Purpose: To confirm the clinical safety and overall performance of Minivisc® Plus, a cohesive ophthalmic viscosurgical device (OVD). Setting: Multicenter study conducted at 6 sites in Sweden and Belgium. Design: Prospective, randomized, partially comparative, multicenter post market study. Methods: Subjects requiring anterior segment ophthalmic surgery were eligible for inclusion. The study consisted of two phases. In Phase A (90-day follow-up), a randomized comparison was conducted between Minivisc® Plus and Healon GV® Pro. In Phase B, eyes were treated with Minivisc® Plus and followed for 30 days. Primary endpoint was incidence of intraocular pressure (IOP) ≥30 mmHg at 7 days following operation. Secondary endpoints included postoperative inflammation, corneal endothelial cell density (ECD), surgeon-reported device performance, and the incidence of adverse events (AEs) and device deficiencies (DDs). Results: In total, 163 eyes were included in the study: 54 eyes in Phase A (25 eyes treated with Minivisc® Plus and 29 eyes treated with Healon GV® Pro) and 109 eyes in Phase B. All surgical procedures were phacoemulsification cataract surgeries, apart from two cases (both in Phase B), which were glaucoma surgeries. Two eyes (1.5%) treated with Minivisc® Plus exhibited intraocular pressure (IOP) ≥30 mmHg at postoperative day 7. Inflammation grading, ECD loss, and the incidence of AEs were comparable between the study substances throughout the 90-day follow-up period. Surgeon-reported assessments indicated comparable device performance between the two OVDs. Conclusions: This study demonstrates the safety of Minivisc® Plus in terms of IOP spikes, postoperative ocular inflammation, ECD loss, with clinical performance comparable to that of Healon GV® PRO.
PURPOSE:To characterize the surface metrology of 4 multifocal intraocular lenses (IOLs) and simulate their behavior across pupil sizes. SETTING:Physiological Optics & Imaging Laboratory, Daegu, South Korea. DESIGN:Laboratory investigation. METHODS:Four +20.0-diopter multifocal IOLs-Envy, PanOptix, Odyssey, and Synergy-were evaluated using a Mach-Zehnder interferometer (NIMO TEMPO) following ISO 11979-2 standards. Optical path difference maps generated wavefront profiles, diffractive step profiles, point spread functions, and modulation transfer functions (MTFs). Through-focus MTFs were obtained at 50 line pairs per millimeter under of 2.0 mm, 3.0 mm, and 4.5 mm pupil diameters. RESULTS:Envy exhibited gradually decreasing diffractive step heights peripherally, favoring distance vision under mesopic conditions. PanOptix maintained uniform step heights, whereas Odyssey and Synergy exhibited larger diffractive steps with significant primary and secondary spherical aberrations, producing extended depth-of-field. Odyssey exhibited a distance-dominant energy distribution, while Synergy displayed a more balanced intermediate and near dispersal. Through-focus MTFs revealed stable trifocal peaks for Envy, a near-shifted tendency for PanOptix under small pupils, and far-dominant patterns for Odyssey and Synergy converging under larger pupils. CONCLUSIONS:Interferometric optical metrology revealed distinct through-focus optical profiles among contemporary diffractive multifocal IOLs, reflecting design-dependent differences in focal energy distribution across pupil sizes.
Cataract is a leading cause of visual impairment globally, with surgery as the only effective treatment. Management involves a care pathway, including screening, patient selection, preoperative assessment, surgery, and postoperative care. The ESCRS developed evidence-based guidelines to aid decision-making for patients, clinicians, and stakeholders. A multidisciplinary panel, supported by methodologists using the Grading of Recommendations, Assessment, Development, and Evaluations approach, addressed 32 key clinical questions. Recommendations include intracameral antibiotics to prevent endophthalmitis, topical anesthesia as the preferred technique, and toric intraocular lenses for corneal astigmatism ≥1.0 diopter. Conventional and femtosecond laser-assisted surgeries are comparably safe and effective. Nonsteroidal anti-inflammatory drug eyedrops, alone or with corticosteroids, are recommended to reduce inflammation and prevent cystoid macular edema. Additional guidance includes shared decision-making for lens selection, safe use of immediate sequential bilateral cataract surgery, and potential of remote postoperative care to enhance healthcare efficiency. These guidelines aim to improve outcomes, patient experience, and care delivery.
