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Purpose Design Methods Results Conclusion To identify factors predicting slow visual recovery following myopic microkeratome assisted in situ keratomileusis (LASIK).Retrospective study.This study included consecutive patients who underwent microkeratome‐assisted myopic LASIK between January 2005 and December 2019 at Care Vision Laser Center, Tel Aviv, Israel. Patients were divided into three groups according to whether they experienced normal recovery of visual acuity (1 week visit), slow visual recovery (1 month visit) or very slow recovery (>1 month). Normal visual recovery was defined as achieving an efficacy index of 0.9 or greater. Efficacy index was calculated as postoperative uncorrected visual acuity/preoperative best corrected visual acuity. A comparison of baseline and intraoperative parameters was performed.Overall, 10 439 eyes were included. Mean age was 30.8 ± 8.7 years and 47.1% were females. The slower visual recovery groups (slow 11.4%, n = 1191; very slow 8.4%, n = 875) were of older age (p < 0.001), steeper preoperative steep keratometry (p = 0.002) and larger refractive astigmatism (p < 0.001). In binary logistic regression older age (p < 0.001), female gender (p = 0.001), larger astigmatism (p < 0.001) and high myopia (p < 0.001) remained significant predictors of slow visual recovery.Slow visual recovery was observed in 19.8% of patients following myopic LASIK. Older age, female gender, larger astigmatism and high myopia were associated with slow visual recovery. Patients may be advised accordingly. [ABSTRACT FROM AUTHOR]

This retrospective study found that postoperative corneal steepness greater than 49 D is not associated with worse visual outcomes after hyperopic LASIK, suggesting need for revision of the traditional postoperative 49 D cutoff. Purpose: To compare corrected distance visual acuity (CDVA) outcomes of hyperopic laser in situ keratomileusis (LASIK) with a postoperative corneal steepness above vs below 49 diopters (D). Setting: Care-Vision Laser Centers, Tel-Aviv, Israel. Design: Retrospective study. Methods: This study included consecutive patients who underwent hyperopic LASIK between January 2013 and December 2019. Hyperopic patients were divided into 2 groups based on postoperative corneal steepness with steep corneas defined >49.0 D and the control group ≤49.0 D. Adjustments were performed to account for differences in baseline and intraoperative parameters. Results: Overall, 1703 eyes of 1703 patients were included. Mean age was 48.3 ± 10.0 years, and 45.3% were male. Preoperatively, the steep group (2.4%, n = 41/1703) had steeper mean (44.6 D vs 43.1 D, P <.001) and steep (45.1 D vs 43.5 D, P <.001) keratometry, worse logMAR CDVA (0.07 vs 0.04, P =.02), and higher sphere (4.9 D vs 2.9 D, P <.001). Intraoperatively, they had a higher spherical treatment (4.6 D vs 2.8 D, P <.001). After hyperopic LASIK, the steep group had worse logMAR CDVA (0.10 vs 0.06, P =.01). However, after accounting for differences in baseline and spherical treatment, no significant differences were found in postoperative logMAR CDVA (0.06 vs 0.06, P =.99). The factors that remained associated with worse postoperative CDVA were higher spherical treatment (0.01 logMAR per 1 D, P <.001) and preoperative CDVA (0.60 logMAR per 1.00 logMAR, P <.001). Conclusions: Postoperative corneal steepness greater than 49 D is not associated with worse visual outcomes after hyperopic LASIK. However, lower preoperative visual potential and higher spherical treatment applied are associated with worse outcomes. The 49 D cutoff should be revisited. [ABSTRACT FROM AUTHOR]

