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Purpose: To evaluate the effects of SMART surgery (SCHWIND eye-tech-solutions GmbH) on corneal abnormalities and refractive errors compared to traditional femtosecond laser-assisted laser in situ keratomileusis (FSLASIK)., Methods: A retrospective case series was conducted at Xi'an Gucheng Aier-Eye Hospital, analyzing data from 83 patients who underwent FS-LASIK and SMART procedures in 2021. Pentacam (Oculus Optikgeräte GmbH) measurements were taken before surgery and at 1, 3, and 6 months postoperatively to assess corneal higher order aberrations, spherical aberrations, and coma. Statistical analyses included an independent Student test between the two groups. Visual acuities were compared by the Mann-Whitney U test, paired t -tests, and repeated measures analysis of variance., Results: Comparison of visual acuity at 1 week and 1 month postoperatively showed significant differences between the FSLASIK and SMART groups. After 6 months, a higher percentage of patients in the SMART group achieved spherical equivalent within +1.00 diopter compared to the FS-LASIK group. Both groups showed a shift from negative to positive Q-values, indicating improved visual quality. Corneal spherical aberrations and horizontal coma were more prevalent at 6 months postoperatively in both groups compared to preoperatively., Conclusions: In the long term, SMART surgery demonstrates comparable results to FS-LASIK for myopia and astigmatism correction. Higher order aberrations were less common after SMART surgery compared to FS-LASIK. These findings suggest that SMART surgery may be a suitable option for patients seeking refractive surgery, considering its potential benefits for visual quality and corneal health. [ J Refract Surg . 2025;41(2):e164-e172.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To investigate the in vivo corneal biomechanical response to FS-LASIK combined with accelerated corneal crosslinking (LASIK Xtra) compared with conventional FS-LASIK (convLASIK) in highly myopic eyes., Setting: Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany., Design: Prospective, randomized fellow eye-controlled clinical trial., Methods: Patients who received treatment with LASIK Xtra (30mW/cm 2 , 90 seconds with continuous UV-A) in 1 eye and convLASIK in the other eye were enrolled. Both eyes were subjected preoperatively and 12 months postoperatively to a Corvis ST examination. The stiffness parameter at first applanation (SP-A1), integrated inverse radius (IIR), deformation amplitude (DA), deformation amplitude 2 mm away from apex, and the apical deformation (DARatio2mm) were evaluated., Results: The study included 38 high myopic eyes (-7.34 ± 1.02 diopters) of 19 patients. The results of the corneal biomechanical measurement showed a significant reduction in overall corneal stiffness with a significant decrease in postoperative SP-A1 and increase in IIR, DA, and DARatio2mm ( P < .001). In a direct comparison, there was no evidence of an increase in corneal stiffness in the LASIK Xtra group compared with the convLASIK group 12 months postoperatively. No statistically significant difference was detected in any of the 4 biomechanical parameters ( P > .05)., Conclusions: The corneal biomechanical response to convLASIK and LASIK Xtra did not vary significantly. With a similar corneal thickness loss, there was no significant difference in the 4 biomechanical metrics between the convLASIK and LASIK Xtra groups. Thus, LASIK Xtra appeared not to have a protective corneal stiffening effect compared with convLASIK 12 months postoperatively., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To assess the 6-month visual and refractive outcomes of keratorefractive lenticule extraction (KLEx) as compared with laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) in a military population at a Joint Warfighter Refractive Surgery Center., Setting: Joint Warfighter Refractive Surgery Center (JWRSC), Lackland Air Force Base, San Antonio, Texas., Design: Retrospective study., Methods: Patients who underwent KLEx, PRK, or LASIK between 2019 and 2022 were included. Anonymized data collected included demographics, preoperative and postoperative uncorrected and corrected visual acuity, and manifest refraction., Results: Of the 4466 treated eyes, 737 (16.5%) underwent the KLEx, 2801 (62.7%) underwent PRK, and 928 (20.8%) underwent LASIK treatment. Regarding efficacy, there was no statistically significant difference at postoperative month (POM) 6 between the percentage of eyes reaching an uncorrected distance visual acuity of 20/20 or better between the 3 procedures. At POM1 ( P < .001) and POM3 ( P < .001), there were a greater number of eyes in the KLEx group that achieved the same or 1 line better of distance visual acuity than the PRK group. The efficacy indices of KLEx, PRK, and LASIK at POM6 were 1.09, 1.10, and 0.97, respectively. The safety indices for KLEx, PRK, and LASIK at POM6 were 0.96, 1.01, and 0.81, respectively., Conclusions: After the initial recovery period, KLEx demonstrates comparable outcomes in efficacy, safety, and accuracy as compared with LASIK and PRK., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Objective: To assess refractive and visual outcomes of a spherical Implantable Collamer Lens (ICL) followed by planned postoperative adjunctive laser-assisted in situ keratomileusis (LASIK) in the treatment of high compound hyperopic astigmatism., Methods: In this prospective, multi-center, multi-surgeon, single-arm trial, eyes with ≥ 3.50 D hyperopia and ≥ 2.00 D of astigmatism underwent surgery receiving a spherical Implantable Collamer Lens (ICL) followed by a planned adjunctive LASIK postoperatively. Outcomes measures included postoperative uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, spherical (SEQ) and defocus equivalent (DEQ), efficacy index, safety index, and astigmatism vector analyses., Results: 48 eyes had a mean sphere of 6.18 ± 1.35 D and mean cylinder of 2.69 ± 0.89 D preoperatively. After ICL and LASIK, 94% of eyes achieved a UDVA within 1 line of preoperative CDVA. Efficacy and safety indices were 0.94 ± 0.13 and 1.00 ± 0.13, respectively. We obtained near-to-emmetropia SEQ postoperatively (mean - 0.03 ± 0.43D), and the scatterplot of attempted versus achieved refractive correction revealed a predictable procedure (R 2  = 0.89). 93.8% and 100% of eyes achieved target SEQ within 0.75 and 1.00 D. 87.5% and 100% of eyes were within 0.50 and 0.75 D of intended plano cylinder., Conclusion: Spherical ICL with postoperative adjunctive LASIK was safe with good early visual and refractive outcomes. The combined modality is a promising approach to treating high compound hyperopic astigmatism where toric hyperopic ICL is not available., Trial Registration: This trial was retrospectively registered on ClinicalTrials.gov with the trial registration number NCT06742541., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Review Board of the Canadian Ophthalmic Research Centre and fully adhered to the principles of the Declaration of Helsinki. All patients were fully informed of the nature and purpose of the procedures, and any potential risks or benefits associated with them. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The purpose of this study was to evaluate the stability of small-incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK) when ascending from near sea level to an altitude of 3874 m. The visual acuity (VA), intraocular pressure (IOP), spherical equivalent refraction (SER) and biometric parameters of 20 normal subjects (40 eyes, controls) and 36 subjects who underwent corneal refractive surgery (35 eyes with SMILE and 36 eyes with LASIK) were examined in Chongqing (C, 500 m above sea level) and 7-10 days after a collective travel to Shigatse (S, 3874 m above sea level). SER and corneal thickness (CT) were choosed as main indicators of the stability of corneal refractive surgery at high altitude. The IOP decreased and CT increased from C to S, while VA and SER did not significantly change in the control subjects. The VA and IOP of both the SMILE and LASIK subjects did not significantly change at an altitude of 3874 m. At high altitudes, no significant difference in the SER was found among the SMILE subjects, while a significant myopic shift was found among the LASIK subjects. With an increase in the altitude of 3874 m in S, an obvious increase in CT was observed in subjects who underwent corneal refraction surgery. The increase in CT in the SMILE group was significantly less than the increase in CT in the LASIK group. In addition, the biometric parameters of the SMILE and LASIK subjects showed the same minor changes as those of the control subjects when exposed to high altitude. The VA, IOP and biometric parameters of the subjects who underwent SMILE and LASIK remained stable at an altitude of 3874 m. SMILE shows better stability than LASIK in the refractive state and CT when exposed to high altitude.Trial registration: This study was approved by the Ethics Committee of The Second Affiliated Hospital of Army Medical University (ID: 2022-No.084-1) and adhered to the principles of the Declaration of Helsinki. The study was registered at http://www.chictr.org.cn (Study NO. ChiCTR2200059833) on 12/5/2022., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: The ethics committee of the Second Affiliated Hospital of the Army Medical University approved this study. The study registration number in China Clinical Trial Center is ChiCTR2200059833., (© 2025. The Author(s).)