PURPOSE:To validate the Least Absolute Shrinkage and Selection Operator (LASSO) formulas for phakic intraocular lens sizing, published by Rocamora et al. in 2023, in a larger and multicenter cohort. SETTING:University hospital and private clinical practice. DESIGN:Multicenter retrospective observational study in Belgium. METHODS:Patients who underwent implantable Collamer lens (ICL) surgery between September 2018 and June 2024 were included. The mean absolute error (MAE) was used as primary endpoint to compare LASSO-OCT, LASSO-Biometry, LASSO-Full, Luo, Russo, Kim, Nakamura (NK) V1, NK V2 and NK V3 formulas. Secondary endpoints included the maximum absolute error and the percentage of eyes within error categories of <100, <200, <300, <500, <750 µm. RESULTS:A total of 437 eyes of 226 patients were included. The pooled MAE of the LASSO-OCT formula (155.6 ±123.0 µm) was lower than that of the LASSO-Biometry (193.3±140.3 µm) and LASSO-Full (247.2 ±174.7 µm) formulas. The Russo formula showed the lowest MAE (142.3 ±112.4 µm) followed by the NK V3 (149.3 ±121.0 µm). The MAE was significantly higher for the LASSO-Full, Luo, NK V1 and V2 formulas when compared with the LASSO-OCT formula. At the center where postoperative vault was measured using Scheimpflug imaging, the LASSO-Full formula achieved a lower MAE than the LASSO-OCT formula, although this difference was not statistically significant. CONCLUSION:In this study the accuracy of the LASSO-formulas varies across the different models and according to the postoperative measurement method, with the LASSO-OCT formula outperforming the LASSO-Full when vault is measured with AS-OCT. Other OCT based formulas, including NK V3 and Russo, demonstrated high accuracy and reliability, supporting the safety of OCT-based ICL sizing.
Purpose:To evaluate the effect of caffeine intake on intraocular pressure (IOP). Methods:The PubMed, Cochrane, Scopus, and ProQuest databases were searched for publications of randomized trials investigating the effect of caffeine consumption on IOP in healthy and glaucomatous populations until February 1, 2025. Outcomes at 30 min, 1, 1.5, 2, and 3 h were analyzed using a random-effects model. Subgroup analysis was done for different types of caffeine-containing beverages and different amounts of caffeine. Results:Sixteen studies, including 599 healthy participants and 63 glaucomatous patients (with primary open-angle glaucoma, ocular hypertension, and normotensive glaucoma), were included in this meta-analysis. The weighted mean difference (WMD) with 95% confidence intervals of IOP in the healthy population at 30 min, 1 h, 1.5 h, and 2 h were significant at 0.61 (0.07; 1.16), 0.87 (0.40; 1.33), 1.60 (0.40; 2.80), and 0.63 (0.03; 1.22), respectively. In glaucomatous patients, WMD at 1 and 1.5 h time points were significant at 1.51 (0.83; 2.18) and 1.39 (0.99; 1.78), respectively. Ingestion of >100 mg of caffeine significantly increased IOP at 30 min, 1, and 1.5 h, whereas ingestion of ≤100 mg did not significantly increase IOP in healthy populations. All included studies with glaucomatous populations used >100 mg of caffeine. Conclusion:Caffeine ingestion, especially of >100 mg, acutely elevates IOP in both healthy and glaucomatous populations.
PURPOSE:To describe long-term visual, refractive, and topographic outcomes after photorefractive keratectomy (PRK) in keratoconus patients treated before corneal cross-linking (CXL) became available. SETTING:Single private ophthalmic center in Bogotá, Colombia. DESIGN:Retrospective observational study. METHODS:1,532 archived paper charts from all patients at the practice between 1996 and 2004 were screened. Patients with keratoconus who underwent PRK using multiple excimer laser techniques, with adequate preoperative documentation and available for re-evaluation after ≥20 years, were included. Outcomes included uncorrected (UDVA) and corrected distance visual acuity (CDVA), refractive spherical equivalent, astigmatism, and keratometry. RESULTS:Sixty-eight keratoconus patients treated with PRK were identified; 16 patients (29 eyes) with available long-term follow-up were included, (mean follow-up of 22 years). UDVA improved from 0.81 ± 0.50 to 0.46 ± 0.36 logMAR (P = .005) and CDVA from 0.14 ± 0.17 to 0.08 ± 0.11 logMAR (P = .02), although not significant after excluding eyes that later required keratoplasty. Spherical equivalent decreased by 1.51 D (P = .001), and astigmatism by 0.82 D (P = .03). Maximum keratometry showed no significant change (P = .19). Four eyes (13.8%) required keratoplasty, including 3 of 7 (43%) with advanced disease. The remaining 25 eyes (86.2%) did not require keratoplasty, although some required additional interventions. CONCLUSION:In this small pre-CXL cohort, mild-to-moderate keratoconus eyes had visual and refractive improvement, while keratoplasty was required mainly in advanced cases. These findings offer historical observational context rather than evidence of safety or efficacy.
