Efficacy of custom-made soft keratoconus lenses on corneal aberrations and photic phenomena in patients with keratoconus:a corneal topography imaging based study

AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were examined at baseline and after fitting HydroCone(Toris K)soft silicone hydrogel lenses.Best spectacle-corrected visual acuity(BSCVA)and contact lens-corrected visual acuity(CLCVA)were recorded.Lower-and higher-order corneal aberrations(LOAs and HOAs)were measured with and without Toris K lenses and compared in central 4.5 mm and 7 mm zones.Mesopic pupil diameter and subjective photic phenomena were also assessed.RESULTS:Mean CLCVA was significantly improved compared to BSCVA(P<0.0001).Corneal curvature and refractive measurements were found to be significantly reduced by the use of Toris K lenses,except for posterior corneal curvature values.In the 4.5 mm central optical zone,all wavefront aberrations decreased significantly after lens fitting(P<0.0001).In contrast,in the 7 mm(peripheral)optical zone,values for HOAs,spherical and residual aberrations,and optical path differences were increased,while LOAs,trefoil,and quadrifoil coefficients were decreased.The rate of photic phenomena was significantly higher in participants with a pupil size>6.00 mm(85.7%).CONCLUSION:Toris K lenses provide good visual results and a significant reduction in central corneal aberrations in patients with KC but could cause an increase in peripheral aberrations.This practical and nonsurgical approach appears to be an effective method for the visual management of KC.

One-year clinical efficacy evaluation of selective corneal wavefront aberration-guided FS-LASIK correction in patients with high myopia

AIM:To evaluate the effectiveness,safety,predictability,precision and changes of higher-order aberrations(HOAs)on corneal front surface of selective corneal wavefront aberration-guided femtosecond laser-assisted in situ keratomileusis(CW-FS-LASIK)in patients with high myopia 1-year postoperatively.METHODS:Totally 74 eyes of 37 patients with high myopia or myopic astigmatism in both the eyes who underwent the CW-FS-LASIK procedure in Xi’an Gaoxin Hospital from January 2021 to June 2021 were included.The changes of uncorrected distance visual acuity(UDVA),best corrected visual acuity(BCVA),spherical equivalent refraction(SER),astigmatism,HOAs and Strehl ratio(SR)on the anterior surface of the cornea after 1y of the surgery were analyzed.RESULTS:At postoperative 1y,the UDVA(logMAR)of 74 eyes(100%)reached 0 or better,including 0 in 8 eyes(10.81%),-0.1 in 45 eyes(60.81%),and-0.2 in 21 eyes(28.38%).The effectiveness index was 1.29±0.134.There was no decrease in postoperative BCVA compared with preoperative BCVA in all patients.Postoperative BCVA was the same in 44 eyes(59.46%)as preoperative BCVA,increased by 1 line in 23 eyes(31.08%)and increased by 2 lines in 7 eyes(9.46%)compared with preoperative BCVA.The safety index was 1.11±0.159.The estimated corrected SER before surgery was(-7.76±1.21)D,and the actual corrected SER was(-7.83±1.25)D(Y=0.9811X+0.2156,R2=0.9084).There was a high correlation between the estimated corrected SER and the actual corrected SER.The postoperative SER in 74 eyes(100%)was within±0.75 D.The postoperative astigmatism of all was within-0.75 D to 0.Root mean square(RMS)HOAs of spherical aberration and SR within 5 mm of the corneal front surface were all increased compared with those before operation(P<0.01).The total coma,horizontal coma and vertical coma were all decreased compared with those before operation(P<0.01).There was no statistically significant difference in horizontal trefoil and vertical trefoil compared with preoperative ones(P>0.05).CONCLUSION:Selective CW-FS-LASIK for correction of high myopia is effective,safe,predictive,and accurate.For patients with preoperative RMS HOAs over 0.25 defocus equivalent,postoperative coma aberration can be significantly reduced,and SR value can be increased,thus corneal imaging quality can be improved.

