 0.73), and a cylinder of 1.25 ± 0.83 D and 0.75 ± 0.81 D, respectively (P = 0.85). At 12 months postoperatively, in group 1, 162 eyes (100%) achieved a UCVA of 20/25, 154 eyes (95.06%) achieved a UCVA of 20/20, and 110 eyes (67.90%) achieved 20/16. In group 2, 162 eyes (100%) achieved a UCVA of 20/25, 156 eyes (96.29%) achieved a UCVA of 20/20, and 113 eyes (69.75%) achieved 20/16. The mean MRSE at 12 months postoperatively was − 0.25 ± 0.33 D in group 1 and − 0.5 ± 0.33 D in group 2 (P = 0.62). Conclusion: Dual-incision SMILE is safe and effective as single-incision SMILE, with a predictable and stable effect in correcting myopia and myopic astigmatism. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the efficacy, safety, predictability, and stability in myopic and astigmatic small-incision lenticule extraction (SMILE) with simultaneous prophylactic corneal crosslinking (CXL) in thin corneas.Methods: A total of 48 eyes from 24 patients who underwent myopic and astigmatism SMILE with simultaneous prophylactic CXL were included in this retrospective study. All patients had a 24-month follow-up. A femtosecond laser was performed with VisuMax (Carl Zeiss Meditec). CXL treatment was applied when the predicted stromal thickness was less than 330 μm.Results: The patients' mean age was 31.58 ± 6.23 years. The previous mean spherical equivalent was - 6.85 ± 1.80 (-9.75 to - 2.00) D. The postoperative mean spherical equivalent was - 0.50 ± 0.26 (-1.00 to + 0.25) D; 60% of the eyes had 20/20 or better; 19% lost one line; 58% were within ± 0.50 D; and 8.3% of the eyes changed 0.50 D or more between 3 and 24 months.Conclusion: Prophylactic CXL with simultaneous SMILE for myopia and astigmatism femtosecond laser surgery technique appears to be partially effective, safe, predictable, and stable after 24 months of follow-up. [ABSTRACT FROM AUTHOR]

Aims: To compare the vault performance between implantable collamer lens (ICL) V4c and Toric ICL (TICL) V4c after implantation and to investigate the affecting factors. Methods: Sixty‐eight eyes from 34 patients with myopia or myopia astigmatism who underwent implantation of TICL in one eye (group A) and identically sized ICL (group B) in the contralateral eye were included. Mean follow‐up time were 7.58 ± 1.63 months (range: 6–10 months). Vault was compared between the two groups and correlations between vault and age, preoperative ocular biometric measurements were analysed. Generalized estimating equation (GEE) model of postoperative vault adjusting for within‐patient intereye correlations was performed. Results: The safety indices were 1.27 and 1.35, and the efficacy indices were 1.20 and 1.24 for groups A and B, respectively. Vault of TICL was significantly higher than that of ICL (554.11 ± 219.36 μm vs 449.70 ± 172.47 μm, P < 0.001). The difference between ICL/TICL size and WTW (size‐WTW) and STS (size‐STS), anterior chamber depth and pupil diameter (PD) were positively correlated with vault. Patient age and clear lens rise measured by Pentacam were negatively correlated with vault. Results of GEE model showed preoperative PD, age, cylindrical power of TICL and size‐WTW were influencing factors for postoperative vault. Conclusions: Vault after TICL implantation is higher than that with ICL. PD, age, cylindrical power of TICL and size‐WTW could affect postoperative vault. [ABSTRACT FROM AUTHOR]

Background To evaluate the changes in corneal endothelium cell density (ECD) and the correlated factors after Implantable Collamer Lens (ICL) V4c implantation. Methods In this retrospective, consecutive study, 48 eyes of 25 patients with myopia who underwent ICL V4c implantation were enrolled. Patients were followed up for at least 4 years, during which manifest refraction, uncorrected distance visual acuity, corrected distance visual acuity (CDVA), intraocular pressure, ECD, anterior chamber depth, anterior chamber volume (ACV), anterior chamber angle (ACA), vault and distance from the corneal endothelium to the central ICL (C-ICL) were measured. Spearman's correlation analysis was used to identify variables correlated with changes in ECD, and generalised estimating equation model adjusting within-patient intereye correlations was used to predict changes in ECD. Results All surgeries were performed safely with no complications during follow-up (average 52±2.9 months). Safety and efficacy indices were 1.23±0.22 and 1.04±0.16, respectively. No eyes had decreased CDVA, and 67% gained one or more lines. Further, 79% were within ±0.50 D, and 100% were within ±1.0 D of the attempted refraction. Additionally, a 4.03%±2.2% reduction in ECD compared with the preoperative value was observed at the last follow-up visit. Changes in ECD were significantly correlated with vault, C-ICL, change in ACA and change in ACV. Vault was the most significant factor for changes in ECD. Conclusions ICL V4c implantation is safe and effective for myopia correction. Anterior segment biometric parameters including the vault, ACA and C-ICL may influence changes in ECD; specifically, the vault plays a major role. [ABSTRACT FROM AUTHOR]