Purpose:To report a case of progressive anatomical improvement documented over 3 years after epiretinal membrane (ERM) peeling and to describe how fundus autofluorescence (FAF) imaging contributed to the documentation and evaluation of this long-term recovery. Methods:A retrospective case report was conducted. Results:This case report describes a 70-year-old male patient with decreased visual acuity due to idiopathic ERM. Preoperative FAF demonstrated vessel displacement, and optical coherence tomography showed Grade 3 tractional changes. The patient underwent pars plana vitrectomy with ERM and internal limiting membrane peeling. Visual acuity improved rapidly, while FAF follow-up over 3 years demonstrated progressive centrifugal repositioning of retinal vessels toward their predisplacement locations. Conclusions:This finding illustrates the utility of FAF in documenting long-term anatomical recovery beyond macular thickness normalization. FAF may serve as a valuable complementary tool to monitor retinal remodeling and vessel realignment following membrane peeling, supporting its role in postoperative assessment of ERM surgery outcomes.
TOPIC:Keratorefractive lenticule extraction (KLEx) treats myopia and myopic astigmatism while preserving corneal biomechanics better than flap-based procedures. KLEx with prophylactic accelerated corneal cross-linking (KLEx-CXL) has been proposed for thinner corneas, higher myopia, or borderline tomography, but its incremental value remains uncertain. CLINICAL RELEVANCE:KLEx-CXL may reduce biomechanical instability, but adds operative time, cost, and protocol variability. Comparative evidence is needed to determine whether it improves outcomes over KLEx alone. METHODS:MEDLINE, Embase, Scopus, Web of Science, CENTRAL, and CINAHL were searched to July 2, 2026. Comparative adult studies with at least 6 months' follow-up reporting refractive or visual outcomes were included. Two reviewers extracted data, assessed risk of bias, and rated certainty using GRADE. Random-effects meta-analyses pooled mean differences. RESULTS:Nine studies included 730 eyes: 386 KLEx and 344 KLEx-CXL. Residual MRSE was similar overall (MD 0.03 D; 95% CI, -0.01 to 0.06; P=0.17), with no consistent timepoint-specific difference. A small residual difference was confined to moderate-myopia cohorts (0.09 D; 95% CI, 0.04 to 0.15) and absent in high myopia. KLEx showed a 1-month advantage in uncorrected distance vision (MD -0.04 logMAR), safety index (MD 0.07), and efficacy index (MD 0.08), resolving by 12 months. Corrected vision was similar throughout. Biomechanical measures favored KLEx-CXL. Early haze was transient; no ectasia occurred. Certainty was low. CONCLUSION:KLEx and KLEx-CXL achieved similar residual refraction and corrected visual acuity. KLEx-CXL produced measurable biomechanical reinforcement but transiently delayed early uncorrected visual recovery. Current evidence supports reserving prophylactic cross-linking for higher-risk eyes.
