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Anitha V, Rajaraman R, Periasamy M, Ravindran M, Rangappa R, Uduman MS. Reasons for declining corneal refractive laser correction for refractive candidates in Southern India. Indian J Ophthalmol 2024; 72:118-122. [PMID: 38131581 PMCID: PMC10841811 DOI: 10.4103/ijo.ijo_1595_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To analyze the reasons for declining corneal refractive laser correction procedures in patients presenting to tertiary eye care centers in Tamil Nadu, Southern India, and review the literature. METHODS Retrospective case records of subjects presenting from January 2019 to December 2021 for refractive surgery workup were analyzed. Demographic details and refractive parameters of patients rejected for corneal refractive laser corrections (CRLC) were documented and reviewed. RESULTS A total of 2358 patients presented for refractive surgery evaluation during the study period, and out of them, 395 patients (16.8%) were not considered ideal candidates for undergoing CRLC. The common reasons for rejecting the patients were unfit topography (n = 110, 27.8%), unstable refraction over a one-year duration (n = 9, 2.27%), low corneal thickness (n = 85, 21.5%), keratoconus (n = 5, 12.9%), and other ocular and systemic disorders (n = 48, 12.1%). CONCLUSION There was a marked change in magnitude and rationalization for not performing either laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy in our study. The reasons are unfit topography, keratoconus, and systemic disorders, which were diagnosed during pre-LASIK screening workup, being the most common cause for rejecting patients for corneal refractive corrections.
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Affiliation(s)
- Venugopal Anitha
- Cornea, and Refractive Services, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Revathi Rajaraman
- Cornea and Refractive Services, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Mangala Periasamy
- Cornea and Refractive Surgery, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Meenakshi Ravindran
- Paediatric and Strabismus Services, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Ramakrishnan Rangappa
- Glaucoma Services, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Mohammed Sithiq Uduman
- BioStatistician, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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Zhang S, Huang C, Miao H, Wu J, Xing C, Dai Z, Sun J. Assessment of biosafety and implantation feasibility of novel phakic refractive lens. Int Ophthalmol 2022; 42:3459-3468. [PMID: 35556204 PMCID: PMC9587979 DOI: 10.1007/s10792-022-02345-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
Purpose We investigated the biosafety and implantation feasibility of a new phakic refractive lens (PRL) in rabbit eyes. Methods Short PRLs (S-PRLs), large PRLs (L-PRLs), and large-grooved PRLs (LG-PRLs), were prepared by molding medical-grade liquid silicon. The cytotoxicity and cellular adhesion of the PRLs was assessed in vitro. To assess implantation feasibility, the S-PRL, L-PRL, and LG-PRL were implanted in the posterior chamber of rabbit eyes and the relative position was assessed by optical coherence tomography. The intraocular pressures (IOP) were compared between the S-PRL, L-PRL, LG-PRL, and control groups to evaluate the PRL biosafety after implantation. Results The in vitro assays showed that cell viability and cellular adhesion in the S-PRL, L-PRL and LG-PRL groups was not significantly different to those in the control group throughout the study. After implantation into the posterior chamber of rabbit eyes, there were no obvious signs of inflammation or increases in IOP at each time point relative to the control group, demonstrating good biosafety of the PRL. The relative positions of the L-PRLs and LG-PRLs in the posterior chamber were appropriate and the retention frequencies were high. Conclusions The newly developed LG-PRL showed good biosafety with negligible in vitro cytotoxicity, ocular inflammation, or fluctuations in IOP. The LG-PRL provided the best implantation feasibility. The grooves on the LG-PRL provided channels for aqueous humor circulation. The LG-PRL is a promising type of PRL with an appropriate size and surface structure for effective correction of refractive errors in rabbit eyes.
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Affiliation(s)
- Shaohua Zhang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Chang Huang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Huamao Miao
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Junyao Wu
- Hangzhou Aijinglun Technology Co., Ltd., Zhejiang, 311100, China
| | - Chao Xing
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China
| | - Zhaoxing Dai
- Shanghai Haohai Biological Technology Co. Ltd., Shanghai, 200052, China.
| | - Jianguo Sun
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China.
- NHC Key Laboratory of Myopia (Fudan University), Shanghai, 200031, China.
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China.
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, 200031, China.