We aimed to summarize the outcomes reported following the implantation of the V4c implantable collamer lens with a central port (ICL, STAAR Surgical Inc) for myopia correction. A literature search in PubMed, Web of Science and Scopus was carried out to identify publications reporting clinical outcomes of patients who were implanted with the V4c ICL model and had a follow‐up period of at least 6 months. A total of 35 clinical studies published between 2012 and 2020 were included in the present review. A comprehensive analysis of the available data was performed, focusing on visual and refractive outcomes at different time‐points post‐surgery. In addition, adverse events and other parameters such as endothelial cell density, intraocular pressure and vault measurements—which were evaluated in some of the studies—were also compared. This review encompassed a total of 2904 eyes. The outcomes reported in this review lead us to conclude that ICL V4c implantation for myopia correction is a safe and efficient procedure, with stable visual and refractive outcomes and low adverse event rates. The patient's anterior segment should be thoroughly characterized, and the ICL parameters should be carefully selected so as to achieve good outcomes and avoid complications. [ABSTRACT FROM AUTHOR]

To discuss and evaluate new technologies for a better diagnosis of corneal diseases and limbal stem cell deficiency, the outcomes of a consensus process within the European Vision Institute (and of a workshop at the University of Cologne) are outlined. Various technologies are presented and analyzed for their potential clinical use also in defining new end points in clinical trials. The disease areas which are discussed comprise dry eye and ocular surface inflammation, imaging, and corneal neovascularization and corneal grafting/stem cell and cell transplantation. The unmet needs in the abovementioned disease areas are discussed, and realistically achievable new technologies for better diagnosis and use in clinical trials are outlined. To sum up, it can be said that there are several new technologies that can improve current diagnostics in the field of ophthalmology in the near future and will have impact on clinical trial end point design. [ABSTRACT FROM AUTHOR]

Purpose: : The aim of this study was to evaluate the safety, efficacy, and complications of V4c Toric implantable collamer Lens (TICL) implantation for myopic astigmatism in the south Indian population.Methods: In this retrospective observational case series, a total of 109 eyes of 67 patients who underwent V4c TICL implantation (ICL, V4C Staar Surgical, Nidau, Switzerland) between January 2012 and August 2019 were studied with a minimum follow-up period of 6 months (mean 24 months). The main outcome measures were objective and subjective refraction, uncorrected distance visual acuity, corrected distance visual acuity (CDVA), safety, predictability, adverse events, and postoperative complications.Results: At 6 months, mean manifest refractive spherical equivalent (SE) decreased from -10.90 ± 3.7D preoperatively to -0.02 ± 0.13D postoperatively (P < 0.001) and mean cylinder decreased from -2.3 ± 1.3 D preoperatively to -0.04 ± 0.2 D postoperatively (P < 0.001). Postoperatively, SE within ± 0.5 D and ± 1.0 D of attempted correction were achieved in 96.3 (105 eyes) and 100% (109 eyes), respectively. Manifest refractive cylinder within ± 0.5 D and ± 1.0 D of attempted correction were achieved in 97.2 (106 eyes) and 100% (109 eyes), respectively. Sixty-two percent (68 eyes) showed no change in CDVA postoperatively, and no eye had lost lines of CDVA. The safety index was 1.12, and the efficacy index was 1.10. Complications were seen in two eyes (1.8%) due to high postoperative vault requiring secondary surgical interventions.Conclusion: V4c TICL is a highly effective, safe, and predictable option in treating myopic astigmatism with excellent improvement in vision and spectacle independence. [ABSTRACT FROM AUTHOR]