To assess the efficacy, safety, and stability of refractive outcomes in hyperopic Laser-Assisted in Situ Keratomileusis (LASIK) with and without the application of Mitomycin C (MMC). This randomized, parallel group, controlled multicenter trial included 140 hyperopic eyes. The participants were randomly assigned to two groups: one receiving LASIK with mitomycin C (MMC) (n = 70) and the other receiving LASIK without MMC (n = 70). The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and safety parameters at six months postoperatively. The statistical analysis employed t-tests, Mann-Whitney tests, and Fisher's Exact Test, with a significance level of p < 0.05. All 140 eyes (70 per group) were analyzed. No statistically significant differences were identified between the two groups in postoperative UDVA, CDVA, or safety parameters (p > 0.05). Both groups demonstrated highly effective and safe refractive outcomes. No intraoperative complications or postoperative adverse events were observed. Age and preoperative spherical equivalent did not significantly affect outcomes. Hyperopic LASIK with and without MMC showed comparable efficacy, safety, and stability of refractive outcomes at the six-month postoperative interval. Although MMC use in hyperopic LASIK appears to be a safe procedure, it was not found to be significantly superior to conventional LASIK. Further investigation with longer follow-up periods and larger cohorts is necessary to confirm these results., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: To study the factors that define the density of macrophage-like cells (MLC) of the inner retinal surface in healthy eyes., Methods: Healthy individuals, including candidates for laser in situ keratomileusis surgery, and post-laser in situ keratomileusis patients were included. Density of MLC was calculated using structural en face projections of optical coherence tomography angiography scans. The status of the vitreoretinal interface was assessed as the distance from the inner limiting membrane to the posterior hyaloid membrane on cross-sectional scans and as the area of tight posterior vitreous adhesion on en face projections. The correlation between MLC density and various demographic and anatomical parameters, including the status of the vitreoretinal interface, was calculated., Results: Fifty-four healthy individuals, 30 post-laser in situ keratomileusis patients all without posterior vitreous detachment, and 20 patients with partial posterior vitreous detachment were included. Density of MLC showed a statistically significant correlation with axial length, refractive error, age, subfoveal choroidal thickness, and the status of the vitreoretinal interface ( P < 0.05) in eyes without posterior vitreous detachment. In multiple regression analysis, the axial length was the main parameter independently correlated with MLC density ( P = 0.025). The status of the vitreoretinal interface had a statistically significant correlation with the axial length ( P < 0.001). Partial posterior vitreous detachment was associated with almost complete loss of MLC ( P < 0.001)., Conclusion: The status of the vitreoretinal interface is a characteristic directly defining the density of retinal MLC in healthy eyes. However, axial length seems to be a key anatomical parameter that correlates with MLC density because of its effects on the adhesion of the posterior hyaloid membrane to the retinal surface.

Purpose: To observe the changes in corneal epithelial thickness after FS-LASIK and Trans-PRK surgery and to investigate the impact of corneal epithelial remodeling on Q-value and HOA., Methods: In this prospective cohort study, 50 patients (100 eyes) underwent FS-LASIK and 45 patients (90 eyes) underwent Trans-PRK. Anterior segment OCT was used to measure the corneal epithelial thickness in different corneal zones (central zone: 0-2 mm; paracentral zone: 2-5 mm; and mid-peripheral zone: 5-6 mm) preoperatively and postoperatively at 1 week, 1 month, 3 months, and 6 months. The correlation between △CET in the superior, nasal, inferior, and temporal region at 6 months postoperatively and △Q and △HOA was analyzed., Results: At 6 months postoperatively, the epithelial thickness increased in the central, paracentral, and mid-peripheral zones in FS-LASIK and Trans-PRK. Central epithelial thickness and different regions of the paracentral zone and mid-peripheral exhibited significant thickening ( P < 0.001). In the para-central zone and mid-peripheral zone, the △CET in different regions after LASIK and Trans-PRK was positively correlated with △Q ( P < 0.05) and △HOA ( P < 0.05)., Conclusion: After FS-LASIK and Trans-PRK, significant epithelial thickening was observed. Epithelial changes in different regions lead to different Q-values in different regions and have different effects on HOA. This has a certain guiding significance for the design of refractive surgery, and minimizing the increase of Q-value may improve the postoperative visual quality., (Copyright © 2024 Indian Journal of Ophthalmology.)

Refractive surgery, which includes techniques such as Laser-Assisted In Situ Keratomileusis (LASIK), Photorefractive Keratectomy (PRK) and Small Incision Lenticule Extraction (SMILE), has revolutionized ophthalmology by offering advanced solutions for vision correction. However, the choice of the technique to be used in the individual patient is highly dependent on a thorough preoperative evaluation. This retrospective study aims to investigate how preoperative parameters, including corneal thickness, topography, and refraction, affect long-term post-operative clinical outcomes. Through a systematic review of the literature published between 2000 and 2023, we identify the main predictors of success for each surgical technique. This study emphasizes the importance of personalized surgical strategies based on meticulous preoperative analysis.

Introduction: Laser-assisted in situ keratomileusis (LASIK) is a common refractive surgery. But it may lead to temporary dry eye due to reversible damage to the corneal subbasal nerve plexus. However, evidence on chronic ocular surface changes are unclear. This study reports the ocular surface changes, partial blinking rates, and meibomian gland statuses in eyes that underwent LASIK for at least 48 months., Methods: Cross-sectional, matched case-control comparison study, including 48 post-LASIK patients and 48 sex-, age-, smoking-, and axial length-matched healthy controls, recruited from a community eye screening program. Outcome measures include anterior segment clinical findings, keratographic and meibographic imaging., Results: Totally, 48 right eyes of 48 post-LASIK Chinese patients (39 females, 2 smokers) were analyzed with 48 right eyes of 48 matched healthy controls. The mean age at the time of ocular surface examination was 50 ± 11 years, and the axial length 26±1 mm. Post-LASIK eyes had a lower quality of meibum (p = 0.008) compared to healthy controls. Post-LASIK eyes were associated with a shorter Schirmer's test (p = 0.03). The ocular surface disease index (OSDI) score was higher in post-LASIK patients (p = 0.00001). Other anterior segment examination parameters, partial blinking rate, meibomian gland dropout, lipid layer thickness, noninvasive tear break-up time, and tear meniscus height were comparable between the 2 groups., Conclusions: Up to 75% of post-LASIK patients complained of on-going, chronic dry eye symptoms. Post-LASIK eyes were associated with a reduced aqueous tear production. Post-LASIK patients with chronic dry eye symptoms are advised to have periodic ocular surface evaluation. Treatments might be considered in patients with poor tear film stability., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Purpose: To investigate the differences between dominant and nondominant eyes in a predominantly young patient population by analyzing the angle kappa, pupil size, and center position in dominant and nondominant eyes., Methods: A total of 126 young college students (252 eyes) with myopia who underwent femtosecond laser-combined LASIK were randomly selected. Ocular dominance was determined using the hole-in-card test. The WaveLight Allegro Topolyzer (WaveLight Laser Technologies AG, Erlangen, Germany) was used to measure the pupil size and center position. The offset between the pupil center and the coaxially sighted corneal light reflex (P-Dist) of the patients was recorded by the x- and y-axis eyeball tracking adjustment program of the WaveLight Eagle Vision EX500 excimer laser system (Wavelight GmbH). The patient's vision (uncorrected distance visual acuity [UDVA], best-corrected visual acuity (BCVA), and refractive power (spherical equivalent, SE) were observed preoperatively, 1 week, 4 weeks, and 12 weeks postoperatively, and a quality of vision (QoV) questionnaire was completed., Results: Ocular dominance occurred predominantly in the right eye [right vs. left: (178) 70.63% vs. (74) 29.37%; p < 0.001]. The P-Dist was 0.202 ± 0.095 mm in the dominant eye and 0.215 ± 0.103 mm in the nondominant eye (p = 0.021). The horizontal pupil shift was - 0.07 ± 0.14 mm in dominant eyes and 0.01 ± 0.13 mm in nondominant eyes (p = 0.001) (the temporal displacement of the dominant eye under mesopic conditions). The SE was negatively correlated with the P-Dist (r = - 0.223, p = 0.012 for the dominant eye and r = - 0.199, p = 0.025 for the nondominant eye). At 12 weeks postoperatively, the safety index (postoperative BDVA/preoperative BDVA) of the dominant and nondominant eyes was 1.20 (1.00, 1.22) and 1.20 (1.00, 1.20), respectively, and the efficacy index (postoperative UDVA/preoperative BDVA) was 1.00 (1.00, 1.20) and 1.00 (1.00, 1.20), respectively; the proportion of residual SE within ± 0.50 D was 98 and 100%, respectively., Conclusions: This study found that ocular dominance occurred predominantly in the right eye. The pupil size change was larger in the dominant eye. The angle kappa of the dominant eye was smaller than that of the nondominant eye and the pupil center of the dominant eye was slightly shifted to the temporal side under mesopic conditions. The correction of myopia in the dominant and nondominant eyes exhibits good safety, efficacy, and predictability in the short term after surgery, and has good subjective visual quality performance after correction. We suggest adjusting the angle kappa percentage in the dominant eye to be lower than that of the nondominant eye in individualized corneal refractive surgery in order to find the ablation center closest to the visual axis., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Objective: To compare the postoperative visual outcomes of corneal topography-guided femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia and myopic astigmatism. Methods: Embase and PubMed were searched for randomized controlled trials (RCTs), prospective comparative studies, observational studies and retrospective studies of patients with myopia and/or myopic astigmatism treated by corneal topography-guided FS-LASIK, the other FS-LASIKs or SMILE (inception to November 2023). The studies meeting the criteria were collected and underwent quality assessment according to the Jadad scale for RCTs and the Newcastle-Ottawa scale for non-randomized studies. RevMan4.3.0 was used for network meta-analysis. Results: A total of 17 studies were included for meta-analysis, including 7 RCT and 10 observational studies. For the percentage of surgical eyes with uncorrected distance visual acuity≥20/20 (≤3 months), there were no statistically significant differences among corneal topography-guided FS-LASIK, the other FS-LASIKs and SMILE. The surface under the cumulative ranking curve (SUCRA) ranking from best to worst was corneal topography-guided FS-LASIK (86.7%), the other FS-LASIKs (53.1%) and SMILE (10.2%). For the percentage of surgical eyes with postoperative manifest refraction spherical equivalent (MRSE) within ±0.50 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses disclosed the relative risk ( RR ) of corneal topography-guided FS-LASIK significantly increased by 14% ( RR= 1.14, 95% CI :0.78-1.59) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (90.4%), SMILE (31.7%) and the other FS-LASIKs (27.9%). For the percentage of surgical eyes with postoperative MRSE within± 1.00 D (combined follow-up measure timepoint), the main analyses showed no statistical differences among the 3 surgery groups. The sensitivity analyses showed the RR of corneal topography-guided FS-LASIK significantly increased by 15% ( RR= 1.15, 95% CI :0.93-1.61) as compared to that of the other FS-LASIKs, while there was no significant difference between SMILE and the other FS-LASIKs. The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (94.5%), the other FS-LASIKs (53.9%) and SMILE (1.7%). For the percentage of surgical eyes with postoperative corrected distance visual acuity improved by 1 or more lines (combined follow-up measure timepoint), the main analyses showed no statistical difference between corneal topography-guided FS-LASIK and the other FS-LASIKs, while the RR of SMILE was slightly lower than that of the other FS-LASIKs ( RR= 0.86, 95% CI :0.65-1.14). The sensitivity analyses disclosed the RR of corneal topography-guided FS-LASIK significantly increased by 40% ( RR= 1.40, 95% CI :0.06-24.00) as compared to that of the other FS-LASIKs, while SMILE had a slightly lower RR as compared with the other FS-LASIKs ( RR= 0.77, 95% CI :0.17-2.74). The SUCRA ranking from best to worst was corneal topography-guided FS-LASIK (72.4%), the other FS-LASIKs (67.3%) and SMILE (10.3%). Conclusions: Compared with SMILE, FS-LASIK showed a similar postoperative visual acuity improvement. The corneal topography-guided FS-LASIK had better predictability with a higher rate of MRSE within ±0.50 D/1.00 D.

