María José Ayala

Retreatment after laser in situ keratomileusis1

Abstract Objective To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) retreatment for correcting residual myopia. Design Retrospective noncomparative case series. Participants and intervention Fifty-nine consecutive eyes (43 patients) underwent LASIK retreatment at 3 or 6 months after the primary LASIK procedure. Lifting the corneal flap and reablating the stromal bed with a VISX 20/20 excimer laser was the procedure used for LASIK enhancement. Main outcome measures The following parameters were studied before and after retreatment: visual acuity, refraction, videokeratography, applanation tonometry, and corneal thickness. Complications after LASIK enhancement also were evaluated. Follow-up was 12 months. Results Before retreatment, only 3.38% of eyes (2 of 59) had an uncorrected visual acuity of 0.5 (20/40) or better, and after retreatment, this percentage increased to 60% (30 of 50) at 6 months and 61.8% (34 of 55) at 12 months. After reoperation, mean best-corrected visual acuity improved by half a line over the values before retreatment. The preretreatment refraction of −2.92 ± 1.22 diopters (D) (mean ± standard deviation) decreased significantly to −0.44 ± 0.80 D at 6 months and to −0.61 ± 0.82 D at 12 months ( P P Conclusions LASIK retreatment was an effective and predictable procedure for correcting residual myopia. Epithelial ingrowth and flap melting were more frequent after than before LASIK retreatment, whereas decentration and night-vision symptoms improved.

Complications of photorefractive keratectomy for myopia: two year follow-up of 3000 cases.

Purpose: To evaluate the results and complications of photorefractive keratectomy (PRK) for myopia. Setting: Alicante Institute of Ophthalmology, University of Alicante, Spain. Methods: This prospective study evaluated the results and complications of the first 3000 cases of PRK performed with a VISX Twenty‐Twenty excimer laser. Myopia ranged from −1.0 to −14.0 diopters (D) and astigmatism, from −1.0 to −5.0 D. Follow‐up was 2 years. Results: Ten eyes (0.7%) lost two or more lines of best corrected visual acuity 1 year after surgery. Retreatment for undercorrection or regression was done in 7.41% in the low myopia group and 38.69% in the high myopia group. Central islands, which could be detected only on videokeratoscopy, occurred frequently but influenced the refractive and visual outcomes in few cases. Severe haze was present in 17 eyes only after 1 year follow‐up. There were no cases of progressive hyperopia. Other complications such as eccentric ablation producing astigmatism (n = 15), delayed re‐epithelialization, or recurrent corneal erosion were rare. Conclusion: There were few complications after PRK in 3000 eyes. With proper patient selection, PRK can be considered relatively safe compared with other refractive orocedures.

Photorefractive keratectomy for pediatric myopic anisometropia

Purpose: To evaluate the visual results of excimer laser photorefractive keratectomy (PRK) to treat pediatric patients with amblyopic myopic anisometropia in whom conventional amblyopia treatments have failed. Setting: Instituto Oftalmológico de Alicante, University of Alicante, Spain. Methods: Six patients aged 5 to 7 years with amblyopic myopic anisometropia were treated by PRK in the more myopic eye using a VISX Twenty‐Twenty excimer laser. Minimum preoperative refraction in the amblyopic eyes ranged from −4.00 to −13.00 diopters and best corrected visual acuity (BCVA), from 20/40 to 20/400. All cases completed a minimum of 2 years follow‐up of antiamblyopic treatment. Results: After PRK, preoperative BCVA was maintained without optical correction and complementary refraction resulted in increased BCVA in every case. One patient with high myopia developed severe haze. There were no other significant complications. Conclusion: Our results indicate’ that PRK may be an alternative for the correction of pediatric myopic anisometropia and an important aid in treating amblyopia. When other therapies have failed, using PRK in children of the ages in this study must be carefully evaluated; however, our results suggest a beneficial effect.