The past two decades have witnessed an unprecedented evolution in the management of keratoconus that demands a holistic approach comprising of inhibiting the ectatic progression as well as visual rehabilitation. The advent of corneal cross-linking (CXL) in the late 1990s resulted in long-term stabilization of the ectatic cornea along with limited reduction in corneal steepening and regularization of corneal curvature. However, CXL as a standalone procedure does not suffice in rehabilitating the functional vision especially in patients who are unwilling or intolerant towards contact lenses. The concept of "CXL plus" was proposed which incorporates adjunctive use of refractive procedures with CXL in order to overcome the optical inefficiency due to corneal irregularity, decrease the irregular astigmatism, correct the residual refractive error and improve functional visual outcome in keratoconus. Several refractive procedures such as conductive keratoplasty (CK), photorefractive keratectomy (PRK), transepithelial phototherapeutic keratectomy (t-PTK), intrastromal corneal ring segments (ICRS) implantation, phakic intraocular lens (PIOL) implantation and multiple other techniques have been combined with CXL to optimize and enhance the CXL outcome. This review aimed to summarize the different protocols of CXL plus, provide guidelines for selection of the optimum CXL plus technique and aid in decision-making for the comprehensive management of cases with primary keratoconus in addition to discussing the future and scope for innovations in the existing treatment protocols. [ABSTRACT FROM AUTHOR]

Simultaneous corneal cross-linking (CXL) has been proposed as an adjunct therapy to corneal refractive procedures to prevent future ectasia, especially when performed in borderline corneas. This review analyses the currently available literature (minimum follow-up 6 months) on corneal refractive surgery and simultaneous CXL (PRK Xtra, LASIK Xtra, and SMILE Xtra) to evaluate the overall results including the safety, efficacy, and potential complications associated with these procedures. A comprehensive literature search of various electronic databases (PubMed, PubMed Central, Cochrane database, and MEDLINE) was performed up to 20th May 2020. Four relevant studies were found for PRK Xtra, 12 for LASIK Xtra, and 3 for SMILE Xtra. The total number of eyes included in this review was 1,512: 294 for PRK Xtra, 221 for PRK-only, 446 eyes for LASIK Xtra, 398 eyes for LASIK-only, 91 for SMILE Xtra and 62 for SMILE-only. Current literature suggests that refractive surgery and simultaneous CXL is generally safe and delivers comparable results in terms of visual and refractive outcomes than refractive surgery alone. However, there is no consensus on a standard cross-linking protocol, and complications such as diffuse lamellar keratitis, central toxic keratopathy, and corneal ectasia following Xtra procedures have been reported. It is therefore suggested that surgeons exercise caution in case-selection and counsel their patients regarding the potential risks and benefits with Xtra procedures. Also, further studies are required to standardize the UV-A irradiation protocols and to evaluate the long-term effect on safety, refractive predictability, and stability of these procedures. [ABSTRACT FROM AUTHOR]

Purpose: To assess the stability, safety, predictability, and efficacy of small incision lenticule extraction (SMILE) with dual-incisions in myopic patients. Setting: Ebsar Eye center, Benha, Qalyopia, Egypt. Design: Single-center, retrospective, COHORT study. Patients and Methods: The study was conducted as a retrospective non-comparative analysis of the records of 105 eyes of 53 patients treated by the SMILE with a dual-incisions technique for a mean spherical myopic error of − 5.05 ± 1.93 D (range: − 1.38 to − 9.0 D) with or without astigmatism and the mean astigmatism of − 0.90 ± 0.83 D. The mean LogMAR corrected distance visual acuity (CDVA) was − 0.04 ± 0.07. Results: One month after surgery, the mean refractive error was − 0.03 ± 0.56 D (range: 0.88 to − 1.50 D), and the mean postoperative astigmatism was 0.20 ± 0.31 D. The mean LogMAR UDVA was 0.07 ± 0.18 in the last follow-up visit, 12 months after surgery. At the end of the follow-up period, approximately 91.43% of patients had unchanged CDVA or gained one or more lines, 8.57% lost one line of CDVA, and 0.0% lost 2 lines. Conclusion: SMILE with dual-incisions is effective and safe, with a stable and predictable outcome for correction of myopia and myopic astigmatism. [ABSTRACT FROM AUTHOR]

