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Ferrara S, Crincoli E, Savastano A, Savastano MC, Catania F, Rizzo S. Refractive Outcomes With New Generation Formulas for Intraocular Lens Power Calculation in Radial Keratotomy Patients. Cornea 2024; 43:178-183. [PMID: 37126644 DOI: 10.1097/ico.0000000000003301] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE Radial keratotomies (RKs) are responsible for corneal irregularities resulting in biometric errors and lower best-corrected visual acuity (BCVA) due to lower-order and higher-order optical aberrations. The aim of the study was to compare performances of new and old generation formulas in a population of RK patients. METHODS RK patients who underwent phacoemulsification with intraocular lens (IOL) implantation were retrospectively recruited. Inclusion criteria were availability of preoperative and 6-month postoperative BCVA assessment, topography, and tomography. Documented refraction instability, corneal ectasia, and previous ocular surgery except for RK were exclusion criteria. Mean prediction error (ME), mean absolute prediction error (MAE), and incidence of MAE > 0.25D were calculated for SRK-T, Barrett True K, EVO 2.0, Kane, and PEARL-DGS. RESULTS Twenty-seven patients with a mean baseline BCVA of 0.32 ± 0.18 logMAR and a mean corneal root mean square (RMS) value of 1.59 ± 0.91 μm were included. EVO 2.0, Kane, and PEARL-DGS showed a significantly lower MAE and lower ME compared with all other formulas ( P < 0.001 and P < 0.001) and a significant lower incidence of MAE >0.25D ( P < 0.001). Significant differences were still detected when using 3-mm mean keratometry for IOL calculation. CONCLUSIONS PEARL-DGS, Kane, and EVO 2.0 formulas show superior accuracy in IOL power calculation compared with SRK-T and Barrett True K in RK patients, with no significant differences between the 3.
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Affiliation(s)
- Silvia Ferrara
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Emanuele Crincoli
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Maria Cristina Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
| | - Fiammetta Catania
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; and
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University of "Sacro Cuore", Rome, Italy
- "Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze", Pisa, Italy
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Chen SS, Torii H, Yotsukura E, Nishi Y, Negishi K. Implantation of a toric intraocular lens after repeated radial keratotomy procedures: A case report. Heliyon 2023; 9:e22500. [PMID: 38125435 PMCID: PMC10730715 DOI: 10.1016/j.heliyon.2023.e22500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Corneal alterations due to radial keratotomy (RK) complicate intraocular lens calculations, which may explain why there have been few reports of toric intraocular lens (TIOL) implantation after excessive or multiple operations. A 71-year-old male with a history of repeated RKs and at least 30 corneal incisions in each eye was referred for cataract surgery. Preoperatively, the best-corrected distance visual acuity was 0.7 decimal (0.15 logMAR) in the right eye and 0.9 decimal (0.05 logMAR) in the left eye. The refractive errors were -8.00 -3.00 × 80 and -6.00 -3.50 × 80, respectively. The total corneal cylindrical powers (real power; anterior and posterior) were, respectively, -0.90 D and -3.60 D at 9 a.m., compared to -1.60 D and -3.80 D at 1 p.m. Corneal astigmatism in the left eye was considered symmetric and diurnally stable; therefore, an XY1AT6 TIOL (Hoya, Tokyo, Japan; cylindrical power at the plane, +3.75 D) was implanted. A non-toric intraocular lens, the XY1 (Hoya), was implanted in the right eye. Six-month postoperative best-corrected distance visual acuities were 1.2 decimal (-0.08 logMAR) and 1.0 decimal (0.00 logMAR) in the right and left eyes, respectively. Post-operative manifest refractions were +0.00 -3.00 × 70 and -1.00 -2.00 × 85, respectively. The TIOL reduced refractive astigmatism in the left eye; therefore, we believe that even after multiple RKs, the TIOL can be a suitable candidate to correct astigmatism if the corneal astigmatism is diurnally stable and symmetric.