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Evaluation of Visual Outcome of 2 Phakic Posterior Chamber Implantable Lenses in High Myopia: A Comparative Study. Eye Contact Lens 2021; 48:38-44. [PMID: 34775453 DOI: 10.1097/icl.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate and compare the visual outcomes of two phakic intraocular lenses in high myopia. METHODS A prospective comparative study was undertaken on 50 eyes of 26 patients {age ≥21 years and divided into two groups (implantable collamer lens [ICL] V4c, n=25 eyes and refractive implantable lens [RIL], n=25 eyes)}. Patients were evaluated for uncorrected distance visual acuity (UCVA), best-corrected distance visual acuity, manifest refractive spherical equivalent (MRSE), contrast sensitivity, intraocular pressure, dilated fundus examination, trabecular-iris angle (TIA), anterior chamber depth, horizontal white-to-white diameter, wavefront aberrometry, and endothelial cell (EC) count. All patients were followed up until 6 months and additionally evaluated for anterior chamber inflammation, cataract, and lens vault. RESULTS The baseline parameters (UCVA, MRSE, and EC count) and postoperative improvement in UCVA, contrast sensitivity, MRSE, EC loss, safety index, and efficacy index were comparable between both the lenses. The improvement in aberrometric profile was significantly better in the ICL group. The mean postoperative vault was higher in RIL group (434.88±162.48 μm vs. 547.24±159.83 μm, P=0.0173); however, the vault was within normal range in both the groups. The decrease in mean TIA was significantly higher in RIL group (8.58 vs. 13.45 μm, P=0.0073). CONCLUSION Acrylic phakic lens can be considered as a suitable alternative to collamer lens for refractive correction of high myopia. The collamer lenses showed slight superiority in some qualitative visual parameters; however, collamer lenses do not present with subjective complaints in the patients.
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Duch F, López-Marín I, Alonso-Aliste F, Hernández-Barahona-Campos M, Manito SC, Sánchez-Trancón Á, Cadarso L, Sánchez-González JM, Fernández J. Influence of tomographic and biomechanical corneal indexes on myopic refractive surgery indications: A multicenter study. Eur J Ophthalmol 2021; 32:2630-2637. [PMID: 34751040 DOI: 10.1177/11206721211054725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the influence of corneal tomographic and biomechanical indexes on the refractive technique indication. METHODS A total of 251 eyes from 251 patients interested in refractive surgery were enrolled in this cross-sectional and multicenter study. Previous to the surgeon decision, a preoperative protocol was performed by refractive optometrists, containing four sections: refraction, biometry, corneal tomography and biomechanics. The refractive surgeons made a first decision based only on refraction, biometric and tomographic information. Biomechanical indexes were revealed, and refractive surgeons made a second indication. Additionally, for Laser-Assisted in-situ Keratomileusis cases, the percent tissue altered were calculated. Possible indications were no refractive surgery, photorefractive keratectomy, Laser-Assisted in-situ Keratomileusis or intraocular Collamer lens. RESULTS After the first surgery indication, the distribution was photorefractive keratectomy (47.4%), Laser-Assisted in-situ Keratomileusis (48.2%) while intraocular Collamer lens achieved 2.8%. This proportion changed significantly after the second indication regarding corneal biomechanics and photorefractive keratectomy and Laser-Assisted in-situ Keratomileusis decreased by 24% while intraocular Collamer lens increased 19%. A total of 69 eyes changed the indication (27.5%) and 182 eyes (72.5%) remained unchanged. All indications changes were from photorefractive keratectomy or Laser-Assisted in-situ Keratomileusis to intraocular Collamer lens or no surgery. Indication changes to intraocular Collamer lens were observed in 49 eyes (71%). Tomographic, biomechanical indexes, ablation depth and percent tissue altered achieved statistically significant differences between eyes without and with indication changes (all, P < .01). CONCLUSION New corneal biomechanical indexes could change the indication decision regarding biometric and tomographic data alone. Intraocular Collamer len was the preferred indication for eyes at risk of ectasia or with subclinical keratoconus due to corneal biomechanical parameters.