Purpose: To identify risk factors that increase the likelihood of re-treatment following refractive surgery in patients with mixed astigmatism. Methods: This was a retrospective study including patients who underwent either laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between 2000 and 2019 and had mixed astigmatism (spherical error of +0.50 D or greater and spherical equivalent of less than 0.00 diopters [D]). Patients were divided into two groups according to whether they underwent re-treatments during the study period. Results: Overall, 785 eyes (785 patients) were included. In total, 5.2% of the eyes (n = 41) underwent re-treatment. The re-treatment group was more likely to have preoperative high astigmatism (80.5% vs 48.3%, P <.001), moderate to high hyperopia (36.6% vs 22.3%, P =.035), and to have undergone surgery earlier during the study period (P <.001). They were also more likely to have undergone surgery using the Wave-Light EX200 rather than the EX500 laser platform (Alcon Laboratories, Inc) (P <.001), have a treated optical zone of 6 mm rather than 6.5 mm (P <.001 for both), and their maximum ablation depth was greater (P <.001). There was no difference between the re-treatment and control groups regarding procedure type (PRK vs LASIK). Binary logistic regression found preoperative high astigmatism (odds ratio = 3.97, P <.001) and the type of laser platform used (EX200, odds ratio = 7.78, P <.001) as the only independent factors associated with re-treatment. Conclusions: Re-treatment rates following correction of mixed astigmatism were 5.2% over 20 years. Use of a sixth-generation laser platform significantly reduced the risk of re-treatment. Presence of high astigmatism is a significant risk factor for re-treatment. There was no difference in retreatment risk between PRK and LASIK. [J Refract Surg. 2024;40(2):e73–e78.] [ABSTRACT FROM AUTHOR]

Purpose: To identify factors predicting slow visual recovery following hyperopic laser in situ keratomileusis (LASIK). Methods: The study included consecutive patients who underwent hyperopic LASIK between January 2005 and December 2019 at a single medical center. Patients were divided into two groups according to whether they experienced normal recovery of visual acuity (1-week visit) or slow visual recovery (1-month visit). Visual recovery was defined as achieving an efficacy index of 0.9 or greater. Efficacy index was calculated as postoperative uncorrected distance visual acuity / preoperative corrected distance visual acuity. A comparison of baseline and intraoperative parameters was performed. Binary logistic regression was performed to identify potential predictors of slow visual recovery. Results: Overall, 861 eyes of 861 patients were included. Mean age was 48.0 ± 9.5 years and 55.9% were women. Two hundred forty-nine patients (28.9%) experienced slow visual recovery. Younger age (P =.01), a larger preoperative spherical equivalence (P =.002), and greater maximum ablation depth (P =.002) were predictors of slow visual recovery. In binary logistic regression, female gender (P =.036) and greater spherical equivalence (P =.007) remained significant predictors of slow visual recovery. Conclusions: Female gender and greater preoperative spherical equivalence were associated with slow visual recovery. Patients may be advised accordingly. [J Refract Surg. 2024;40(1):e42–e47.] [ABSTRACT FROM AUTHOR]

To compare outcomes of phototherapeutic keratectomy (PTK) versus epithelial debridement combined with anterior stromal puncture (ASP) or diamond burr for the treatment of recurrent corneal erosions (RCES) in a large tertiary centre. Patients with a diagnosis of RCES secondary to trauma or epithelial basement membrane dystrophy who underwent a surgical procedure between 2009 and 2019 were included in the study. The following data were collected: demographics, ocular history, prior medical treatment, ocular surgeries, intervention, complete epithelialization at postoperative week 1, recurrences, and complications. Recurrence was defined as either an objective finding of a corneal epithelial defect or symptoms suggestive of recurrent epithelial erosion on history. Recurrence rate and time to epithelialization were compared between groups. A total of 97 eyes (73 patients) were included in the study. Mean patient age was 51 ± 16.1 years, and mean follow-up was 474 days. RCES was secondary to epithelial basement membrane dystrophy in 80% (n = 78 of 97), trauma (15%, n = 15 of 97), or idiopathic (4%, n = 4 of 97). Epithelial debridement with ASP was performed in 34 eyes (35%), diamond burr in 33 eyes (33%), and PTK in 30 eyes (31%). Compared with epithelial debridement with ASP (recurrence 29.4%), the recurrence rate was significantly lower for both the diamond burr (9.1%, p = 0.031) and PTK groups (10%, p = 0.048). The diamond burr and PTK groups also had a significantly higher rate of complete epithelialization at 1 week (p < 0.05). Compared with epithelial debridement with ASP, diamond burr and PTK have significantly lower rates of recurrence and time to epithelialization and may be considered first for surgical management of RCES. [ABSTRACT FROM AUTHOR]

