Mari Komatsu

Four-year follow-up of posterior chamber phakic intraocular lens implantation for moderate to high myopia.

OBJECTIVE To assess the long-term clinical outcomes of implantation of a lens consisting of a biocompatible collagen copolymer (Visian implantable Collamer lens [ICL]; STAAR Surgical, Nidau, Switzerland) for moderate to high myopia. METHODS We evaluated 56 eyes of 34 patients with myopic refractive errors of -4.00 to -15.25 diopters (D) who underwent ICL implantation and routine postoperative examinations. Before and 1, 3, and 6 months and 1, 2, and 4 years after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery. RESULTS Mean (SD) logMAR uncorrected and best spectacle-corrected visual acuities were -0.03 (0.23) and -0.21 (0.09), respectively, at 4 years after surgery. The mean (SD) safety and efficacy indexes were 1.19 (0.25) and 0.83 (0.29), respectively. At 4 years, 44 (79%) and 52 (93%) of the eyes were within +/-0.5 and +/-1.0 D, respectively, of the targeted correction. Mean (SD) manifest refraction changes of -0.24 (0.57) D occurred from 1 month to 4 years after surgery. No vision-threatening complications occurred during the observation period. CONCLUSION Implantation of ICLs is safe and effective and provides predictable and stable refractive results in the treatment of moderate to high myopia during a 4-year observation period, suggesting its viability as a surgical option for the treatment of such eyes.

Clinical outcomes of wavefront-guided laser in situ keratomileusis: 6-month follow-up

Purpose: To evaluate the clinical outcomes 6 months after wavefront‐guided laser in situ keratomileusis (LASIK) for myopia in Japan. Setting: Department of Ophthalmology, Sanno Hospital, Tokyo, Japan. Methods: This prospective study comprised 22 eyes of 12 patients treated with wavefront‐guided LASIK who were available for evaluation at 6 months. The mean patient age was 31.2 years ± 8.4 (SD) (range 23 to 50 years), and the mean preoperative spherical equivalent refraction was −7.30 ± 2.72 diopters (D) (range −2.75 to −11.88 D). In all cases, preoperative wavefront analysis was performed with a Hartmann‐Shack aberrometer and the Technolas® 217z flying‐spot excimer laser system (Bausch & Lomb) was used with 1.0 mm and 2.0 mm spot sizes and an active eye tracker with a 120 Hz tracking rate. The clinical outcomes of wavefront‐guided LASIK were evaluated in terms of safety, efficacy, predictability, stability, complications, and preoperative and postoperative aberrations. Results: At 6 months, 10 eyes had no change in best spectacle‐correct visual acuity and 10 gained 1 or more lines. The safety index was 1.11 and the efficacy index, 0.82. Slight undercorrections were observed in highly myopic eyes. In all eyes, the postoperative refraction tended slightly toward myopia for 3 months and stabilized after that. No complication such as epithelial ingrowth, diffuse lamellar keratitis, or infection was observed. Comparison of the preoperative and postoperative aberrations showed that 2nd‐order aberrations decreased and higher‐order aberrations increased. In the 3rd order, aberrations increased in the high‐myopia group (−6.0 D or worse) and decreased in the low to moderate‐myopia group (better than −6.0 D). Conclusion: Wavefront‐guided LASIK was a good option for refractive surgery, although a longer follow‐up in a larger study is required.

Comparison of Collamer toric contact lens implantation and wavefront-guided laser in situ keratomileusis for high myopic astigmatism

PURPOSE: To compare the postoperative visual outcomes after implantation of a Collamer toric implantable contact lens (ICL) and after wavefront‐guided laser in situ keratomileusis in high myopic astigmatism. SETTING: Department of Ophthalmology, Kitasato University, Kanagawa, Japan. METHODS: This study comprised 30 eyes (18 patients) having toric ICL implantation and 24 eyes (17 patients) having wavefront‐guided LASIK (Technolas 217z) to correct high myopic astigmatism (manifest spherical equivalent [SE] ≤−6.0 diopters [D]; manifest refractive cylinder ≥1.0 D). The safety, efficacy, predictability, stability, and adverse events were assessed preoperatively and 1 week and 1, 3, and 6 months postoperatively. RESULTS: At 6 months, the mean safety index was 1.28 ± 0.25 (SD) in the ICL group and 1.01 ± 0.16 in the LASIK group and the mean efficacy index, 0.87 ± 0.15 and 0.83 ± 0.23, respectively. All eyes in the ICL group and 71% of eyes in the LASIK group were within ±1.00 D of the targeted SE correction at 6 months. The mean change in manifest refraction from 1 week to 6 months was −0.04 ± 0.24 D in the ICL group and −0.60 ± 0.49 D in the LASIK group. There were no significant complications in the ICL group; 2 eyes (8.3%) in the LASIK group required enhancement ablations. CONCLUSION: Toric ICL implantation was better than wavefront‐guided LASIK in eyes with high myopic astigmatism in almost all measures of safety, efficacy, predictability, and stability, suggesting that toric ICL implantation may become a viable surgical option to treat high myopic astigmatism.