PURPOSE: To develop and validate a new algorithm for predicting the postoperative vault of the myopic EVO Visian Implantable Collamer Lens (ICL) V4c (STAAR Surgical AG). METHODS: This study included 81 eyes of 43 patients who had undergone ICL implantation. Preoperative data obtained by swept-source optical coherence tomography, Scheimpflug camera, and anterior segment optical coherence tomography were applied to develop a new partial least squares (PLS) regression algorithm. ICL sizing was performed using the standard white-to-white method with the online calculation and ordering system. The postoperative vault was assessed based on anterior segment optical coherence tomography. The PLS approach was applied to create the calibration model for predicting the postoperative vault. The new PLS model was cross-validated using the leave-one-out method and compared to a recently published linear regression model. Agreement between the actual and predicted vault values for the two methods was assessed by the Bland-Altman method. RESULTS: There was a statistically significant correlation (There was a statistically significant correlation (P <.001, r = 0.73) between the postoperative vault values and those predicted by the PLS algorithm. Validation of the PLS model yielded lower mean differences and limits of agreement (0 and 410 µm, respectively) than the linear regression method (400 and 750 µm, respectively). CONCLUSIONS: The PLS algorithm increases the precision of ICL vault prediction. However, it shows a tendency to overestimate small vault values and underestimate high vaults. [[J Refract Surg. 2020;36(9):606–612.] [ABSTRACT FROM AUTHOR]

Purpose: To quantitatively assess anterior chamber and angle parameters by anterior segment optical coherence tomography (AS-OCT) in myopic eyes undergoing Implantable Collamer Lens (ICL V4c) implantation.Methods: Prospective noncomparative observational case series. Pre and postoperative (1st and 3rd month) AS-OCT angle parameters (anterior chamber depth [ACD], anterior chamber angle [ACA], Angle opening distance [AOD], trabecular iris space area [TISA], scleral spur angle [SSA]) were evaluated in 32 eyes (16 patients). SPSS version 20 with paired t-test for intragroup and Mann-Whitney U value test for intergroup comparisons.Results: It included 6 (37.5%) males and 10 (62.5%) females. Preoperative ACA of 34.6 ± 2.3° reduced to 32.2 ± 2.4°, 31.9 ± 2.5° at 1 and 3 months postoperatively (P = 0.001). Preoperative mean AOD500, AOD750, TISA500, TISA750, SSA of 0.34 ± 0.06 mm, 0.52 ± 0.15 mm, 0.09 ± 0.02 mm2, 0.20 ± 0.04 mm2, 34.27 ± 4.6° decreased to 0.32 ± 0.06 mm, 0.48 ± 0.15 mm, 0.08 ± 0.02 mm2, 0.17 ± 0.05 mm2, 32.5 ± 4.3° at 1-month (P = 0.001); 0.32 ± 0.06 mm, 0.47 ± 0.13 mm, 0.08 ± 0.02 mm2, 0.17 ± 0.05 mm2 and 32.4 ± 4.6° (P = 0.001) at 3-months, respectively. Correlation analysis between preoperative ACD/intraocular pressure (IOP) was - 0.62 (P = 0.0002) [1st month], -0.40 (0.024) [third month]; between IOP/postoperative ACA, AOD500, AOD750, TISA500, TISA750, SSA was - 0.04 (0.81), -0.03 (0.85), -0.08 (0.64), -0.12 (0.48), -0.10 (0.57), -0.06 (0.73) at 1 month; -0.09 (0.58), 0.04 (0.78), 0.12 (0.48), -0.02 (0.9), -0.04 (0.79), 0.02 (0.88) at 3 months; between ICL vault/ACA, AOD500, AOD750, TISA500, TISA750, SSA was 0.38 (0.02), 0.24 (0.17), 0.21 (0.25), 0.05 (0.75), 0.15 (0.41), 0.27 (0.13) at 1st month; 0.19 (0.28), 0.06 (0.71), -0.03 (0.85), 0.005 (0.97), 0.05 (0.78), 0.07 (0.68) at 3rd month.Conclusion: Postoperatively significant angle narrowing was noted. There was a negative correlation between IOP and preoperative ACD. There was no significant correlation between IOP and ICL vault with postoperative AS-OCT angle parameters. [ABSTRACT FROM AUTHOR]

