OBJECTIVES: To compare the efficacy of toric implantable collamer lens (Toric-ICL) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia correction in patients with moderate to high myopia complicated with astigmatism. METHODS: We retrospectively collected data from 64 patients (aged 18-42 years) with moderate to high myopia complicated with astigmatism (128 eyes) undergoing either Toric-ICL (28 patients/56 eyes) or FS-LASIK (36 patients/72 eyes) at our department between January, 2019 and December, 2020. The changes of uncorrected distance visual acuity (UCVA), spherical equivalent (SE), mean astigmatism correction index (CI), corneal endothelial cell density (ECD) and intraocular pressure (IOP) following the procedures were compared between the two groups. RESULTS: In FS-LASIK group, all the eyes (72/72) achieved an UCVA≥1.0, similar to the rate in Toric-ICL group (55/56 eyes; P=0.2374). The postoperative SE was also comparable between FS-LASIK and Toric-ICL groups [0.43±0.06 D (range: -1.0 to 1.50 D) vs 0.38±0.05 D (range: -0.75 to 1.00 D); P=0.56]. The mean astigmatism CI was significantly higher in FS-LASIK group than in Toric-ICL group (0.8561 vs 0.7176; P<0.0001), and 88.89% of the eyes in FS-LASIK group and 69.64% in Toric-ICL group had postoperative astigmatism ≤0.50 D. No significant changes were observed in postoperative corneal ECD in FS-LASIK group, whereas ECD decreased significantly after the procedure in Toric-ICL group (P=0.0057). The patients undergoing Toric-ICL exhibited no significant changes of postoperative IOP, but the patients receiving FS-LASIK had significantly reduced IOP after the procedure (P<0.001). CONCLUSIONS Although the patients included in Toric-ICL group had higher myopia and astigmatism, Toric-ICL still showed better predictability and efficacy for astigmatic correction in Toric-ICL group. Toric-ICL is an effective and safe equivalent of FS-LASIK for correcting moderate myopia but can be more advantageous for correcting high myopia with astigmatism.
Humans ; Astigmatism/complications* ; Myopia/complications* ; Keratomileusis, Laser In Situ/methods* ; Retrospective Studies ; Adult ; Visual Acuity ; Adolescent ; Young Adult ; Treatment Outcome ; Male ; Lens Implantation, Intraocular/methods* ; Female ; Phakic Intraocular Lenses ; Intraocular Pressure

PURPOSE: To report the results of a new technique for intraocular lens scleral fixation of temporary haptic externalization and four-point fixation for enhanced stability. METHODS: Two 10–0 polypropylene strands were fixed at two points 2 mm apart on each haptic of a conventional three-piece intraocular lens, using our previously reported method of temporary haptic externalization after injector implantation. Postoperative refractive outcome and stability were evaluated. RESULTS: Although the intraocular lens was fixed at a total of four points, no intraoperative difficulties were observed during the process. Patients showed successful fixation of the intraocular lens postoperatively. The fixed intraocular lens showed good centering and minimal tilting. When compared to the two-point fixation technique, postoperative astigmatism was significantly smaller in the four-point fixation group (1.80 ± 0.84 vs. 1.00 ± 0.0.50, p = 0.033). Lens-induced astigmatism calculated from subtraction of corneal astigmatism from total astigmatism was also significantly smaller in the four-point fixation group (2.23 ± 0.98 vs.1.17 ± 0.0.70, p = 0.043). No postoperative complications were identified during a mean follow-up period of 14.8 months (range, 10 to 19 months). CONCLUSIONS: By fixing the intraocular lens at two points on each side of the haptics, this method minimizes the tilting of the intraocular lens and thus decreases postoperative lens-induced astigmatism. Also, the possibility of intraocular lens dislocation in the long term might be decreased by this two-point fixation technique.
Aphakia ; Astigmatism ; Cataract ; Dislocations ; Follow-Up Studies ; Humans ; Lens Subluxation ; Lenses, Intraocular ; Methods ; Polypropylenes ; Postoperative Complications