Visual performance after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis for high myopia.

PURPOSE To compare postoperative visual function after implantable collamer lens (ICL; STAAR Surgical, Nidau, Switzerland) implantation and after wavefront-guided laser in situ keratomileusis (WFG-LASIK) in eyes with high myopia. DESIGN Retrospective, observational case study. METHODS We investigated 46 eyes of 33 patients undergoing ICL implantation and 47 eyes of 29 patients undergoing WFG-LASIK (Technolas217z; Bausch & Lomb, Rochester, New York, USA) for the correction of high myopia (manifest spherical equivalent < or = -6 diopters). Ocular higher-order aberrations (HOA) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry (KR-9000; Topcon, Tokyo, Japan) and a CS unit (VCTS-6500; Vistech Consultants Inc, Dayton, Ohio, USA) before and 3 months after surgery, respectively. From the CS, the area under the log CS function (AULCSF) was calculated. RESULTS For a 4-mm pupil, the changes in ocular coma-like aberrations, spherical-like aberrations, and total HOAs after ICL implantation were significantly less than those after WFG-LASIK (P < .001, Mann-Whitney U test). The postoperative AULCSF was significantly increased after ICL implantation (P < .001), whereas after WFG-LASIK, it was significantly decreased (P < .001). CONCLUSIONS ICL implantation induces significantly fewer ocular HOAs than WFG-LASIK. Moreover, CS was improved significantly after ICL implantation, but deteriorated after WFG-LASIK in eyes with high myopia. Thus, in the correction of high myopia, ICL implantation seems to be superior in visual performance to WFG-LASIK, suggesting that it may be a better surgical option for the treatment of such eyes.

Visual Performance After Posterior Chamber Phakic Intraocular Lens Implantation and Wavefront-Guided Laser In Situ Keratomileusis for Low to Moderate Myopia

PURPOSE To compare postoperative visual function after implantable collamer lens (ICL) implantation and after wavefront-guided laser in situ keratomileusis (LASIK) in eyes with low to moderate myopia. DESIGN Retrospective observational case study. PATIENTS AND METHODS We investigated 30 eyes of 20 patients undergoing ICL implantation and 64 eyes of 38 patients undergoing wavefront-guided LASIK for the correction of low to moderate myopia (manifest spherical equivalent: -3.00 to -5.88 diopters [D]). Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry and a contrast sensitivity unit before and 3 months after surgery, respectively. From the contrast sensitivity, the area under the log contrast sensitivity function was calculated. RESULTS For 4-mm and 6-mm pupils, the changes in ocular third-order aberrations, fourth-order aberrations, and total HOAs after ICL implantation were significantly less than those after wavefront-guided LASIK (P < .05, Mann-Whitney U test). The postoperative area under the log contrast sensitivity function was significantly increased after ICL implantation (P < .001), whereas, after wavefront-guided LASIK, it was not significantly changed (P = .11). CONCLUSIONS ICL implantation induces significantly fewer ocular HOAs than wavefront-guided LASIK. Moreover, CS was significantly improved after ICL implantation but unchanged after wavefront-guided LASIK in eyes with low to moderate myopia. Thus, even in the correction of low to moderate myopia, ICL implantation appears to be superior in visual performance to wavefront-guided LASIK, suggesting that it may be a viable surgical option for the treatment of such eyes.

Comparison of visual acuity, higher-order aberrations and corneal asphericity after refractive lenticule extraction and wavefront-guided laser-assisted in situ keratomileusis for myopia

Aim To compare postoperative visual acuity, higher-order aberrations (HOAs) and corneal asphericity after femtosecond lenticule extraction (FLEx) and after wavefront-guided laser-assisted in situ keratomileusis (wfg-LASIK) in myopic eyes. Methods We examined 43 eyes of 23 patients undergoing FLEx and 34 eyes of 19 patients undergoing wfg-LASIK to correct myopia. Ocular HOAs were measured by Hartmann-Shack aberrometry and corneal asphericity was measured by a rotating Scheimpflug imaging system before and 3 months after surgery. Results There was no statistically significant difference in uncorrected (p=0.66 Mann–Whitney U-test) or corrected distance visual acuity (p=0.14) after two surgical procedures. For a 6-mm pupil, the changes in fourth-order aberrations after FLEx were statistically significantly less than those after wfg-LASIK (p<0.001). On the other hand, there were no statistically significant differences in the changes in third-order aberrations (p=0.24) and total HOAs (p=0.13). Similar results were obtained for a 4-mm pupil. The positive changes in the Q value after FLEx were statistically significantly less than those after wfg-LASIK (p=0.001). Conclusions In myopic eyes, FLEx induces significantly fewer ocular fourth-order aberrations than wfg-LASIK, possibly because it causes less oblation in the corneal shape, but there was no statistically significant difference in visual acuity or in the induction of third-order aberrations and total HOAs. It is suggested that FLEx is essentially equivalent to wfg-LASIK in terms of visual acuity and total HOA induction, although the characteristics of HOA induction are different.