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Affiliation(s)
- Steve S.W. Chen
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Erisa Yotsukura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyo Nishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Xiong T, Mu J, Chen H, Fan W. Intraocular lens power calculation after radical keratotomy and photorefractive keratectomy: A case report. Medicine (Baltimore) 2022; 101:e29465. [PMID: 35801733 PMCID: PMC9259111 DOI: 10.1097/md.0000000000029465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE To report a rare case of calculating the IOL power in a cataract patient who underwent both radial keratotomy (RK) and photorefractive keratectomy (PRK). PATIENT CONCERNS A 48-year-old woman underwent bilateral RK at age 22 and bilateral PRK at age 46. She developed bilateral corneal haze and corneal endothelial inflammation and received steroids therapy for long time after PRK. Then she was referred to our hospital due to decreased vision in the both eyes. DIAGNOSES The patient was diagnosed with binocular complicated cataract, corneal haze, high myopia and post corneal refractive surgery (RK and PRK). INTERVENTIONS The patient underwent bilateral phacoemulsification. The IOL power was calculated using SRK/T formula for RK and Haigis-L formula for PRK, respectively. We finally selected the Haigis-L formula and the intraocular lens (SN60WF) was implanted within the capsular bag. OUTCOMES After the surgery, both eyes showed myopia drift, and the right eye continuously fluctuated in refractive results. However, by nearly 1 year later, refractive results in both eyes had stabilized, and no other complications had occurred. LESSONS IOL power in patients who undergo both RK and PRK can be reliably calculated using the Shammas-PL, Average of multiple formulas, or Barret True-K No History formulas. Haigis-L formula is not suitable. Such patients require at least three months after surgery to attain refractive stability in both eyes.
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Affiliation(s)
- Tianxu Xiong
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jiancheng Mu
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Hao Chen
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Fan
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
- *Correspondence: Wei Fan, Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610041, China (e-mail: )
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Chung D, Meier EJ. "Rapid and reversible alteration in corneal contour and power associated with Netarsudil/Latanoprost". Am J Ophthalmol Case Rep 2022; 26:101501. [PMID: 35387385 PMCID: PMC8978266 DOI: 10.1016/j.ajoc.2022.101501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 03/06/2022] [Accepted: 03/20/2022] [Indexed: 12/11/2022] Open
Abstract
Purpose To describe a previously unreported case of reversible myopic shift with corresponding changes in corneal contour in a patient treated with netarsudil/latanoprost. Observations A 72-year-old male with history of primary open angle glaucoma, prior cataract surgery, and remote radial keratotomy surgery was treated with fixed-dose combination of netarsudil/latanoprost. Despite no prior history of refractive shift in the twenty years since radial keratotomy surgery, on one month follow-up, he reported reduced visual acuity and presented with approximately 1.50 D shift in both eyes. There were associated corneal contour changes. No corneal epithelial bullae or edema were appreciated. Netarsudil/latanoprost was discontinued and timolol was initiated. One month later, both refractive error and corneal contour returned to prior levels. Conclusions Netarsudil is a rho-kinase and norepinephrine transporter inhibitor that may be effective in the treatment of primary open angle glaucoma resistant to other topical treatments. In addition to corneal epithelial bullous edema previously reported, this drug may induce reversible changes in corneal contour in patients with prior corneal or refractive surgery.
