Short term visual outcomes of a new trifocal intraocular lens

Background: Today, patients often expect to achieve spectacle independance after cataract surgery. New trifocal intraocular lenses have been developed to try and fullfill this demand. The purpose of this study is to report the short-term visual outcomes of a new trifocal intraocular lens (AcrySof PanOptix™). Methods: Consecutive adult patients undergoing cataract surgery with bilateral implantation of the study intraocular lens in a private practice clinic were considered for inclusion. Exclusion criteria were the presence of other ocular pathologies or preoperative astigmatism >1.5 diopters (D). Patients with intraoperative complications were excluded from analysis. One month after surgery patients underwent: monocular defocus curve; monocular and binocular uncorrected visual acuity in photopic and mesopic conditions, for far (4 m), intermediate (60 cm) and near (33 cm) distances and binocular contrast sensitivity. Patients completed a visual satisfaction questionnaire between 9 and 12 months after surgery. Results: One hundred and sixteen eyes of fifty-eight patients receiving bilateral implantation of the study intraocular lens were analysed. Mean binocular uncorrected visual acuity in photopic conditions was 0.03 LogMAR for far, 0.12 for intermediate and 0.02 for near distances. All patients achieved a binocular uncorrected visual acuity better than 0.3 LogMAR (20/40 Snellen equivalent) for distance and near vision and 94.8% of patients for intermediate vision. Mesopic binocular uncorrected visual acuity values were similar to photopic values. The monocular defocus curves showed that the best visual acuity was reached at a vergence of 0.00D. Visual acuity dropped slightly at −1.00D and peaked again at −2.00D. Visual acuities better than 0.2 LogMAR were maintained between −2.50D and +0.50D. Contrast sensitivity was high and similar in photopic and mesopic conditions. As regards patient-evaluated outcomes, only 2 patients (3.4%) were fairly dissatisfied with their sight after surgery. Three patients (5.1%) reported the need for spectacle correction for certain activities. All other patients (94.8%) reported never using spectacle correction. Conclusions: The PanOptix trifocal IOL provides good short-term visual outcomes, with good intermediate performance and excellent patient-reported satisfaction. The similar values achieved in mesopic and photopic conditions in binocular uncorrected visual acuity and contrast sensitivity suggest low pupillary dependence for light distribution. Trial registration number: ISRCTN60143265 , retrospectively registered on the 24th of April 2017

Measurement of the Intraocular Pressure Elevation During Laser-Assisted In Situ Keratomileusis Flap Creation Using a Femtosecond Laser Platform

Purpose: The purpose of this study was to measure the intraocular pressure (IOP) elevation during laser assisted in situ keratomileusis (LASIK) flap creation using the WaveLight FS200 femtosecond (FS) laser platform. Methods: We conducted an ex vivo experimental study in an animal model. The WaveLight FS200 FS laser platform was used to perform the corneal LASIK flap in freshly enucleated porcine eyes. We measured the changes in IOP from the application of the suction ring (suctioning phase) through the creation of the lamellar corneal flap (cutting phase). The IOP was recorded using a manometric technique with direct cannulation to the anterior chamber. Results: Nine freshly enucleated porcine eyes were included in the study. The mean baseline IOP before the procedure was 20.33 ± 5.9 mm Hg. The mean IOP increase over baseline IOP was 32.33 ± 11.3 mm Hg at the suctioning phase, and 38.22 ± 11.3 mm Hg at the cutting phase. The total surgical time needed to complete the procedure was 29.5 ± 4.4 seconds. Conclusions: The WaveLight FS200 FS laser platform produces a low to moderate increase in IOP during LASIK flap creation. Translational Relevance: The WaveLight FS200 is a safe FS laser platform because it induces a low to moderate IOP increase during LASIK flap creation

Estudio de la progresión perimétrica en distintos tipos de glaucoma: sistemas de diagnóstico y factores de riesgo