Comparison of a New Refractive Multifocal Intraocular Lens with an Inferior Segmental Near Add and a Diffractive Multifocal Intraocular Lens

PURPOSE To compare the visual acuity outcomes and ocular optical performance of eyes implanted with a multifocal refractive intraocular lens (IOL) with an inferior segmental near add or a diffractive multifocal IOL. DESIGN Prospective, comparative, nonrandomized, consecutive case series. PARTICIPANTS Eighty-three consecutive eyes of 45 patients (age range, 36-82 years) with cataract were divided into 2 groups: group A, 45 eyes implanted with Lentis Mplus LS-312 (Oculentis GmbH, Berlin, Germany); group B, 38 eyes implanted with diffractive IOL Acri.Lisa 366D (Zeiss, Oberkochen, Germany). METHODS All patients underwent phacoemulsification followed by IOL implantation in the capsular bag. Distance corrected, intermediate, and near with the distance correction visual acuity outcomes and contrast sensitivity, intraocular aberrations, and defocus curve were evaluated postoperatively during a 3-month follow-up. MAIN OUTCOME MEASURES Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), corrected distance near and intermediate visual acuity (CDNVA), contrast sensitivity, intraocular aberrations, and defocus curve. RESULTS A significant improvement in UDVA, CDVA, and UNVA was observed in both groups after surgery (P ≤ 0.04). Significantly better values of UNVA (P<0.01) and CDNVA (P<0.04) were found in group B. In the defocus curve, significantly better visual acuities were present in eyes in group A for intermediate vision levels of defocus (P ≤ 0.04). Significantly higher amounts of postoperative intraocular primary coma and spherical aberrations were found in group A (P<0.01). In addition, significantly better values were observed in photopic contrast sensitivity for high spatial frequencies in group A (P ≤ 0.04). CONCLUSIONS The Lentis Mplus LS-312 and Acri.Lisa 366D IOLs are able to successfully restore visual function after cataract surgery. The Lentis Mplus LS-312 provided better intermediate vision and contrast sensitivity outcomes than the Acri.Lisa 366D. However, the Acri.Lisa design provided better distance and near visual outcomes and intraocular optical performance parameters.

Laser in situ keratomileusis to correct residual myopia after cataract surgery

PURPOSE To evaluate the effectiveness, predictability, and safety of laser in situ keratomileusis (LASIK) for correcting residual myopia after cataract surgery with intraocular lens implantation. METHODS Twenty-two eyes of 22 patients underwent LASIK for the correction of residual myopia after cataract surgery. LASIK was carried out using the Chiron Automated Corneal Shaper and the NIDEK EC-5000 excimer laser. In all eyes, the follow-up was 12 months. RESULTS Before LASIK, 1 eye (4.5%) had an uncorrected visual acuity of 0.5 or better; 12 months after LASIK, 10 eyes (45.4%) achieved this level of visual acuity and 0 eyes achieved 1.00 or better. Before LASIK, mean refraction was -2.90 +/- 1.80 D; 12 months after LASIK it decreased significantly to 0.40 +/- 0.60 D (P < .01). In 18 eyes (81.8%) at 12 months after LASIK, spherical equivalent refraction was within +/-1.00 D of emmetropia; 11 eyes (50%) were within 0.50 D. No vision-threatening complications occurred. CONCLUSION LASIK with the Automated Corneal Shaper and Nidek EC-5000 excimer laser was an effective, predictable, stable, and safe procedure for correcting residual myopia after cataract surgery. No intraocular lens or cataract incision related complications occurred when LASIK was performed at least 3 months after phacoemulsification.

Comparison of the visual and intraocular optical performance of a refractive multifocal IOL with rotational asymmetry and an apodized diffractive multifocal IOL.