Three-year follow-up of posterior chamber toric phakic intraocular lens implantation for the correction of high myopic astigmatism in eyes with keratoconus

Aim To assess the clinical outcomes following the use of toric implantable collamer lenses (toric ICL, STAAR Surgical) for the correction of high myopic astigmatism with keratoconus. Methods This retrospective study evaluated 21 eyes of 11 patients with spherical equivalents of −9.70±2.33 D (mean±SD) and astigmatism of −3.21±1.56 D who underwent toric ICL implantation for keratoconus. Preoperatively, and at 1, 3 and 6 months and 1, 2 and 3 years postoperatively, we assessed the safety, efficacy, predictability, stability and adverse events of the surgery. Results The logarithm of the minimum angle of resolution (logMAR) uncorrected distance visual acuity (UDVA) and the logMAR corrected distance visual acuity (CDVA) were −0.06±0.11 and −0.12±0.09, respectively, at 3 years postoperatively. At 3 years, 67% and 86% of the eyes were within ±0.5 and ±1.0 D, respectively, of the targeted correction. Manifest refraction changes of 0.04±0.33 D occurred from 1 month to 3 years postoperatively. No significant change in manifest refraction (analysis of variance, p=0.989) or keratometry (p=0.951), or vision-threatening complications occurred during the observation period. Conclusions Toric ICL implantation is beneficial according to measures of safety, efficacy, predictability and stability for the correction of refractive errors for keratoconus during a 3-year observation period. The disease did not progress even in the late-postoperative period, suggesting the viability of this procedure as a surgical option for the treatment of such eyes.

Ultraviolet-absorbing intraocular lens versus non-UV-absorbing intraocular lens: Comparison of angiographic cystoid macular edema

ABSTRACT We compared the incidence of angiographic cystoid macular edema (CME) in eyes with ultraviolet (UV)‐absorbing intraocular lenses (IOLs) with that in eyes with non‐UV‐absorbing IOLs. Fifty‐five bilateral pseudophakic patients received a UV‐absorbing IOL in one eye and a non‐UV‐absorbing IOL in the fellow eye. All cases were implanted with posterior chamber lenses following extracapsular cataract extraction. Fluorescein angiography for CME was performed at least six months postoperatively (average 20.0 months). There was no statistically significant difference in visual acuity or in the incidence of CME.

Posterior chamber toric phakic intraocular lens implantation for high myopic astigmatism in eyes with pellucid marginal degeneration

UNLABELLED We report a case in which toric intraocular Collamer lenses (ICLs) effectively corrected the refractive errors of pellucid marginal degeneration (PMD). Preoperatively, in the patients right eye, the manifest refraction was -10.5 -3.5 x 55, the uncorrected distance visual acuity (UDVA) was 20/1000, and the corrected distance visual acuity (CDVA) was 20/16; in the left eye, the manifest refraction was -11.0 - 6.5 x 130 and the UDVA and CDVA were 20/1000 and 20/20, respectively. After bilateral implantation of a toric ICL, in the right eye, the manifest refraction was +1.50 - 0.75 x 10, the UDVA was 20/16, and the CDVA was 20/12.5; in the left eye, the manifest refraction was +2.5 -3.25 x 125 and the UDVA and CDVA were 20/40 and 20/16, respectively. No sign of progressive disease and no vision-threatening complication were observed during the 6-month follow-up. Toric ICL implantation may be a viable surgical option for the correction of high myopic astigmatism in eyes with PMD. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Three-Year Follow-Up of Posterior Chamber Toric Phakic Intraocular Lens Implantation for Moderate to High Myopic Astigmatism

Purpose To assess the 3-year clinical outcomes of toric phakic intraocular lens (Visian ICL™; STAAR Surgical) implantation for moderate to high myopic astigmatism. Methods This retrospective study evaluated fifty eyes of 28 patients who underwent toric ICL implantation for the correction of moderate to high myopic astigmatism and who regularly returned for postoperative examination. Before, and 1, 3, and 6 months after, and 1, 2, and 3 years after surgery, we assessed the safety, efficacy, predictability, stability, and adverse events of the surgery in eyes undergoing toric ICL implantation. Results The logarithm of the minimal angle of resolution (LogMAR) uncorrected visual acuity and LogMAR best spectacle-corrected visual acuity were –0.10 (corresponding to Snellen equivalents 20/16) ± 0.16 and –0.20 (corresponding to 20/12.5) ± 0.07, 3 years postoperatively, respectively. The safety and efficacy indices were 1.16 ± 0.20 and 0.94 ± 0.28. At 3 year, 82% and 98% of the eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. Manifest refraction changes of –0.15 ± 0.31 D occurred from 1 month to 3 year. No vision-threatening complications occurred during the observation period. Conclusions On the basis of the clinical results of this study, toric ICL implantation was good in all measures of safety, efficacy, predictability, and stability for the correction of moderate to high myopic astigmatism throughout a 3-year observation period.