Highest Graded Refractive Surgery e-Posters 2016

June 6, 2017

Outcomes of Intrastromal Corneal Ring Segment Implantation in Keratoconus Using an Easy, Self-Designed Nomogram
Authors: Rosa Elena Alvarado Villacorta, MD; William Robert Munoz Cruz, MD; Claudia Garcia, MD; FERNANDO Munayco

Purpose: To report the outcomes of intrastromal corneal ring segment (ICRS) implantation in patients with keratoconus using a new nomogram. Methods: Retrospective case series study of 22 patients (26 eyes) who underwent ICRS implantation using the manual technique from July 2014 to July 2015. A self-designed decision-making nomogram was used. Results: Three months postoperatively, the mean UCVA increased significantly (P < .01) from 1.21 ± 0.71 to 0.69 ± 0.31 logMAR, and the mean BCVA increased from 0.63 ± 0.32 to 0.30 ± 0.16 logMAR (P < .01). Eighty-one percent gained 1 to 11 lines of BCVA. No patient lost lines of visual acuity. All K readings decreased significantly (P < .01): steep K, from 55.94 ± 4.05 to 47.17 ± 3.17 D; mean K, from 52.79 ± 4.06 to 45.52 ± 3.03 D; and maximum K, from 60.20 ± 5.365 to 51.86 ± 3.95 D. Conclusion: This new nomogram improves the outcomes in patients with keratoconus.

Changes in Corneal Density After Accelerated Corneal Collagen Crosslinking With Different Irradiation Intensities and Energy Exposures: One-Year Follow-up
Authors: Ebru Toker MD; Semra Turhan

Purpose: To determine and compare the changes in corneal density following two different protocols of accelerated corneal collagen crosslinking (A-CXL) in patients with progressive keratoconus. Methods: Patients assigned to Group A (44 eyes) received A-CXL using continuous UVA light exposure at 9 mW/cm2 for 10 minutes (total energy dose of 5.4 J/cm2), and Group B (27 eyes) received A-CXL using continuous UVA light exposure at 30 mW/cm2 for 4 minutes (total energy dose of 7.2 J/cm2). Corneal density was measured with Scheimpflug topography at 1, 3, 6, and 12 months of follow-up. Results: Compared to preoperative values, corneal density significantly increased at 1 month and decreased over time in both groups. The mean increase in corneal densitometry tended to be higher in Group B than in Group A at 1 month (P = .05). At 12 months, while densitometry returned completely to baseline values in Group B, it was slightly higher than preoperative values in Group A. Conclusions: High-energy exposure may tend to induce more haze at the early post-treatment period, but it is reversible.

Five-Year Follow-up of Small-Incision Lenticule Extraction Procedure for the Correction of Astigmatism
Authors: Edgar Adrian Gonzalez, MD; Arturo J Ramirez-Miranda MD; Alejandro Navas MD; Enrique O Graue Hernandez MD

Purpose: To evaluate the visual and refractive outcome of 110 eyes treated with small-incision lenticule extraction (SMILE ) in patients with myopic astigmatism. Methods: A SMILE procedure was performed. Outcome measures were corrected distance (CDVA) and uncorrected distance (UDVA) visual acuity; induced torsion and achieved corrections of sphere and cylinder were determined. Results: 110 eyes of 56 patients received = 2.0 D astigmatic correction. Preoperative mean spherical equivalent was -6.25 D, 3.27 SD, and 5-year postop spherical equivalent was +0.24 D, 0.45 SD. Refractive stability was achieved within 6 weeks. Forty-eight months after surgery, 97% of all cases had a UDVA of 20/25 or better. Conclusion: SMILE appears to be a predictable and effective procedure to treat myopic astigmatism; a small, significant undercorrection of the astigmatic error is present, specially in astigmatism over 3.0 D.

Performance of a Videokeratography-Based Artificial Intelligence System in Detecting Keratoconus and Keratoconus Suspect
Authors: Mujtaba A Qazi MD; Alain Saad MD; Abu-Bakar Zafar, MD; Ashraf M Mahmoud; Damien Gatinel MD; Cynthia Roberts PhD; Jay Stuart Pepose MD PhD

Purpose: To assess the efficacy of corneal indices derived from slit-scanning videokeratography (Orbscan), including the SCORE Analyzer, to differentiate populations with a clinical diagnosis of normal (NRM), suspect keratoconus (KCS), and keratectasia (KCN). Methods: Previously published indices and algorithms, including SCORE and the Cone Location and Magnitude Index (CLMI), derived from Orbscan curvature, elevation, and pachymetry maps, were calculated and statistically compared for a retrospective data set. Results: KCN (mean thinnest optical pachymetry 482.6 ± 56.0 µm) and KCS (514.3 ± 37.7 µm) had significantly higher SCORE (14.4 ± 9.7 and 0.6 ± 2.0, P < .01) than NRM (543.1 ± 34.9, SCORE -1.2 ± 1.1). 66.7% of preoperative Orbscans of eyes that developed ectasia after LASIK were correctly screened using SCORE, compared to 50% with the I-S Index. Conclusion: Evaluation of keratoconus and suspect corneas highlights the importance of combining curvature, elevation, and pachymetry indices for the preoperative screening of keratorefractive surgery candidates.