Effect of High-Order Aberrations and Satisfaction on Cataract Patients Implanted with Four Types of AcrySof Blue Light Filtering Intraocular Lens

Objective: The objective is to evaluate the visual acuity, high-order aberrations and satisfaction in the cataract patients with the implantation of different types of AcrySof blue light filtering intraocular lens, which would provide the clinical guidance for the selection of individualized intraocular lens. Methods: From January 2019 to December 2020, the patients with age-related cataract in Guangzhou Red Cross Hospital were equally randomized to be divided into four groups. 20 patients (20 eyes) were implanted with AcrySof (SN60WF), which was the blue light filtering single focus group;20 patients (20 eyes) were implanted with blue light filtering aspheric multifocal intraocular lens (AcrySof ReSTOR IOL +3.0D, SN6AD1), which was the multifocal intraocular lens group;20 patients (20 eyes) were implanted with aspheric astigmatism correction intraocular lens (Toric SN6AT), which was the astigmatism group;20 patients (20 eyes) were implanted with blue filtering aspheric multifocal astigmatism correction intraocular lens (AcrySof ReSTOR IOL +2.5D IQ, SV25T0), which was the ART group. Three months after the operation, the patients were followed up with slit lamp to check the visual acuity, including uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best corrected distance visual acuity, (BCDVA);the questionnaire surveys on the satisfaction of different intraocular lens implantation (far and near vision, glare, halo and abnormal visual symptoms);the iTrace visual function analyzer was used to check the total high-order aberrations (spherical aberration, wisdom aberration and Clover aberration) in the 3 mm pupil diameter. Results: Three months after cataract surgery, American Simplified version of questionnaire survey showed that the scores of near removing glasses in the multifocal group and the ART group were significantly better than those in the single focus group and the astigmatism group (P < 0.05);there was no significant difference in the satisfaction of far removing glasses, glare and halo in each group (P > 0.05). Three months after cataract surgery, there were statistically significant differences about UCDVA, BCDVA and UCNVA among the four groups (F = 18.189, P < 0.001), the UCNVA in the multifocal group and ART group was significantly better than that in the single focus group and the astigmatism group (P < 0.01). The difference of higher-order aberrations (total higher-order aberrations, wisdom aberrations, spherical aberrations, clover aberrations) was no statistically significant among the four groups (P > 0.05). Conclusion: Different types of AcrySof blue light filtering intraocular lens implantation could improve the far vision and satisfaction of cataract patients, without different higher-order aberrations. Multifocal intraocular lens and ART intraocular lens could significantly improve the far vision of patients and reduce the dependence on near glasses.

Changes in corneal curvature and aberrations after cataract surgery

Background:Surgically induced astigmatism(SIA)and corneal high-order aberrations(HOAs)are the two main causes of poor visual quality after cataract surgery.Changes in the parameters of corneal HOAs after cataract surgery and their effects on and relationships with changes in corneal curvature have not yet been reported.This study aimed to explore changes in anterior,posterior and total corneal curvature,astigmatism and HOAs after microincision cataract surgery.Methods:Sixty-one age-related cataract patients(61 eyes)were included in this prospective study.The total,anterior and posterior corneal astigmatism and corneal HOAs were analyzed by anterior segment optical coherence tomography(AS-OCT)and iTrace before,one day,one week and three months after 2.2 mm temporal microincision coaxial phacoemulsification to evaluate the changes in anterior,posterior and total corneal curvature,astigmatism and corneal HOAs.Results:The mean J0 and J45 values of anterior,posterior and total corneal curvature obtained by ASOCT showed no statistically significant difference between preoperatively and any postoperative followup.SIA occurred on the anterior,posterior and total corneal surfaces and showed no statistically significant difference at any postoperative follow-up.No significant changes in 3rd-order oblique trefoil,vertical coma or 4th-order spherical aberrations were observed after surgery except for a significant increase in horizontal coma at postoperative day 1(POD1).Conclusions:There were no significant changes in corneal curvature after 2.2 mm temporal microincision coaxial phacoemulsification,and the corneal HOAs were not changed significantly except for the increase in horizontal coma at POD1,which may be one of the main reasons of poor visual quality at POD1 in some cataract patients who have good uncorrected or corrected distance vision.

Personalized aspheric intraocular lens implantation based on corneal spherical aberration: a review

With the evolution of cataract surgery from visual rehabilitation to refractive surgery, aspheric intraocular lenses(IOLs) are being increasingly used in the field of ophthalmology. This increased use can be attributed to negative or zero spherical aberrations with unique optical designs, which counteract some of the positive spherical aberrations of the cornea. These alterations reduce the total spherical aberration of human eyes and improve the visual acuity in patients with cataract postoperatively. At present, various types of aspheric IOLs are used worldwide. Although the implantation of aspheric IOL is beneficial to the patients who need correction of spherical aberrations, much controversy is still associated with ocular residual spherical aberrations that facilitate the best visual quality for patients postoperatively. In order to provide reference for future clinical work and scientific research, this report reviews the relationship between the ocular residual spherical aberration of human eyes and visual quality.