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Affiliation(s)
- David Chung
- University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA
| | - Edward J Meier
- University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, USA.,Cincinnati Eye Institute, 6150 Radio Way, Mason, OH, 45040, USA
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Dawson VJ, Patnaik JL, Ifantides C, Miller DC, Lynch AM, Christopher KL. Comparison of refractive prediction for intraoperative aberrometry and Barrett True K no history formula in cataract surgery patients with prior radial keratotomy. Acta Ophthalmol 2021; 99:e844-e851. [PMID: 33258305 DOI: 10.1111/aos.14688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare prediction errors of the Barrett True K No History (Barrett TKNH) formula and intraoperative aberrometry (IA) in eyes with prior radial keratotomy (RK). METHODS A retrospective, non-randomized study of all patients with RK who underwent cataract surgery using IA at the UCHealth Sue Anschutz-Rodgers Eye Center from 2014 to 2019 was conducted. Refraction prediction error (RPE) for IA and Barrett TKNH was compared. General linear modelling accounting for the correlation between eyes was used to determine whether absolute RPE differed significantly between Barrett TKNH and IA. Outcome by number of RK cuts was also compared between the two methods. RESULTS Forty-seven eyes (31 patients) were included. The mean RPEs for Barrett TKNH and IA were 0.04 ± 0.92D and 0.01 ± 0.92D, respectively, neither was significantly different than zero (p = 0.77, p = 0.91). The median absolute RPEs were 0.50D and 0.48D, respectively (p = 0.70). The refractive outcome fell within ± 0.50D of prediction for 51.1% of eyes with Barrett TKNH and 55.3% with IA, and 80.8% were within ± 1.00D for both techniques. Mean absolute RPE increased with a higher number of RK cuts (grouped into < 8 cuts and ≥ 8 cuts) for both Barrett TKNH (0.35D and 0.74D, p = 0.008) and IA (0.30D and 0.80D, p = 0.0001). CONCLUSIONS There is no statistically significant difference between Barrett TKNH and IA in predicting postoperative refractive error in eyes with prior RK. Both are reasonable methods for choosing intraocular lens power. Eyes with more RK cuts have higher prediction errors.
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Affiliation(s)
- Valerie J. Dawson
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Cristos Ifantides
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - D. Claire Miller
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Anne M. Lynch
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
| | - Karen L. Christopher
- Department of Ophthalmology University of Colorado School of Medicine Aurora Colorado USA
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Parker JS, Dockery PW, Parker JS, Dapena I, van Dijk K, Melles GRJ. Bowman Layer Onlay Graft for Reducing Fluctuation in Visual Acuity After Previous Radial Keratotomy. Cornea 2020; 39:1303-6. [PMID: 32371843 DOI: 10.1097/ICO.0000000000002346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical outcome of a first patient undergoing Bowman layer (BL) transplantation with an onlay graft to reduce fluctuation in visual acuity and refractive error after previous radial keratotomy (RK) surgery. METHODS In 2018, a 66-year-old woman presented with complaints of long-standing diurnal fluctuation in best-spectacle corrected visual acuity (BSCVA) after RK in 1983. After the removal of host epithelium, a BL graft was positioned onto the host cornea. BSCVA, Scheimpflug-based corneal tomography, and anterior segment optical coherence tomography were evaluated up to 12 months postoperatively. RESULTS The surgery and postoperative course were uneventful. After surgery, the subjective complaints of visual fluctuation were reduced from 10 to 3 on a scale from 1 to 10. BSCVA (20/40; 0.5) did not change from preoperative to postoperative. Corneal tomography showed an overall central corneal steepening of 5.9 diopters. Biomicroscopy, Scheimpflug imaging, and anterior segment optical coherence tomography showed a completely epithelialized and well-integrated graft, with some minor epithelial remnants located in the preexisting keratotomy incisions. CONCLUSIONS BL onlay grafting may have the potential to manage patients with subjective complaints of diurnal fluctuation in visual acuity after previous RK.
