PURPOSE: To evaluate the efficacy of epithelium-on photorefractive intrastromal crosslinking (PiXL), a noninvasive procedure to reduce refractive error in patients with low hyperopia. SETTING: Gemini Eye Clinic, Zlin, Czech Republic. DESIGN: Prospective single-center study. METHODS: Twenty-two low hyperopic eyes were enrolled and underwent PiXL treatment according to a standardized treatment protocol. Visual acuity, subjective distance refraction, keratometry, topography, pachymetry, subjective discomfort, and endothelial cell density (ECD) were recorded during 12-month follow-up. RESULTS: In 22 eyes, the median manifest refraction decreased significantly (P < .0001) from +0.75 diopters (D) (interquartile range [IQR], +0.63 to +1.06 D), median and IQR) diopters (D) preoperatively to +0.25 D (IQR, 0.0 to +0.50 D) at 12-month follow-up and remained stable. Seventy-seven percent of eyes achieved refraction within ± 0.50 D of emmetropia by 1 month postoperatively and was stable through 12-month follow-up. ECD was stable and did not show significant changes. There was low incidence of postoperative pain and dry eye. CONCLUSIONS: PiXL is a promising alternative to conventional laser refractive surgeries for low hyperopia. Further studies are warranted to optimize treatment parameters for a wider range of refractive errors and to evaluate the potential to improve precision.
- MeSH
- fotochemoterapie metody MeSH
- fotosenzibilizující látky terapeutické užití MeSH
- hypermetropie farmakoterapie metabolismus patofyziologie MeSH
- kolagen metabolismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- pachymetrie rohovky MeSH
- pilotní projekty MeSH
- prospektivní studie MeSH
- reagencia zkříženě vázaná * MeSH
- refrakce oka fyziologie MeSH
- riboflavin terapeutické užití MeSH
- senioři MeSH
- stroma rohovky účinky léků metabolismus MeSH
- ultrafialové záření MeSH
- výsledek terapie MeSH
- zraková ostrost fyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- fotosenzibilizující látky MeSH
- kolagen MeSH
- reagencia zkříženě vázaná * MeSH
- riboflavin MeSH
AIM: To evaluate late postoperative complications, especially cataract occurrence, its morphological type and factors affecting its development in patients implanted with ICL (Implantable Collamer Lens). METHODS: We analysed the results of ICL implantation in 34 patients (type ICM V4 for myopia, ICH V3 for hyperopia, TICM V4 for astigmatism) in our department between 1998 and 2013. The cohort comprised 62 eyes (40 myopic and 22 hyperopic). Seven eyes with a toric ICL implanted were included in these groups according to spherical equivalent (SE). The average follow-up period was 10.5 ± 3.5 years. We examined uncorrected and best-corrected visual acuity (UCVA and BCVA), SE, ICL vaulting (using anterior segment OCT) and occurrence of late postoperative complications, especially cataract formation in 2 groups of patients - myopes and hyperopes. RESULTS: Among the most common late postoperative complications were pigment dispersion syndrome in 27 eyes, 43.5% (12 myopic eyes and 15 hyperopic eyes) and cataract formation. Lens opacities, including opacities without loss of BCVA, were observed in 18 eyes (29%). Opacities affecting visual acuity were observed in 10 eyes (16.1%). Cataract significantly affecting visual acuity occurred in 7 eyes, i.e. 11.3% (5 myopic eyes and 2 hyperopic eyes). In these eyes, ICL removal and cataract surgery with implantation of posterior chamber intraocular lens (PC IOL) was performed. The most common morphological type of cataract were anterior subcapsular opacities (83.3%), the average time of onset was 3.4 ± 1.9 years after ICL implantation. We did not prove a statistically significant association either between cataract occurrence and age at the time of surgery, or between cataract occurrence and higher preoperative spherical equivalent. We did not prove a significant association between cataract occurrence and low vault, however in 7 eyes after cataract surgery and ICL removal we do not know the vault values. In one eye uveitis with cystoid macular oedema was observed, in two highly myopic eyes repeated ICL dislocation and cataract occurred. In both of these cases the ICL was removed. CONCLUSIONS: According to our experience, implantation of ICL in moderate and high ametropia was relatively safe upon assessing the long-term outcomes. Among the most common complications were pigment dispersion syndrome and anterior subcapsular cataract formation. Cataract can be managed effectively surgically with good refractive outcomes without loss of BCVA. However, loss of accommodation after cataract surgery and risk of vitreoretinal complications must be considered.Key words: ICL (Implantable Collamer Lens), posterior chamber phakic intraocular lens, refractive surgery, cataract occurrence.