TOPIC:This review evaluated the incidence and visual significance of flap-related complications in femtosecond LASIK. CLINICAL RELEVANCE:Femtosecond laser-assisted LASIK has largely replaced mechanical microkeratomes for flap creation due to improved precision and safety. Understanding the incidence and clinical consequences of flap-related complications is essential for patient counseling and surgical planning. METHODS:A systematic search of Ovid MEDLINE, Embase, and CINAHL was conducted from database inception to October 10, 2024 including English-language clinical reports of patients undergoing femtosecond LASIK that reported flap-related complications. Small case series (<5 patients), secondary articles, conference abstracts, and cost-analysis studies were excluded. Study screening and data extraction were performed independently by two reviewers. The primary outcome was the incidence of LASIK flap complications stratified by femtosecond laser platform; secondary outcomes included postoperative visual acuity. Risk of bias was assessed at the outcome level using RoB 2 for randomized clinical trials and ROBINS-I for observational studies. Findings were synthesized narratively with descriptive summary of incidence proportions; no meta-analysis was performed due to heterogeneity in study designs and laser platforms. The review was registered in PROSPERO (CRD42024608238) with no post-submission amendments. RESULTS:Twenty-seven studies published between 1997 and 2024 were included, comprising 28,531 eyes across multiple countries. The most frequently reported intraoperative event was opaque bubble layer, occurring in 19.7% of eyes (range 2.0-56.4%). Diffuse lamellar keratitis was reported in 6.3% of eyes and typically resolved without long-term visual impact. Epithelial ingrowth (2.1%), microstriae (1.6%), and incomplete flaps (0.17%) were uncommon. Other flap-related events, including buttonholes, free caps, epithelial defects, and traumatic flap injuries, were rare (<1%). CONCLUSIONS:Femtosecond LASIK is associated with low rates of clinically significant flap-related complications, with excellent visual outcomes in most cases. Standardized reporting and longer-term prospective studies are needed to further refine complication benchmarks across femtosecond platforms.
PURPOSE:Multifocal intraocular lenses (MIOLs) are disadvised among patients with irregular corneas, but the role of subclinical corneal irregular astigmatism on long-term visual outcomes remains poorly elucidated. SETTING:Keye Eye Center, Seoul, Korea. DESIGN:Retrospective single-center clinical cohort study. METHODS:Bilateral implantation of PanOptix MIOL with 3 years follow-up. Eyes were stratified based on total corneal irregular astigmatism (TCIA) in Scheimpflug tomography into low (≤0.15 µm), moderate (>0.15 to <0.30 µm), and high (≥0.30 µm) TCIA groups. RESULTS:In the cohort of 474 eyes of 237 patients, those with high TCIA had greater prevalence of prior refractive surgery (16% vs 2%; p<0.001), greater spherical aberration (0.45±0.26D vs 0.28±0.10D; p<0.001), and lower central corneal thickness (511±43µm vs 548±30µm; p=0.001) than those with low TCIA. High TCIA resulted in worse uncorrected distance visual acuity (UDVA) at 1-year (0.11±0.10 vs 0.03±0.08 logMAR units; p=0.001) and at 3-years (0.16±0.15 vs 0.04±0.08 logMAR units; p<0.001) compared to low TCIA, despite comparable postoperative refractive outcomes. At 3-years, Strehl ratio (0.024±0.019 vs 0.041±0.027; p=0.001), photopic (1.23±0.14 vs 1.39±0.20; p<0.001) and mesopic AULCSF (0.91±0.16 vs 1.06±0.19; p<0.001) were worse in high TCIA group compared to low TCIA group. Greater preoperative TCIA was associated with poorer age- and sex-adjusted UDVA (B=0.174, 95%CI: 0.101 to 0.248, p<0.001), corrected distance visual acuity (B=0.261, 95%CI: 0.132 to 0.389, p<0.001), and Strehl ratio (B=-0.598, 95%CI: -0.865 to -0.332, p<0.001) at 3-years. CONCLUSIONS:High preoperative TCIA should be considered as predictive for impaired long-term visual acuity and quality outcomes after MIOL implantation.