The Eyestar 900 and IOLMaster 700 had strong agreement in biometry measurements and IOL power prediction by the Barrett Universal II formula using either standard or total corneal keratometry. Purpose: To evaluate the agreement in biometry measurements and intraocular lens (IOL) power prediction between the Eyestar 900 and the IOLMaster 700. Setting: Institutional. Design: Retrospective comparative study. Methods: Patients were evaluated before cataract surgery using both devices on the same visit. Axial length, anterior and posterior keratometry, anterior chamber depth, corneal diameter (CD), central corneal thickness, and lens thickness were recorded by both devices. The agreement in measurements and in IOL power calculations was evaluated using the Barrett Universal II (BU-II) formula with either predicted or measured posterior keratometry. Results: In total, 402 eyes of 402 consecutive patients were included. The mean age was 72.0 ± 9.2 years. Clinically, mean differences in measured variables were small, albeit slightly larger for posterior flat and steep keratometry (0.43 diopters [D] and 0.42 D, respectively). The measurement correlation and agreement between the devices were good for all variables with slightly lower agreement in CD measurements. Consistent bias was seen in measurements of posterior flat and steep keratometry. Good agreement was also found in anterior and posterior astigmatism measurements. Good IOL power calculation agreement was found using either predicted posterior keratometry (95% limits of agreement [LoA] of −0.40 to +0.30 D) or measured posterior keratometry (95% LoA of −0.45 to +0.40 D). The agreement was within ±0.5 D in 394 eyes (98.0%) using predicted posterior keratometry and in 386 eyes (96.0%) using measured posterior keratometry. Conclusions: The Eyestar 900 and the IOLMaster 700 show strong agreement in biometry measurements and IOL power prediction by the BU-II formula using either standard or total corneal keratometry and can be used interchangeably. [ABSTRACT FROM AUTHOR]

A comparison of two new integrated SS-OCT tomography/biometry devices (the Eyestar 900 and Anterion) showed good agreement in biometry measurements and IOL power calculation. Corneal diameter measurements had reduced agreement. Purpose: To evaluate the agreement in biometry measurements and intraocular lens (IOL) power calculations between 2 integrated swept-source optical coherence tomography (SS-OCT) tomography/biometry devices: the Eyestar 900 and the Anterion. Setting: Tel Aviv Medical Center, Tel Aviv, Israel. Design: Retrospective comparative study. Methods: 113 eyes of 66 consecutive patients who were evaluated prior to cataract surgery using both devices on the same visit were included. Measurements of axial length, anterior and posterior keratometry, anterior chamber depth, corneal diameter (CD), central corneal thickness, and lens thickness were recorded from both devices and analyzed for agreement and correlation. IOL power calculations using Barrett Universal II formula were compared between the devices in addition to prediction error (PE) and the mean absolute error (MAE). Results: The mean age was 71.6 ± 9.8 years. Clinically, the mean differences in measured variables were small. Measurement correlation and agreement between the devices were excellent for all variables, except for CD (Spearman r = 0.763, P <.001, and Bland-Altman 95% limits of agreement −0.21 to +0.65 mm). Good agreement was found between the devices in IOL power calculations, PE, and MAE, and the agreement was better when using the Eyestar 900 reflective keratometry measurements than the Eyestar 900 SS-OCT keratometry measurements (IOL power agreement within ±0.5 diopter (D) in 90.5% [n = 95] and 81.0% [n = 85], respectively [ P =.076], and within ±0.25 D in 64.8% [n = 68] and 44.8% [n = 47], respectively [ P =.005]). Conclusions: The 2 integrated SS-OCT tomography/biometry devices had good agreement in biometry measurements and IOL power calculations. Agreement was better when the Eyestar 900 reflective anterior keratometry measurements were used rather than the Eyestar 900 SS-OCT anterior keratometry measurements. Measurements of CD had reduced agreement and were not interchangeable. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the agreement of central corneal thickness (CCT) measurement between Scheimpflug imaging and ultrasound (U/S) pachymetry in keratoconic eyes, and investigate factors that affect the agreement. Methods This post hoc analysis within a prospective, observational non-randomised study preformed at the Kensington Eye Institute, Toronto, Ontario, Canada, included crosslinking candidates with progressive keratoconus (KC). Main outcome measures were the agreement of CCT measurement between Scheimpflug imaging (Pentacam Oculus, Wetzlar, Germany) and U/S pachymetry (PachPen 24-5100, Accutome Inc., Malvern, Pennsylvania, USA), and factors that affect the agreement. Results A total of 794 keratoconic eyes of 456 subjects with a mean age of 27.6±8.0 years (69.7% males and 49.6% right eyes) were included. Agreement between devices was moderate (intraclass correlation coefficient: 74.9%, Bland-Altman limitsof agreement: -48.5 µm to +62.5 µm). In a multivariable analysis, cone decentration (p<0.001, coefficient +10.13 [+6.73 to +13.53 95% CIs]) and Kmax (p<0.001, coefficient +0.68 [+0.46 to +0.90 95% CIs]) were significantly associated (both clinically and statistically) with the level of agreement between the devices; the discrepancy in CCT between the devices increased on average by 10.13 µm for every mm of cone decentration, and by 6.8 µm for every 10D of Kmax. Age, corneal astigmatism and spherical equivalent were statistically but not clinically significant factors affecting agreement. Conclusion The agreement of CCT measurement between Scheimpflug imaging and U/S pachymetry in KC was moderate. To ensure the safety of crosslinking in keratoconic corneas, Scheimpflug and U/S CCT measurements should not be used interchangeably, especially in steep corneas and corneas with decentred cones. [ABSTRACT FROM AUTHOR]