- MeSH
- hypermetropie * MeSH
- implantace nitrooční čočky * MeSH
- incidence MeSH
- katarakta * terapie MeSH
- lidé MeSH
- myopie * MeSH
- následné studie MeSH
- nitrooční čočky * MeSH
- pooperační komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: To evaluate long-term refractive outcomes of implantable collamer lens (ICL) implantation and late postoperative complications. METHODS: We assessed outcomes of patients who underwent ICL implantation (type ICM V4 for myopia, ICH V3 for hyperopia, TICM V4 for astigmatism) in our department between 1998 and 2013. It comprised 62 eyes (40 myopic and 22 hyperopic). The average follow-up period was 10.5 years. We evaluated: uncorrected and best-corrected visual acuity (UCVA and BCVA), spherical equivalent (SE), ICL vault, endothelial cell density and late postoperative complications. RESULTS: In myopes, the average UCVA was 1.0±0.37 and BCVA 1.18±0.38, in hyperopes 0.78±0.19 and 1.14±0.18, respectively. The average SE in myopes, whose target refraction was emmetropia, was -0.6±0.83 Dsf, in hyperopes +0.73±0.93. Central ICL vault was 206.16μm±105.94, (range 10-427) in myopes, 195.5μm±109.09, (range 20-404) in hyperopes. The most common late postoperative complication was cataract formation. Three myopic eyes (7.5%) developed symptomatic anterior subcapsular opacities with loss of at least two lines of BCVA. Cataract significantly affecting visual acuity occurred in 5 myopic eyes (12.5%) and 2 hyperopic eyes (9.09%). In these eyes, ICL removal and cataract surgery was performed. CONCLUSIONS: In our experience, ICL implantation in moderate and high ametropia was effective and relatively safe. The most common late complication was cataract formation. This complication can be managed effectively surgically with good refractive outcomes without loss of BCVA.
- Klíčová slova
- Chirurgie réfractive, ICL, Implant phaque intra-oculaire de chambre postérieure, Implantable collamer lens, Implantable collamer lens (ICL), Posterior chamber phakic intraocular lens, Refractive surgery,
- MeSH
- dospělí MeSH
- fakické nitrooční čočky * škodlivé účinky MeSH
- hypermetropie diagnóza chirurgie MeSH
- implantace nitrooční čočky škodlivé účinky metody MeSH
- lidé MeSH
- mladý dospělý MeSH
- myopie diagnóza chirurgie MeSH
- následné studie MeSH
- pooperační komplikace etiologie MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
UNLABELLED: We report the first experience with presbyopia correcting femtosecond laser surgical procedure INTRACOR. This procedure is so far the only one that is made purely intrastromally without generating a wound connected to corneal surface or anterior chamber.Presbyopia - caused by physiological aging and decreasing elasticity of the lens, impairs patients accommodative ability. In the case of the method INTRACOR, presbyopia is corrected by steepening of corneal curvature in the central optical zone. Procedure is usually performed only in the non-dominant eye. METHODS: Intracor procedure was performed in 10 eyes of 10 patients (3 women and 7 men, aged 47-58 years). All procedures were performed with the femtosecond laser VICTUS (Bausch - Lomb, USA) in the non-dominant eye by an experienced surgeon. RESULTS: One-year follow-up. Mean monocular uncorrected near visual acuity (UNVA) improved from 0.2 ± 0.1 before surgery to 0.7 ± 0.3 after treatment (mean improvement of four lines). Mean near uncorrected binocular visual acuity (UNBVA) improved from a mean preoperative value of 0.23 ± 0.08 to a mean postoperative value of 0.8 ± 0.22 (mean improvement of about 5 lines). The mean monocular uncorrected distance visual acuity (UDVA) was 0.9 ± 0.1 before surgery and 0.8 ± 0.3 after treatment (average loss of 1 line). The mean binocular uncorrected distance visual acuity improved from 1.0 ± 0,1 to 1,3 ± 0.3 after surgery. All patients had improvements in near vision. In 3 patient, monocular distance vision improved, in 6 patient improved binocular distance vision. We observed statistically significant decrease (mean loss of 1 line) of monocular best corrected distance visual acuity (BCDVA). Patients subjectively reported satisfaction with the quality of vision achieved for near and distance and high levels of spectacle independence under good lighting conditions.The results shows that INTRACOR method is well suitable for low hyperopic patients, who because of good distance visual acuity are not good candidates for refractive lens exchange with multifocal intraocular lens implantation. KEY WORDS: presbyopia, Intracor, intrastromal, femtosecond laser.
