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State of the Art in Cataract and Refractive Surgery
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State of the Art in Cataract and Refractive Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (24 September 2024) | Viewed by 2749

Special Issue Editor

Dr. Ioannis Halkiadakis

E-Mail Website
Guest Editor
Department of Ophthalmology, Ophthalmiatrion Athinon, Athens, Greece
Interests: cataract surgery; ophthalmology; glaucoma; intraocular pressure; optical coherence tomography; phacoemulsification

Special Issue Information

Dear Colleagues,

Cataract surgery is the most common surgical procedure. It undisputably improves visual functioning dramatically, which in tern gives great improvement in a person’s quality of life. Numerous advances in instrumentation and medical treatment have increased the safety of the procedure, even in complicated cases. Moreover, advances in intraocular lens design and biometry have further increased patients’ and doctors’ expectations of cataract surgery. It is considered not only as an operation that restores vision but also as a refractive procedure that minimizes if not eliminates the use of glasses.

Refractive surgery, likewise, is continuously evolving. New techniques with an improved safety and predictability profile are coming into practice, aiming to provide refractive results that match the increased expectations of the patients.

Accordingly, we would like to announce a Special Issue called “State of the Art in Cataract and Refractive Surgery”. This Special Issue calls for original research and reviews that have investigated new techniques in cataract and refractive surgery.

Dr. Ioannis Halkiadakis
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cataract
  • refractive surgery
  • biometry
  • laser assisted in situ keratomileusis
  • smile
  • femtosecond laser
  • multifocal intraocular lenses
  • extended depth-of-focus intraocular lenses
  • phakic intraocular lenses

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Published Papers (4 papers)