Optimal incision sites to reduce corneal aberration variations after small incision phacoemulsification cataract surgery

AIM： To analyze the effect of steep meridian small incision phacoemulsification cataract surgery on anterior,posterior and total corneal wavefront aberration.· METHODS： Steep meridian small incision phacoemulsification cataract surgery was performed in age-related cataract patients which were divided into three groups according to the incision site： 12 o＇clock, 9o＇clock and between 9 and 12 o＇clock（BENT） incision groups. The preoperative and 3-month postoperative root mean square（RMS） values of anterior, posterior and total corneal wavefront aberration including coma,spherical aberration, and total higher-order aberrations（HOAs）, were measured by Pentacam scheimpflug imaging. The mean preoperative and postoperative corneal wavefront aberrations were documented.·RESULTS： Total corneal aberration and total lower-order aberrations decreased significantly in three groups after operation. RMS value of total HOAs decreased significantly postoperatively in the 12 o＇clock incision group（P 〈0.001）. Corneal spherical aberration was statistically significantly lower after steep meridian small incision phacoemulsification cataract surgery in BENT incision group（P 〈0.05） and Pearson correlation analysisindicated that spherical aberration changes had no significant relationship with total astigmatism changes in all three corneal incision location.·CONCLUSION： Corneal incision of phacoemulsification cataract surgery can affect corneal wavefront aberration.The 12 o＇clock corneal incision eliminated more HOAs and the spherical aberrations decreased in BENT incision group obviously when we selected steep meridian small incision. Cataract lens replacement using wavefront-corrected intraocular lens combined with optimized corneal incision site would improve ocular aberration results.

Evaluations of wavefront aberrations and corneal surface regularity in dry eye patients measured with OPD Scan Ⅲ

AIM: To compare the wavefront aberrations and corneal surface regularity between dry eye(DE) patients and normal subjects and assess its diagnostic performance for DE measured with OPD Scan-Ⅲ.METHODS: Fifty right eyes of 50 DE patients and 31 right eyes of normal subjects were included.The examinations for ocular surface including logarithm of the minimum angle of resolution best-corrected distance visual acuity(logMAR BCVA) the ocular surface disease index(OSDI), tear film break-up time(TBUT) and corneal fluorescein staining(CFS).OPD Scan-Ⅲ was used to measure anterior corneal aberrations including total corneal aberrations, high order aberration(HOA), coma, trefoil, spherical aberration(SA), standard deviation of corneal power(SDP), surface regularity index(SRI) and surface asymmetry index(SAI).Statistical analysis were assessed with nonparametric tests and Spearman’s correlations.All parameters were also analyzed for sensitivity, specificity, and receiver operating characteristics(ROC) curves.RESULTS: Wavefront aberrations parameters including total corneal aberrations, HOA, coma, trefoil, and SA in DE group were significantly higher than those in normal group(P<0.001).Corneal surface regularity parameters including SRI and SAI in DE group were significantly higher than both in normal group(P<0.05).All the wavefront aberrations parameters had significant correlations with ocular surface parameters(P<0.05).The logMAR BCVA had positive correlations with SAI and SRI(all P<0.001).CFS scores had positive correlations with SAI and SRI(all P<0.001).All the wavefront aberrations parameters showed good diagnosis sensitivity and specificity, however, the corneal regularity parameters showed only good specificity but poor sensitivity.The cut-off value selected for trefoil in diagnosis DE showed the highest area under the curve(AUC, 0.921) values as compared to the other parameters with sensitivity of 0.955 and specificity of 0.867.CONCLUSION: Wavefront aberrations and corneal surface regularity are increased in DE patients and also correlated with ocular surface parameters.Wavefront aberrations parameters have potential to be indicators to diagnosis and monitor DE.

Efficacy, safety, predictability, aberrations and corneal biomechnical parameters after SMILE and FLEx: Metaanalysis