Extreme myopic laser-assisted in situ keratomileusis (LASIK) poses challenges regarding future intraocular lens (IOL) power selection. A male patient in his 40s complained of progressive right eye (OD) diminished visual acuity. He had a history of myopic LASIK in both eyes (OU) 20 years before, and implantable collamer lens (ICL) implant in OU 8 years before. The best-corrected visual acuity (BCVA) was 20/63OD (+2.00-4.00 ×80), with a posterior subcapsular cataract OD and intraocular pressure of 30 mm Hg. Anterior segment optical coherence tomography revealed an upside-down ICL. Lens explantation followed by cataract surgery was decided. The American Society of Cataract and Refractive Surgery IOL power calculator for prior myopic LASIK was used to determine the IOL power and a monofocal IOL was implanted. One month later, the distance BCVA was 20/32. The IOL power calculation and selection were particularly challenging given the extreme biometric data. In such cases, careful preoperative assessment is critical to achieve a successful result., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To compare the degree of myopic regression after myopia correction with either femtosecond laser-assisted in situ keratomileusis (FS-LASIK) or small-incision lenticule extraction (SMILE) over 18 months., Methods: Patients undergoing FS-LASIK or SMILE surgery for myopia correction were retrospectively recruited. The propensity scores were used to match patients by age and preoperative manifest spherical equivalent (SEQ) from these 2 groups. Myopic regression was analyzed using the Cox proportional hazard model., Results: A total of 416 eyes of 416 patients undergoing FS-LASIK and 416 eyes of 416 patients undergoing SMILE were matched. Using 1-month SEQ as baseline, the SEQ regression values after FS-LASIK were 0D, -0.17 ± 0.69D, -0.24 ± 0.65D, -0.31 ± 0.65D, -0.32 ± 0.63D, and -0.33 ± 0.62D and the SEQ regression values after SMILE were 0D, -0.07 ± 0.75D, -0.18 ± 0.77D, -0.23 ± 0.82 D, -0.21 ± 0.77D, and -0.24 ± 0.68D at 1, 3, 6, 9, 12, and 18 months, respectively. The Cox proportional hazard model showed that preoperative manifest SEQ ( P = 0.021) and designed optical zone ( P = 0.048) are significant predictors. The selected surgical procedure had no significant effect on predicting myopic regression ( P = 0.470). The cumulative survival rates of myopic regression were 54.74% and 42.10% in the FS-LASIK group and 58.66% and 43.83% in the SMILE group, at 12 and 18 months, respectively (log-rank test, P = 0.11)., Conclusions: After matching based on age and preoperative manifest SEQ, we found that higher myopia and a smaller optical zone contribute significantly to the development of myopic regression after undergoing FS-LASIK or SMILE surgery at 18 months. The selected surgical procedure, however, does not affect the likelihood of myopic regression., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To evaluate the performance of the InnovEyes Sightmap platform (Alcon Laboratories, Inc) in refractive surgery by comparing the visual acuity and higher order aberrations (HOAs) between ray-tracing-guided laser in situ keratomileusis (LASIK) and topography-guided LASIK., Methods: This prospective study enrolled participants who underwent either ray-tracing-guided LASIK or topography-guided LASIK. Comprehensive ophthalmic evaluations were performed preoperatively, as well as at 1 day, 2 weeks, 1 month, and 3 months postoperatively. Patients in the ray-tracing-guided LASIK group underwent wavefront, tomography, and biometry assessment using the InnovEyes Sightmap diagnostic device. Assessments included visual acuity, manifest refraction, and whole-eye HOAs., Results: A total of 42 eyes treated with ray-tracing-guided LASIK and 42 eyes treated with topography-guided LASIK were analyzed. Both strategies demonstrated comparable good refraction accuracy and refractive stability ( P > .05). The ray-tracing-guided LASIK group exhibited significantly better postoperative uncorrected distance visual acuity (UDVA) compared to the topography-guided LASIK group (-0.12 ± 0.05 vs -0.07 ± 0.04 logarithm of the minimum angle of resolution, respectively; P < .05), with 48% of eyes achieving a UDVA of 20/12.5 or better. Ray-tracing-guided LASIK induced a small but statistically significant increase in HOAs and vertical coma aberration, along with a significant reduction in spherical aberration ( P < .05). In contrast, topography-guided LASIK resulted in a significant increase in vertical coma ( P < .05) without significant changes in overall HOAs or spherical aberration ( P > .05). At 3 months postoperatively, spherical aberration was significantly different between the two groups (-0.021 ± 0.031 vs 0.054 ± 0.122 µm, respectively; P < .05)., Conclusions: The InnovEyes Sightmap platform's ray-tracing-guided LASIK demonstrated potential advantages in visual acuity outcomes compared to topography-guided LASIK. The observed negative shift in spherical aberration, characterized by a lower absolute value, may have contributed to the enhanced visual acuity results. [ J Refract Surg . 2024;40(12):e994-e1002.] .

Background: One of the major causes of reversible visual impairment is a refractive error, which can be corrected through refractive surgery. Data regarding the outcomes and complications of these procedures exist; however, there is a notable gap in understanding the factors leading to patient rejection, particularly in diverse populations like Israel., Objectives: To detect clinical risk factors of patients who intend to undergo LASIK procedure and to improve the conversion rates of LASIK procedure in this population., Methods: The study included a retrospective analysis of patients who were rejected from having refractive surgery in two Enaim Refractive Surgery Centers: Jerusalem and Tel Aviv. Comparisons between centers were conducted using the t-test for continuous variables and Fisher's exact test for categorical data., Results: Our study included 337 patients who were rejected from having refractive surgery, including 152 (45.1%) who were rejected permanently and 185 (54.9%) rejected temporarily. The most common reasons for permanent rejection were corneal irregularity (n=81, 53.3%), keratoconus (n=27, 17.8%), thin corneas (n=13, 8.6%), and amblyopia (n=10, 6.6%). The most common temporary reasons were unstable refraction (n=96, 51.9%), prolonged use of contact lenses (n=54, 29.2%), and corneal irregularity (n=16, 8.6%)., Conclusions: The leading permanent cause of rejection for refractive surgery was a corneal irregularity, whereas the primary temporary cause was unstable refraction. In a time of rapid technological advancements and growing demand for freedom from glasses, there is an increasing need for more informed and patient-focused refractive correction approaches.