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Research

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13 pages, 2904 KiB  
Article
Progressive Keratoconus Treatment with Transepithelial Two-Step Phototherapeutic Keratectomy Combined with Corneal Crosslinking (CXL): Clinical Outcomes and Postoperative Management Including Potential Complications of the Modified Athens Protocol Designed for US-Approved Excimer Laser Specifications
by Anastasios John Kanellopoulos and Alexander J. Kanellopoulos
J. Clin. Med. 2024, 13(23), 7024; https://doi.org/10.3390/jcm13237024 - 21 Nov 2024
Viewed by 212
Abstract
Objectives: To report a novel application within the USA of excimer ablation for the normalization of central corneal refractive irregularity, combined with higher fluence CXL in the effective management and visual rehabilitation of progressive keratoconus. Methods: 17 consecutive cases with progressive keratoconus were [...] Read more.
Objectives: To report a novel application within the USA of excimer ablation for the normalization of central corneal refractive irregularity, combined with higher fluence CXL in the effective management and visual rehabilitation of progressive keratoconus. Methods: 17 consecutive cases with progressive keratoconus were treated with corneal surface excimer laser ablation normalization using topography-guided (Contura) myopic ablation for customized corneal re-shaping with a 6 mm optical zone. The epithelial removal was accounted for by adding a −2.75 diopter correction to this topography-guided normalizing surface ablation followed by a second wavefront-optimized hyperopic excimer treatment of +2.75 diopters also with a 6 mm optical zone. The two sequential excimer ablations applied on the intact epithelium were followed by corneal crosslinking (CXL). Visual acuity, refraction, and keratoconus documentation via keratometry, topography, and pachymetry, as well as endothelial cell density were evaluated over 36 months. Results: Keratoconus stabilized in all cases. The severity and stage of keratoconus determined by the Amsler–Krumeich criteria improved for the OD from an average of 2.2 to 1. The median UDVA showed marked improvement at one-year follow-up (all values in LogMAR), from 0.8 preoperative to 0.3 at 12 months, and was stable through the 3 years at 0.3. The median CDVA increased from 0.5 to 0.1 at 1 year and was stable at 0.1 at 3 years. The average minimal corneal thickness decreased from 466 μm to 396 μm, as recorded the first year postoperatively, and then slightly increased to 405 μm at the 3-year follow-up. Conclusions: We introduce herein the initial clinical data for the use of a novel, off-label therapeutic excimer laser surface ablation application. It was designed to perform both epithelial removal and anterior corneal stroma reshaping and combined with CXL to apply the Athens Protocol CXL with US excimer laser-approved specifications. Full article
(This article belongs to the Special Issue State of the Art in Cataract and Refractive Surgery)
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9 pages, 951 KiB  
Article
Comparative Analysis of Refractive Outcomes Following Cataract Surgery Using IOL Master 500 and IOL Master 700 Biometry Devices: A Retrospective Analysis
by Sebastian Arens, Daniel Böhringer, Thabo Lapp, Thomas Reinhard and Sonja Heinzelmann-Mink
J. Clin. Med. 2024, 13(17), 5125; https://doi.org/10.3390/jcm13175125 - 29 Aug 2024
Viewed by 657
Abstract
Background: This study aims to compare the refractive outcomes of cataract surgery using two different biometry devices, the IOL Master 500 and IOL Master 700, and to investigate the influence of patient-related factors on these outcomes. Methods: In this retrospective study, we analyzed [...] Read more.
Background: This study aims to compare the refractive outcomes of cataract surgery using two different biometry devices, the IOL Master 500 and IOL Master 700, and to investigate the influence of patient-related factors on these outcomes. Methods: In this retrospective study, we analyzed data from 2994 eyes that underwent cataract surgery. Multiple linear regression analyses were performed to examine the impact of the biometry device (IOL Master 500 or IOL Master 700), patient age, time elapsed between biometry and surgery, gender, and insurance status, as well as biometric parameters (anterior chamber depth, axial length, and corneal curvature), on postoperative refractive outcomes, specifically the deviation from target refraction. Results: The choice of the IOL Master device did not result in a statistically significant difference between the two devices (p = 0.205). Age (p = 0.006) and gender (p = 0.001) were identified as significant predictors of refractive outcomes, with older patients and males experiencing slightly more hyperopic outcomes compared to younger patients and females, respectively. The time elapsed between biometry and surgery and insurance status did not significantly influence the refractive outcomes. Conclusions: Our study, supported by a large cohort and a diverse group of patients representing typical anatomical variants seen in cataract surgery, supports the thesis that the IOL Master 500 and IOL Master 700 can be regarded as equivalent and effective for biometry in cataract surgery. The differences between the devices were negligible. Therefore, switching between the devices is safe for bilateral patients. Full article
(This article belongs to the Special Issue State of the Art in Cataract and Refractive Surgery)
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10 pages, 3704 KiB  
Article
Topographic Keratoconus Incidence in Greece Diagnosed in Routine Consecutive Cataract Procedures: A Consecutive Case Series of 1250 Cases over 5 Years
by Anastasios John Kanellopoulos and Alexander J. Kanellopoulos
J. Clin. Med. 2024, 13(8), 2378; https://doi.org/10.3390/jcm13082378 - 19 Apr 2024
Viewed by 785
Abstract
Background: Scheimpflug tomography has for many years been an integral part of our pre-operative assessment in cataract extraction. We retrospectively reviewed the incidence of topographic keratoconus and keratoconus suspicion in our routine cataract surgery population over 5 years. Setting: The Laservision Clinical [...] Read more.
Background: Scheimpflug tomography has for many years been an integral part of our pre-operative assessment in cataract extraction. We retrospectively reviewed the incidence of topographic keratoconus and keratoconus suspicion in our routine cataract surgery population over 5 years. Setting: The Laservision Clinical and Research Institute, Athens, Greece. Methods: In 1250 consecutive cataract surgery cases in otherwise naïve eyes, accounting for years 2017 to 2021, we retrospectively evaluated preoperative Pentacam HR imaging. The cases already classified as keratoconus were included in group A. The residual cases were assessed by five different experienced evaluators (two ophthalmic surgeons and three optometrists) for topographic and tomographic keratoconus suspicion based on irregular pachymetry distribution, astigmatism truncation, and/or astigmatic imaging irregularity and included in group B. Regular corneas, by this assessment, were included in group C; irregular corneas, as determined by the evaluators but unrelated to keratoconus, were included in group D. Results: Based on the above, 138 cases (11.08%) were classified by Pentacam tomography as keratoconus and by default were included in group A. Of the residual cases, 314 or 25.12% were classified as suspect keratoconus and included in group B; 725 cases (58%) were classified as normal and non-keratoconus and included in group C; and 73 cases or 5.84% were placed in group D as non-keratoconus but abnormal. There was no disagreement between the five evaluators over any of the cases in groups C and D, and little variance among them for cases included in group B (less than 5% by ANOVA). Conclusions: The incidence of keratoconus and corneas suspicious for keratoconus in Greece appears to be much higher than respective reports from other regions: one in ten Greeks appear to have topographic keratoconus, most not diagnosed even by the age of cataract surgery, and almost an additional one in four may have suspicious corneal imaging for keratoconus. These data strongly imply that routine screening for disease should be promoted among Greeks, especially during puberty, to halt possible progression; moreover, careful screening should be performed when laser vision correction is being considered. Full article
(This article belongs to the Special Issue State of the Art in Cataract and Refractive Surgery)
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17 pages, 2856 KiB  
Systematic Review
Intraocular Pressure Reduction Following Phacoemulsification in Patients with Exfoliation: A Systematic Review and Meta-Analysis
by Konstantinos Benekos, Andreas Katsanos, Panagiotis Laspas, Iordanis Vagiakis, Anna-Bettina Haidich and Anastasios G. Konstas
J. Clin. Med. 2024, 13(22), 6774; https://doi.org/10.3390/jcm13226774 - 11 Nov 2024
Viewed by 490
Abstract
Objectives: The objective of this systematic review and meta-analysis is to evaluate the existing evidence and estimate the impact of phacoemulsification and intraocular lens implantation on the intraocular pressure (IOP) of subjects with exfoliation syndrome (XFS) or exfoliative glaucoma (XFG). Methods: [...] Read more.
Objectives: The objective of this systematic review and meta-analysis is to evaluate the existing evidence and estimate the impact of phacoemulsification and intraocular lens implantation on the intraocular pressure (IOP) of subjects with exfoliation syndrome (XFS) or exfoliative glaucoma (XFG). Methods: In July 2024, an in-depth literature review across three databases was undertaken. This study focused only on adult patients with exfoliation who had not undergone previous ocular surgery. The primary outcome of interest was the mean IOP reduction at 6 and 12 months after uncomplicated phacoemulsification surgery. Results: This meta-analysis included one randomized controlled trial and eight observational studies, comprising 220 patients at 6 months and 430 patients at the 12-month time point, respectively. The mean IOP reduction after surgery was 3.43 mmHg (95% CI: −4.77 to −2.09) after 6 months and 2.75 mmHg (95% CI: −4.24 to −1.26) after 12 months. In both time points, there was no heterogeneity (I2 = 0), but the certainty of evidence following the GRADE evaluation was very low. Conclusions: The present meta-analysis demonstrates that phacoemulsification can significantly reduce IOP in exfoliation subjects 6 and 12 months after surgery. Nevertheless, significant limitations in included studies do not allow a precise and certain estimate of the magnitude of postoperative IOP lowering in exfoliation patients. Additional research is needed to confirm these results. Full article
(This article belongs to the Special Issue State of the Art in Cataract and Refractive Surgery)
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