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Srirampur A. Extended depth of focus lens implantation after radial keratotomy [Letter]. Clin Ophthalmol 2019; 13:1645-1646. [PMID: 31695314 PMCID: PMC6717719 DOI: 10.2147/opth.s225386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Arjun Srirampur
- Department of Cornea, Cataract and Refractive Surgery, Anand Eye Institute, Hyderabad 500007, India
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Martín-Escuer B, Alfonso JF, Fernández-Vega-Cueto L, Domíngez-Vicent A, Montés-Micó R. Refractive correction with multifocal intraocular lenses after radial keratotomy. Eye (Lond) 2019; 33:1000-7. [PMID: 30770864 DOI: 10.1038/s41433-019-0364-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/10/2018] [Accepted: 12/19/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess visual and refractive results of multifocal intraocular lens (IOLs) implantation for refractive correction after radial keratotomy (RK). METHODS In a retrospective non-comparative interventional case series, we analyzed the outcomes of multifocal IOL implantation performed in the context of cataract or refractive lens exchange surgery following RK. A total of 17 eyes from nine patients were included in the study. IOL power calculation was done using the Double-K formula. Refractive error was used to assess predictability, and distance-corrected visual acuity (DCVA) and uncorrected distance visual acuity (UDVA) values were used to assess the surgical procedure's efficacy and safety. Distance-corrected near visual acuity (DCNVA) was also determined. RESULTS Phacoemulsification and multifocal IOL implantation was successful in all cases, with neither complications nor adverse events. At 6 months postoperatively, monocular UDVA, DCVA, and DCNVA were 0.51 ± 0.39, 0.20 ± 0.30, and 0.11 ± 0.11, respectively (logMAR scale). More specifically, 35.29% of the eyes had DCVA ≥20/20 and 52.94% showed DCVA ≥20/25. Regarding pre- vs. post-operative changes, 52.94% had lost one line of DCVA, 23.53% showed no changes, 11.76% had gained one line of DCVA, 5.88% had gained two lines, and 5.88% had gained three or more lines. The efficacy and safety indexes were 0.56 and 0.98, respectively. As for near vision surgical outcomes, 29.41% of the eyes had DCNVA ≥20/20 and 64.71% had DCNVA ≥20/25. As for surgical accuracy, 29% of the eyes were within ±0.50 D of the target refraction, whereas 65% were within ±1.00 D. CONCLUSIONS Multifocal IOL implantation following radial keratotomy (RK) does not result in good distance visual performance, at least after 6 months of follow-up. Thus, this surgical approach has to be considered with only limited expectations.
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Koch DD. The Enigmatic Cornea and Intraocular Lens Calculations: The LXXIII Edward Jackson Memorial Lecture. Am J Ophthalmol 2016; 171:xv-xxx. [PMID: 27562430 DOI: 10.1016/j.ajo.2016.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE To review the progress and challenges in obtaining accurate corneal power measurements for intraocular lens (IOL) calculations. DESIGN Personal perspective, review of literature, case presentations, and personal data. METHODS Through literature review findings, case presentations, and data from the author's center, the types of corneal measurement errors that can occur in IOL calculation are categorized and described, along with discussion of future options to improve accuracy. RESULTS Advances in IOL calculation technology and formulas have greatly increased the accuracy of IOL calculations. Recent reports suggest that over 90% of normal eyes implanted with IOLs may achieve accuracy to within 0.5 diopter (D) of the refractive target. Though errors in estimation of corneal power can cause IOL calculation errors in eyes with normal corneas, greater difficulties in measuring corneal power are encountered in eyes with diseased, scarred, and postsurgical corneas. For these corneas, problematic issues are quantifying anterior corneal power and measuring posterior corneal power and astigmatism. Results in these eyes are improving, but 2 examples illustrate current limitations: (1) spherical accuracy within 0.5 D is achieved in only 70% of eyes with post-refractive surgery corneas, and (2) astigmatism accuracy within 0.5 D is achieved in only 80% of eyes implanted with toric IOLs. CONCLUSION Corneal power measurements are a major source of error in IOL calculations. New corneal imaging technology and IOL calculation formulas have improved outcomes and hold the promise of ongoing progress.