PURPOSE:To identify risk factors for retreatment after laser-assisted in situ keratomileusis (LASIK) in eyes with high myopia. SETTING:Care Vision Laser Center, Tel Aviv, Israel. DESIGN:Retrospective comparative study. METHODS:Data from eyes with myopia ≥6 diopters (D) treated between 2000 and 2022 were analyzed. Eyes were grouped according to retreatment status. Preoperative and intraoperative parameters were compared using t tests and chi-square tests. Generalized estimating equations (GEE) logistic regression accounting for intereye correlation, including variables with P < .1, was performed to identify independent predictors of retreatment. RESULTS:The study included 2100 eyes (2020 controls and 80 retreatments). Retreatment eyes had shorter contact lens-free intervals ( P = .029) and a higher proportion of baseline cylinder <-1.0 D (32.5% vs 21.9%, P = .025). Significant differences were observed in uncorrected distance visual acuity ( P = .026) and corrected distance visual acuity ( P = .034). Intraoperatively, retreatment cases had higher treated cylinder ( P = .043), greater ablation depth (104.7 ± 14.8 vs 100.6 ± 12.5 μm, P = .004), and the optical-zone distribution differed between groups, with more 6.0 mm treatments and no 7.0 mm treatments in retreatment eyes ( P < .001). Retreatment was also associated with earlier surgical years ( P < .001) and use of the EX200 laser ( P = .01). GEE logistic regression identified 2 independent predictors: baseline cylinder <-1.0 D (odds ratio [OR] 2.208, 95% CI 1.126-4.330, P = .021) and EX200 laser use (OR 4.776, 95% CI 2.496-9.140, P < .001). CONCLUSIONS:LASIK retreatment in high myopia is independently associated with higher baseline refractive cylinder and older laser technology (EX200). Optimizing patient selection and adopting modern laser platforms may reduce the likelihood of additional procedures.
Purpose:To investigate the prevalence, clinical course, and prognostic significance of hyporeflective micro-elevations and irregularity of the ellipsoid zone (MEEZ) in blunt ocular trauma. Methods:Patients with blunt ocular trauma underwent standard ophthalmological examination and optical coherence tomography angiography. MEEZ was defined as small hyporeflective foci at the level of the ellipsoid and interdigitation zone, with disappearance of the thin hyporeflective band between these layers. The prevalence and spatial distribution of MEEZ, choriocapillaris perfusion, and associated findings were evaluated. Results:MEEZ was identified in 62 (40.3%) out of 154 eyes with blunt trauma, including nine eyes with MEEZ as the only form of posterior segment injury, and 53 eyes where MEEZ was found with other posterior segment injuries. Mean best-corrected visual acuity in eyes with MEEZ only was 0.0 logMAR (20/20 of Snellen equivalent). In eyes where MEEZ was associated with other posterior segment injuries, mean best-corrected visual acuity was 0.9 ± 0.64 logMAR (approximately 20/160 of Snellen equivalent). Choriocapillaris perfusion area in eyes with MEEZ only and healthy fellow eyes was 21.1 ± 1.3 and 20.4 ± 1.2 mm2 (P > 0.05), respectively. During the follow-up, MEEZ showed complete resolution in all cases with available follow-up data (n = 15) after a median period of 34.0 days. Conclusions:MEEZ is an important part of the spectrum of traumatic retinal changes frequently observed in blunt ocular trauma. As the only manifestation of blunt ocular trauma, MEEZ is associated with a favorable prognosis.
Purpose:To evaluate the differences in intraocular pressure (IOP) response to the water drinking test (WDT) in advanced glaucoma patients following trabeculectomy or Preserflo MicroShunt implantation. Methods:This prospective study included 30 eyes from 29 advanced glaucoma patients: 15 underwent trabeculectomy, and 15 received the Preserflo MicroShunt. Baseline IOP was measured using Goldmann applanation tonometry, followed by WDT involving the consumption of 10 mL of water per kilogram of body weight over 5 min. IOP was measured at 15-min intervals until it returned to baseline. Outcomes included peak IOP, time to peak IOP, IOP fluctuation, and time to return to baseline. Results:Baseline IOP was comparable between groups (trabeculectomy: 14.83 ± 2.28 mmHg; Preserflo: 15 ± 1.23 mmHg, P = 0.515). The peak IOP and IOP fluctuation were also similar (P = 0.978 and P = 0.614, respectively). However, trabeculectomy patients exhibited a shorter time to peak IOP (27 ± 5.6 min vs. 36.25 ± 9.8 min, P = 0.017) and faster return to baseline (55 ± 4.8 min vs. 57.25 ± 9.8 min, P = 0.03). Conclusions:Both trabeculectomy and the Preserflo MicroShunt effectively controlled IOP during WDT, with the Preserflo MicroShunt demonstrating noninferiority in overall IOP control. Trabeculectomy exhibited superior dynamic outflow capacity, making it suitable for patients requiring aggressive IOP reduction.