PURPOSE To compare the visual outcomes and intraocular optical quality observed postoperatively in patients implanted with a rotationally asymmetric multifocal intraocular lens (IOL) and an apodized diffractive multifocal IOL. METHODS Seventy-four consecutive eyes of 40 cataract patients (age range: 36 to 79 years) were divided into two groups: zonal refractive group, 39 eyes implanted with a rotationally asymmetric multifocal IOL (Lentis Mplus LS-312 IOL, Oculentis GmbH); and diffractive group, 35 eyes implanted with an apodized diffractive multifocal IOL (ReSTOR SN6AD3, Alcon Laboratories Inc). Distance and near visual acuity outcomes, contrast sensitivity, intraocular optical quality, and defocus curves were evaluated during 3-month follow-up. Calculation of the intraocular aberrations was performed by subtracting corneal aberrations from total ocular aberrations. RESULTS Uncorrected near visual acuity and distance-corrected near visual acuity were better in the diffractive group than in the zonal refractive group (P=.01), whereas intermediate visual acuity (defocus +1.00 and +1.50 diopters) was better in the zonal refractive group. Photopic contrast sensitivity was significantly better in the zonal refractive group (P=.04). Wavefront aberrations (total, higher order, tilt, primary coma) were significantly higher in the zonal refractive group than in the diffractive group (P=.02). CONCLUSIONS Both multifocal IOLs are able to successfully restore visual function after cataract surgery. The zonal refractive multifocal IOL provides better results in contrast sensitivity and intermediate vision, whereas the diffractive multifocal IOL provides better near vision at a closer distance.

Quality of life evaluation after implantation of 2 multifocal intraocular lens models and a monofocal model

PURPOSE: To compare vision‐related quality of life using the National Eye Institute Visual Function Questionnaire (NEI VFQ‐25) in patients with 1 of 3 types of intraocular lenses (IOLs) and to correlate it with postoperative visual outcomes. SETTING: Vissum Corporation–Instituto Oftalmológico de Alicante, Alicante, Spain. DESIGN: Comparative case series. METHODS: This study comprised eyes having cataract surgery with bilateral implantation of a monofocal IOL (Group A), apodized multifocal IOL (Group B), or full diffractive multifocal IOL (Group C). Distance and near visual acuities, contrast sensitivity, and quality of life were evaluated preoperatively and postoperatively. RESULTS: The study enrolled 106 eyes (53 patients; age range 49 to 80 years). All groups had significant improvement in uncorrected and corrected distance visual acuities postoperatively (P≤.05). Near vision outcomes were significantly better in Groups B and C (P≤.01). Groups B and C had significantly less difficulty in some near tasks, such as reading the newspaper (A–B, P=.02; A–C, P=.02) or reading bills (A–B, P=.04; A–C, P=.004). Group C also had significantly less difficulty driving at night than Group B (P<.01). Near visual acuity and contrast sensitivity were significantly correlated with difficulty in near visual tasks in Groups B and C. Night‐driving difficulty correlated significantly with contrast sensitivity in Group B. CONCLUSIONS: Patients with multifocal IOLs could perform several daily tasks at near and intermediate distances, with less night‐driving limitation with the full diffractive IOL than with apodized multifocal and monofocal IOLs. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Comparative analysis of the clinical outcomes with 2 multifocal intraocular lens models with rotational asymmetry.