Purpose. To assess the efficacy, safety, and predictability of the Visian Implantable Collamer Lens (ICL) model having a central port in patients over 40 years of age. Methods. This study included 33 eyes from 21 patients who underwent V4c ICL implantation for the correction of myopia and myopic astigmatism. We assessed uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault, and adverse events occurring over a 1-year period. Results. Mean age of the patients at the time of implantation was 43.52 ± 4.49 years (range: 40 to 56 years). Efficacy and safety indexes were 1 and 1.09, respectively. Surgical outcomes for CDVA were as follows: no eye lost any lines, 19 eyes (57.58%) showed no CDVA changes, 7 eyes (21.21%) gained 1 line, 4 eyes (12.12%) gained 2 lines, and 3 eyes (9.09%) gained ≥3 lines. Mean postoperative spherical equivalent (SE) was −0.09 ± 0.47 D. A total of 29 eyes (87.8%) were within ±0.50 D and 31 eyes (93.9%) were within ±1.00 D of the desired SE. At 1-year, mean IOP was 15.27 ± 3.03 mmHg (range: 9 to 20 mmHg, p = 0.12 pre vs. post) and mean ECD was 2516 ± 234 cells/mm2 (p = 0.29 pre vs. post). Mean postoperative vault was 320 ± 136 μm, with 201–300 μm being the most prevalent vault range for 9 eyes (31.03%). None of the eyes showed a vault >701 μm. There were neither intraoperative nor postoperative complications; in fact, all ICL implantation procedures were uneventful. Conclusions. Our study's findings support the use of this lens in patients over 40 years of age. A long follow-up period is advisable to monitor ICL position relative to the crystalline lens. [ABSTRACT FROM AUTHOR]

Background: Corneal refractive surgery is widely used worldwide. Myopia is the most common reason for laser-assisted corneal refractive surgery (LASIK) and one of the risk factors for glaucoma. Intraocular pressure (IOP) measurement becomes variable postoperatively as the results are affected by the decrease in corneal thickness and biomechanics. This prospective clinical case study attempted to establish a simple correction formula for the calculation of IOP in post-LASIK myopic patients. Methods: This study included 300 eyes of 150 patients with myopia and myopic astigmatism as a refractive error who underwent LASIK. IOP was measured preoperatively and 6 months postoperatively. Preoperative and postoperative corneal thickness as well as ablation depth were measured. Statistical analysis was performed to detect the relationship between ablation depth and change in IOP. An attempt was made to construct a correction formula for the calculation of post-LASIK IOP. Results: The age of the patients ranged between 18 and 50 (mean ± SD 34.78± 8.8) years. The spherical equivalent of refractive error ranged between − 1.5 and − 10 diopters. The mean IOP decreased significantly from 15.72± 2.37 mmHg preoperatively to 11.71± 2.24 mmHg postoperatively, with a mean difference of  4± 1.75 mmHg (p˂0.001). A positive correlation was detected between corneal thickness and IOP difference among patients both preoperatively and postoperatively (p˂0.001). A positive correlation was identified between ablation depth and IOP change (p˂0.001). The correction formula for IOP was established: Real IOP=4+0.7(preoperative IOP)− 0.3(ablation depth). Conclusion: IOP measurements change after corneal refractive surgery with LASIK. A corrected formula may be a good option for the proper calculation of post-LASIK IOP. [ABSTRACT FROM AUTHOR]

Purpose. To assess the safety and stability in cases of small incision lenticule extraction with collagen cross-linking (SMILE Xtra). Methods. This study was a retrospective interventional comparative study that included 60 eyes of 30 patients divided equally into two groups: SMILE Xtra and SMILE alone. The inclusion criteria were patients >18 years of age, myopic error >6 D, thinner cornea <520 microns, and abnormal corneal topography. Outcome data were recorded including uncorrected distance visual acuity and corrected distance visual acuity (UDVA and CDVA), manifest refraction spherical equivalent (MRSE), central corneal thickness, average keratometry, endothelial cell density, corneal resistance factor (CRF), and corneal densitometry. The follow-up period was 24 months. Results. There was a significant difference between the 2 groups regarding UDVA, CDVA, and MRSE at 1 month. In the SMILE Xtra group, 90% of eyes had postoperative UDVA of 20/20 and 97% had UDVA of 20/30 at 24 months. At 24 months, 26 eyes (87%) vs. 25 eyes (84%) were within ±0.50 D of attempted correction in SMILE Xtra and SMILE groups, respectively. Regarding stability, both groups showed improvement of MRSE at 1st month postoperatively and remained stable along the 24 months of follow-up. CRF and corneal densitometry were higher in the SMILE Xtra group along the whole follow-up period (p=0.001). Conclusion. Combining corneal cross-linking with SMILE procedure (SMILE Xtra) is a promising tool to prevent ectasia in high-risk patients. It is a safe and simple procedure that can be offered to patients undergoing SMILE with risk for ectasia. Trial registration no: PACTR201810577524718. [ABSTRACT FROM AUTHOR]