Purpose: To evaluate the objective and subjective visual quality 3 months after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) performed with Q-value-guided optimized monovision scheme (Custom-Q) for correction of myopia with or without astigmatism and compensate for age-related accommodation deficiency., Design: Prospective before-and-after study., Methods: Patients who had Custom-Q FS-LASIK for myopia with age-related accommodation deficiency were included in this prospective study. Distance, intermediate, and near visual acuities; refraction; Q value; corneal higher-order aberrations; accommodative and binocular function measurements; defocus curve; contrast sensitivity; and a subjective questionnaire assessing near visual ability and visual discomforts were evaluated before and after surgery., Results: Clinical data of 48 cases were analyzed. The mean age was 42.73 ± 2.67 years (range 40-50 years). At the 3-month follow-up, there were 100% (48/48), 92% (44/48), and 56% patients (27/48) who achieved a binocular uncorrected distance, intermediate, and near visual acuity not less than 20/20 separately. Defocus curves revealed better results postoperatively at -1.00 diopter (D) and -1.50 D. The Q value in the dominant eyes was more positive postoperatively (P < .001), and in the nondominant eyes, the Q value and corneal spherical aberration became more negative (P < .05). The accommodative amplitude and relative accommodation improved binocularly (P < .001). The questionnaire demonstrated high patient satisfaction with near vision, and patients' perceptions of visual discomforts had no significant difference compared with preoperative., Conclusion: For myopic patients with age-related accommodation deficiency, the Custom-Q ablation could improve near vision without compromising distance vision. It also led to minimal changes in objective optical quality, coordination of accommodative and binocular functions, contrast sensitivity, and subjective visual discomfort perceptions., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To identify factors predicting slow visual recovery following myopic microkeratome assisted in situ keratomileusis (LASIK)., Design: Retrospective study., Methods: 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., Results: 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., Conclusion: 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., (© 2024 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: This study identified and compared variables causing changes in corneal tissue structure following the smooth incision lenticular keratomileusis (SILK) procedure using the ELITA Femtosecond Laser System by characterizing the resulting disrupted tissue interface., Methods: Seventy-one ex vivo porcine eyes and six human cadaver eyes underwent ELITA SILK with diverse surgical steps, pulse energies, scan overlaps, and surgical methods. Flaps created with the iFS Advanced Femtosecond Laser and ELITA systems were also evaluated. The disrupted interface thickness was determined by imaging corneal layers at different depths through the interface with confocal microscopy and counting layers with elevated backscattered light via computer program-assisted, subject-matter-expert visual judgment with blinding., Results: The disrupted interface thickness for ELITA SILK was 25 ± 3 µm; for the ELITA flap, it was 25 ± 2 µm; and for the iFS flap, it was 32 ± 3 µm. Factors influencing the total ELITA SILK disrupted interface thickness included laser pulse energy (0.11 µm/nJ; P < 0.01), scan overlap (5 µm; P < 0.01), and mechanical manipulation (7 µm; P < 0.01). Varying surgical techniques for mechanical manipulation resulted in a difference in disrupted interface thickness of 4 µm (P < 0.01)., Conclusions: The ELITA SILK disrupted interface thickness was less than that of the iFS flap and similar to that of the ELITA flap. Assessing disrupted interface thickness identified factors influencing the quality of the corneal interface with SILK., Translational Relevance: The disrupted interface thickness, a new method for measuring corneal damage, has been used to quantify the potential effects of various refractive surgery factors on surgical outcomes.

This retrospective study compared postoperative prediction errors of recent formulas using standard- or total keratometry (K or TK) for intraocular lens (IOL) power calculation in post-myopic LASIK patients. It included 56 eyes of 56 patients who underwent uncomplicated cataract surgery, with at least 1-month follow-up at Keio University Hospital in Tokyo or Hayashi Eye Hospital in Yokohama, Japan. Prediction errors, absolute errors, and percentage of eyes with prediction errors within ± 0.25 D, ± 0.50 D, and ± 1.00 D were calculated using nine formulas: Barrett True-K, Barrett True-K TK, Haigis-L, Haigis TK, Pearl-DGS, Hoffer QST, Hoffer QST PK, EVO K, and EVO PK. Statistical comparisons utilized Friedman test, Conover's all-pairs post-hoc, Cochran's Q, and McNemar post-hoc testing. Root-Mean-Square Error (RMSE) was compared with heteroscedastic testing. Barrett True-K TK had the lowest median predicted refractive error (-0.01). EVO PK had the smallest median absolute error (0.20). EVO PK had the highest percentage of eyes within ± 0.25 D of the predicted value (58.9%), significantly better than Haigis-L (p = 0.047). EVO PK had the lowest mean RMSE value (0.499). The EVO PK formula yielded the most accurate IOL power calculation in post-myopic LASIK eyes, with TK/PK values enhancing accuracy., (© 2024. The Author(s).)

Purpose: The purpose of this study was to compare the actual corneal consumption and subsequent corneal biomechanical changes after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) in eyes with high myopic astigmatism., Methods: In this prospective, randomized study on high myopic astigmatic eyes, 74 patients with similar refractive error received SMILE in one eye and FS-LASIK in the contralateral eye were enrolled. The central stromal reduction was calculated by preoperative and postoperative central stromal thickness (CST) measurements by the RTVue optical coherence tomography (OCT). Changes in corneal volume (CV) were evaluated by Pentacam HR. The corneal biomechanical parameters were measured with Corvis ST II., Results: At the 6-month postoperative visit, the mean actual central stromal reduction achieved with SMILE was significantly less than that achieved with FS-LASIK (108.23 ± 16.52 µm vs. 122.66 ± 27.33 µm, P < 0.001). The residual central corneal thickness (CCT), CV 3 mm, CV 5 mm, and stiffness parameter at first applanation (SP-A1) after SMILE were all greater than those of FS-LASIK (all P < 0.05). Moreover, the residual CCT, CV 3 mm, and CV 5 mm were positively correlated with Ambrósio relational thickness through the horizontal meridian (ARTh) and SP-A1, while negatively correlated with the integrated radius (IR) and deformation amplitude (DA) ratio 2.0 mm in both the SMILE and FS-LASIK groups (all P < 0.05)., Conclusions: In patients with high myopia astigmatism, SMILE required fewer corneal stromal tissues and thus better corneal biomechanics than FS-LASIK when correcting a similar spherical equivalent refraction. Moreover, SP-A1 may be a more sensitive indicator for evaluating corneal biomechanical changes after refractive surgeries., Translational Relevance: Fewer corneal stromal consumption with SMILE surgery may contribute to better corneal biomechanics in high myopic astigmatic eyes in comparison to FS-LASIK, which could provide reliable evidence for the appropriate choice of refractive surgery for patients with high myopic astigmatism.

Purpose: To assess the incidence and causes for re-treatment following monovision laser refractive surgery in a large data study spanning a decade., Methods: The setting for this retrospective comparative study was Care Vision Laser Center, Tel Aviv, Israel. This study included patients aged 36 to 60 years who underwent monovision laser vision correction at the Care Vision Laser Centers, Israel, from January 2012 to December 2022. Demographic, preoperative, and postoperative data were retrieved for analysis., Results: Overall, 3,674 eyes of 1,847 patients were included. Re-treatment was performed in 1.28% (n = 47) of eyes, 0.84% (n = 31) distance-targeted and 0.44% (n = 16) near-targeted. Monovision reversal in near-targeted eyes occurred due to overcorrection (37.5%, n = 6 of 16), despite being on target (25%, n = 4 of 16), insufficient myopia (18.8%, n = 3 of 16), and de novo astigmatism (12.5%, n = 2 of 16). One eye was targeted for near vision due to de novo astigmatism. Re-treatment in distance-targeted eyes was due to myopic undercorrection (45.2%, n = 14 of 31), myopic regression (19.4%, n = 6 of 31), myopic overcorrection (12.9%, n = 4 of 31), hyperopic regression (6.5%, n = 2 of 31), astigmatism undercorrection (6.5%, n = 2 of 31), de novo astigmatism (6.5%, n = 2 of 31), and astigmatism regression (3.2%, n = 1 of 31). Re-treatment was more likely in distance targeted eyes of patients with monovision compared to near-targeted eyes ( P = .025) and patients without monovision ( P < .001)., Conclusions: In monovision laser vision correction, retreatment in the near-targeted eye is rare when the ideal near target (-1.50 to -1.25 diopters) is achieved. However, the distance-targeted eye is more likely to require re-treatment. Surgeons can plan monovision surgery and advise patients accordingly. [ J Refract Surg . 2024;40(11):e892-e897.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

A retrospective assessment of the visual acuity (UCVA) variations in bare eyes of the refractive error cases treated with SMILE, LASIK and WF-LASIK. A retrospective selection of 126 patients with refractive error treated by refractive surgery admitted to our hospital between January 2019 and December 2021 were divided into three separate sets of patients according to their surgical methods: the SMILE cohort, the LASIK cohort, and the WF-LASIK cohort, and the three sets of patients were analyzed for bare eye visual acuity, refraction, higher-order aberration, BUT, SIt index, and complications, and the recovery effects of patients with the three surgical procedures. All three types of refractive surgery, SMILE, LASIK and WF-LASIK, can yield good surgical results in the reduction of refractive error, and patients with SMILE have better postoperative tear film stability, while patients with WF-LASIK have the best postoperative visual quality.