Introducción: La perimetría automatizada blanco-blanco utilizando el Perímetro Humphrey está ampliamente difundida para el diagnóstico y seguimiento del daño perimétrico desarrollado en el glaucoma. Debido a la ausencia de gold standard entre las estrategias desarrolladas para el diagnóstico de progresión perimétrica, se han desarrollado múltiples procedimientos, uno de los últimos es el Visual Field Index (VFI). Los glaucomas de ángulo abierto pueden ser clasificados en función de la morfología papilar, y de acuerdo con esta morfología papilar presentan un comportamiento clínico y perimétrico diferenciado. Nuestro objetivo es analizar el comportamiento de tres tipos distintos de glaucoma en función de su morfología papilar aplicando el software VFI y compararlo con otros tres sistemas de diagnóstico de progresión perimétrica. La validez del diagnóstico de progresión perimétrica. La validez del diagnóstico de progresión se valorará a través del estudio en paralelo del comportamiento de determinadas características clínicas asociadas a progresión a lo largo del seguimiento. Material y métodos: Se realizó un estudio retrospectivo con 296 ojos de 153 pacientes con glaucoma primario de ángulo abierto bajo tratamiento; 112 de ellos con glaucoma focal, 136 con glaucoma hiperbárico y 48 con glaucoma pseudoexfoliativo. Todos los campos visuales disponibles de estos ojos se analizaron con el software GPA II. Aquellos campos visuales compatibles con el GPA II se analizaron a continuación a través de la puntuación AGIS y un criterio clínico. Se recogieron determinadas características clínicas de la historia clínica con el fin de valorar la validez de los sistemas de diagnóstico de progresión estudiados. Conclusiones: Es necesario un algoritmo de seguimiento perimétrico diferente a la pauta clásica con el fin de aplicar el software GPA II. No encontramos diferencias estadísticamente significativas en la prevalencia de progresión entre glaucomas hiperbáricos y focales independientemente del sistema de diagnóstico de progresión estudiado. Asimismo, la prevalencia de progresión varía según el sistema de diagnóstico de progresión utilizado. De los sistemas de diagnóstico de progresión estudiados, el sistema de puntuación AGIS es el más específico, dado que el diagnóstico de progresión perimétrica se correlaciona con características clínicas asociadas con progresión perimétrica contrastadas en la literatura. El hecho de que distintos tipos de glaucoma se comporten de forma diferente en función del sistema de diagnóstico de progresión perimétrica, parece indicar que se trata de entidades clínicas diferenciadas dentro de una misma enfermedad. La tasa de progresión perimétrica VFI en bruto, es mejor predictor de la progresión perimétrica que el nivel de significación estadística de la tasa de progresión perimétrica obtenido con el software GPA

Estudio de la progresión perimétrica en distintos tipos de glaucoma: sistemas de diagnóstico y factores de riesgo