AIM： To identify possible differences of efficacy, safety predictability, higher-order aberrations and cornea biomechnical parameters after small-incision lenticule extraction（SMILE） and femtosecond lenticule extraction（FLEx）.· METHODS： A systematic literature retrieval was conducted in Medline,Embase and the Cochrane Library up to October, 2015. The included studies were subject to a Meta-analysis. Comparison between SMILE and FLEx was measured as pooled odds ratio（OR） or weighted mean differences（WMD）. Of 95% confidence intervals（CI） were used to analyze data.·RESULTS： A total of seven studies were included Firstly, there were no differences in uncorrected distance visual acuity（UDVA） 20/20 or better（OR, 1.37; 95% CI0.69 to 2.69; P =0.37） and log MAR UDVA（WMD,-0.02;95% CI,-0.05 to 0.01; P =0.17） after SMILE versus FLEx We found no differences in corrected distance visua acuity（CDVA） unchanged（OR, 0.98; 95% CI, 0.46 to 2.11;P =0.97） and log MAR CDVA（WMD,-0.00; 95% CI,-0.01 to 0.01; P =0.90） either. Secondly, we found no differences in refraction within ±1.00 D（OR, 0.98; 95% CI0.13 to 7.28; P =0.99） and ±0.50 D（OR, 1.62; 95% CI0.62 to 4.28; P =0.33） of target postoperatively. Thirdly for higher-order aberrations, we found no differences in the total higher-order aberrations（WMD,-0.04; 95%CI,-0.09 to 0.01;P =0.14）, coma（WMD,-0.04; 95% CI,-0.09 to 0.01; P =0.11）, spherical（WMD, 0.01; 95% CI,-0.02 to0.03; P =0.60） and trefoil（WMD,-0.00; 95% CI,-0.04 to0.03; P =0.76）. Furthermore, for corneal biomechanica parameters, we also found no differences（WMD, 0.08;95% CI,-0.17 to 0.33; P =0.54） after SMILE versus FLEx.·CONCLUSION： There are no statistically differences in efficacy, safety, predictability, higher-order aberrations and corneal biomechnical parameters postoperative between SMILE and FLEx.

Study on the Corneal Higher-Order Aberrations and Correlation in Patients with Different Degrees of Myopia Suitable for Wavefront-Guided FS-LASIK

Background: Individualized corneal refractive surgery requires an understanding of the basis of higher-order aberrations before surgery. To investigate the characteristics and distribution of anterior surface wavefront aberrations in patients suitable for corneal refractive surgery. Methods: A total of 121 myopic patients (121 eyes, 18 - 45 years old) who underwent corneal refractive surgery were recruited from January to May 2016 at Affiliated Hospital, Yanbian University. Patients were randomly selected by the Pentacam anterior segment analysis system with a spherical equivalent (SE) of -0.25 to -10.00 D. The corneal anterior aberrations (total higher-order aberration;spherical aberration;Coma;Trefoil) and Q and K values were detected, and a correlation analysis of the relevant parameters was carried out. Results: The root-mean-square (RMS) of the third to sixth order aberrations of the corneal anterior wavefront aberrations at a 6 mm analysis diameter showed a decreasing trend in patients suitable for the corneal refractive surgery, and the RMS of the third order aberrations accounted for 62.92% of the total HOAs. The coma ratio (coma/total cornea higher-order aberrations) was increased with the increasing diopters, while the spherical aberration ratio (spherical aberration/total cornea higher-order aberrations) was not changed. In addition, the spherical aberration was 0.203 ± 0.082 μm (range: 0.061 to 0.503 μm), and the Q30 was -0.19 ± 0.03 (range: -0.58 to 0.31). There were significant differences in the coma aberrations of preoperative corneal anterior surface (3, 1) between the low, middle and high myopia groups (P = 0.013). The spherical equivalent was positively correlated with the corneal coma of the anterior corneal surfaces (R =?-0.241, P = 0.009), and the Q value was positively correlated with the total higher-order aberrations (R = 0.326, P Conclusions: Individual wavefront aberrations on the anterior surfaces of the cornea are comparatively different, and the Zernike coefficients are related to the degree of myopia. Spherical aberrations are the most overriding aberrations of the cornea.

Analysis of Corneal Spherical Aberration in Patients before and after Phacoemulsification

