Long-term observation on safety and visual quality of implantable collamer lens V4c implantation for myopia correction:a 5-year follow-up

AIM:To elucidate the safety and visual quality of implantable collamer lens with central hole(ICL V4c)implantation for correcting moderate and high myopia for at least 5y.METHODS:This retrospective study was conducted on 58 patients(114 eyes)who were followed up for at least 5y after ICL V4c implantation.The observation was done before and on 1d,1mo,1 and 5y or more after the surgical procedure.The visual acuity,subjective refraction,intraocular pressure,vault,axial length,central hole position,pupil diameter,visual quality,and adverse events were analyzed.The visual quality includes aberration,the modulation transfer function cutoff frequency(MTF cutoff),objective scattering index(OSI),Stroller's ratio(SR),and visual quality questionnaire.RESULTS:The average follow-up period was 69.25±3.80mo(range 60–82mo)and the preoperative spherical equivalent(SE)was-8.66±1.97 D.At 5y after operation,the safety index was 1.01±0.02 and the efficacy index was 0.99±0.42 and SE was-0.65±0.63 D.The 59.6%of the eyes achieved an uncorrected distance visual acuity of 20/20,76.3%of the eyes had SE within±1.0 D at the last visit.The axial length increased by 0.29±0.71 mm 5y after the surgery(t=-3.843,P<0.001).The mean vault at the last follow-up was 510.59±245.61μm.The central hole was on the temporal side in 80 eyes(84.2%).The visual quality questionnaire showed that 98.2%patients were satisfied with the surgical procedure.Adverse events occurred in 4 eyes(3.5%),including the posttraumatic toric ICL rotation(2 eyes),iris incarceration(1 eye),and posttraumatic ICL displacement(1 eye)at the last follow-up.CONCLUSION:Long-term ICL V4c implantation is safe,effective,and stable for correcting moderate and to high myopia,and the visual quality with patients is excellent and satisfactory,but the progression of axial length still needs attention after surgery.

Ultrastructural and Immunohistochemical Characteristics of Corneal Lenticule Extracted during Correction of Residual Myopia in the Long-Term Period after SMILE

Purpose: To evaluate ultrastructural characteristics of lenticule surface extracted during correction of residual myopia in patients after small-incision lenticule extraction (SMILE). Methods and material: This study had a prospective, consecutive, comparative design. Sixteen patients (16 eyes) underwent additional intervention for residual myopia correction after SMILE. 16 specimens of removed lenticules underwent morphological examination. Markers and reagents were used to determine actin microfilaments, neutral fats and cell nuclei. The tissue was analyzed in layers in 2D slices form, volumetric Z-stacks, or selected areas were formed in orthogonal projections. The surface of the extracted lenticule was analyzed using scanning electron microscopy. Patients’ refractive outcomes were measured postoperatively (1 day;1 and 3 months). Results: Postoperatively uncorrected distance visual acuity (20/20 or better) was in 100% cases 3 months after surgery. Ultrastructural studies have shown the difference in surfaces of the newly formed lenticule. Structural changes of the posterior lenticule surface were characterized by ruptures of collagen fibers on its surface, degenerative changes in keratocytes with signs of colliquation necrosis, cell apoptosis and F-actin in cell cytoplasm. Conclusion: Collagen fibers are immersed in the stroma on the anterior surface of the lenticule. There is no complete structure restoration of collagen fibers explaining the lack of tight adhesion of anterior and posterior surfaces of the intrastromal space even in the long-term postoperative period. There are no degenerative changes of keratocytes on the anterior lenticule surface, that is, their changes in SMILE are reversible in most cases.

Orthokeratology for myopia control: an optometrist’s view

Orthokeratology(OK)is a clinical technique that uses reverse geometry design rigid contact lenses to reshape the corneal profile and modify its refractive power during overnight lens wear in order to correct refractive error temporarily.OK achieves its reshaping effect through thinning of the central corneal epithelium.This raises concerns about the safety of this modality particularly in terms of microbial keratitis(MK).Since the mid 2000’s,with our increasing understanding of modifiable risk factors for MK in OK the prevalence of MK appears to have reduced significantly.It is now clear that the relative risk of MK in overnight OK is equivalent to other modalities of contact lens wear,provided that safe practice is followed in terms of lens fitting,wear and care.Although OK was originally used predominantly for correction of low to moderate myopic refractive error,its use for myopia control have become more common in recent years.This follows on from published clinical trials demonstrating an average of approximately 45%reduction in axial eye elongation when overnight OK is used in progressive myopic children.But there is significant individual variability in efficacy,and one of the current challenges for OK in myopia control is to identify those children who will benefit most from this particular intervention.Modifying OK lens parameters to customise corneal reshaping for enhanced myopia control efficacy also remains a significant challenge for the future of this modality.