Purpose: To assess corneal sensitivity and the ocular surface in patients undergoing primary femtosecond laser in situ keratomileusis (FS-LASIK) and those undergoing FS-LASIK retreatment under the same flap due to residual refractive error., Setting: Ekol Eye Hospital, Izmir, Turkey., Design: Prospective case series., Methods: 19 patients with previous FS-LASIK who had myopic and astigmatic refractive error were included in the study group, and 19 age-matched and sex-matched patients undergoing FS-LASIK for the first time as the control group. Corneal sensitivity, Schirmer test, tear film break-up time (TBUT), Oxford grading scheme for ocular surface staining, and Ocular Surface Disease Index (OSDI) were measured preoperatively and at postoperative 1 week and 1, 3, and 6 months., Results: The mean refractive correction in the study and control groups, respectively, was 2.18 ± 0.78 diopters (D) (range: 1.00 to 3.50) and 2.76 ± 1.20 D (range: 1.00 to 4.50; P = .07). Corneal esthesiometry results in the study and control groups, respectively, were 6.10 ± 12.55 vs 9.90 ± 11.50 mm at 1 week ( P = .001), 41.95 ± 6.98 vs 45.09 ± 5.88 mm at 1 month ( P = .004), 56.09 ± 3.37 vs 56.19 ± 2.52 mm at 3 months ( P = .8), and 58.60 ± 2.01 vs 58.80 ± 1.39 mm at 6 months ( P = .5). Significant difference between the 2 groups in Schirmer test score that disappeared at postoperative 3 months and in TBUT and ocular surface staining that disappeared at 6 months, whereas the statistically significant difference in OSDI score persisted at 6 months ( P = .03) was detected., Conclusions: Corneal surface sensitivity and ocular surface health are more impaired in patients undergoing FS-LASIK retreatment due to residual refractive error., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To compare the safety, efficacy, and visual outcomes of topography-guided (TG) LASIK ablation versus advanced ablation algorithm (AAA) on Zeiss Mel 90 on virgin eyes., Setting: A tertiary care hospital in north India., Design: A retrospective comparative study., Methods: Case sheets of 30 patients who underwent TG LASIK and 45 patients who underwent AAA LASIK between January 2021 and September 2022 were retrieved and reviewed. The TG group included 60 eyes of 30 patients, and the AAA group included age- and sex-matched 90 eyes of 45 patients. Both groups were compared for visual outcomes, residual refraction, and root-mean-square higher-order aberrations (rms HOA) at 1 week, 1 month, 3 months, and 6 months postoperatively and using unpaired t -test and Mann-Whitney U test., Results: The mean preoperative spherical equivalent in the TG group and AAA group was - 3.12 (1.67) and - 3.19 (1.61), respectively. The safety and efficacy of the treatment were 100% in both groups. The postoperative increase in rms HOA was comparable in both groups ( P = 0.55). The ablation duration was significantly longer in topo-guided LASIK ( P = 0.001)., Conclusion: AAA LASIK on MEL 90 is comparable to topography-guided LASIK for the management of low myopia and myopic astigmatism., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To create an equation for identifying postmyopic laser vision correction (M-LVC) eyes by using corneal shape parameters in a swept-source optical coherence tomography (SS-OCT) biometer and verify its accuracy., Setting: Nagoya Eye Clinic, Nagoya, Japan., Design: Retrospective evaluation of a screening approach., Methods: Control participants were selected retrospectively from patients who visited the clinic for cataract surgery or refractive surgery. M-LVC patients were selected retrospectively from patients who visited the clinic for cataract surgery or M-LVC postoperative checkups. The control and post-M-LVC patients with keratometric values between 39 diopters (D) and 43 D were included in the final analysis. Patients were randomly assigned to equation-creation and validation groups in a 2:1 ratio. To discriminate post-M-LVC patients from control participants, multiple logistic regression analysis was performed with the corneal shape parameters from the optical biometer as independent variables., Results: The M-LVC and control groups consisted of 90 eyes from 90 patients and 97 eyes from 97 patients, respectively. The average keratometry (Ave-K) values did not differ significantly between the control and M-LVC groups ( P = .187). The multiple logistic analysis identified the asymmetry component (regression coefficient, 5.357; odds ratio, 212.158) and corneal eccentricity index (regression coefficient, -5.088; odds ratio, 0.006) as explanatory variables. The area under the receiver operating characteristic curve in the predictive equation-creation group was 0.946. The sensitivity and specificity in the validation group were 93.3% and 87.5%, respectively., Conclusions: The M-LVC discriminant prediction equation with the topography-equipped SS-OCT biometer was effective in detecting post-M-LVC eyes with high accuracy., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To compare the safety and efficacy of individualized ray-tracing-guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for correction of myopia and myopic astigmatism., Methods: This prospective, randomized, double-blind, contralateral eye study included 68 eyes of 34 patients with myopia or myopic astigmatism requiring FS-LASIK treatment. For each patient, one eye was randomly assigned to receive the ray-tracing-guided treatment, whereas the contralateral eye underwent Q-value-adjusted ablation. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), sphere, cylinder, effective optical zone (EOZ), and 6-mm corneal aberrations were measured and analyzed before operation and after a 3-month postoperative follow-up., Results: At 3 months postoperatively, the UDVA of 20/16 or better was measured in 94% of eyes in the ray-tracing group and 85% of eyes in the Custom-Q group ( P = .064). Forty-seven percent in the ray-tracing group and 32% in the Custom-Q group gained one or more Snellen lines of CDVA ( P = .043). The MRSE, refractive astigmatism, surgically induced astigmatism, and difference vector were better in the Custom-Q group ( P < .05). The postoperative corneal HOAs and optical path difference were significantly better in the ray-tracing group ( P = .008). The EOZs of the ray-tracing and Custom-Q groups were 5.77 and 5.43 mm ( P < .001), and the average ablation depths of the ray-tracing and Custom-Q groups were 100.97 and 85.24 µm ( P < .001), respectively., Conclusions: Despite the overcorrection and excessive ablation of corneal tissue, ray-tracing-guided FS-LASIK in clinical practice was found to be safe and effective for myopic correction both with and without astigmatism, particularly in achieving UDVA and inducing fewer corneal HOAs and less OPD. [ J Refract Surg . 2024;40(11):e804-e813.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

This study assessed the clinical safety and efficacy of elliptical thin-flap LASIK with a low-pulse energy femtosecond laser in 3 thickness subgroups (85, 90, and 100 μm). A total of 80 patients who underwent bilateral LASIK surgery at Taiwan between April and September 2019 were retrospectively enrolled. Elliptical corneal flaps with wide temporal hinges and inverted-angled side cuts were created. Target flap thickness was calculated on the basis of residual stromal bed thickness and percent tissue altered. Before flap creation, an optical coherence tomography image for visualization of the precut flap position was obtained with the built-in camera. At postoperative month 1, the overall mean logMAR uncorrected distance visual acuity (UDVA) was - 0.04 ± 0.07 (20/18 Snellen), with 96% of eyes achieving UDVA of 20/20 or better. Postoperative mean manifest spherical equivalent was - 0.37 ± 0.42 D at 1 month. The visual and refractive outcomes in each of the 3 subgroups were similar. The achieved flap thicknesses were found to be highly predictable and consistent in the respective thickness subgroups. Optical coherence tomography-guided thin-flap LASIK performed with the low-pulse energy femtosecond laser was found to be safe with no intraoperative or postoperative complications., (© 2024. The Author(s).)

This study aimed to compare the seven-year refractive outcomes of small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) for correction of myopia and myopic astigmatism. This retrospective cohort study included 97 eyes of 53 patients who had undergone SMILE or FS-LASIK for myopia seven years prior. Measured parameters included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction. There were no significant differences between the SMILE and FS-LASIK groups in logMAR UDVA, cylinder, and logMAR CDVA at 7 years postoperatively (P>0.05). However, there were significant differences between the two groups in sphere and spherical equivalent (P=0.035 and P=0.016, respectively). UDVA was better than or equal to 20/20 in 81% of the eyes after SMILE and in 63% after FS-LASIK (P = 0.045). The efficacy indices of the SMILE and FS-LASIK groups were 1.04 ± 0.23 and 0.97 ± 0.23 (P=0.405), and the safety indices were 1.18 ± 0.19 and 1.10 ± 0.17 (P=0.543), respectively. This study demonstrates the good predictivity of both SMILE and FS-LASIK. SMILE could offer superior refractive outcomes than FS-LASIK during a 7-year follow-up in correcting myopia and myopic astigmatism., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background: Apart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management., Case Presentation: A 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 μm and 200 μm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 μm in the right eye and 83 μm in the left eye. Considering the patient's history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0., Conclusions: Our report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully., (© 2024. The Author(s).)

Purpose: To evaluate curvature changes in different regions and their correlation with corneal epithelial remodeling in myopic patients undergoing femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and transepithelial refractive keratectomy (Trans-PRK) after surgery., Methods: One hundred and sixty-three patients (163 right eyes) undergoing Trans-PRK and LASIK were evaluated for up to 6 months using anterior segment optical coherence tomography (OCT) to measure the epithelial thickness and corneal topography to measure corneal curvature in different areas (2 mm, 5 mm, and 7 mm). We calculated the curvature ΔK (ΔK = preoperative - postoperative), ΔK 5-2 (ΔK 5-2 = K 5mm - K 2mm ), ΔK 7-5 (ΔK 7-5  = K 7mm - K 5mm ), and the epithelial thickness ΔET 5-2 (ΔET 5-2  = ET 5mm - ET 2mm ) and ΔET 7-5 (ΔET 7-5 = ET 7mm - ET 5mm )., Results: Corneal curvature flattened in each region of the two groups (all p  < 0.001) and gradually steepened during the follow-up period. The Trans-PRK group flattened more significantly within 2 mm and 5 mm, while the FS-LASIK group at 7 mm. Both groups of ΔK decreased over time. Both groups of ΔK 5-2 and ΔK 7-5 gradually decreased during the follow-up period (P 5-2 =0.025 and P 7-5  < 0.001 for Trans-PRK, P 5-2  = 0.011 and P 7-5  < 0.001 for FS-LASIK). The corneal epithelium of the two groups gradually thickened during the follow-up period, with Trans-PRK significantly thickening in the central and peripheral regions and FS-LASIK in the central and paracentral regions. There is a significant correlation between the ΔK 5-2 and ΔET 5-2, ΔK 7-5 and ΔET 7-5 (all r  > 0.37, p  < 0.001)., Conclusions: All groups showed significant curvature flattening after surgery and gradually steepening during the follow-up period. The corneal epithelium thickness in both groups of 17 regions became thicker,. In contrast, Trans-PRK group showed more significant thickening to the periphery and the central 5 mm area of the FS-LASIK. This study indicates a significant positive correlation between differences in epithelial thickening in different regions and differences in curvature changes in the corresponding areas PRK, FS-LASIK, curvature, corneal epithelial thickness.