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Affiliation(s)
- Francesc Duch
- Refractive Surgery Department, 537040Institut Català de Retina, Spain
| | | | | | | | | | | | - Luís Cadarso
- Refractive Surgery Department, Cadarso Clinic, Spain
| | - José-María Sánchez-González
- Refractive Surgery Department, Tecnolaser Clinic Vision, Spain.,Physics of Condensed Matter Department, Optics Area, 16778University of Seville, Spain
| | - Joaquín Fernández
- Refractive Surgery Department, Qvision, 221663Vithas Virgen del Mar Hospital, Spain
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Balparda K, Vanegas-Ramírez CM, Herrera-Chalarca T, Silva-Quintero LA. Early results with the EyeCryl Phakic Toric intraocular lens implantation in keratoconus patients. Rom J Ophthalmol 2021; 65:163-170. [PMID: 34179582 PMCID: PMC8207862 DOI: 10.22336/rjo.2021.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Refractive management in keratoconus is challenging. Although some kinds of phakic intraocular lenses have been studied in keratoconus so far, no study evaluated the results of EyeCryl Phakic Toric intraocular lenses in this kind of patients. Materials and Methods: This is a retrospective chart review study, including all keratoconus patients implanted with an EyeCryl Phakic Toric intraocular lens in at least one of their eyes by an experienced cornea surgeon in Colombia. Follow-up to 6 months after surgery was also included. Results: A total of 20 eyes of 14 patients were included, with an average age of 29.3 ± 4.2 years. Spherical equivalent improved from a pre-surgical value of –10.31 D to +0.09 D at 6 months. 65% of the patients improved at least one line in the best-corrected distance visual acuity. At 6 months, 70% of the patients were within ± 0.50 D of spherical equivalent emmetropia. No complications occurred in any of the patients. Conclusion: EyeCryl Phakic intraocular lenses are an excellent option in keratoconus patients with high refractive error. Abbreviations: KC = Keratoconus, P-IOL = phakic intraocular lenses, ICL = Implantable Collamer Lens, WTW = White to White, SD = standard deviation, ANOVA = an analysis of variance, UDVA = monocular uncorrected distance visual acuity, CDVA = corrected distance visual acuity
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Affiliation(s)
- Kepa Balparda
- Department of Research and Surgery, Black Mammoth Surgical, Medellín, Colombia
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Chaitanya SR, Anitha V, Ravindran M, Ghorpade A, Rengappa R, Uduman MS. Safety and efficacy of toric implantable collamer lens V4c model - A retrospective South Indian study. Indian J Ophthalmol 2020; 68:3006-3011. [PMID: 33229687 PMCID: PMC7856968 DOI: 10.4103/ijo.ijo_1492_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the safety, efficacy, and complications of V4c Toric implantable collamer Lens (TICL) implantation for myopic astigmatism in the south Indian population. Methods: In this retrospective observational case series, a total of 109 eyes of 67 patients who underwent V4c TICL implantation (ICL, V4C Staar Surgical, Nidau, Switzerland) between January 2012 and August 2019 were studied with a minimum follow-up period of 6 months (mean 24 months). The main outcome measures were objective and subjective refraction, uncorrected distance visual acuity, corrected distance visual acuity (CDVA), safety, predictability, adverse events, and postoperative complications. Results: At 6 months, mean manifest refractive spherical equivalent (SE) decreased from - 10.90 ± 3.7D preoperatively to - 0.02 ± 0.13D postoperatively (P < 0.001) and mean cylinder decreased from - 2.3 ± 1.3 D preoperatively to - 0.04 ± 0.2 D postoperatively (P < 0.001). Postoperatively, SE within ± 0.5 D and ± 1.0 D of attempted correction were achieved in 96.3 (105 eyes) and 100% (109 eyes), respectively. Manifest refractive cylinder within ± 0.5 D and ± 1.0 D of attempted correction were achieved in 97.2 (106 eyes) and 100% (109 eyes), respectively. Sixty-two percent (68 eyes) showed no change in CDVA postoperatively, and no eye had lost lines of CDVA. The safety index was 1.12, and the efficacy index was 1.10. Complications were seen in two eyes (1.8%) due to high postoperative vault requiring secondary surgical interventions. Conclusion: V4c TICL is a highly effective, safe, and predictable option in treating myopic astigmatism with excellent improvement in vision and spectacle independence.