PURPOSE: To compare the clinical outcomes after cataract surgery with implantation of 2 models of a new rotationally asymmetric multifocal IOL to ascertain which provides better visual performance and patient satisfaction. SETTING: Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. DESIGN: Comparative case series. METHODS: Consecutive eyes of cataract patients were divided into 2 groups. Group A received a Lentis Mplus LS‐312 MF15 IOL (with a near addition [add] power of +1.50 diopters [D]) and Group B, a Lentis Mplus LS‐312 MF30 IOL (with a near add power of +3.00 D). Distance, near, and intermediate visual acuity outcomes were evaluated preoperatively and postoperatively during a 6‐month follow‐up. Postoperative contrast sensitivity, patient satisfaction, ocular aberrations, ocular optical quality, and defocus curves were analyzed. RESULTS: Patients ranged in age from 55 to 83 years. Group A comprised 22 eyes and Group B, 21 eyes. Both groups had a statistically significant improvement in uncorrected and corrected distance and corrected near visual acuities postoperatively (P≤.01). Group B had statistically significantly better uncorrected and distance‐corrected near visual acuity (P≤.01) and Group A, significantly better uncorrected intermediate visual acuity (P=.01) at 3 months. There were statistically significant differences between‐group differences in several levels of defocus based on defocus curves. There were no significant differences in postoperative contrast sensitivity, patient satisfaction, optical quality, and ocular aberrometry between groups (P≥.07). CONCLUSIONS: Both IOL models restored distance visual function and improved intermediate vision. Near visual rehabilitation was complete with the +3.00 D add IOL. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Postoperative bilateral reading performance with 4 intraocular lens models: Six-month results

PURPOSE: To compare bilateral reading performance within the first 6 months after implantation of 4 intraocular lens (IOL) models. SETTING: Vissum‐Instituto de Oftalmológico de Alicante, Alicante, Spain, and University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. DESIGN: Comparative case series. METHODS: Patients had bilateral phacoemulsification and implantation of Acri.Smart 48S monofocal, Acrysof Restor SN6AD3 apodized multifocal, Acri.LISA 366D diffractive multifocal, or Rezoom refractive multifocal IOLs. Bilateral reading performance with and without near correction was evaluated preoperatively and postoperatively using the Salzburg Reading Desk. RESULTS: The study comprised 304 eyes of 152 patients 51 to 90 years old. All groups had a significant improvement in uncorrected and corrected distance visual acuities postoperatively (P≤.01). The apodized multifocal and diffractive multifocal groups had significantly better uncorrected reading acuity than the monofocal and refractive multifocal groups 1 month and 6 months postoperatively (P<.01). Uncorrected reading speed was significantly worse in the refractive multifocal group than in the monofocal group at 1 month (P<.01). The monofocal group had the greatest uncorrected reading distance at 1 month and 6 months (P<.01). CONCLUSION: Multifocal IOLs with a diffractive component provided a comparable reading performance that was significantly better than the one obtained with refractive multifocal and monofocal IOLs. Financial Disclosure: Drs. Alió, Plaza‐Puche, Rasp, Piñero, Seyeddain, Rodríguez‐Prats, Ayala, Moreu, Hohensinn, and Riha have no financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Treatment of laser in situ keratomileusis interface epithelial ingrowth with neodymium:yytrium-aluminum-garnet laser.

PURPOSE To evaluate the results obtained with the treatment for interface epithelial ingrowth after laser in situ keratomileusis (LASIK) with neodymium:yytrium-aluminum-garnet (Nd:YAG) laser. DESIGN Retrospective, interventional, noncomparative, consecutive case series. METHODS Thirty eyes were treated with Nd:YAG laser for clinically significant epithelial ingrowth developed after LASIK. Each impact produced an explosion with evaporation of epithelial cells giving rise to bubbles. The mean intensity of the spots was 0.6 mJ, and they were variable in quantity depending on the size of the epithelial ingrowth area. The patients were followed up for two years. RESULTS The opacities caused by the epithelial ingrowth disappeared in 80% of the cases with the Nd:YAG laser treatment. In 40% of the cases, two or more sessions of Nd:YAG laser treatment were necessary to eliminate the epithelial ingrowth areas entirely. In 60% of the cases, visual acuity improved by one or more lines of vision and the corneal topography was more regular. After the treatment, symptoms like glare and halos improved in all cases. The intensity of the laser was adjusted in each case and was focused perfectly on the epithelial ingrowth areas. There were no complications. CONCLUSIONS Nd:YAG laser, in our experience, is an easy and effective technique for the treatment of epithelial ingrowth after LASIK.