Unexpected ocular morphological changes after corneal refractive surgery: A review

Bernardo, Maddalena De; Pagliarulo, Sergio; Rosa, Nicola

doi:10.3389/fmed.2022.1014277

Cited by 5 publications

(4 citation statements)

References 36 publications

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“…In addition, the biomechanical changes and epithelial remodeling issues of the cornea after surgery have not yet been predicted or compensated for. 26 …”

Section: Discussionmentioning

confidence: 99%

A Comparison of Three Cylindrical Treatment Strategies for Topography-Guided LASIK: Manifest, Topographic, and ZZ VR Cylinders

Zhang¹,

Li²,

Zheng³

et al. 2023

OPTH

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Purpose This study was designed to compare the clinical outcomes of three cylindrical treatment strategies using manifest, topographic, and Zhang & Zheng vector-compensated refraction (ZZ VR) cylinders, for topography-guided laser-assisted in situ keratomileusis (LASIK) and to identify the laser programming strategy that optimizes refractive astigmatism outcomes and visual acuity. Methods Consecutive patients referred for therapeutic refractive surgery between March and September 2018 at a single center were prospectively analyzed. Using double-masked simple randomization, patients were randomly assigned to undergo treatment based on manifest cylinder, topographic cylinder, and ZZ VR cylinder strategies. Uncorrected distance visual acuity and astigmatic refraction were analyzed preoperatively and 6 months postoperatively. Results A total of 138 eyes from 71 patients met the inclusion criteria. The manifest group consisted of 46 eyes in 24 patients, the topographic group consisted of 43 eyes in 22 patients, and the ZZ VR group consisted of 49 eyes in 25 patients. The absolute residual cylindrical refractions at 6 months postoperatively in these three groups were 0.69 ± 0.32 D, 0.58 ± 0.31 D, and 0.42 ± 0.19 D, respectively (P < 0.001; adjusted P < 0.01 for manifest vs ZZ VR, adjusted P = 0.08 for topographic vs ZZ VR). The percentages of postoperative absolute residual cylindrical power within 0.50 D in the manifest, topographic, and ZZ VR groups were 30.4%, 55.8%, and 59.2%, respectively (P = 0.01; adjusted P = 0.06 for manifest vs topographic, adjusted P = 0.02 for manifest vs ZZ VR). Conclusion The ZZ VR strategy may achieve better outcomes, as determined by cylindrical correction and visual activity, during topography-guided LASIK. Clinical Trial Registration Number ChiCTR1900025779.

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“…In addition, the biomechanical changes and epithelial remodeling issues of the cornea after surgery have not yet been predicted or compensated for. 26 …”

Section: Discussionmentioning

confidence: 99%

A Comparison of Three Cylindrical Treatment Strategies for Topography-Guided LASIK: Manifest, Topographic, and ZZ VR Cylinders

Zhang¹,

Li²,

Zheng³

et al. 2023

OPTH

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“…The first step is to acquire accurate ocular biometrics. Ocular parameters, including the anterior chamber depth, the AL, and the corneal curvature, often change after refractive surgery ( 29 , 30 ). Thereinto, precise measurement of the corneal refractive power is the greatest challenge when managing myopic post-CRS eyes.…”

Section: Emerging Challenges and A Paradigm Shift In The Management O...mentioning

confidence: 99%

Challenges of refractive cataract surgery in the era of myopia epidemic: a mini-review

Du,

Meng,

et al. 2023

Front. Med.

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Myopia is the leading cause of visual impairment in the world. With ever-increasing prevalence in these years, it creates an alarming global epidemic. In addition to the difficulty in seeing distant objects, myopia also increases the risk of cataract and advances its onset, greatly affecting the productivity of myopes of working age. Cataract management in myopic eyes, especially highly myopic eyes is originally more complicated than that in normal eyes, whereas the growing population of cataract with myopia, increasing popularity of corneal and lens based refractive surgery, and rising demand for spectacle independence after cataract surgery all further pose unprecedented challenges to ophthalmologists. Previous history of corneal refractive surgery and existence of implantable collamer lens will both affect the accuracy of biometry including measurement of corneal curvature and axial length before cataract surgery, which may result in larger intraocular lens (IOL) power prediction errors and a compromise in the surgical outcome especially in a refractive cataract surgery. A prudent choice of formula for cataract patients with different characteristics is essential in improving this condition. Besides, the characteristics of myopic eyes might affect the long-term stability of IOL, which is important for the maintenance of visual outcomes especially after the implantation of premium IOLs, thus a proper selection of IOL accordingly is crucial. In this mini-review, we provide an overview of the impact of myopia epidemic on treatment for cataract and to discuss new challenges that surgeons may encounter in the foreseeable future when planning refractive cataract surgery for myopic patients.

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“…It is well known that LRS can induce changes that involve not only the cornea, but also other ocular structures [3]. These changes can make several measurements, such as the intraocular pressure and the corneal power, unreliable [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…The following values were calculated, in absolute values: Moreover, the parameter AL/K was identified. Each group was then divided into three subpopulations, based on the AL/K value closer to the fraction value of 2/3 (0.67) and 3 4 (0.75).…”

mentioning

confidence: 99%

A No-History Multi-Formula Approach to Improve the IOL Power Calculation after Laser Refractive Surgery: Preliminary Results

Cione

Bernardo

Gioia

et al. 2023

JCM

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This retrospective comparative study proposes a multi-formula approach by comparing no-history IOL power calculation methods after myopic laser-refractive-surgery (LRS). One-hundred-thirty-two eyes of 132 patients who had myopic-LRS and cataract surgery were examined. ALMA, Barrett True-K (TK), Ferrara, Jin, Kim, Latkany and Shammas methods were evaluated in order to back-calculate refractive prediction error (PE). To eliminate any systematic error, constant optimization through zeroing-out the mean error (ME) was performed for each formula. Median absolute error (MedAE) and percentage of eyes within ±0.50 and ±1.00 diopters (D) of PE were analyzed. PEs were plotted with corresponding mean keratometry (K), axial length (AL), and AL/K ratio; then, different ranges were evaluated. With optimized constants through zeroing-out ME (90 eyes), ALMA was better when K ≤ 38.00 D-AL > 28.00 mm and when 38.00 D < K ≤ 40.00 D-26.50 mm < AL ≤ 29.50 mm; Barrett-TK was better when K ≤ 38.00 D-AL ≤ 26.50 mm and when K > 40.00 D-AL ≤ 28.00 mm or AL > 29.50 mm; and both ALMA and Barrett-TK were better in other ranges. (p < 0.05) Without modified constants (132 eyes), ALMA was better when K > 38.00 D-AL ≤ 29.50 mm and when 36.00 < K ≤ 38.00 D-AL ≤ 26.50 mm; Barrett-TK was better when K ≤ 36.00 D and when K ≤ 38.00 D with AL > 29.50 mm; and both ALMA and Barrett-TK were better in other ranges (p < 0.05). A multi-formula approach, according to different ranges of K and AL, could improve refractive outcomes in post-myopic-LRS eyes.

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Unexpected ocular morphological changes after corneal refractive surgery: A review

Cited by 5 publications

References 36 publications

A Comparison of Three Cylindrical Treatment Strategies for Topography-Guided LASIK: Manifest, Topographic, and ZZ VR Cylinders

A Comparison of Three Cylindrical Treatment Strategies for Topography-Guided LASIK: Manifest, Topographic, and ZZ VR Cylinders

Challenges of refractive cataract surgery in the era of myopia epidemic: a mini-review

A No-History Multi-Formula Approach to Improve the IOL Power Calculation after Laser Refractive Surgery: Preliminary Results

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