Vitrectomized eyes pose a technical challenge when performing endothelial keratoplasty (EK). The aim of the study was to compare outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in complex eyes undergoing pars plana vitrectomy (PPV) prior to or during surgery. This retrospective study included consecutive eyes that underwent pars plana infusion-assisted DMEK or pull-through DSAEK which underwent PPV prior to or during the EK at a tertiary center. Included were eyes with at least 1-year follow-up. The main outcome measures were best-corrected visual acuity (BCVA) and serious adverse events. Fifty-two eyes (n = 52) with a mean follow-up time of 24.6 ± 7.4 months were included. Both groups were similar in terms of baseline characteristics although the DMEK group had a significantly larger proportion of Fuchs' patients (p =.009). There was no significant difference in postoperative logMAR BCVA between groups at each visit (p >.05 for all). There was a significantly higher proportion of overall serious adverse events (50.0% versus 15.4%, p =.02), retinal detachments (19.2% versus 0.0%, p =.05) and cystoid macular edema (23.1% versus 0.0%, p =.02) following DMEK. Graft detachment occurred more often following DMEK (53.9% versus 11.5%, p =.001) with no significant difference in rebubbling rates (23.1% versus 11.5%, p =.27). A significant and similar improvement in BCVA was achieved following DMEK and DSAEK in complex vitrectomized eyes. Patients should be advised regarding the higher rates of potential serious complications associated with a pars plana infusion DMEK in this situation. [ABSTRACT FROM AUTHOR]