Purpose: To describe the Shammas-Cooke formula, an updated no-history (NH) formula for IOL calculation in eyes with prior myopic laser vision correction (M-LVC), and to compare the results with the Shammas PL, Haigis-L, and Barrett True-K NH formulas., Setting: Bascom Palmer Eye Institute (BPEI), The Lennar Foundation Medical Center, University of Miami, Miami, Florida; Dean A. McGee Eye Institute (DMEI), University of Oklahoma, Oklahoma City, Oklahoma; and private practice, Lynwood, California, and St Joseph, Michigan., Design: Retrospective observational study., Methods: We analyzed 2 large series of cataractous eyes with prior M-LVC. The training set (BPEI series of 330 eyes) was used to derive the new corneal power conversion equation to be used in the new Shammas-Cooke formula and the testing set (165 eyes of 165 patients in the DMEI series) to compare the updated formula with 3 other M-LVC NH formulas on the ASCRS calculator: Shammas PL, Haigis-L, and Barrett True-K NH., Results: Mean prediction error was 0.09 ± 0.56 diopters (D), -0.44 ± 0.61 D, -0.47 ± 0.59 D, and -0.18 ± 0.56 D and the mean absolute error was 0.43 D, 0.60 D, 0.61 D, and 0.45 D for the Shammas-Cooke, Shammas PL, Haigis-L, and Barrett True-K NH, respectively. The percentage of eyes within ±0.50 D was 66.7% vs 47.9%, 48.5%, and 65.5%, respectively., Conclusions: The Shammas-Cooke formula performed better than the Shammas PL and Haigis-L (P < .001 for both) and as well as the Barrett True-K NH formula (P = .923)., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of ASCRS and ESCRS.)

Objetive: To assess differences in corneal higher-order aberrations (i.e., HOAs) between six different types of irregular corneas (i.e, keratoconus (KC), keratoglobus (KG), pellucid marginal degeneration (PMD), laser-assisted in situ keratomileusis (LASIK), penetrating keratoplasty (PK), and intrastromal corneal ring segments (ICRS))., Methods: Corneal aberration data from the 3 rd and 4 th order together with secondary vertical and horizontal coma, and secondary spherical aberration were retrospectively retrieved from a corneal tomographer and compared between irregular cornea types and for 3-, 5-, and 7-mm pupil diameters., Results: Significant differences were observed in vertical coma, oblique trefoil, secondary oblique astigmatism, primary spherical, and secondary spherical between irregular cornea types across all three pupil sizes (all p≤0.025). Vertical coma consistently exhibited the greatest magnitude of HOA across all irregular cornea types and pupil diameters. For the larger pupil diameters (5 and 7 mm), the 3rd order aberrations (mainly coma-like), the 4th order aberrations (mainly spherical-like), and total HOA RMS were significantly lower in the LASIK group compared to all other irregular cornea types (all p≤0.003). Additionally, at pupil sizes of 5 and 7 mm, the 3rd, 4th, coma-like, spherical-like, and total HOA RMS were significantly lower in KC compared to the ICRS and PK groups (all p≤0.01). Furthermore, the 4th, spherical-like, and total HOA RMS were significantly lower in KC compared to KG at pupil diameters of 3 and 7 mm, 5 and 7 mm, and 7 mm, respectively (all p≤0.03)., Conclusions: Vertical coma was the most elevated HOA across all irregular cornea types and pupil diameters. Corneal aberrations were lower in LASIK and KC, and higher in KG and PK., Competing Interests: Conflicts of interest Clara Martínez-Pérez, María Serramito, Julia Bodas, Gonzalo Carracedo and César Villa-Collar report no declarations of interest. Jacinto Santodomingo-Rubido and Asaki Susaki are full-time employees of Menicon Co., Ltd., (Copyright © 2024 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: To evaluate the clinical and patient-reported outcomes (PROMs) of cataract surgery with implantation of a wavefront-shaping extended depth of focus (EDOF) intraocular lens (IOL) in eyes with previous laser in situ keratomileusis (LASIK) for myopia correction., Methods: This prospective observational study enrolled 50 eyes with previous LASIK from 25 patients (age: 46 to 70 years) who underwent cataract surgery with implantation of the AcrySof IQ Vivity IOL (Alcon Laboratories, Inc). Visual and refractive outcomes were evaluated during a 3-month follow-up. PROMs were evaluated with the Intraocular Lens Satisfaction (IOLSAT; Alcon Vision, LLC) (general satisfaction), Catquest-9SF (difficulty in doing vision-related activities), and Questionnaire for Visual Disturbances (QUVID; Alcon Vision, LLC) (photic phenomena) questionnaires., Results: Mean 3-month postoperative binocular uncorrected distance, intermediate, and near visual acuities were 0.02 ± 0.11, -0.02 ± 0.09, and 0.14 ± 0.13 logarithm of the minimum angle of resolution (logMAR), respectively. Mean binocular distance-corrected intermediate and near visual acuities were 0.05 ± 0.11 and 0.32 ± 0.14 logMAR, respectively. All eyes had a postoperative spherical equivalent within ±0.75 diopters (D). The mean defocus curve showed visual acuity values better than 0.20 logMAR for defocus levels from +0.50 to -1.50 D. Most patients (92.0%) confirmed that they had no vision-related difficulties limiting their normal daily life. Perception of starbursts, halos, glare, hazy vision, blurry vision, and double vision was referred by 24%, 24%, 28%, 28%, 8%, and 4% of patients, respectively. Most of symptoms were described as mild and not or a little bothersome., Conclusions: The wavefront-shaping EDOF IOL evaluated provides efficacious distance, intermediate, and near visual restoration in eyes with previous LASIK, with minimal photic phenomena associated. [ J Refract Surg . 2024;40(10):e742-e753.] .

Purpose: To compare the corneal epithelial remodeling in eyes with high astigmatism that had small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK)., Methods: Seventy-four patients with myopic astigmatism of greater than -2.00 diopters (D) and little binocular difference in spherical equivalent were included in this contralateral comparative study. All patients received SMILE in one eye and FS-LASIK in the other eye randomly. The corneal epithelial remodeling pattern was mapped using the latest RTVue spectral-domain optical coherence tomographer (Optovue) by region., Results: Satisfactory refractive correction was achieved in all enrolled eyes with either SMILE or FS-LASIK. The corneal epithelium gradually thickened following surgical cylinder correction, distributing mainly along the flat medium. The corneal epithelium proliferation is milder centrally but more pronounced in the mid-peripheral area after SMILE, compared with FS-LASIK. The flat-steep difference in corneal epithelial thickness (CET) is evident in the mid-peripheral and peripheral areas, which is more obvious in SMILE. Residual cylinder was positively correlated with CET in eyes that had FS-LASIK, but not SMILE. More importantly, these epithelial changes were positively correlated with the ablation depth and higher order aberrations following surgical refractive correction., Conclusions: The postoperative CET map varied between SMILE and FS-LASIK. In eyes with high astigmatism, SMILE surgery is followed by milder and more stable corneal epithelial thickening. Moreover, the corneal epithelium is sensitive to stromal ablation and corneal remodeling is crucial to the postoperative visual quality. This study rigorously distinguished the CET difference between SMILE and FS-LASIK in astigmatic eyes and shed light on subsequent research. [ J Refract Surg . 2024;40(10);e728-e741.] .

Background: To evaluate clinical outcomes and visual quality 3 months after mini-monovision (spherical equivalent [SE] between - 0.25 D and - 0.50 D) femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for correction of high myopia in patients with presbyopia., Methods: Patients who had mini-monovision FS-LASIK for high myopia (SE < -6.0 D) and aged between 40 and 50 years were included. At the 3-month postoperative visit, we evaluated full range of visual acuity; defocus curve; optical quality; accommodation function, contrast sensitivity and stereopsis. Binocular tests were done twice, once in mini-monovision condition and once with the residual myopia in the non-dominant eye corrected. Subjective visual quality was evaluated with questionnaire postoperatively with mini-monovision correction., Results: Clinical data of 31 cases were analyzed. The average patient age was 42.58 ± 3.06 years. At the 3-month follow-up, the mean uncorrected binocular visual acuity at distance, intermediate, and near was - 0.11 ± 0.07, -0.06 ± 0.10, and 0.04 ± 0.11 logMAR separately. In comparison, patients with binocular full distance correction achieved better uncorrected distance visual acuity (UDVA), and they achieved superior uncorrected near visual acuity (UNVA, P = 0.04) with mini-monovision correction. FS-LASIK induced significant increases in higher-order aberrations (HOAs) (P < 0.001). For accommodative function, only the negative relative accommodation (NRA) improved significantly after surgery (P < 0.001). A slight decrease in contrast sensitivity was observed at low spatial frequency with mini-monovision correction (P < 0.05). Questionnaire demonstrated high satisfaction with near vision and visual quality., Conclusion: FS-LASIK with mini-monovision (SE between - 0.25 D and - 0.50 D) appeared to be safe and effective in treating high myopia combined with presbyopia to get satisfying visual quality at distant and at near., (© 2024. The Author(s).)