Purpose:To investigate the distribution and changes in corneal four-order spherical aberration Z40 in patients with age-related cataract before and after phacoemulsification,and to direct the application of aspherical intraocular lens (IOL)in PHACO combined with IOL implantation.Methods:A total of 155 eyes in 93 patients with age-related cataract were included.All patients received a comprehensive ophthalmologic examination.Corneal Z40 at a pupil diameter of 6 mm was measured by using a Scheimpflug photography system (Pentacam) preoperatively and 3 months postoperatively.Results:The mean corneal Z40 before and after the PHACO at a diameter of 6 mm was(0.294 ±0.138)μm and(0.271 ± 0.130)μm,respectively,with statistical significance(P<0.05, t =4.384).There was no significant difference between male (n=45, 76 eyes) and female patients (n=48,79 eyes) regard- ing corneal Z40 (t=-0.418,P=0.676).The corneal Z40 for patients (35 eyes) aged from 50 to 59 years was (0.238±0.104) μm preoperatively;(0.308 ±0.104)μm for 60 to 69 years; (0.332±0.151)μm for 70 to 79 years; and (0.307±0.164) μm for 80 to 89 years.A significant difference in Z40 was observed among different age groups.A linear positive correlation was noted between corneal Z40 and ages (r=0.203,P<0.003). Conclusion:The corneal Z40 varied significantly among cataract patients. Patients' corneal Z40 , which should be considered when choosing aspherical IOL, increases slightly with age.Thus,customized aspheric IOLs are needed.

Evaluation of corneal parameter changes under different accommodative stimuli with Scheimpflug imaging-based tomography

AIM:To evaluate the reliability of measurements of corneal changes with accommodation in healthy eyes using a Scheimpflug imaging-based system and how these measurements distribute in the normal population.METHODS:Prospective,non-randomized,comparative study including 27 healthy subjects(54 eyes),including emmetropia(13 eyes),myopia(17 eyes),hyperopia(4 eyes)and astigmatism(20 eyes)groups.In all cases,a complete eye examination was performed,including the analysis of corneal changes with different accommodative stimuli(+2.00,0.00 and-3.00 D)using the Pentacam AXL system.The investigation was structured in 2 phases:repeatability analysis and characterization of accommodation-related corneal changes in healthy populations.RESULTS:In the repeatability analysis,the index of height asymmetry(IHA)showed the greatest variability with the three accommodative stimuli,being the results for the rest of parameters acceptable.The group of emmetropes showed significant differences with accommodative changes in the position of maximum keratometry(Kmax;P<0.05),whereas in the astigmatism group,significant changes were not only observed in the position of Kmax,but also in minimum corneal thickness(MCT),corneal spherical aberration,and total and low order aberration root mean square(all P<0.05).Likewise,a significant difference was found in the displacement of the X position of Kmax with+2.00 D and-3.00 D in the myopia group(P=0.033)as well as in changes with+2.00 D and-3.00 D in the magnitude of the position vector of Kmax in the emmetropia group(P<0.05).No significant changes were found between accommodative stimuli in the displacement of coordinates of MCT(P≥0.109).CONCLUSION:The position of Kmax and MCT in healthy corneas can change significantly when presenting different accommodative stimuli using the accommodation mode of the Pentacam system,with different trends in these accommodation-related corneal changes between refractive errors.Likewise,the consistency of the measurements obtained with Scheimpflug has been confirmed.

Ocular higher-order aberrations and mesopic pupil size in individuals screened for refractive surgery

AIM: To study the distribution of ocular higher-order aberrations(HOAs) and mesopic pupil size in individuals screened for refractive surgery. · METHODS: Ocular HOAs and mesopic pupil size were studied in 2 458 eyes of 1 240 patients with myopia, myopic astigmatism and compound myopic astigmatism and 215 eyes of 110 patients with hyperopia, hyperopic astigmatism and compound hyperopic astigmatism using the Zywave aberrometer (Busch& Lomb). All patients had correctable refractive errors without a history of refractive surgery or underlying diseases. Root-mean-square values of HOAs, total spherical aberration, total coma and mesopic pupil size were analyzed. Ocular HOAs were measured across a ≥ 6.0 mm pupil, and pupil size measurements were performed under the mesopic condition. · RESULTS: The mean values of HOAs, total spherical aberration and total coma in the myopic group were 0.369 μm, ±0.233, 0.133±0.112μm and 0.330±0.188μm, respectively. In the hyperopic group the mean values of HOAs, total spherical aberration and total coma were 0.418μm±0.214, 0.202±0.209μm and 0.343±0.201μm, respectively. Hyperopes showed greater total HOAs (P <0.01) and total spherical aberration (P <0.01) compared to myopes. In age-matched analysis, only the amount of total spherical aberration was higher in the hyperopic group (P =0.05). Mesopic pupil size in the myopic group was larger (P ≤0.05). · CONCLUSION: The results suggested that significant levels of HOAs were found in both groups which are important for planning refractive surgeries on Iranians. There were significantly higher levels of total spherical aberration in hyperopes compared to myopes. Mesopic pupil size was larger in myopic group.