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Affiliation(s)
- Douglas D Koch
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
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Elbaz U, Yeung SN, Ziai S, Lichtinger AD, Zauberman NA, Goldich Y, Slomovic AR, Rootman DS. Collagen crosslinking after radial keratotomy. Cornea 2014; 33:131-6. [PMID: 24342889 DOI: 10.1097/ICO.0000000000000044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to report the outcomes of corneal collagen crosslinking (CXL) after previous radial keratotomy (RK) in patients with decreasing visual acuity and/or diurnal visual fluctuations. METHODS The charts of all patients who had undergone CXL because of a worsening corrected distance visual acuity (CDVA) and/or diurnal visual fluctuations after RK were reviewed retrospectively. Uncorrected distance visual acuity, CDVA, manifest refraction, and corneal topography were recorded preoperatively and at 1, 3, 6, and 12 months after the procedure. RESULTS Nine eyes of 6 patients that had undergone an RK 15 to 23 years before the CXL were included in the study. In 5 patients (8 out of 9 eyes), discontinuation of diurnal visual fluctuation was reported between 6 and 12 months after the CXL. The mean uncorrected distance visual acuities pre and 12 months after the CXL were 0.7 logarithm of the minimum angle of resolution (logMAR) and 0.6 logMAR, respectively (P = 0.3). The mean CDVAs pre and 12 months after the CXL were 0.2 logMAR and 0.1 logMAR (P = 0.5), respectively. The mean average keratometry pre and 12 months after the CXL were 40.1 and 39.1 diopters (P = 0.06), respectively. The mean corneal astigmatism values pre and 12 months after the CXL were 2.3 and 1.9 diopters (P = 0.06), respectively. The mean manifest refraction spherical equivalents (MRSEs) before and 12 months after the CXL were +1.4 and +2.5 (P = 0.1), respectively. CONCLUSIONS CXL is a safe and effective method to restore corneal stability in eyes with a history of RK. However, some of the effect that was achieved at the 6-month visit was blunted at the 12-month visit. Therefore, a longer follow-up is necessary to validate these findings.
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Fuentes-páez G, Castanera F, Salazar-martinez RGD, Salas JF, Izquierdo E, Pinalla B. Corneal Cross-Linking in Patients With Radial Keratotomy: Short-term Follow-up. Cornea 2012; 31:232-5. [DOI: 10.1097/ico.0b013e31821f28bb] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Purpose To describe the presentation and clinical course of eyes with a history of radial keratotomy (RK) and varying degrees of endothelial degeneration. Methods Retrospective case series were used. Results Thirteen eyes (seven patients) were identified with clinical findings of significant guttata and a prior history of RK. The mean age of presentation for cornea evaluation was 54.3 years (range: 38–72 years), averaging 18.7 years (range: 11–33 years) after RK. The presentation of guttata varied in degree from moderate to severe. Best corrected visual acuity (BCVA) ranged from 20/25 to 20/80. All patients had a history of bilateral RK, except one patient who did not develop any guttata in the eye without prior RK. No patients reported a family history of Fuch’s Dystrophy. One patient underwent a penetrating keratoplasty in one eye and a Descemet’s stripping automated endothelial keratoplasty (DSAEK) in the other eye. Conclusions RK may induce a spectrum of endothelial degeneration. In elderly patients, the findings of guttata may signify comorbid Fuch’s dystrophy in which RK incisions could potentially hasten endothelial decomposition. In these select patients with stable cornea topography and prior RK, DSAEK may successfully treat RK endothelial degeneration.
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Affiliation(s)
- Majid Moshirfar
- John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
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Weiss JS, Mokhtarzadeh M. Myopic regression after laser in situ keratomileusis: a medical alternative to surgical enhancement. Am J Ophthalmol 2008; 145:189-90. [PMID: 18222186 DOI: 10.1016/j.ajo.2007.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 11/15/2007] [Accepted: 11/16/2007] [Indexed: 12/01/2022]
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Abstract
PURPOSE To report the visual and refractive changes observed after double concentric corneal suture to correct hyperopic shift after radial keratotomy (RK). METHODS This retrospective consecutive case series comprised 17 eyes (15 patients) that underwent two concentric corneal sutures (modified Grene Lasso suture) to correct hyperopic shift after RK. All surgeries were performed by the same surgeon between 2000 and 2003. RESULTS The mean time after RK was 11.6 +/- 3.2 years. The mean follow-up was 20.3 +/- 11.3 months. The spherical equivalent refraction was reduced from a preoperative mean of +4.38 +/- 2.87 diopters (D) to -0.54 +/- 2.59 D at last postoperative follow-up (P < .001). No statistically significant difference was observed in mean refractive astigmatism before and after the corneal suture (P = .15). Before surgery, no eye presented with best spectacle-corrected visual acuity (BSCVA) > or = 20/20. At final follow-up, 3 (17.6%) eyes attained this level. Seven (41.2%) eyes improved their BSCVA by > or = 2 Snellen lines. One (5.9%) eye lost 2 Snellen lines of BSCVA. CONCLUSIONS Corneal suture can be used to correct RK-induced hyperopia, improving the corneal asphericity in an attempt to stabilize these corneas. It appeared to be effective even for high degrees of hyperopia and in cases with associated irregular astigmatism or open incisions.