Purpose: Myopia, or nearsightedness, is one of the most common eye conditions worldwide. However, a comparison of the effectiveness of different laser-assisted interventions is lacking. Thus, we aimed to compare the efficacy and safety of LASIK and IntraLASIK in addressing myopia., Methods: The study was conducted in two ophthalmology clinics in Beijing, China, in 2022. A total of 84 patients (152 eyes) with different degrees of myopia were examined and underwent LASIK (n=46, 80 eyes) or IntraLASIK (n=38, 72 eyes). Keratometry, corneal topography, pachymetry, visual acuity evaluation, and corneal biomechanical analysis were performed before and after the intervention., Results: IntraLASIK produced more precise flaps than LASIK, with deviations of <8 mm and 0.1 mm from the intended thickness and diameter, respectively. LASIK resulted in nonuniform flaps, with thickness deviations of 5-86 mm. IntraLASIK demonstrated a superior efficacy for patients with severe myopia and thin corneas, with a mean spherical equivalent of 0.9 D at 6 months compared to the 1.4 D for LASIK. Approximately 91% and 83% of the patients with mild to moderate and severe myopia, respectively, achieved results within ± 0.49 D from the refractive target with IntraLASIK., Conclusions: Corneal hysteresis and corneal resistance factor decreased with an increase in laser intensity, and they decreased faster with thinner corneas. Thus, IntraLASIK is more useful than LASIK in patients with thin corneas and severe myopia.

Background: To compare clinical outcomes of trifocal intraocular lens in patients with and without prior history of laser in situ keratomileusis (LASIK)., Methods: A retrospective study included patients who underwent bilateral cataract surgery and PanOptix trifocal intraocular lens (IOLs) implantation. Patients were grouped: Group A for patients with history of LASIK and Group B for patients without history of LASIK. Postoperative outcome measures comprised distance, intermediate, and near visual acuity, manifest refraction, defocus curve, contrast sensitivity, visual quality, patient satisfaction, and the rate of spectacle independence., Results: A total of 288 eyes (144 patients) were included: 132 eyes in Group A and 156 eyes in Group B. At 6 months post-surgery, patients of both groups achieved a continuous satisfying visual acuity from 33 cm to distance. 73% of eyes in Group A and 75% of eyes in Group B were within ± 0.50 D of emmetropia (P > 0.05). The percentages of eyes within ± 1.00 D of emmetropia were 98% for Group A and 96% for Group B (P > 0.05). The total scores of satisfaction were 52.58 ± 3.46 for Group A and 53.23 ± 3.46 for Group B (P > 0.05). Most of patients (98% for Group A, 99% for Group B) were able to be spectacle independence for daily living. 53% of patients in Group A and 51% in Group B experiencd mild to moderate negative visual symptoms, which made it a little or moderate difficult to drive at night., Conclusions: Cataract patients with and without history of LASIK could safely undergo implantation of the PanOptix IOLs, which results in precise refractive outcomes and satisfactory visual acuity. Although contrast sensitivity decreased and some negative visual symptoms were observed, patients' satisfaction was generally high due to the high rate of spectacles independence. There were no statistically significant differences between the study groups., (© 2024. The Author(s).)

To assess the impact of glucocorticosteroids with varying potencies on inflammatory mediators in tears and corneal optical density after femtosecond-assisted laser in situ keratomileusis (FS-LASIK). In a prospective study, 110 patients (220 eyes) who underwent FS-LASIK were divided into 2 groups: 55 patients (110 eyes) received dexamethasone, and another 55 patients (110 eyes) received fluorometholone. Visual acuity, intraocular pressure, and corneal optical density were measured before, 1 week, and 1 month after surgery. Tear fluid samples were also collected to assess expression levels of TNF-α, IL-1α, IL-6, and TGF-β1. One week after the procedure, the dexamethasone group exhibited elevated intraocular pressure (IOP) levels (P > .05) and a decreased expression of TNF-α in tears (P < .001) compared to the fluorometholone group. Within the 0 to 2 mm range from the corneal apex, the anterior corneal layer's optical density in the fluorometholone group surpassed that of the dexamethasone group (P < .05). At 1 month post-surgery, the IOP in the fluorometholone group was higher than that in the dexamethasone group (P < .05). In both the 0 to 2 mm and 2 to 6 mm intervals from the corneal apex, the optical density of the anterior corneal layer was significantly higher in the fluorometholone group compared to the dexamethasone group (P < .05). There was no statistically significant difference in visual acuity between the 2 groups at any postoperative time point. Short-term use of potent corticosteroids after FS-LASIK can swiftly address ocular surface inflammation, enhance corneal wound healing, reduce corneal edema, and accelerate the restoration of corneal transparency, in contrast to prolonged use of milder corticosteroids post-surgery., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: This study aimed to observe corneal and retinal thicknesses at 5 years after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) for myopia, investigate the effect of epithelial remodeling on refractive status and visual quality, and compare retinal thicknesses among fundus tessellation grades., Methods: Patients who received FS-LASIK or SMILE 5 years before were enrolled in this cross-sectional study. After 1:1 propensity score matching, each surgical group obtained 177 patients (177 eyes). Examinations including visual acuity, refraction, corneal and retinal thicknesses, corneal higher-order aberrations (HOAs), and fundus photography were performed in this visit at 5 years after surgery. The Quality of Vision (QoV) questionnaire was used to assess visual symptoms and overall satisfaction. Corneal and retinal thicknesses between groups were compared, contributing factors were analyzed, and correlations with postoperative refractive status, HOAs, QoV scores and overall satisfaction were evaluated., Results: The discrepancy of epithelial thickness between central and pericentral zones in FS-LASIK group was larger than that in SMILE group, which was negatively correlated with postoperative spherical equivalent (SE), positively correlated with spherical aberration (all P < 0.05), but not correlated with QoV scores and overall satisfaction (all P > 0.05) in both surgical groups. There was no statistical difference in stromal thickness and total corneal thickness (all P > 0.05). Most annuluses of epithelial and stromal thicknesse were linearly related to preoperative SE (all P < 0.05). The macular thickness, ganglion cell complex thickness, and retinal nerve fiber layer thickness exhibited comparable values between two surgical groups and four fundus tessellation grades, with no significant association observed with postoperative SE (all P > 0.05)., Conclusion: The tendency that epithelial thickness in central zone was thicker than peripheral zone was more obvious at 5 years after FS-LASIK compared to SMILE. This uneven distribution of epithelial thickness might play a role in myopic regression and the changes in HOAs, especially in patients with high myopia, but it had little effect on patients' subjective visual quality and satisfaction. Retinal thicknesses were not affected by these two surgical methods, and they did not appear to be the clinical indicators for myopic regression or fundus tessellation progression., (© 2024. The Author(s).)

Background: Visual quality after corneal refractive surgery is linked to the postoperative effective optical zone (EOZ). This study aims to compare long-term changes in the EOZ following small incision lenticule extraction (SMILE) and femtosecond laser-assisted in-situ keratomileusis (FS-LASIK) for moderate and high myopia., Methods: This study included 42 patients (72 eyes) who underwent either SMILE (36 eyes) or FS-LASIK (36 eyes). A custom software program based on the tangential curvature difference map of the Pentacam HR (Oculus Optikgeräte GmbH) was used to define the EOZ at 3 and 7 years postoperatively. The EOZ, its chronological changes compared to the programmed optical zone (POZ), and the corneal wavefront aberrations following SMILE and FS-LASIK were analyzed. Correlations between the EOZ changes and relevant parameters were evaluated., Results: Three years postoperatively, EOZ following SMILE and FS-LASIK were 5.13 ± 0.27 mm and 4.70 ± 0.24 mm (P < 0.001), respectively. Seven years postoperatively, EOZ following SMILE and FS-LASIK decreased to 5.03 ± 0.28 mm and 4.63 ± 0.23 mm (P < 0.001), respectively. At postoperative 7 years, the percentages of EOZ/POZ were negatively correlated with Q-value changes (β = -5.120, P = 0.009) following SMILE and positively correlated with the cylinder correction (β = 1.184, P = 0.004) following FS-LASIK. The induced spherical aberrations in the SMILE group were less than those in the FS-LASIK group (P < 0.05) and were negatively correlated with the EOZ/POZ (β = -16.653, P < 0.001)., Conclusions: The EOZ following SMILE was larger than that following FS-LASIK in the long postoperative term for moderate and high myopia. Furthermore, a continual reduction in the EOZ was noted after both surgical modalities., (© 2024. The Author(s).)