EFFECT OF SHORT-TERM SOFT CONTACT LENS WEAR ON HUMAN OCULAR ABERRATIONS

Objective To evaluate the effect of short-term soft contact lens （SCLs） wearing on human ocular aberrations （ HOA ）. Methods This prospective study included 50 eyes of 50 young volunteers wearing SCLs for 1 month. The ocular aberrations were measured by Allegretto Wavefront Analyzer. The root-mean-square （RMS） values of the general （RMSG） , higher-order （RMSH） , first to sixth order （ RMS1 to RMS6） and aberration coefficients were analyzed. Results There were no significant differences in the mean values of RMSG, RMSH, RMS1 to RMS6 （ P 〉 0. 05 ） and changes of absolute values of aberration coefficients between baseline and various visits after SCLs discontinuation. However, at d I after the discontinuation of SCLs, changes in coefficient values of the third-order aberrations （ C6 to C9 ） were slightly higher than others, and C7 was the highest. The increase factors of RMS values were higher at 1 week and lower at the 2 week visit after SCLs discontinuation. The uniformity of dominating type in HOA and the corneal topography form was both about 60% after discontinuation of SCLs. The corneal thickness increased after SCLs wear and gradually decreased to baseline until 1 month discontinuation of SCLs. Conclusion The effect of short-term SCLs wear on human ocular aberrations is slight but profound. A month or more wait should be allowed before the short-term SCLs wearers are scheduled for wavefronted-guided LASIK.

波前像差引导的LASIK与SMILE手术对屈光不正患者视觉质量及泪膜稳定的影响

目的 探究波前像差引导的准分子激光原位角膜磨镶术(WF-LASIK)与飞秒激光小切口角膜基质透镜取出术(SMILE)手术对屈光不正患者视觉质量及泪膜稳定的影响。方法 选取2020年1月-2023年1月我院诊治的屈光不正患者60例(120只眼)作为研究对象。根据手术方式不同分为WF-LASIK组(30例,60只眼)与SMILE组(30例,60只眼),比较2组裸眼视力、屈光度、视觉质量、泪膜稳定及并发症。结果 经重复测量方差分析:两组裸眼视力、球镜、柱镜、等效球镜的时间效应有统计学意义(P<0.05),且WF-LASIK组术后1、3mo裸眼视力高于SMILE组(P<0.05);两组球差、水平彗差、垂直彗差、总高阶像差、泪膜破裂时间、泪液分泌试验的时间效应、组间效应及交互效应均有统计学意义(P<0.05),且WF-LASIK组术后1、3mo球差大于SMILE组(P<0.05),水平彗差、垂直彗差、泪膜破裂时间、泪液分泌试验低于SMILE组(P<0.05)。两组并发症总发生率比较无统计学意义(P>0.05)。结论 屈光不正患者通过WF-LASIK与SMILE手术均能获得良好视力效果,其中WF-LASIK手术在视觉质量方面具有较明显优势,SMILE手术在泪膜稳定性方面具有明显优势。

近视患者角膜生物力学参数与像差的相关性分析

目的探讨近视患者角膜生物力学参数与全眼像差、角膜前表面像差的相关性。方法选取95例(190眼)近视患者作为研究对象,测量全眼像差、角膜前表面像差,记录总像差均方根(RMS)、总高阶像差均方根(RMSh),测量角膜生物力学参数[中央角膜厚度(CCT)、眼内压(IOP)、校正Goldman眼压(IOPg)、角膜补偿眼压(IOPcc)、角膜黏滞阻力(CH)、角膜阻力因子(CRF)]。比较不同近视程度患者的角膜生物力学参数和总RMS、总RMSh,采用Pearson相关分析法分析角膜生物力学参数与全眼、角膜前表面高阶像差(彗差、球差)的相关性。结果95例患者左眼、右眼的角膜前表面像差(总RMS、总RMSh)均大于全眼像差,差异有统计学意义(P<0.05);高度近视患者全眼、角膜前表面的总RMS均高于中度、低度近视患者,且中度近视患者高于低度近视患者,差异有统计学意义(P<0.05)。相关性分析结果显示,IOP与低度、中度近视患者的全眼和角膜前表面球差均呈强正相关(P<0.01),与高度近视患者的全眼球差呈强正相关(P<0.01);IOPg与低度、中度、高度近视患者的全眼球差均呈强正相关(P<0.01),与中度近视患者的角膜前表面球差呈强正相关(P<0.01);IOPcc与低度、中度近视患者的全眼球差呈正相关(P<0.05);CRF、CH均分别与低度、中度近视患者的全眼和角膜前表面球差呈正相关(P<0.05),与高度近视患者的全眼球差呈正相关(P<0.05)。结论近视患者的全眼像差通常小于角膜前表面像差,IOP、IOPg、IOPcc均与全眼球差存在相关性,且低度近视患者角膜生物力学参数与高阶像差的相关性强于中度、高度近视患者。