OBJECTIVE: To determine the safe distance range of clear corneal incision (CCI) from the corneal limbus and how different CCI sites affect surgery efficacy and anterior segment parameters in patients undergoing phacoemulsification. METHODS: This retrospective case-control study was conducted in 44 patients (44 eyes) undergoing phacoemulsification and IOL implantation. The patients were divided into two groups with CCI distances ranging from 1 mm to 1.5 mm (group A, = 22) and from 0.5 mm to 1.0 mm (group B, = 22). The visual acuity, surgically induced astigmatism (SIA), corneal aberration, and anterior segment parameters were analyzed. RESULTS: Compared with the preoperative data, all the patients showed significant improvements in the postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), anterior chamber depth (ACD), and anterior chamber angle (ACA) after the surgery ( < 0.05). No significant differences were found between the two groups in postoperative UCVA, BCVA, SIA, total corneal aberration RMS, lower- and higher-order aberration RMS, spherical aberration (Z), horizontal three leaf clover (Z), vertical three leaf clover(Z), horizontal coma(Z), vertical coma(Z), ACD, ACA, anterior chamber volume, or central corneal thickness (>0.05). CONCLUSIONS Phacoemulsification is an effective therapy for cataract with a CCI distance range either of 1-1.5 mm or 0.5-1.0 mm. These two CCI distance ranges produce no significant differences in the visual quality following phacoemulsification, indicating that a CCI distance range of 0.5-1.5 mm can be safe for phacoemulsification.
Anterior Eye Segment ; Astigmatism ; etiology ; Case-Control Studies ; Cornea ; surgery ; Humans ; Lens Implantation, Intraocular ; Limbus Corneae ; Phacoemulsification ; adverse effects ; methods ; Postoperative Complications ; etiology ; Retrospective Studies ; Surgical Wound ; Treatment Outcome ; Visual Acuity

PURPOSE: To evaluate the efficacy and safety of pterygium excision using a large conjunctival autograft for the treatment of recurrent pterygium. METHODS: The medical records of 120 patients (126 eyes) with recurrent pterygium were reviewed. For each affected eye, pterygium excision with a large conjunctival autograft was performed. The graft was harvested from the superior bulbar area and measured more than 8 × 10 mm in size. Only patients who completed at least six months of follow-up were included. Postoperative clinical outcomes, recurrence rate, and complications were analyzed. Patients with any evidence of recurrence after surgery received a subconjunctival bevacizumab injection. RESULTS: The average patient age was 56.5 ± 10.2 years, and 45 out of 120 patients were male. The mean study follow-up period was 17.7 ± 17.6 months. Most patients were satisfied with the cosmetic outcome. Postoperative visual acuity improved from 0.69 to 0.75 (p < 0.05). Postoperative refractive astigmatism and corneal astigmatism decreased by 0.55 and 2.73 diopters, respectively (p < 0.05). The postoperative recurrence rate was 4.0%, and the average recurrence period was 7.4 ± 0.6 weeks. A subconjunctival injection of 5 mg bevacizumab was performed in cases of recurrence; no progression of the pterygium was observed following the injection. Postoperative complications included 2 cases of conjunctival graft edema in 2 eyes, 5 donor site scars in 5 eyes, 13 pyogenic granulomas in 13 eyes, and a conjunctival epithelial inclusion cyst in 7 eyes. CONCLUSIONS: Pterygium excision with a large conjunctival autograft for the treatment of recurrent pterygium produced an excellent cosmetic outcome, a low recurrence rate, and minimal complications. A subconjunctival bevacizumab injection given in cases of recurrence following surgery might be effective in preventing progression of the pterygium.
Astigmatism ; Autografts* ; Bevacizumab ; Cicatrix ; Edema ; Follow-Up Studies ; Granuloma, Pyogenic ; Humans ; Male ; Medical Records ; Postoperative Complications ; Pterygium* ; Recurrence ; Tissue Donors ; Transplants ; Visual Acuity

PURPOSE: To compare the safety and efficacy of cataract surgery using nasal clear corneal incision (CCI) versus superior or temporal CCIs in Korean patients. METHODS: A retrospective comparative study was conducted. Patients underwent cataract surgery using CCI performed by 3 surgeons between January 2012 and December 2013.The patients were divided into the following 3 groups based on CCI direction: nasal CCIs (group I), superior CCIs (Group II), and temporal CCIs (Group III). To assess usability, surgically induced astigmatism (SIA), best-corrected visual acuity (BCVA), intraocular pressure (IOP), keratometry reading, and refractive errors at baseline and 1 month after surgery were compared. Operation times were compared between groups. To assess safety, intraoperative complications and wound stability were compared. RESULTS: A total of 1,374 eyes (Group I, 283 eyes; Group II, 587 eyes; Group III, 504 eyes) were included in the present study. The SIA was not significantly different among the 3 groups. The postoperative mean BCVA, IOP, keratometry reading and spherical equivalent as well as the mean operation times were not significantly different between the 3 groups (14.04 ± 3.79 vs. 13.80 ± 3.27 vs. 13.80 ± 3.70; p = 0.473). The rate of intraocular complications and incidence of corneal wound suture were not significantly different between the 3 groups (1.7% vs. 3.2% vs. 2.3%; p = 0.378). CONCLUSIONS: The safety and efficacy of cataract surgery using nasal CCI were not significantly different compared with the use of temporal or superior CCI. Our results showed that cataract surgery using nasal CCI can be performed safely and conveniently in Korean patients.
Astigmatism ; Cataract* ; Humans ; Incidence ; Intraocular Pressure ; Intraoperative Complications ; Refractive Errors ; Retrospective Studies ; Surgeons ; Sutures ; Visual Acuity ; Wounds and Injuries