Purpose: To evaluate the visual and refractive outcomes in eyes with a history of laser corneal refractive surgery implanted with the second-generation light-adjustable lens (LAL)., Setting: Private practice, Sioux Falls, South Dakota., Design: Retrospective, consecutive case series., Methods: Eyes with a history of prior corneal refractive surgery that underwent cataract surgery with implantation of the LAL and were targeted for plano were included. Data on the type and number of prior refractive surgeries were collected, in addition to the timing and number of postoperative adjustments. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity, and the percentage (%) of eyes within ±0.25 diopter (D), ±0.50 D, and ±1.00 D of their refractive target., Results: 76 eyes from 70 patients were included. A total of 45 eyes with a history of 1 prior refractive surgery and 31 eyes with a history of ≥2 refractive surgeries were included. 74% (n = 56) of all eyes achieved UDVA of 20/20 or better, 88% (n = 67) achieved 20/25 UDVA or better, and 93% (n = 71) were correctable to 20/20 or better postoperatively. For refractive outcomes, 66% of eyes (n = 50) were within ±0.25 D and 86% (n = 65) were within ±0.50 D of refractive target., Conclusions: Patients with a history of laser corneal refractive surgery achieved favorable visual and refractive outcomes with the LAL. This intraocular lens (IOL), which affords postoperative adjustability, is a promising option for patients with a history of corneal refractive surgery who maintain high expectations for functional uncorrected acuity after cataract surgery., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: This study aimed to compare the safety, efficacy, and visual outcomes of 80-microns LASIK versus 100-microns LASIK in managing myopia and myopic astigmatism. The study was conducted at a tertiary care hospital in North India., Methods: This was a prospective contralateral eye study that included patients with myopia and myopic astigmatism seeking refractive correction. The eligibility criteria included normal corneal topography, an epithelial thickness less than 60 microns, a calculated percentage tissue ablation (with 100-microns flap) less than 40%, a calculated residual stromal bed thickness (with 100-microns flap) more than 300 microns, and willingness to participate and follow up. Patients with glaucoma, cataracts, other visually disabling ocular pathologies, and a history of past ocular surgery were excluded. All patients underwent LASIK with 80-microns LASIK in one eye and 100-microns LASIK in the other eye. The patients were followed up for 6 months, and the results were analyzed., Results: The study included 216 eyes of 108 patients. The mean preoperative spherical equivalent in the 80-microns group and the 100-microns group was -3.53 ± 1.81 and -3.69 ± 1.32 diopters, respectively (P = 0.78). The mean 6 months decimal postoperative UCVA was 0.98 ± 0.13 in the 80-microns group and 0.97 ± 0.14 in the 100-microns group (P = 0.99). The postoperative change in the higher-order aberration profile was comparable in both groups (P = 0.78). The percentage tissue ablation was significantly lower in the 80-microns group (P = 0.002). The incidence of flap micro striae and OBL was higher in the 80-microns group, while neither of these had any visual implications., Conclusion: The study concluded that 80-microns LASIK is an efficacious and safe alternative to 100-micron LASIK, especially useful in patients with higher myopia., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: We herein present Descemet membrane endothelial keratoplasty (DMEK) as an effective surgical means of treatment for the management of interface fluid syndrome (IFS) in a series of cases with distant history of laser in situ keratomileusis (LASIK)., Methods: Three cases from a single institution were included. All patients had documented IFS in the setting of history of LASIK. All 3 patients underwent DMEK for the treatment of IFS. Visual acuity, clinical findings, pachymetry, endothelial cell count, and anterior segment optical coherence tomography were recorded., Results: We describe 3 cases of late-onset IFS that developed in eyes many years after LASIK (ranging from 15 to 31 years). All 3 patients had clinically significant corneal edema and evidence of poor endothelial function at the time of IFS diagnosis. DMEK was subsequently performed in each case. All 3 eyes showed resolution of corneal edema and improvement in best-corrected visual acuity after DMEK., Conclusions: DMEK can provide successful visual and anatomical recovery in patients who have had previous LASIK and experience late-onset IFS due to endothelial cell dysfunction., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To evaluate visual outcomes of high hyperopic laser in situ keratomileusis (LASIK), using corneal aspherization to control the induced spherical aberration., Setting: Fondation Ophtalmologique Adolphe de Rothschild, Paris, France., Design: Prospective interventional case series., Methods: Prospective interventional study of consecutive high hyperopes (≥+3 diopters [D] of spherical equivalent [SE]) undergoing LASIK with the WaveLight FS200 femtosecond and EX500 excimer laser platform. An aspheric ablation profile (planned change in corneal asphericity ΔQ = +0.2) was delivered using the Custom-Q nomogram on an optical zone of ≥6.5 mm centered near the corneal vertex. Uncorrected corrected distance visual acuity (UDVA) and corrected distance visual acuity, as well as changes in SE, corneal asphericity (ΔQ), and higher-order aberrations, were analyzed preoperatively and on day 1, 1, 3, 6, and 12 months., Results: 117 eyes of 63 patients (mean age of 30.1 ± 5.6 years) were included. Preoperatively and at 12 months postoperatively, the mean SE was 5.1 ± 1.1 D and 0.00 ± 0.7 D, respectively. 88% of eyes achieved 0 logMAR or better UDVA at 12 months. 1 month postoperatively, there was a statistically significant induction of positive spherical aberration decreasing progressively and significantly until the last visit (preop SA4 = 0.09 ± 0.11 μm, day 1 SA4 = 0.30 ± 0.32 μm, 12 months SA4 = 0.08 ± 0.21 μm, P = .056). 2 eyes needed enhancement at 12 months., Conclusions: LASIK for high levels of hyperopia showed good outcomes mainly due to aspheric-customized ablation profile with a change of ΔQ = +0.2 in corneal asphericity., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: The goal of this study is to describe characteristics of cataract surgery patients who previously underwent laser in situ keratomileusis/photorefractive keratectomy (LASIK/PRK) in comparison to non-LASIK/PRK cataract surgery patients including psychiatric comorbidities, as well as describe refractive prediction error after cataract surgery while accounting for axial length (AL) using the Barrett True-K and Barrett Universal II formulas., Methods: This was a retrospective study of patients from the University of Colorado Cataract Outcomes Registry. The primary outcomes were refraction prediction error (RPE), mean absolute RPE, and median absolute RPE. Outcomes were stratified by five axial length groups. Univariate and multivariate models for RPE were stratified by the AL group., Results: Two hundred eighty-one eyes with prior LASIK/PRK and 3101 eyes without are included in the study. Patients with prior LASIK/PRK were significantly younger: 67.0 vs 69.9 years, p < 0.0001. The LASIK/PRK group had significantly better mean pre-operative BCVA in comparison to the non-LASIK group, logMAR 0.204 vs logMAR 0.288, p = 0.003. The LASIK/PRK group had significantly lower rates of cardiovascular disease (18.5% vs 29.3%, p < 0.001), hypertension (49.1% vs 59.3%, p < 0.012), and type 2 diabetes (10.7% vs 26.0%, p < 0.001), and no significant difference in psychiatric disease. The absolute RPE was higher for the LASIK group for all ALs, but only significantly higher for eyes with AL less than 25 mm., Conclusion: Patient eyes with prior LASIK/PRK surgery undergoing cataract surgery were significantly younger, had significantly less comorbidities, and a significantly better pre-operative BCVA. Using the Barrett formulas, absolute prediction error for eyes with longer ALs was not significantly worse for LASIK/PRK eyes than those without and the difference was smaller for eyes with longer AL., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To compare early visual quality of small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK) in terms of low contrast acuity., Methods: A secondary analysis was performed using a harmonized dataset derived from two completed prospective cohort studies on active-duty military service members undergoing either SMILE (n = 37), wavefront-guided (WFG) LASIK (n = 51), or wavefront-optimized (WFO) LASIK (n = 56). Night vision and photopic and mesopic low contrast visual acuity (LCVA) up to 3 months postoperatively were compared between groups., Results: Compared to SMILE-treated eyes, WFG LASIK-treated eyes had significantly better night vision and photopic LCVA at 1 month postoperatively (beta = -0.039, P = .016; beta = -0.043, P = .007, respectively). WFO LASIK-treated eyes had significantly better photopic LCVA at 1 month postoperatively (beta = -0.039, P = .012) but had worse mesopic LCVA at 3 months postoperatively (beta = 0.033, P = .015) versus SMILE-treated eyes., Conclusions: SMILE and LASIK, on either a WFG or WFO laser platform, yielded excellent outcomes, but LCVA seemed to recover quicker following LASIK compared to SMILE. [ J Refract Surg . 2024;40(9):e667-e671.] .

Purpose: To investigate the impact of back-to-front corneal radius ratio (B/F ratio) and posterior keratometry (PK) on the accuracy of intraocular lens power calculation formulas in eyes after myopic laser in situ keratomileusis (LASIK)/photorefractive keratectomy (PRK) surgery., Methods: A retrospective, consecutive case series study included 101 patients (132 eyes) with cataract after myopic LASIK/PRK. Mean prediction error (PE), mean absolute PE (MAE), median absolute error (MedAE), and the percentage of eyes within ±0.25, ±0.50, and ±1.00 diopters (D) of PE were determined., Results: The Barrett True K-TK formula exhibited the lowest MAE (0.59 D) and MedAE (0.48 D) and the highest percentage of eyes within ±0.50 D of PE (54.55%) in total. In eyes with a B/F ratio of 0.70 or less and PK of -5.70 D or greater, the Potvin-Hill formula displayed the lowest MAE (0.46 to 0.67 D)., Conclusions: The Barrett True-TK exhibited the highest prediction accuracy in eyes after myopic LASIK/PRK overall. However, for eyes with a low B/F ratio and flat PK, the Potvin-Hill performed best. [ J Refract Surg . 2024;40(9):e635-e644.] .

Presbyopia is an inevitable and progressive loss of the eye's ability to focus on nearby objects due to aging, which affects everyone regardless of their refractive error. Uncorrected presbyopia is a significant burden worldwide and affects the quality of life. Conservative options include spectacle correction, contact lenses, and pharmacologic agents. Spectacles are commonly used to correct vision, but have certain drawbacks such as peripheral blur and impaired depth perception. These limitations have been associated with an increased risk of accidental falls. Several surgical options are available to address these issues, including cornea-based, lens-based, or scleral procedures. These procedures involve modifying the cornea's optics, replacing the crystalline lens, or attempting to restore accommodation. Each of the options has its benefits and limitations. One of the most common surgical methods of presbyopic correction that has recently become popular is presbyopic Laser assisted In situ keratomileusis (LASIK) due to its improved safety and efficacy. This article is a review of all the currently available data and studies regarding the various methods of correction of presbyopia, with an emphasis on the principles and outcomes of the corneal laser refractive procedures for presbyopia correction, such as PresbyLASIK, Supracor, PRESBYOND laser blended vision, and Custom Q., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)