Background Postoperative ametropia, especially large astigmatism after deep anterior lamellar keratoplasty (DALK) for keratoconus often results in poor visual acuity.Though postoperative ametropia can be corrected by wearing glasses or performing corneal refractive surgery, the visual quality of patients is still poor, and the operations are difficult to implement because of insufficient corneal thickness.Toric intraocular collamer lens (TICL) implantation appears to have good corrective efficacy on severe astigmatism,but the research on the eyes after DALK is still less.Objective This study was to evaluate the efficacy and safety of TICL implantation for the ametropic eyes following DALK for keratoconus.Methods This study protocol was approved by Ethic Commission of Nanjing Drum Tower Hospital,and written informed consent was obtained from each patient prior to any medical procedure.A self-controlled serial observational research was carried out.Eight ametropic eyes of 8 patients who received the DALK for keratoconus before 18 months were enrolled in Nanjing Drum Tower Hospital from August 201 1 to March 2012, with the spherical diopter range from 0 D to-7.5 D and cylindrical diopter range from-2.5 D to-6.0 D.TICL implantation was performed on the eyes.The eye examinations were carried out before surgery and 1 week,3 months,6 months, 1 year and 2 years after surgery,including uncorrected visual acuity (UCVA) ,best corrected visual acuity (BCVA) ,comprehensive optometry, corneal astigmatism degree, the central corneal thickness and anterior chamber depth (ACD), corneal endothelial cell counts (ECD) ,intraocular pressure.The examination outcomes were compared before and after surgery.The intraoperative and postoperative complications were observed to evaluate the safety of TICL implantation for the ametropic eyes following DALK for keratoconus.Results The UCVA and BCVA were obviously improved at 6 months after TICL implantation in comparison with before surgery and maintained stable during the follow-up duration.The mean spherical diopter was from-0.5 D to-1.0 D and the mean cylindrical diopter was from-0.5 D to-2.0 D after surgery.The corneal endothelial cell counts were (2 520.2 ± 307.2) , (2 496.2 ± 306.2) , (2 469.6±304.5) , (2 432.0 ± 305.4), (2 383.4 ± 309.4)/mm2, and the intraoeular pressures were (14.57 ± 3.75), (16.62±4.21), (16.57±3.56), (15.66±3.37), (15.13±3.48) mmHg, showing insignificant differences among different time points (F =0.375,P =0.825;F =9.871, P =0.394).No significant differences were found in mean ACD and intraocular pressure between before and after surgery (t =1.56 ,P =0.16).The axial deviation of TICL was less than 10° in all the operated eyes 6 months after surgery.No intraoperative and postoperative complications were found during the follow-up duration.Conclusions TICL implantation is a safe and effective alternative and viable approach to myopic and astigmatism patients following DALK for keratoconus.

Objective:To compare the one-year postoperative visual quality after trifocal intraocular lens (IOL) implantation and monofocal IOL implantation.Methods:A cohort study was conducted.Forty-one eyes from 41 age-related cataract patients who underwent phacoemulsification extraction combined with IOL implantation in Nanjing Drum Tower Hospital from May 2017 to June 2018 were enrolled.The patients were divided into trifocal IOL group (20 eyes) receiving ZEISS AT LISA tri 839MP trifocal IOL implantation and monofocal IOL group (21 eyes) receiving ZEISS 603P monofocal IOL implantation according to their willingness.One year after surgery, uncorrected distant visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), best corrected distance visual acuity (BCDVA), distance corrected intermediate visual acuity (DCIVA) and distance corrected near visual acuity (DCNVA) were detected in both groups.The patient point spread function (PSF), modulation transfer function (MTF) cutoff frequency, Strehl ratio (SR), OQAS Ⅱ values at 100%, 20%, and 9% contrast (OV 100%, OV 20%, OV 9%) and objective scattering index (OSI) were measured by OQAS Ⅱ.Wavefront aberrations including total aberration (TA), total high order aberrations (tHOAs), spherical aberration, coma, trefoil aberration, total low order aberrations (tLOAs), defocus, and astigmatism were evaluated with the iTrace visual function analyzer.All aberrations were represented by root mean square.The visual acuity of operative eyes was measured with a phoropter, and defocus curves were drawn with visual acuity better than 0.5 LogMAR.The incidence of posterior capsular opacification (PCO) in the IOL region was quantitatively analyzed by Sellman method.Visual function was scored by visual function index (VF-14). This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School (No.2018-219-01). Written informed consent was obtained from each subject prior to any medical examination.Results:One year after the operation, UCIVA, UCNVA, DCIVA, and DCNVA of trifocal IOL group were significantly better than those of monofocal IOL group, and the differences were statistically significant (all at P<0.001). OQAS Ⅱ visual quality indicators showed that the MTF cutoff frequency, SR, OV 100%, and OSI values of trifocal IOL group were significantly higher than those of monofocal IOL group, showing statistically significant differences (all at P<0.001). No significant difference in wavefront aberrations was found between the two groups (all at P>0.05). Defocus curve showed that the LogMAR visual acuity of patients at -1.0 D, -1.5 D, -2.0 D, -2.5 D, -3.0 D, and -3.5 D (namely, 1 m, 66 cm, 50 cm, 40 cm, 33 cm, and 29 cm) in monofocal IOL group were significantly better than those in trifocal IOL group (all at P<0.05). There was a higher incidence of PCO in trifocal IOL group than monofocal IOL group, with a statistically significant difference ( χ 2=41.0, P<0.001). The VF-14 score of trifocal IOL group was 87.99±1.09, which was significantly higher than 81.49±1.67 of monofocal IOL group ( t=10.301, P<0.001). Conclusions:One year after trifocal IOL implantation, the full range of vision, subjective and objective visual quality of eyes are better than eyes implanted with monofocal IOL.