- MeSH
- hypermetropie MeSH
- laserová chirurgie rohovky metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- optická koherentní tomografie MeSH
- presbyopie patofyziologie chirurgie MeSH
- prospektivní studie MeSH
- rohovková topografie MeSH
- spokojenost pacientů MeSH
- vidění binokulární fyziologie MeSH
- výsledek terapie MeSH
- zraková ostrost fyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The study describes cases of patients screened for worse vision and headaches. We are trying to point out we can measure minus diopters even at latent hypemetropes. These patients come to a doctor for a variety of problems that may be caused by inadequate correction of ametropia. It is necessary to know about this possibility, and rather perform cycloplegia in sporadic cases. METHODS: Patients were measured at autorefractometer without mydriasis, and then after using UNITROPIC 1% or CYCLOGYL 1%. Both of these substances induce cycloplegia. Visual acuity with the best correction was tested with and without cycloplegia. RESULTS: After cycloplegia, a significant change in both objective and subjective refraction was detected in most of the selected patients. This change was within the meaning of a shift to hyperopia. Subsequent adjustment correction led to resolving of problems. CONCLUSION: The work should highlight the necessity of an individual approach of prescription of the best correction. Not always an autorefractometer gives correct information, the real-needed correction is completely different in some cases.
- MeSH
- bolesti hlavy etiologie terapie MeSH
- brýle MeSH
- dospělí MeSH
- hypermetropie komplikace diagnóza terapie MeSH
- lidé MeSH
- mladý dospělý MeSH
- myopie komplikace diagnóza terapie MeSH
- zraková ostrost * MeSH
- zrakové testy MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: The aim of this work is to compare the findings of keratometric values and their differences at various ametropias. The eccentricity of the cornea in the sense compared to the possible influence of refraction of the eye is topographically observed. Groups of myopia, hyperopia and emmetropia are always represented 100 subjects, i.e. 600 eyes. The results of these measurements are mutually compared and statistically processed. METHODS: The studied cohort a total of 300 clients enrolled. To measure the steepest (r1) and flattest meridian (r2) and to determine corneal eccentricity was used autorefraktokeratometer with Placido disc (KR 8100P, Topcon, Japan). The obtained data were processed with appropriate software and statistically evaluated. RESULTS: Group A consisted of 100 myopes (n = 200), 35 men and 65 women, average age 37.3 +/- 18.7 years (min. 10 years, max. 87 years). Objective refractive error - sphere: - 2.9 +/- 2.27 D (min.-0.25 D, -14.5 D max), cylinder: -0.88 +/- 0.75 D (min. -0.25 D, up to -5.0 D). Keratametry in this group is as follows: radius of curvature of the cornea in the front area of the steepest meridian 7.62 +/- 0.28 mm (min. 6.96 mm, max. 8.44 mm) and the flattest meridian is 7.76 +/- 0.3 mm (min. 7.08 mm, max 8.75 mm). The mean eccentricity was 0.37 +/- 0.12 (min 0.00, max. 0.79). Group B consisting of 100 hyperopic subjects (n = 200), 40 men and 60 women, average age 61.6 +/- 15 years (min. 21 years, max 88 years). Objective refraction in this group -sphere: +2.71 +/- 1.6 D (at least +0.25 D, up to +9.0 D), cylinder: -1.0 +/- 0.9 D (min. -0.25 D, max. -5.75 D).Corneal surface curvature in two main sections according keratometric measurement looks as follows: the steepest meridian is 7.67 +/- 0.29 mm (min. 6.99 mm, max. 8.62 mm), the flattest meridian then 7.81 +/- 0.29 mm (min. 7.10 mm, max. 8.70 mm). The value of the median eccentricity for these hundred hyperopes is 0.37 +/- 0.14 (min. 0.00; max 0.86). The third group C consists of 100 emetropic subjects (n = 200), then clients without refractive errors who achieve without corrective aids Vmin = 1.0. This group is composed of 42 men and 58 women, mean age 41.4 +/- 17.8 years (min. 3 years, max. 82 years). Measured values of objective refraction - sphere: +0.32 +/- 0.47 D (at least -1.75 D, up to +1.5 D), cylinder: -0.28 +/- 0.45 D (min. -1.25 D, up to +1.25 D). Keratometry values measured at the corneal surface in two perpendicular cross-section are: steepest meridian corresponds to the radius of curvature of 7.72 +/- 0.26 mm (min. 6.91 mm, max. 8.32 mm), the flattest meridian reaches values 7.83 +/- 0.25 mm (min. 7.10 mm, max. 8.53 mm). The median eccentricity is represented by the observed values of 0.36 +/- 0.11 (min 0.00; max. 0.57). Due to the validity of the results from the groups as unsuitable respondents with corneal astigmatism greater than -1.0 D were subsequently eliminated. CONCLUSION: Keratometry as well as topography is one of the fundamental methods of measuring corneal front surface. Their proportions are essential for the proper parameters selection, especially with contact lenses as one of the possible means intended to correct refractive errors. The study subjects were not included in any load condition cornea, purulent conjunctivitis, blepharitis, after refractive surgery or other eye symptoms.