PURPOSE: To compare the two transscleral fixation (TSF) techniques of intrascleral pocket and conventional scleral flap with conjunctival division techniques in terms of short-term clinical effects. METHODS: This retrospective cohort study included all consecutive patients with aphakia in Gyeongsang National University Hospital in Jinju, Korea, who underwent TSF between January 2012 and December 2014. The medical records of all patients were retrospectively reviewed, and the endothelial cell count (ECC), refraction, best-corrected visual acuity (BCVA), intraocular pressure, slit lamp, and fundus examination results before and 1 day and 6 months after surgery were recorded. The postoperative complications and visual outcomes were also recorded. RESULTS: The intrascleral pocket and conventional-flap groups did not differ significantly in terms of demographics, presurgical BCVA, or ECC. However, the intrascleral pocket group had a significantly lower BCVA at 1 day and 6 months after surgery compared to the conventional-flap group. The two groups did not differ in terms of ECC 6 months after surgery. The intrascleral pocket group had no postoperative complications, but five patients in the conventional-flap group complained of irritation. In both groups, the intraocular lens was well positioned without tilting or subluxation, and astigmatism was significantly reduced at 1 day and 6 months after surgery. CONCLUSIONS: The intrascleral pocket technique of TSF does not involve conjunctival dissection and is a successful method of sulcus fixation. It stably corrects the intraocular lens and is easy to perform, which helps to reduce operation time. It also reliably yields rapid visual acuity recovery without complications.
Aphakia ; Astigmatism ; Cohort Studies* ; Demography ; Endothelial Cells ; Gyeongsangnam-do ; Humans ; Intraocular Pressure ; Korea ; Lenses, Intraocular ; Medical Records ; Postoperative Complications ; Retrospective Studies* ; Visual Acuity

PURPOSE: To evaluate the clinical outcomes of a combined procedure of astigmatic keratotomy (AK) and laser in situ keratomileusis (LASIK) for the correction of high astigmatism. METHODS: Thirty-five eyes of 19 patients who had astigmatic keratotomy were studied. The patients had a secondary procedure, LASIK, to correct the residual refractive error. Follow-up visits were at 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity, refractive error, efficacy, safety, and predictability. We compared preoperative and post-AK expected corneal ablation depth using an Amaris Ablation depth table. RESULTS: After astigmatic keratotomy, astigmatism was reduced by 61.43 ± 14.62%, and after LASIK, astigmatism was reduced by 91.65 ± 8.68%. Expected corneal ablation depth was reduced by 18.72 ± 11.77% after astigmatic keratotomy. The proportion of eyes with spherical equivalent 0.5 D or less was 85.71% at 6 months after the combined procedure of astigmatic keratotomy and LASIK. No intraoperative or postoperative complications were observed. CONCLUSIONS: This study showed the combined procedure of astigmatic keratotomy and LASIK is effective for visual acuity, refraction, and reduction in corneal ablation depth.
Astigmatism ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ* ; Outcome Assessment (Health Care) ; Postoperative Complications ; Refractive Errors ; Visual Acuity

