Publications by authors named "Kazutaka Kamiya"

184 Publications

Effect of Photochromic Contact Lens Wear on Indoor Visual Performance and Patient Satisfaction.

Ophthalmol Ther 2022 Jul 30. Epub 2022 Jul 30.

Visual Physiology, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan.

Introduction: To quantitatively assess visual performance and patient satisfaction during photochromic contact lens (CL) wear in an indoor environment.

Methods: This observational study comprised 82 eyes of 41 healthy subjects (mean age ± standard deviation, 21.7 ± 0.7 years) who had no ophthalmic diseases except for refractive errors at Kitasato University in 2021. We prospectively compared visual acuity, kinetic visual acuity, functional (time-dependent) visual acuity, the maintaining rate of visual acuity, the response time, contrast sensitivity function, higher-order aberrations, and patient satisfaction score for overall vision in such subjects during photochromic and non-photochromic CL wear in such an environment.

Results: The kinetic visual acuity at 30 km/h was 0.32 ± 0.21 and 0.41 ± 0.24 in the photochromic and non-photochromic CL groups, respectively (p = 0.008). The kinetic visual acuity at 60 km/h was 0.32 ± 0.21 and 0.41 ± 0.24, respectively (p = 0.034). The functional visual acuity was 0.00 ± 0.21 and 0.05 ± 0.25, respectively (p = 0.030). The average response time was 1.19 ± 0.15 s and 1.23 ± 0.15 s, respectively (p = 0.029). The patient satisfaction score for overall visual performance was 4.22 ± 0.11 and 3.59 ± 0.68, respectively (p < 0.001). Otherwise, we found no significant differences in visual acuity, the maintaining rate, higher-order aberrations, or contrast sensitivity function (p = 0.116, p = 0.053, p = 0.371, or p = 0.943). We found no apparent complications such as ocular discomfort, superficial punctate keratitis, conjunctival injection, or infectious keratitis during the observation period.

Conclusions: According to our experience, the photochromic CL showed good visual quality, especially in terms of kinetic and functional visual acuities and subsequent high patient satisfaction, even in an indoor environment, suggesting its viability of visual correction not only in daily activities but also in indoor sports activities.
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http://dx.doi.org/10.1007/s40123-022-00552-5DOI Listing
July 2022

Evaluation of ocular biometry in the Japanese population using a multicenter approach: Prospective observational study.

PLoS One 2022 27;17(7):e0271814. Epub 2022 Jul 27.

Department of Orthoptics, Teikyo University, Tokyo, Japan.

This prospective observational study aimed to evaluate the ocular biometry of Japanese people through a multicenter approach. The uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively) in the log minimum angle of resolution (logMAR), subjective and objective spherical equivalent values (SE) of ocular refraction, anterior and posterior corneal curvature (ACC and PCC, respectively), anterior and posterior corneal asphericity (ACA and PCA, respectively), central corneal thickness (CCT), anterior chamber depth (ACD), and ocular axial length (AL) were measured in the eyes of 250 participants (mean age = 46.5 ± 18.0 years, range: 20-90 years) across five institutions in Japan. The mean UDVA, CDVA, subjective SE, objective SE, ACC, PCC, ACA, PCA, CCT, ACD, and AL were 0.68, -0.08, -2.42 D, -2.66 D, 7.77 mm, 6.33 mm, -0.31, -0.39, 0.55 mm, 2.92 mm, and 24.78 mm, respectively. Age-related changes and sex-based differences were noted in the visual acuity, refraction, corneal shape, ACD, and AL. Our results serve as basis for future studies aiming to develop refractive correction methods and various vision-related fields.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0271814PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9328560PMC
July 2022

Predictability of combined cataract surgery and trabeculectomy using Barrett Universal Ⅱ formula.

PLoS One 2022 23;17(6):e0270363. Epub 2022 Jun 23.

Department of Ophthalmology, Kitasato University, Sagamihara, Japan.

Purpose: To compare the predictability of intraocular lens (IOL) power calculation using the Barrett Universal II and the SRK/T formulas in eyes undergoing combined cataract surgery and trabeculectomy.