Introducción: La perimetría automatizada blanco-blanco utilizando el Perímetro Humphrey está ampliamente difundida para el diagnóstico y seguimiento del daño perimétrico desarrollado en el glaucoma. Debido a la ausencia de gold standard entre las estrategias desarrolladas para el diagnóstico de progresión perimétrica, se han desarrollado múltiples procedimientos, uno de los últimos es el Visual Field Index (VFI). Los glaucomas de ángulo abierto pueden ser clasificados en función de la morfología papilar, y de acuerdo con esta morfología papilar presentan un comportamiento clínico y perimétrico diferenciado. Nuestro objetivo es analizar el comportamiento de tres tipos distintos de glaucoma en función de su morfología papilar aplicando el software VFI y compararlo con otros tres sistemas de diagnóstico de progresión perimétrica. La validez del diagnóstico de progresión perimétrica. La validez del diagnóstico de progresión se valorará a través del estudio en paralelo del comportamiento de determinadas características clínicas asociadas a progresión a lo largo del seguimiento. Material y métodos: Se realizó un estudio retrospectivo con 296 ojos de 153 pacientes con glaucoma primario de ángulo abierto bajo tratamiento; 112 de ellos con glaucoma focal, 136 con glaucoma hiperbárico y 48 con glaucoma pseudoexfoliativo. Todos los campos visuales disponibles de estos ojos se analizaron con el software GPA II. Aquellos campos visuales compatibles con el GPA II se analizaron a continuación a través de la puntuación AGIS y un criterio clínico. Se recogieron determinadas características clínicas de la historia clínica con el fin de valorar la validez de los sistemas de diagnóstico de progresión estudiados. Conclusiones: Es necesario un algoritmo de seguimiento perimétrico diferente a la pauta clásica con el fin de aplicar el software GPA II. No encontramos diferencias estadísticamente significativas en la prevalencia de progresión entre glaucomas hiperbáricos y focales independientemente del sistema de diagnóstico de progresión estudiado. Asimismo, la prevalencia de progresión varía según el sistema de diagnóstico de progresión utilizado. De los sistemas de diagnóstico de progresión estudiados, el sistema de puntuación AGIS es el más específico, dado que el diagnóstico de progresión perimétrica se correlaciona con características clínicas asociadas con progresión perimétrica contrastadas en la literatura. El hecho de que distintos tipos de glaucoma se comporten de forma diferente en función del sistema de diagnóstico de progresión perimétrica, parece indicar que se trata de entidades clínicas diferenciadas dentro de una misma enfermedad. La tasa de progresión perimétrica VFI en bruto, es mejor predictor de la progresión perimétrica que el nivel de significación estadística de la tasa de progresión perimétrica obtenido con el software GPA

Perimetric progression using the Visual Field Index and the Advanced Glaucoma Intervention Study score and its clinical correlations

Purpose: To evaluate the association between clinical parameters and the diagnosis of progression using VFI (Visual Field Index) and AGIS (Advanced Glaucoma Intervention Study) score in primary open angle glaucoma. Methods: Retrospective study of 517 visual fields of 78 eyes with primary open angle glaucoma analyzed with VFI and AGIS score. Clinical data registered included: age, sphere, pachimetry, basal intraocular pressure (IOP), and IOP during the follow up. Results: Only the AGIS score diagnosis of progression was associated with the clinical parameters registered. Among the analyzed data, the mean IOP during follow up (p = 0.0005) and IOP at the third month of follow up (p = 0.004) were statistically associated with progression using the AGIS criteria. Conclusion: The diagnosis of perimetric progression using the AGIS score in the current study was closer to the real functional progression than the diagnosis using the VFI, as the former was associated with known risk factors for progression in glaucoma

Myopic Laser-Assisted Subepithelial Keratectomy (LASEK) outcomes using three different excimer laser platforms: A retrospective observational study

Background: To compare the visual and refractive outcomes after myopic LASEK using three different excimer lasers and standardized surgical and mitomycin C (MMC) application protocols. Methods: In this retrospective, observational cohort study, we examined 122 eyes treated with Allegretto, 135 eyes treated with Esiris and 137 eyes treated with Technolas excimer lasers. All eyes were treated under the same surgical protocol, and a standardized MMC dosage was used. The three groups were refraction-matched, and both visual and refractive outcomes were evaluated at 1 and 7 days and 1 and 3 months after surgery. Results: At 3 months postsurgery, Allegretto provided significantly better outcomes than Esiris and Technolas in terms of postoperative uncorrected distance visual acuity (UDVA) (1.11 ± 0.2 vs 1.01 ± 0.2 vs 0.98 ± 0.2) (P = 0.0001), corrected distance visual acuity (CDVA) (1.13 ± 0.2 vs 1.10 ± 0.1 vs 1.04 ± 0.2) (P = 0.0001), residual sphere (− 0.01 ± 0.2 vs + 0.29 ± 0.7 vs + 0.27 ± 0.6) (P = 0.0001), and efficacy index (0.99 ± 0.2 vs 0.90 ± 0.2 vs 0.91 ± 0.2) (P = 0.0004). Conclusions: We found slightly better visual and refractive outcomes in the Allegretto group at 3 months post-op after LASEK with MMC to correct myopia.Sin financiación1.413 JCR (2019) Q3, 42/60 Ophthalmology0.759 SJR (2019) Q2, 47/124 Ophthalmology, 824/2754 Medicine (miscellaneous)No data IDR 2019UE

