Faculty Bibliography

Purpose/UNASSIGNED:To report a novel application of partial topography-guided photorefractive keratectomy combined with topographically customized, higher fluence, and variable pattern corneal cross-linking applied on the same day of the treatment of keratoconus. Methods/UNASSIGNED:fluence for a total of 5-10 J, and up to 15 J of energy was delivered with the KXL-II device employing an active tracker. The center of the pattern that received the 15 J was topography-matched with the thinnest area of the cone. Visual acuity, refractive error, cornea clarity, keratometry, topography, pachymetry with a multitude of modalities and endothelial cell density were evaluated over 36 months. Results/UNASSIGNED:Keratoconus was stabilized in all cases. The severity of keratoconus stage by Amsler- Krumeich criteria improved from an average of 3.2 (1-4) to 1.8 (0-3). Uncorrected distance visual acuity changed from preoperative 20/80 to 20/25 at 6 months. A maximum astigmatic reduction of 7.8 D (5.3-15.6), and a significant cornea surface normalization (an index of height decentration improvement from 0.155 [±0.065] to 0.045 [±0.042]) were achieved by 1 month and remained relatively stable for 36 months postoperatively. Two cases delayed full reepithelialization for up to 9 days. Conclusion/UNASSIGNED:This paper introduces a novel technique in order to maximize the refractive normalization effect along with ectasia stabilization in young keratoconus patients. This may facilitate the use of less tissue ablation, in comparison to utilizing a homogeneous UV light beam for corneal cross-linking in Athens Protocol cases. It broadens the number of potential candidate cases that would have been limited to employ this technique due to tissue thickness limitations.

Purpose/UNASSIGNED:To evaluate the incidence of transient dry eye associated with LASIK for myopia and the efficacy of topical cyclosporine A administration. Methods/UNASSIGNED:Group A was formed from 145 (82 female, 63 male) eyes that developed clinically significant dry eye within 1 month post-LASIK and were subjected to cyclosporine A treatment. A "non-symptomatic for dry eye" and age- and gender-matched group (group B) was formed from the same pool of patients to serve as control. Schirmer's, tear film break-up time (TBUT) and Ocular Surface Disease Index (OSDI) questionnaire were evaluated. Central corneal epithelial thickness (CET) and topographic epithelial thickness variability (TVT) were evaluated as quantitative dry eye objective markers. Subjective patient survey was also assessed. Results/UNASSIGNED:<0.05), respectively. Following commencement of cyclosporine A treatment in group A, statistically significant improvement was noted, greater than the one in group B, in all metrics at the 12-month examination in comparison to the 1-month baseline. Conclusion/UNASSIGNED:Topical cyclosporine A treatment is an effective alternative in the management of LASIK for myopia-related transient dry eye. Optical coherence tomography epithelial mapping may provide an objective benchmark in diagnosing and monitoring this significant disorder and its correlation with visual symptoms.

Purpose/UNASSIGNED:The aim of this study was to evaluate the health-related quality of life (HRQoL) before and after the management of keratoconus (KCN) with Combined Topography-Guided Transepithelial partial photorefractive keratectomy (PRK) and corneal Cross-Linking: the Athens Protocol. Patients and methods/UNASSIGNED:Thirty-four consecutive patients treated for progressive KCN were selected for retrospective telephone interview and individual questionnaire submission. A disease-specific HRQoL questionnaire was administered before and after the Athens Protocol intervention, using the following administrative questionnaires: National Eye Institute Visual Function Questionnaire (NEI VFQ) 25/39 and IVI-28. The disease grade was ranked according to the Amsler-Krumeich classification (KCN severity). Reliability of collected data was evaluated with Cronbach's α test. Results/UNASSIGNED:Patients' age ranged from 15 to 51 years at the time of the operation. Mean time before the operation during which the questionnaires were administered was 52±6 months. General visual acuity, psychological well-being, and driving ability showed significant improvement. Younger keratoconic patients tend to have more enhanced psychological status and to cope better with difficulties in everyday activities (prior to operation) than older patients. Conclusion/UNASSIGNED:The Athens Protocol treatment has been proven to be beneficial to patients in a large number of aspects.

Purpose of Review: To investigate the latest findings in the field of intraocular lenses and their future development. Recent Findings: The idea of intraocular lenses (IOLs) has changed the clinical practice of cataract surgery over the last 50 years. Technology and scientific studies have created IOLs of different designs, with ultraviolet filters for UV protection, different types of haptics to ensure stability, multifocal designs for distant, and near vision. IOLs' development is fast and it is time to explore the new designs and their usefulness. Summary: The newest data from the IOL field are on light adjustable and trifocal IOLs, which are presented herein and are expected to change our perspective and lead the way in even more complicated and useful IOLs.