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Tahzib NG, Eggink FAGJ, Odenthal MTP, Nuijts RMMA. Artisan iris-fixated toric phakic and aphakic intraocular lens implantation for the correction of astigmatic refractive error after radial keratotomy. J Cataract Refract Surg 2007; 33:531-5. [PMID: 17321407 DOI: 10.1016/j.jcrs.2006.10.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Abstract
We report 2 patients who had radial keratotomy (RK) to correct myopia. The first patient developed a postoperative hyperopic shift and cataract. Nine years post RK, she had intracapsular cataract extraction and implantation of an Artisan aphakic intraocular lens (IOL). Twenty years post RK, hyperopia and astigmatism progressed to +7.0 -5.75 x 100 with a best corrected visual acuity (BCVA) of 20/20. Due to contact lens intolerance, the Artisan aphakic IOL was exchanged for an Artisan toric aphakic IOL. Three months later, the BCVA was 20/20 with +1.0 -0.50 x 130. The second patient demonstrated residual myopic astigmatism 6 years after bilateral RK and had become contact-lens intolerant. An Artisan toric phakic IOL was implanted in both eyes. Four months later, the BCVA was 20/25 with a refraction of +0.25 -1.0 x 135 and 20/20 with a refraction of -1.0 x 40. Both patients were satisfied with the visual outcomes.
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Affiliation(s)
- Nayyirih G Tahzib
- Department of Ophthalmology, the Diaconessenhuis, Leiden, The Netherlands.
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Abstract
PURPOSE To determine the clinical practicability of in vivo dynamic corneal imaging (DCI) to assess the individual elastic properties of normal human eyes, eyes with abnormal findings, and eyes after refractive surgery. SETTING University Eye Clinic, Paracelsus Private Medical University, Salzburg, Austria. METHODS The DCI method uses sagittal, stepwise, central indentation of the cornea with electronically controlled microprecision motors and sequential registration of videotopography images. The indentation steps are preselected and range from 50 to 800 mum. The computerized analysis of the videotopography images captured during the process uses Zernike polynomials to establish a newly defined flexing curve for normal eyes and eyes with abnormal findings. RESULTS Dynamic corneal imaging was done in 187 eyes of 103 patients who had clinically healthy corneas, distinct keratoconus, or previous refractive surgery. The method rapidly evaluated artificially and reversibly induced changes in corneal topography in a clinical setting using a modified Placido disk-based computer-assisted videokeratography system with a small cone. In early analysis, the flexing curve showed a significant correlation with the applied indentation depth. Factors influencing the shape of the curve were central corneal thickness, intraocular pressure, and patient age. The DCI method also allowed easy examination of keratoconic corneas and corneas after refractive surgery. CONCLUSIONS Dynamic corneal imaging induced a reproducible and reversible change in corneal topography corresponding to the different indentation depths. The results indicate that several clinical parameters are correlated with corneal elastic behavior in vivo and that the technology could increase the predictability of refractive corneal surgery and help in the early diagnosis of corneal diseases and with newly developed therapies.
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Affiliation(s)
- Günther Grabner
- University Eye Clinic, Paracelsus Private Medical University, Salzburg, Austria.