- MeSH
- dospělí MeSH
- emetropie * MeSH
- hypermetropie patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- myopie patologie MeSH
- rohovka patologie MeSH
- rohovková topografie * MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- srovnávací studie MeSH
The problems of mild and high hyperopia surgical correction are complicated and an individual approach is needed. The aim of the study was to evaluate long-term efficiency and safety of two types of refractive procedures in mild and high hyperopia correction: LASIK and ICL (phakic intraocular posterior chamber contact lens) implantation. The authors evaluated a group of 37 eyes of 20 patients; the average age was 36.3 years +/- 11.8 (SD) and the follow-up period was 28.1 months +/- 10.2 (SD) after LASIK procedure, and a group of 21 eyes of 13 patients; the average age was 28.6 years +/- 6.1 (SD) and the follow-up period 30.4 months +/- 20.9 (SD) after the ICL implantation. They compared occurrence of preoperative, intraoperative and postoperative complications in both methods. They specified the efficiency and safety of the procedure by means of so called efficiency and safety index. With a questionnaire they evaluated the patient's subjective satisfaction with the refractive procedure. In the group of hyperopic LASIK, they proved statistically significant appearance of the refractive error regression, number of performed re-operations, appearance of the peroperative decentration of the photoablation zone and induced astigmatism (p < 0.05). In the ICL group, the repeated preoperative sessions for Nd-YAG laser iridotomies were necessary. Postoperatively, the appearance of keratitis striata, syndrome of the late pigment dispersion, and glare were statistically significant (p < 0.05). The authors also demonstrated higher efficiency and safety of the ICL implantation method comparing to LASIK during the whole follow up period (p < 0.05), and also higher subjective satisfaction after ICL implantation. Comparing the intraocular procedure (ICL) to the laser method (LASIK), in mild and high hyperopia correction, the higher efficiency and safety was achieved by ICL implantation.
- MeSH
- dospělí MeSH
- hypermetropie chirurgie MeSH
- implantace nitrooční čočky * škodlivé účinky MeSH
- laserová modelace rohovky pod rohovkovou lamelou * škodlivé účinky MeSH
- lidé MeSH
- pooperační komplikace MeSH
- spokojenost pacientů MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- srovnávací studie MeSH
The problems of hyperopia surgical correction are complicated. The most used methods are corneal laser treatments (PRK and LASIK), phakic intraocular lenses or clear lens extraction (CLE). The aim of the study was to evaluate and to compare long-term postoperative results of two types of refractive procedures in mild and high hyperopia correction: LASIK and ICL (phakic intraocular posterior chamber contact lens) implantation. The authors evaluated a group of 37 eyes of 20 patients; the average age was 36.3 years +/- 11.8 (SD) and the follow-up period 28.1 months +/- 10.2 (SD) after LASIK procedure, and group of 21 eyes of 13 patients; the average age was 28.6 years +/- 6.1 (SD) and the follow-up period 30.4 months +/- 20.9 (SD) after the ICL implantation. The final uncorrected (UCVA) and best-corrected visual acuity (BCVA) and postoperative refractive error (for far and near) and their development in time were compared. They found statistically significant improvement of the UCVA postoperatively comparing to the preoperative values in both methods (LASIK and ICL) (p < 0.05). Better UCVA was achieved by means of ICL implantation (p < 0.05). The BCVA improved after the ICL implantation only (p > 0.05). In hyperopic LASIK, the final BCVA worsened comparing to this before treatment (p > 0.05). The BCVA changes were not statistically significant. The authors also proved better final spherical refraction for far (p < 0.05 in the first and second year) and for the near as well (p < 0.05 in the first and second year) in the ICL method comparing to the hyperopic LASIK. The stableness of the postoperative refraction was better after the ICL implantation during the whole follow up period. In the laser treatment, the continuous regression of the postoperative refraction was evident. The final cylindrical refraction value was also lower in the ICL group (p > 0.05). The stableness of the postoperative cylindrical refraction was also higher in the ICL method during the whole follow up period. Comparing the intraocular procedure (ICL) to the laser method (LASIK), the ICL implantation demonstrates better final BCVA and UCVA and the postoperative refraction is more stable.