Functional Evaluation of 3 Different IOL Designs
Authors: Mary Attia MBBCH; Ramin Khoramnia, MD; Tanja M Rabsilber MD; Mike P Holzer MD; Gerd U Auffarth MD

Purpose: Evaluation of 3 IOLs for visual and reading performance and quality of life. Methods: Eighty-eight eyes received a bifocal, a trifocal, or extended-depth-of-focus (EDOF) IOL. Postoperatively, distance, intermediate, and near visual acuity (VA), preferred near and intermediate reading distance, and a patient questionnaire were evaluated. Results: Near VA was higher in the bifocal group, followed by the trifocal, then the EDOF group. Intermediate VA showed the opposite. Preferred intermediate reading distance was ~65 cm with comparable acuities among bi- and trifocal IOLs. There was no statistically significant difference between the groups regarding the perception of halos. Conclusion: No IOL was better in all aspects. The IOL has to fit the patient’s lifestyle.

Visual and Patient-Reported Outcomes Following Implantation of the Tecnis Symfony IOL in a Large Consecutive Series
Author: Steven C Schallhorn MD

Purpose: To assess outcomes following refractive lens exchange (RLE) with a Tecnis Symfony IOL. Methods: A 3-month retrospective analysis of consecutive patients who underwent RLE with the Symfony IOL. Results: There were 2018 eyes of 1211 patients treated, and 97% achieved binocular uncorrected distance VA = 20/25 and 85% achieved uncorrected near VA = 20/40. Ninety-one percent of patients would recommend the procedure. While 4%, 2%, and 1% of patients reported severe difficulty with haloes, glare, and ghosting, respectively, there was a significant mean postop–preop improvement in vision-reported distant and near activities. Conclusion: A small number of patients had quality of vision symptoms 3 months after the Symfony IOL; however, there was a significant improvement in unaided vision as well as quality of life for distant and near activities.

Visual Outcome and Patient Satisfaction Using a Novel Extended-Depth-of Focus IOL
Author: John Allan Vukich MD

Purpose: To evaluate unaided acuity at a range of distances with extended-depth-of-focus IC-8 IOL. Methods: 102 patients had monocular implantation of the IC-8 IOL in the nondominant eye with contralateral implantation of an aspheric monofocal IOL. At 3-month follow-up (N = 63), binocular unaided acuity at far (UDVA), intermediate (UIVA), and near (UNVA) were analyzed. Results: Mean binocular UDVA was -0.03 ± 0.14 logMAR (20/18); UIVA, 0.03 ± 0.10 (20/21); and UNVA, 0.17 ± 0.11 (20/29). 100% of patients had 20/40 or better for distance and intermediate and 95.3% at near. Mean glare score was 1.5 ± 1.1, and halo was 1.1 ± 1.5 (out of 5). 96.7% would do the procedure again. Conclusion: The IC-8 provides good unaided acuity at a continuous range of distances.

Long-term Follow-up of Central Flow Toric Implantable Collamer Lens Implantation
Authors: Valeria Susana Oliva IV ; Eduardo Martinez, MD; Alejandro Navas MD; Aida Jimenez; Alejandro A Lichtinger, MD; Arturo J Ramirez-Miranda MD; Enrique O Graue Hernandez MD

Purpose: To evaluate outcomes of toric phakic implantable collamer lens (ICL) V4c for moderate to high myopic astigmatism. Methods: Prospective study includes 99 eyes of 53 patients who underwent toric ICL V4c. We assessed visual outcomes, refraction, safety, efficacy, predictability, stability, IOP, vaulting, and endothelial cell density (ECD). Results: Mean preoperative uncorrected distance VA (UDVA) was 1.5 (logMAR); corrected distance VA (CDVA) was 0.18 (logMAR); spherical equivalent (SE) was -11.4 D. After 2-year follow-up, average UDVA was 0.17 (logMAR); SE was -0.82 D and refractive cylinder was -1.07; these changes were statistically significant. CDVA, IOP, and vaulting did not show significant differences. Paired t test was used. Conclusion: Toric ICL V4c implantation showed very good results for moderate to high myopic astigmatism.

Internal Aberrations, Strehl Ratio, Modulation Transfer Function, and Corneal Aspheric Function After Femtosecond Laser–Assisted Cataract Surgery
Authors: Neelam Pawar; Dr Meenakshi; Rengaraj Venkatesh, MBBS; Rengappa Ramakrishnan MD; Devendra Maheshwari, DOMS; Shivkumar Chandrashekharan

Purpose: To compare high-order aberrations, Strehl ratio, modulation transfer function (MTF), and corneal aspheric function after femtosecond laser–assisted cataract surgery and traditional phacoemulsification. Methods: In a prospective study, 32 eyes of femtosecond laser–assisted cataract surgery (FLACS) and 40 eyes of traditional phacoemulsification were studied. Wavefront aberrometry and visual quality were measured using the iTrace (Hoya Ltd). Main outcomes included total internal aberrations, Strehl ratio, MTF, and corneal aspheric function. Results: No statistically significant differences were found between corneal aspheric function measurements. The FLACS group had significantly lower values of coma and significantly higher Strehl ratios (P = .041) and MTF values at 5, 10, 15, 25, and 30 cycles per degree (P = .0013, P = .02, P = .034, P = .033, and P = .044, respectively). Conclusion: FLACS induces significantly less internal aberrations and higher MTF performance compared to traditional phacoemulsification.