Purpose/UNASSIGNED:To investigate ex vivo potentially different corneal biomechanical properties after small-incision lenticule extraction (SMILE) versus LASIK for myopic correction. Methods/UNASSIGNED:Thirty human donor corneas were subjected to either myopic SMILE or femtosecond laser-assisted LASIK. Donor corneas were assigned to six investigative groups: Group A, -3.00 D (diopters) SMILE; Group B, -8.00 D SMILE; Group C, -3.00 D LASIK; and Group D, -8.00 D LASIK. Additionally, two control groups were formed: Group E, SMILE and Group F, LASIK. All groups consisted of five corneas, randomly allocated. The corneas in the control groups were subjected to the corresponding femtosecond-laser lamellar cuts but not to tissue removal. Evaluation of biomechanical tensile strength was conducted by biaxial force application. Primary outcome measures were stress at 10% and 15% strain, and Young's modulus at 10% and 15% strain. Results/UNASSIGNED:In SMILE, the average relative difference (Δ) of the four outcome measures was -34.46% for -3.00 D correction versus control Group E and -49.34% for -8.00 D correction versus control Group E. In LASIK, average Δ was -24.88% for -3.00 D correction versus control, and -52.73% for -8.00 D correction versus control. All these differences were statistically significant; SMILE compared to LASIK for the same myopic correction appears to result in more biomechanical reduction for -3.00 D corrections by -26%, while a nonstatistically significant difference was noted in -8.00 D corrections. Conclusion/UNASSIGNED:Both SMILE and LASIK procedures do substantially alter corneal biomechanical properties, and the degree of tensile strength reduction is statistically significantly correlated to the extent of myopic correction. Additionally, SMILE procedure seems to result in more tensile strength reduction in lower myopic corrections compared to LASIK, and similar tensile strength reduction to LASIK in higher myopic corrections when compared to LASIK.

Purpose: Evaluate safety, efficacy and changes of anterior and posterior corneal power of topo-guided LASIK vs. SMILE in contralateral eyes, in myopic laser refractive surgery. Methods: In 22 myopic patients: 22 eyes had TG LASIK, and the contralateral eye had SMILE. Preoperative and postoperative evaluation of: spherical equivalent stability (SE). The eyes were divided in two groups of spherical equivalent (SE). The first group contains eyes with SE between -10 and -5.01 (High Zone) while the second group contains eyes with SE from -5 to 0. All data for corneal power were extracted from Optovue OCT device. Results: In the case of high zone, the anterior corneal power for SMILE technique was preoperatively 49.96+/-167 D and 43.23+/-1.99 D postoperatively. On the other hand, when EX500 method was used, preoperatively the corneal power was 50.20+/-1.58 D and 42.57+/-1.84 D postoperatively. The corresponding results for mild SE zone in the case of SMILE technique were 50.47+/-1.77 D preoperatively and 46.54+/-1.71 D. For the EX500 technique the corneal power pre-op and post-op was 49.35+/-2.43 D and 46.50+/-2.68 D respectively. Concerning posterior corneal power when SMILE method was used, in case of high SE zone the posterior corneal power changed from -6.16+/-0.23 D pre-op to 6.18+/-0.28 D postop. When EX500 method was used the corresponding results were 6.21+/-0.22 D and -6.24+/-0.22 D. Finally in the case of mild SE zone the posterior corneal power increased from -6.23+/-167 to -6.26+/-0.26 D when SMILE method was applied, while for the eyes that surged with EX500 technique the posterior corneal power was -6.15+/-0.37 D pre-op and -6.16+/-0.38 D post-op. Conclusions: Anterior and posterior corneal power was calculated after SMILE and EX500 refractive operations. The results presented, clearly showed that after EX500 operation, anterior corneal power is lower in comparison to SMILE operation in high SE zone. In mild SE zone the anterior corneal power is almost the same for the both methods. On the other hand the posterior corneal power remains unchanged, regardless the SE zone and the operation method

PURPOSE: To compare safety and efficacy of topography-guided LASIK and contralateral eye SMILE for myopia and myopic astigmatism correction. METHODS: This prospective, randomized contralateral eye study included 44 eyes of 22 patients with bilateral myopia or myopic astigmatism. Treated eyes were divided into two groups: 22 eyes were treated with topography-guided LASIK and the fellow eye of each patient was treated with SMILE. The following parameters were evaluated preoperatively and up to 3 months postoperatively: uncorrected distance vision acuity (UDVA), corrected distance vision acuity (CDVA), refractive error, corneal keratometry, contrast sensitivity, and Objective Scatter Index. RESULTS: At 3 months, 86.4% of the LASIK group and 68.2% of the SMILE group had UDVA of 20/20 (P < .002) and 59.1% and 31.8%, respectively, had UDVA of 20/16 (P < .002). Spherical equivalent refraction (+/-0.50 D) was 95.5% for the LASIK group and 77.3% for the SMILE group (P < .002). Residual refraction cylinder (