- MeSH
- dospělí MeSH
- hypermetropie patofyziologie chirurgie MeSH
- implantace nitrooční čočky * MeSH
- laserová modelace rohovky pod rohovkovou lamelou * MeSH
- lidé MeSH
- refrakce oka MeSH
- zraková ostrost MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- srovnávací studie MeSH
AIM: To evaluate the results in patients with hypermetropia having undergone photoreactive keratectomy (PRK). GROUP AND METHODS: The authors present a retrospective analysis of the results in 40 eyes operated on PRK in the period of September 1997 to November 2002 at the Eye Clinic of the Faculty Hospital in Hradec Králové. The mean preoperation spherical refraction was 2.90 +/- 0.98 dioptry (D), the mean astigmatism being -0.82 +/- 0.78 D, visual uncorrected visual acuity (NZO) 0.37 +/- 0.37, the mean corrected visual acuity (KZO) 1.28 +/- 0.27). RESULTS: One year after the operation on 31 eyes, the resulting mean spherical refraction was 0.76 +/- 1.10 D, the mean astigmatism being -1.01 +/- 0.80 D, NZO 0.77 +/- 0.18, KZO 0.99 +/- 0.21, NZO 6/12 and better was detected in 94% of surgically treated eyes. CONCLUSION: The PRK method has been found sufficiently effective for the correction of low and medium hypermetropia.
PURPOSE: To evaluate and compare the efficacy, safety, predictability, and stability of laser-assisted subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK) for low to moderate hyperopia with a 2-year follow-up. SETTING: Department of Ophthalmology, Masaryk University Hospital, Brno, Czech Republic. METHODS: This prospective comparative single-surgeon study included 216 eyes of 108 patients with hyperopia who received PRK in 1 eye and LASEK in the contralateral eye. The mean patient age was 38.3 years (range 25 to 58 years). The mean preoperative spherical equivalent (SE) cycloplegic refraction was +3.67 diopters (D) +/- 1.15 (SD) (range +2.00 to +5.00 D), and astigmatism was less than 1.00 D. In each patient, PRK was performed in 1 eye (Group A) and LASEK was performed in the other eye (Group B) using the Nidek EC-5000 excimer laser. Postoperative uncorrected visual acuity (UCVA), best corrected visual acuity, contrast sensitivity, manifest and cycloplegic refractions, refractive stability and predictability, postoperative pain, and corneal haze were examined and statistically analyzed. A P value less than 0.05 was considered significant. RESULTS: At 1 week, the UCVA was 20/40 or better in 58% of PRK eyes and 85% of LASEK eyes (P =.037); at 2 years, it was 20/40 or better in 81% and 91%, respectively (P =.076). At 2 years, the UCVA for near was N8 or better in 73% of PRK eyes and 89% of LASEK eyes (P =.064). No patient lost 2 or more lines of Snellen visual acuity. The safety index was 1.03 in PRK eyes and 1.08 in LASEK eyes. Refractive stability was achieved at 6 months in LASEK eyes and at 12 months in PRK eyes. The mean SE cycloplegic refraction decreased from +3.58 D (PRK eyes) and +3.76 D (LASEK eyes) at baseline to +0.74 D and +0.32 D, respectively, at 2 years; in 57% and 78% of eyes, respectively, the refraction was within +/-0.50 D of the targeted refraction. Peripheral corneal haze scores at 3 to 9 months and pain scores at 1 to 3 days were significantly lower in the LASEK group than in the PRK group. CONCLUSIONS: Laser-assisted subepithelial keratectomy for hyperopia up to +5.00 D provided good visual and refractive results. It significantly reduced postoperative pain, grade of peripheral ring-shaped corneal haze, and regression of hyperopia. Hyperopic LASEK provided quicker visual recovery and achieved better efficacy, predictability, and refractive stability than hyperopic PRK.
- MeSH
- bezpečnost MeSH
- citlivost na kontrast fyziologie MeSH
- dospělí MeSH
- fotorefrakční keratektomie metody MeSH
- hojení ran MeSH
- hypermetropie patofyziologie chirurgie MeSH
- laserová modelace rohovky pod rohovkovou lamelou metody MeSH
- lasery excimerové MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- pooperační bolest MeSH
- prospektivní studie MeSH
- refrakce oka fyziologie MeSH
- rohovka patofyziologie chirurgie MeSH
- zraková ostrost fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- srovnávací studie MeSH