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Affiliation(s)
- S Ravi Chaitanya
- Fellow in Cornea and External Diseases, Aravind Eye Hospitals and Post Graduate Institute, Tirunelveli, Tamil Nadu, India
| | - Venugopal Anitha
- HOD, Cornea and Refractive Services, Aravind Eye Hospitals and Post Graduate Institute, Tirunelveli, Tamil Nadu, India
| | - Meenakshi Ravindran
- HOD, Paediatric and Strabismus Services, Aravind Eye Hospitals and Post Graduate Institute, Tirunelveli, Tamil Nadu, India
| | - Aditya Ghorpade
- Consultant, Cornea and External Diseases, Aravind Eye Hospitals and Post Graduate Institute, Tirunelveli, Tamil Nadu, India
| | - Ramakrishnan Rengappa
- Prof of Ophthalmology, Glaucoma Services, Aravind Eye Hospitals and Post Graduate Institute, Tirunelveli, Tamil Nadu, India
| | - Mahammed Sithiq Uduman
- Statistics, Aravind Eye Hospitals and Post Graduate Institute, Tirunelveli, Tamil Nadu, India
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Deshpande K, Shroff R, Biswas P, Kapur K, Shetty N, Koshy AS, Khamar P. Phakic intraocular lens: Getting the right size. Indian J Ophthalmol 2020; 68:2880-2887. [PMID: 33229663 PMCID: PMC7856930 DOI: 10.4103/ijo.ijo_2326_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Phakic intraocular lenses (IOL) are a boon for patients who want spectacle independence but are unable to get refractive correction through laser platforms due to high refractive error or certain corneal contraindications. Phakic IOL's (PIOL) have their own set of complications and challenges, the most important being getting the sizing right. This paper attempts to solve the problem of accurate sizing of PIOL's. Parameters needed for calculating the ideal size of PIOL's have been studied in a step by step manner using all possible tools depending upon the availability and preference of the surgeon. The pros and cons of using a particular tool for measurements have been highlighted along with illustrative case examples to help surgeons who are starting PIOL implantation surgery.
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Affiliation(s)
- Kalyaani Deshpande
- Department of Cataract and Refractive Surgery, Mumbai Eye, Brain and Spine Clinic, Mumbai, Maharashtra, India
| | - Rushad Shroff
- Department of Cataract, Cornea, and Refractive Surgery, Shroff Eye Centre, New Delhi, India
| | - Partha Biswas
- Department of Cataract and Refractive Surgery, Director, B B Eye Foundation, Kolkata, West Bengal, India
| | - Kamal Kapur
- Department of Cataract and Refractive Surgery, Director, Sharp Sight Laser Centre Pvt Ltd, New Delhi, India
| | - Naren Shetty
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Ann Sarah Koshy
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Pooja Khamar
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
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Unilateral Toxic Anterior Segment Syndrome Resulting in Cataract and Urrets-Zavalia Syndrome after Sequential Uneventful Implantation of a Posterior Chamber Phakic Toric Intraocular Lens at Two Different Surgical Facilities: A Series of Unfortunate Events. Case Rep Ophthalmol Med 2020; 2020:1216578. [PMID: 33204556 PMCID: PMC7657676 DOI: 10.1155/2020/1216578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background Phakic Intraocular Lens (P-IOL) implantation is a safe, easy, predictable intervention designed to manage moderate to high refractive errors. Complications are relatively uncommon and include mainly cataract and intraocular pressure spikes. Toxic Anterior Segment Syndrome (TASS) is a rather unusual sterile anterior segment inflammation after uneventful intraocular surgery, extremely rarely reported after P-IOL implantation. Urrets-Zavalia Syndrome (UZS) is also very rarely described after P-IOL. To date, to the best of the authors' knowledge, no article has ever described the simultaneous occurrence of TASS and UZS in a patient after P-IOL implantation. Objective In this article, the authors present the case of a female patient with moderate myopic astigmatism, who underwent sequential P-IOL implantation at two different facilities. The postoperative course of the first eye was uneventful, but she developed complications associated to the intervention in the second eye. Materials The article describes the case of a young patient who underwent a sequential Phakic Intraocular Lens (P-IOL) implantation at two different institutions. The postoperative course of the first eye (left eye) was uneventful; however, the second eye (right eye) initially developed Toxic Anterior Segment Syndrome (TASS). Although timely and correct management was instituted, upon resolution of TASS, the patient developed Urrets-Zavalia Syndrome, anterior subcapsular cataract, and significant endothelial damage in the same eye. Results The patient was followed closely and managed accordingly; corneal edema and anterior segment inflammation of the right eye eventually resolved. Nevertheless, an anterior subcapsular cataract and a fixed dilated pupil remained; with normal intraocular pressure (IOP). Specular microscopy confirmed an endothelial cell loss in the TASS eye (right eye). Pupil size showed no reaction to repeated doses of Pilocarpine 2%. A month after surgery, refraction on her right eye was +0.25 + 0.75 × 93, which resulted in a 20/50 vision. Conclusions TASS and UZS are both extremely rare complications after uneventful P-IOL implantation, with only a handful of cases having been reported of each of them. To date, this is the very first case where UZS ensued after and potentially as a consequence of TASS in a patient who had undergone P-IOL implantation. Although a direct causative element could not be pinpointed, the fact that the complication ensued after being operated in one surgical institution and not the other, could suggest some role of different sterilization and handling procedures, but no direct conclusion can be made on this case.
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