Purpose:To evaluate long-term outcomes of bilateral medial rectus recession in infantile esotropia (IET) using survival analysis of real-world data to identify predictors of surgical failure. Methods:This retrospective study included 121 IET patients with ≥12 months of follow-up. Motor success was defined as alignment within ±10 prism diopters at 6 months (early) and final visit (late). Sensory success was defined as binocular single vision (BSV), including fusion with or without stereopsis. Long-term motor stability was evaluated using survival analysis and Cox regression, while sensory outcomes were analyzed using multivariable regression. Results:Median surgical age was 24 months; the mean follow-up was 77.8 ± 59.6 months. Motor success was 56.2% at 6 months and 52.9% at the final follow-up. Cumulative success declined from 95.9% at 1 year to 54.9% at 10 years (median survival: 130 months). Male sex (P = 0.009), larger initial deviation (P = 0.035), and recession ≥6 mm (P = 0.022) were independently associated with failure, whereas surgical timing within the age range represented in this cohort was not. At the last follow-up, 33.1% of patients were undercorrected and 14.0% overcorrected, with overcorrection more frequent in longer follow-up (P = 0.001). Stereopsis was achieved in 9.3% of patients, and 70.9% of patients demonstrated BSV. Amblyopia independently reduced the likelihood of achieving BSV (odds ratio = 0.26, P = 0.015). Conclusions:Long-term motor alignment is maintained in about half of IET patients, though stability declines over time. Male sex, larger deviation, and higher surgical dose predict failure. Peripheral fusion is frequent, fine stereopsis remains rare, and amblyopia adversely affects sensory outcome.
Purpose:To determine the discriminative abilities of macular and retinal nerve fiber layer (RNFL) thicknesses in multiple sclerosis (MS) from normal and to identify optic neuritis (ON) in MS patients. Methods:This cross-sectional case-control study included 133 participants aged 30-45 years: 66 definite MS patients (18 with ON) and 67 age- and sex-matched healthy controls. MS diagnosis was established ≥5 years before enrollment. Exclusion criteria were other neurological/retinal diseases, high refractive error (> ±6.00 diopter), media opacities, glaucoma, or intraocular surgery. All underwent spectral-domain optical coherence tomography (Cirrus High-Definition Optical Coherence Tomography) under pharmacologic mydriasis to measure RNFL and macular thicknesses. Results:MS patients without ON showed significantly reduced macular thickness in inner superior, outer inferior, outer superior, outer nasal, and outer temporal sectors versus controls. MS patients with ON had significantly thinner inner superior and outer superior macular sectors than those without ON. For distinguishing MS from controls, an average RNFL ≤94 μm yielded a sensitivity of 87.9%, a specificity of 70.2%, and the area under the receiver operating characteristic curve (AUC) of 0.836 (P < 0.001). For differentiating MS with versus without ON, the average RNFL ≤83 μm achieved the highest RNFL performance: AUC of 0.836, sensitivity of 72.2%, and specificity of 81.3%. Among macular subregions, outer nasal (AUC = 0.680) and outer superior (AUC = 0.670) sectors best distinguished MS from controls. For ON detection, the outer superior sector performed best (AUC = 0.736, sensitivity: 61.1%, and specificity: 79.2%). Conclusion:RNFL thinning is a robust structural biomarker for MS and prior ON, whereas average macular thickness has limited standalone diagnostic utility for ON, though specific outer macular sectors show moderate discriminative value.
Purpose:To describe a novel technique for repairing large iris defects using an allogenic corneal iris segment (ACIS), referred to as the Antep procedure, and to present its application in two challenging clinical cases. Methods:Two cases with significant iris loss and photic symptoms underwent ACIS implantation. The ACIS was shaped into a crescent-shaped segment specifically designed to cover the iris defect and stained with trypan blue. It was then positioned in the anterior chamber and secured with three-point fixation at the nasal and temporal positions to the residual iris and superiorly to the sclera. Results:In both patients, ACIS implantation provided effective anatomical reconstruction of the iris defect and led to meaningful functional improvement, particularly in photic symptoms. The segments remained well positioned throughout follow-up, and no intraoperative or postoperative complications were observed. Conclusions:The Antep procedure offers a biologically integrated, low-cost, and technically feasible option for reconstruction of large iris defects. Further studies with longer follow-up are warranted to evaluate long-term outcomes and broader applicability.