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17
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Mierdel P, Krinke HE, Pollack K, Spoerl E. Diurnal Fluctuation of Higher Order Ocular Aberrations: Correlation With Intraocular Pressure and Corneal Thickness. J Refract Surg 2004; 20:236-42. [PMID: 15188900 DOI: 10.3928/1081-597x-20040501-07] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Optimal wavefront-guided refractive corneal laser surgery requires sufficiently exact data of optical higher order aberrations. We investigated whether these aberrations had a systematic during-the-day variation, studied the range of variation, and changes in intraocular pressure and central corneal thickness. METHODS In 22 eyes of 22 young volunteers the optical aberrations of higher order were measured by means of a Tscherning-type ocular aberrometer three times during one day (7 AM, 12 noon, 4 PM). In addition, in 12 of these eyes the intraocular pressure and central corneal thickness were measured. The intraocular wavefront aberration was computed using Zernike polynomials up to the sixth order, and Zernike coefficients of third and fourth order were analyzed. RESULTS Only the coefficient Z 2/4 (C13) showed a significant increase during the day by a mean 0.016 microm. A significant regression could be detected between changes of coefficients Z3/3, Z-2/4, Z0/4, Z4/4, and changes of intraocular pressure or central corneal thickness during the day. CONCLUSIONS Due to the small values, the measured during-the-day changes of higher order aberrations had no direct practical consequences for the aberrometry-guided corneal laser surgery. Alterations of some Zernike coefficients during the day may be explained by the biomechanical behavior of the cornea.
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Affiliation(s)
- Peter Mierdel
- Eye Clinic, Dresden University of Technology, Dresden, Germany
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18
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Abstract
A 41-year-old man with 16 radial keratotomy (RK) incisions in each eye reported a paradoxical diurnal variation in vision in both eyes with low Dk/L soft contact lenses. After rk, the patient experienced the conventional diurnal change a morning-to-evening mean (right and left eyes) myopic change of -1.80 diopters (D). However, while wearing low Dk/L contact lenses, a paradoxical morning-to-evening mean hyperopic change of 2.30 D was found. The diurnal variation was minimized (0.50 D) by wearing high Dk/L contact lenses. These results suggest that contact lenses can be used to treat diurnal variation in manifest refraction after RK by inducing appropriate stress.
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Affiliation(s)
- T Inoue
- Department of Ophthalmology, Osaka University Medical School, Suita, Osaka, Japan
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19
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Abstract
With the increase in corneal laser refractive surgery, there is a greater need for precise evaluation of the corneal surface. Articles published in the past year have reported possible use of confocal scanning laser technology-based devices to image the cornea. Other studies have compared existing instruments and software in an effort to determine if data from different instruments are comparable. Topographic evaluation also has served to highlight long-term complications of procedures like radial keratotomy and the promise of newer surgical procedures like the intrastromal corneal ring segments. Studies of the corneal surface have helped refine surgical procedures like photorefractive keratectomy, laser in situ keratomileusis, penetrating keratoplasty, and cataract surgery. Topographic measures that serve as direct correlates of ocular visual performance, however, still remain elusive. Studies in the past year have confirmed that corneal topographic evaluation may be a powerful tool in the search for a genetic basis of keratoconus. Important areas for future research include precise determination of the power of the postrefractive surgery cornea to allow precise estimation of intraocular lens power in these eyes. Detecting the presence of past corneal refractive surgery in donor eyes also is likely to be a challenge. Despite the numerous advances in the field of corneal topography in the past year, there is still a need to present the data in a standardized format that is universal to all instruments and technologies.
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Affiliation(s)
- S K Rao
- Sankara Nethralaya, Medical Research Foundation, Tamil Nadu, India.
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20
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Mathur A, Jones L, Sorbara L. Use of reverse geometry rigid gas permeable contact lenses in the management of the postradial keratotomy patient: review and case report. Int Contact Lens Clin 1999; 26:121-127. [PMID: 11166138 DOI: 10.1016/s0892-8967(00)00034-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Radial keratotomy (RK) is a well-known procedure for reducing myopia. However, the complications associated with the procedure and the development of newer technologies, such as photorefractive keratectomy and laser-assisted in situ keratomileusis, has resulted in the technique of RK falling out of favor. A number of patients who received RK during the 1980s are now experiencing a shift in their prescription and are presenting to primary care practitioners for contact lens fitting. These patients pose a significant challenge to the contact lens practitioner, and novel methods frequently are required to fit corneas that exhibit such abnormal topography. This article reviews the potential problems associated with fitting patients who have received RK and describes a case in which a novel lens design was used to achieve a successful lens fit.
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Affiliation(s)
- A Mathur
- Centre for Contact Lens Research, School of Optometry, University of Waterloo, Waterloo, Ontario, Canada
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