SMILE术后患者早期角膜生物力学变化与角膜体积变化、角膜高阶像差变化之间的关系

目的探讨飞秒激光小切口角膜基质透镜取出术(SMILE)术后患者早期角膜生物力学的变化,分析角膜生物力学变化与角膜体积变化、角膜高阶像差变化之间的关系。方法选取2021年1月至8月在佛山市第二人民医院视光学中心拟行SMILE的近视及近视散光患者72例(72眼)作为研究对象,取患者的右眼作为观测眼。术前和术后3个月分别应用新一代Corvis ST测量患者角膜生物力学新型参数[非接触生物力学校正眼压(bIOP)、2 mm处变形幅度的比值(DA ratio)、综合半径(IR)、最薄点厚度/厚度变化率(ARTh;用来评估角膜的形态和质量)、第一次压平时角膜硬度参数(SP-A1)、Corvis生物力学指数(CBI)和应力和应变参数(SSI)];应用Pentacam测量患者角膜生物力学参数,包括:角膜体积(CV_(3 mm)、CV_(5 mm)、CV_(7 mm)和CV_(10 mm));全角膜、角膜前表面、角膜后表面总均方根[RMS(Cornea、CF、CB)];全角膜、角膜前表面、角膜后表面高阶像差均方根[RMS HOA(Cornea、CF、CB)]。采用配对t检验或Wilcoxon符号秩检验分析各项参数的变化;采用偏最小二乘回归分析和Spearman相关性分析研究SMILE术后角膜生物力学新型参数变化量与角膜体积变化量、角膜高阶像差参数变化量之间的相关性。结果术后3个月,患者角膜bIOP、ARTh、SP-A1和SSI较术前明显下降;DA^(ratio)、IR和CBI较术前明显升高,差异均有统计学意义(均为P<0.05)。术后3个月,患者角膜CV_(3 mm)、CV_(5 mm)、CV_(7 mm)和CV_(10 mm)均较术前显著降低,差异均有统计学意义(均为P<0.05)。角膜体积变化量从小到大依次为CV_(3 mm)、CV_(5 mm)、CV_(7 mm)、CV_(10 mm),越往周边减少量增加。术后3个月,患者RMS(Cornea、CF、CB)、RMS HOA(Cornea、CF、CB)均较术前显著增加,差异均有统计学意义(均为P<0.05);相对于角膜前表面高阶像差的变化,角膜后表面高阶像差的变化相对稳定。相关分析结果显示,△ARTh与△CV_(3 mm)、△CV_(5 mm)均呈正相关,与△CV_(10 mm)呈负相关(均为P<0.05);△bIOP与△CV_(3 mm)、△CV_(5 mm)、△RMS HOA(CF)、△RMS HOA(Cornea)均呈负相关,与△CV_(10 mm)呈正相关(均为P<0.05);△IR与△CV_(10 mm)呈负相关(P<0.05);△SP-A1与△CV_(10 mm)呈正相关(P<0.05);△CBI与△CV_(3 mm)、△CV_(5 mm)均呈负相关,与△CV_(10 mm)、△RMS(CF)均呈正相关(均为P<0.05)。结论SMILE术后患者早期角膜生物力学发生了一些变化,这些角膜生物力学变化与不同区域角膜体积变化、角膜高阶像差参数变化存在一定的相关性。

不同程度近视患者行SMILE术后的有效光学区及角膜高阶像差比较

目的:比较低、中、高度近视患者行飞秒激光小切口基质透镜取出术(SMILE)后的有效光学区和角膜高阶像差。方法:收集2019-02/2021-02在我院行SMILE手术的患者134例,均取右眼入组,按等效球镜度(SE)分为低度近视组SE>-3.00 D,中度近视组-6.00 D<SE≤-3.00 D,高度近视组SE≤-6.00 D三组,分别于术前和术后1 mo行Pentacam检查,分析各组内手术前后角膜总高阶像差(tHOA)、球差、彗差有无差异,及术后三组间角膜总高阶像差、球差、彗差及有效光学区大小(EOZ)有无差异。结果:SMILE术后1 mo,三组术后有效光学区均小于预设光学区,随着屈光度数增加,有效光学区越小(P<0.05);术后1 mo角膜总高阶像差、球差、彗差均高于术前,除低近视度组球差术前与术后1 mo无差异(P>0.05),其余组别均有差异(P<0.05);角膜总高阶像差、球差和彗差随着屈光度数增加而增加,三组角膜总高阶像差和球差有差异(均P<0.05),高度近视组与中度近视组、低度近视组彗差结果均有差异(P<0.05),中度近视组与低度近视组彗差结果无差异(P>0.05)。结论:随着手术矫正的屈光度数增加,术后有效光学区减少越多,角膜高阶像差增加越明显;SMILE术后1 mo角膜高阶像差较术前增加。