Purpose: To compare the outcomes of femtosecond astigmatic keratotomy (FSAK) and manual astigmatic keratotomy (AK) in treatment of postkeratoplasty astigmatism. Methods: A retrospective, comparative, pairwise‐matched case series including 150 patients who underwent either FSAK (n = 75) or manual AK (n = 75) for the treatment of astigmatism (>3.00 D) following penetrating keratoplasty or deep anterior lamellar keratoplasty. Pairwise matching for baseline variables (age, visual acuity and astigmatism) was performed. Results: Mean age was 57.5 ± 16.0 years. The FSAK group had significantly better postoperative best‐corrected visual acuity (BCVA) (p = 0.010), uncorrected visual acuity (UCVA) (p = 0.049), corneal astigmatism (p = 0.020) and manifest astigmatism (p < 0.001) compared with the manual AK group. Gain of ≥3 lines in BCVA (logMAR) was seen in five eyes (6.7%) and 21 eyes (28.0%) in manual AK and FSAK, respectively (p = 0.005). Alpins vector analysis showed lower (closer to 0) index of success (0.50 ± 0.24 and 0.79 ± 0.48, p < 0.001) and higher (closer to 1) correction index (0.94 ± 0.45 and 0.74 ± 0.55, p = 0.020) in FSAK compared with manual AK. Corneal and manifest astigmatism improved significantly in both groups, while BCVA and UCVA improved significantly in FSAK only. Repeat AK rate was 32% (24 eyes) in manual AK and 4% (three eyes) in FSAK (p < 0.001). Overcorrection‐related re‐suturing rate was 0% in manual AK and 8% (six eyes) in FSAK (p = 0.037). There was one microperforation (1.3%) in FSAK, and there were no occurrences of graft dehiscence, infectious keratitis or graft rejection. Conclusions: Both manual AK and FSAK were safe and effective in reducing postkeratoplasty astigmatism. FSAK had superior visual and keratometric outcomes compared with manual AK. [ABSTRACT FROM AUTHOR]

PURPOSE: To identify the potential risk factors that increase the likelihood of requiring re-treatment following refractive surgery in patients with high astigmatism (3.00 diopters or greater). METHODS: This retrospective study included patients who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between January 2005 and December 2019 at the Care-Vision Laser Centers, Tel-Aviv, Israel. Patients with high astigmatism (3.00 diopters or greater) were included and divided into two groups according to whether or not they underwent additional refractive surgery (re-treatment) during the study period. RESULTS: Overall, 2,024 eyes (2,024 patients) were included in the final analysis of this study. In total, 3.1% of the eyes (n = 63) underwent re-treatment. Throughout the study period, there was a significant reduction in the 2-year annual re-treatment rates, with a decline from 7.0% for primary surgeries performed in 2005 to 0.0% for primary surgeries performed in 2017 (r =−0.65, P =.015). The re-treatment group had significantly older preoperative age. They were also more likely to be male and have preoperative against-the-rule astigmatism and preoperative mixed astigmatism. Binary logistic regression analysis demonstrated that preoperative age, male gender, mixed astigmatism, and earlier year of surgery were all associated with higher re-treatment rates. CONCLUSIONS: The following factors are associated with higher rates of re-treatment in patients with high astigmatism: older preoperative age, male gender, and mixed astigmatism. These factors may be incorporated into nomograms to reduce future re-treatment rates in this population. [J Refract Surg. 2021;37(6):366–371.] [ABSTRACT FROM AUTHOR]

PURPOSE: To assess the fellow eye as a predictor for keratoconus progression following bilateral same-day accelerated corneal cross-linking (A-CXL). METHODS: This was a post-hoc analysis of data from a prospective study of bilateral A-CXL for progressive keratoconus between 2013 and 2015. The primary outcome measures were absolute change in maximum keratometry (Kmax) (diopters [D]), relative change in Kmax (%), and A-CXL progression (increase in Kmax > 2.00 D). Responses in both eyes were measured by the change in Kmax, with the right eye serving as the "predictor" of progression for the left eye. RESULTS: Three-hundred ninety-two eyes (196 patients) with a mean age of 26.8 ± 7.7 years were included. There was a significant correlation in absolute and relative Kmax change (r = 0.26, P < .001 and r = 0.32, P < .001, respectively) between right and left eyes. In regression analysis, the only significant predictors of change in Kmax in the left eye were preoperative Kmax of the left eye (P < .02) and change in Kmax of the right eye (P < .001). Eyes that progressed in the right eye were more likely to progress in the left eye (29.4% versus 4.5%, odds ratio = 8.85, P < .001). In multiple regression, right eye progression of greater than 2.00 D was the significant predictor of left eye progression of greater than 2.00 D (odds ratio = 15.15, P < .007). CONCLUSIONS: This large-scale study of keratoconus following A-CXL indicates that patients with progression in the right eye were 15.5 times more likely to have progression in the left eye. Patients with progression following A-CXL in one eye should be closely observed due to increased risk of progression in the fellow eye. [ABSTRACT FROM AUTHOR]