PURPOSE: The purpose of this multi-institute, single-group clinical trial was to evaluate the effectiveness and safety of toric orthokeratology lenses for the treatment of patients with combined myopia and astigmatism. METHODS: A total of 44 patients were included in this clinical trial. The patients ranged in age from 7 to 49 years, with myopia of -0.75 to -6.0 diopters (D) and astigmatism of 1.25 to 4.0 D. After excluding 21 subjects, 23 subjects (39 eyes) were analyzed after toric orthokeratology lens use. The subjects underwent ophthalmologic examination after 1 day and 1, 2, 3, and 4 weeks of wearing overnight toric orthokeratology lenses. RESULTS: A total of 19 subjects (31 eyes) completed the trial after five subjects (eight eyes) dropped out. In the patients who completed the study by wearing lenses for 4 weeks, the myopic refractive error decreased significantly by 2.60 ± 2.21 D (p < 0.001), from -3.65 ± 1.62 to -1.05 ± 1.64 D. The astigmatic refractive error were also significantly decreased by 0.63 ± 0.98 D (p = 0.001), from 2.07 ± 0.83 to 1.44 ± 0.99 D. The mean uncorrected and corrected visual acuities before wearing the lenses were 2.14 ± 0.80 logarithm of the logMAR (logMAR) and 0.05 ± 0.13 logMAR, respectively, which changed to 0.12 ± 0.30 logarithm of the logMAR (p < 0.001) and 0.01 ± 0.04 logMAR (p = 0.156) after 4 weeks. No serious adverse reactions were reported during the clinical trial. CONCLUSIONS: Our results suggest that toric orthokeratology is an effective and safe treatment for correcting visual acuity in patients with combined myopia and astigmatism.
Adolescent ; Adult ; Astigmatism/complications/diagnosis/*therapy ; Child ; Cornea/*diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Myopia/complications/diagnosis/*therapy ; Orthokeratologic Procedures/*methods ; Slit Lamp Microscopy ; Treatment Outcome ; *Visual Acuity ; Young Adult

PURPOSE: To evaluate the beveled, full thickness astigmatic keratotomy. METHODS: This study included 185 eyes of 112 patients treated with beveled, full thickness astigmatic keratotomy. Treated eyes were divided into 3 groups: beveled, full thickness astigmatic keratotomy after implantable collamer lens (ICL) implantation (group A), beveled, full thickness astigmatic keratotomy after cataract surgery (group B) and beveled, full thickness astigmatic keratotomy alone (group C). Follow-up visits were at 1 week, 1 month, 3 months and 6 months. The outcome measures included uncorrected distance visual acuity, astigmatism, efficacy, safety and predictability. RESULTS: At 6 months postoperatively, astigmatism was significantly reduced: 68.9 +/- 18.24% in total, 69.24 +/- 20.76%, in the group A, 67.84 +/- 17.56% in the group B and 67.82 +/- 13.97% in the group C. The proportion of eyes with astigmatism 1.0 or less was 88.65% in total, 91.49% in the group A, 87.5% in the group B and 70.0% in the group C. Mean improvement in corrected distance visual acuity (CDVA) was 0.56 lines; no eyes lost 2 lines of CDVA after 6 months postoperatively. Postoperative complications were not observed. CONCLUSIONS: This study showed the beveled, full thickness astigmatic keratotomy is effective and safe for correcting astigmatism alone as well as correcting astigmatism after ICL implantation or cataract surgery.
Astigmatism ; Cataract ; Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Postoperative Complications ; Visual Acuity

PURPOSE: The 2.2-mm microincision cataract surgery and small-gauge vitrectomy system is known to result in less surgically-induced astigmatism (SIA) in comparison to conventional surgical methods. We compared the amounts of SIA after combined phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy (23G-TSV) using the 2.2-mm microincision and 2.75-mm standard incision methods. METHODS: We studied 59 patients (61 eyes) who underwent combined phacoemulsification and 23G-TSV from November 2008 to September 2012. Twenty-eight patients (28 eyes) underwent 2.2-mm microincision coaxial phacoemulsification, and 31 patients (33 eyes) underwent 2.75-mm standard incision phacoemulsification. SIA was evaluated using Naeser's polar method with the simulated keratometric values obtained from corneal topography. Preoperative and 1-week and 1-month postoperative KP (Naeser's polar value along the specific axis) and DeltaKP values were compared between the 2.2-mm microincision and 2.75-mm standard incision groups. RESULTS: One week after surgery, both groups exhibited similar amounts of SIA (-DeltaKP[120], 0.40 +/- 0.41 vs. 0.51 +/- 0.56 diopters [D]; p = 0.390). One month after surgery, however, the amount of SIA was significantly smaller in the 2.2-mm microincision group as compared to the 2.75-mm standard incision group (-DeltaKP[120], 0.31 +/- 0.54 vs. 0.56 +/- 0.42 D; p = 0.045). CONCLUSIONS: In combined phacoemulsification with 23G-TSV, 2.2-mm microincision coaxial phacoemulsification induces less SIA than does 2.75-mm standard coaxial phacoemulsification.
Aged ; Astigmatism/diagnosis/*etiology ; *Cataract ; Cornea/surgery ; Corneal Topography/methods ; Female ; Humans ; Lens Implantation, Intraocular/*adverse effects/methods ; Male ; Middle Aged ; Phacoemulsification/*adverse effects/methods ; Postoperative Complications/diagnosis/etiology ; Sclera/surgery ; Vitrectomy/*adverse effects/instrumentation/methods