Femtosecond laser-assisted sub-Bowman keratomileusis versus laser-assisted subepithelial keratomileusis to correct myopic astigmatism

Purpose: To compare femtosecond laser-assisted sub-Bowman keratomileusis (FSBK) versus laser-assisted subepithelial keratomileusis (LASEK) to correct moderate to high myopic astigmatism. Methods: Retrospective, nonrandomized, interventional, comparative case series. A total of eight hundred and fifty-two eyes with myopic astigmatism of −1.5 diopters (D) or higher were included in the study. We compared 427 eyes treated with FSBK versus 425 eyes treated with LASEK with or without mitomycin C. Visual and refractive results were evaluated 1 day, 1 week, 3 and 6 months postoperatively. Results: Six months postoperatively, the residual spherical defect was slightly but significantly higher in the LASEK group (+0.15 ± 0.62 D) than in the FSBK group (+0.09 ± 0.35 D) (P = 0.05). The postoperative residual astigmatism was also slightly but significantly higher in the LASEK group (−0.38 ± 0.52 D) than in the FSBK group (−0.26 ± 0.45 D) (P = 0.0005). No significant differences were found in the efficacy (0.98 ± 0.17 versus 0.98 ± 0.36, P = 0.6) and safety indexes (1.04 ± 0.16 versus 1.05 ± 0.37, P = 0.1) between FSBK and LASEK. The enhancement rate was significantly higher in the FSBK group (22.6%) than in the LASEK group (15.5%) (P = 0.01). Conclusions: Both FSBK and LASEK are safe and effective procedures to correct moderate to high myopic astigmatism. Slightly better visual and refractive results were observed in FSBK-treated eyes in a 6-month follow-up

Effect of age on visual and refractive results after LASIK: Mechanical microkeratome versus femtosecond laser

Aim To evaluate the effect of age on visual and refractive results after laser in situ keratomileusis (LASIK) obtained with a mechanical microkeratome or a femtosecond laser. Methods Retrospective, nonrandomized, cohort study. A total of 3826 eyes were included in the study (1725 eyes treated with mechanical LASIK and 2101 eyes treated with femtosecond LASIK). The relationship between patient age and the 3-month postoperative visual and refractive results of both procedures were analyzed by linear regression analysis. Results Three months postoperatively, we found a significant correlation between age and the postoperative spherical equivalent (SE; r2=0.004, P=0.006), efficacy (r2=0.006, P=0.001), and safety indexes (r2=0.05, P=0.0001) in the mechanical LASIK group. On the other hand, we found a significant correlation between age and the postoperative SE (r2=0.02, P=0.0001) and the efficacy index (r2=0.01, P=0.0001) but not the safety index in the femtosecond laser group. Mechanical LASIK provided slightly but significantly better efficacy and predictability in patients 18 to 40 years of age and femtosecond LASIK did so in patients older than 40 years of age. The femtosecond laser provided better safety results than the mechanical microkeratome in both age groups. Conclusion A tendency toward undercorrection and less predictability is found with aging after myopic LASIK regardless of whether the flap was created with a mechanical microkeratome or a femtosecond laser. However, femtosecond laser provides significantly better outcomes in terms of efficacy, safety and predictability compared to mechanical microkeratome for the correction of myopia in patients over 40y.Sin financiación1.330 JCR (2019) Q4, 48/60 Ophthalmology0.575 SJR (2019) Q2, 60/124 OphthalmologyNo data IDR 2019UE