Changes in visual performance after implantation of different intraocular lenses

AIM:To evaluate the trending visual performance of different intraocular lenses(IOLs)over time after implantation.METHODS:Ninety-one patients received cataract surgery with implantations of monofocal(Mon)IOLs,segmental refractive(SegRef)IOLs,diffractive(Dif)IOLs,and extendeddepth-of-focus(EDoF)IOLs were included.The aberrations and optical quality collected with iTrace and OQAS within postoperative 6mo were followed and compared.RESULTS:Most of the visual parameters improved over the postoperative 6mo.The postoperative visual acuity(POVA)of the Mon IOL,SegRef IOL,and EDoF IOL groups achieved relative stability in earlier states compared with the Dif IOL group.Nevertheless,the overall visual performance of the 3 IOLs continued to upturn in small extents within the postoperative 6mo.The optical quality initially improved in the EDoF IOL group,then in the Mon IOL,SegRef IOL,and Dif IOL groups.POVA and objective visual performance of the Mon IOL and EDoF IOL groups,as well as POVA and visual quality of the Dif IOL group,improved in the postoperative 1mo and stabilized.Within the postoperative 6mo,gradual improvements were observed in the visual acuity and objective visual performance of the SegRef IOL group,as well as in the postoperative optical quality of the Dif IOL group.CONCLUSION:The visual performance is different among eyes implanted with different IOLs.The findings of the current study provide a potential reference for ophthalmologists to choose suitable IOLs for cataract patients in a personalized solution.

飞秒激光小切口角膜基质透镜取出术治疗近视性屈光参差

目的:探讨飞秒激光小切口角膜基质透镜取出术(SMILE)治疗近视性屈光参差的临床效果。方法:回顾性分析2021-01/2022-12于本院行SMILE或FS-LASIK治疗的近视性屈光参差患者76例146眼的临床资料,根据手术方式分为SMILE组(39例77眼)和FS-LASIK组(37例69眼)。比较两组患者术后1 wk,1、3 mo裸眼视力(UCVA)、屈光度、屈光参差度、角膜像差及术后并发症发生情况。结果:两组患者术后UCVA均较术前改善,彗差、三叶草、球差、总高阶像差均较术前显著增加(P<0.05),且FS-LASIK组患者彗差、三叶草、球差、总高阶像差显著高于SMILE组(P<0.05)。随访至术后3mo,SMILE组术后并发症发生率显著低于FS-LASIK组(5.2%vs 15.9%,P<0.05)。结论:SMILE与FS-LASIK均可有效提高近视性屈光参差患者UCVA,改善视觉质量,但SMILE术后角膜高阶像差更低、并发症发生率更小,整体效果更好。

Scheimpflug imaged corneal changes on anterior and posterior surfaces after collagen cross-linking

AIM:To compare the anterior and posterior corneal parameters before and after collagen cross-linking therapy for keratoconus.METHODS:Collagen cross-linking was performed in31 eyes of 31 keratoconus patients(mean age 30.6±8.9y).Prior to treatment and an average 7mo after therapy,Scheimpflug analysis was performed using Pentacam HR.In addition to corneal thickness assessments,corneal radius,elevation,and aberrometric measurements were performed both on anterior and posterior corneal surfaces.Data obtained before and after surgery were statistically analyzed.RESULTS:In terms of horizontal and vertical corneal radius,and central corneal thickness no deviations were observed an average 7mo after operation.Corneal higher order aberration showed no difference neither on anterior nor on posterior corneal surfaces.During follow-up period,no significant deviation was detected regarding elevation values obtained by measurement in mm units between the 3.0-8.0 mm-zones.CONCLUSION:Corneal stabilization could be observed in terms of anterior and posterior corneal surfaces,elevation and higher order aberration values 7mo after collagen cross-linking therapy for keratoconus.