PURPOSE: To assess the long-term correction of moderate to high myopia using a posterior chamber phakic intraocular lens with a central port design. METHODS: Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault, and adverse events over a 5-year period were evaluated retrospectively. RESULTS: A total of 147 eyes (83 patients) were evaluated. Mean postoperative UDVA and CDVA were 0.05 ± 0.11 and 0.02 ± 0.08 logMAR at 1 year and 0.13 ± 0.18 and 0.02 ± 0.09 logMAR at 5 years, respectively. More than 95% of eyes achieved CDVA of 20/25 or better at both follow-up periods. CDVA was unchanged or improved from one to three or more lines in all eyes. Preoperatively, mean spherical equivalent (SE) was -9.20 ± 3.02 diopters (D). At 1 year, the mean SE was -0.17 ± 0.26 D, with 91.53% of eyes within ±0.50 D and 100% of eyes within ±1.00 D of the target. At 5 years, the mean SE was -0.44 ± 0.47 D, with 67.4% of eyes within ±0.50 D and 90.1% of eyes within ±1.00 D of the target. Mean IOP was 12.74 ± 1.65 and 13.0 ± 2.03 mm Hg, at 1 and 5 years, respectively. No significant rise in IOP (> 20 mm Hg) occurred during the follow-up period. Mean ECD was 2,696 ± 358 and 2,645 ± 359 cells/mm2 at 1 and 5 years, respectively, representing a nonsignificant loss of 0.43% from preoperative values (P = .304). Mean vault changed significantly from 398 ± 187 μm at 1 year to 340 ± 163 μm at 5 years (P < .001). No intraoperative or postoperative complications or adverse events occurred during the follow-up period. CONCLUSIONS: The good long-term outcomes found in this study support the use of this lens with a central port design for the correction of moderate to high myopia. [ABSTRACT FROM AUTHOR]

The purpose of this review is to summarize preclinical and clinical data from publications appearing in the peer-reviewed scientific literature relevant to the safety and effectiveness of the EVO Implantable Collamer Lens (ICL) posterior chamber phakic refractive lens with a central port (V4c Visian ICL with KS Aquaport, STAAR Surgical, Inc.). A literature search was conducted using PubMed.gov to identify all articles relating to the EVO ICL. Articles were examined for their relevance, and the references cited in each article were also searched for additional relevant publications. On the basis of a total of 67 preclinical studies and clinical reports, including effectiveness data on 1,905 eyes with average weighted follow-up of 12.5 months and safety data on 4,196 eyes with weighted average follow up of 14.0 months, the EVO ICL is safe and effective for the correction of a broad range of refractive errors. High levels of postoperative uncorrected visual acuity, refractive predictability, and stability demonstrate the effectiveness of the EVO ICL. Safety data suggest reduced rates of anterior subcapsular cataract and pupillary block compared with earlier models. Improved safety and proven effectiveness make EVO an attractive option for surgeons and patients. [ABSTRACT FROM AUTHOR]

Introduction:Corneal ectasia is a group of related diseases characterized by progressive corneal steepening and thinning. It includes keratoconus, pellucid marginal degeneration (PMD), and post-laser ectasia. Traditionally, treatment of these conditions has involved visual rehabilitation with spectacles or contact lenses, with often eventual need for corneal transplantation. Areas covered:This review focuses on refractive surgery treatment options available for ectasia including collagen cross-linking (CXL), excimer laser, intrastromal corneal ring segments (ICRSs), and intraocular lenses (IOLs). A comprehensive literature review using OVID Medline and Embase was undertaken. Expert commentary:CXL has shown promising short- and long-term results in stabilizing patients with corneal ectasia. When combined with excimer laser using topography- or wavefront-guided photorefractive keratectomy (PRK), many patients are able to gain significant improvements in visual acuity and contact lens tolerance, which may delay or prevent altogether the need for corneal transplantation. Other treatments such as ICRSs, phakic IOLs, and TORIC IOLs may be beneficial in select cases for visual rehabilitation. [ABSTRACT FROM PUBLISHER]