Methods: We retrospectively reviewed the clinical charts of 56 consecutive eyes undergoing cataract surgery and trabeculectomy. IOL power calculations were performed using the Barrett Universal II and SRK/T formulas. We compared the prediction error, the absolute error, and the percentages within ± 0.5 D and ±1.0 D of the targeted refraction, 3 months postoperatively, and also investigated the relationship of the prediction error with the keratometric readings and axial length, using the two formulas.

Results: The prediction error using the SRK/T formula was significantly more myopic than that using the Barrett Universal II formula (paired t-test, p<0.001). The absolute error using the Barrett Universal II formula was significantly smaller than that using the SRK/T formula (p = 0.039). We found significant correlations of the prediction error with the axial length (Pearson correlation coefficient, r = 0.273, p = 0.042), and the keratometric readings (r = -0.317, p = 0.017), using SRK/T formula, but no significant correlations between them (r = 0.219, p = 0.167, and r = -0.023, p = 0.870), using the Barrett Universal II formula.

Conclusions: The Barrett Universal II formula provides a better predictability of IOL power calculation and is less susceptible to the effect of the axial length and the corneal shape, than the SRK/T formula. The Barrett Universal formula, rather than the SRK/T formula, may be clinically helpful for improving the refractive accuracy in such eyes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270363PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9223616PMC
June 2022

Comparison of Laser Iridotomy and Lensectomy Outcomes for Acute Primary Angle Closure.

J Ophthalmol 2022 30;2022:6959479. Epub 2022 May 30.

Department of Ophthalmology, School of Medicine, Kitasato University, Tokyo, Japan.

Purpose: To compare the clinical outcomes of the different treatments for acute primary angle closure (APAC).

Methods: We retrospectively reviewed the clinical charts of 87 eyes of 87 patients undergoing treatment for APAC. We investigated the best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and secondary interventions after each treatment.

Results: The pretreated IOP was 56.4 ± 9.0 mmHg. As the first treatment for APAC, all eyes underwent topical 2% pilocarpine and systemic mannitol administration. Subsequent laser iridotomy (LI) and lensectomy were necessary in 29 eyes (33%) and 35 eyes (40%), respectively. Bullous keratopathy developed in 1 eye (1%), and following glaucoma surgery was required in 7 eyes (8%). The BSCVA at the final follow-up was 0.16 ± 0.53 and 0.01 ± 0.20 logMAR (Mann-Whitney test, =0.149), the IOP was 12.8 ± 2.6, and 12.6 ± 2.9 mmHg (=0.860), and the ECD was 2295.9 ± 658.2 and 2244.1 ± 622.0 cells/mm (=0.735) in the LI and lensectomy groups, respectively.

Conclusions: Approximately 26% of eyes with APAC were resolved after the initial medical treatment, and subsequent surgical treatments, such as LI and lensectomy, were required in 33% and 40% of eyes, respectively. We found no significant differences in the BSCVA, the IOP, or the ECD among LI and lensectomy treatment groups.
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http://dx.doi.org/10.1155/2022/6959479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9170445PMC
May 2022

A Nationwide Multicenter Study on 1-Year Outcomes of Posterior Chamber Phakic Intraocular Lens Implantation for Low Myopia.

Front Med (Lausanne) 2022 4;9:762153. Epub 2022 May 4.

Department of Ophthalmology, Fujimoto Eye Clinic, Osaka, Japan.

Purpose: To assess the nationwide multicenter outcomes of posterior chamber phakic intraocular lens implantation with a central hole (EVO-ICL, STAAR Surgical) for patients with low myopia.

Methods: This multicenter study comprised 172 eyes of 111 consecutive patients undergoing hole ICL implantation to correct low myopia and myopic astigmatism [manifest spherical equivalent (MSE);-3 diopters (D) or less] at seven nationwide major surgical facilities. We retrospectively determined safety, efficacy, predictability, stability, and adverse events at 1 week, 1, 3, 6, and 12 months postoperatively, and at the final visit.

Results: The mean follow-up period was 1.4 ± 1.0 years. Uncorrected and corrected visual acuities at 1 year postoperatively were -0.17 ± 0.12 and -0.24 ± 0.07 logarithm of the minimal angle of resolution (logMAR), respectively. At 1 year postoperatively, 91% and 100% of eyes were within 0.5 and 1.0 D of the target correction, respectively. No significant manifest refraction changes of -0.07 ± 0.26 D occurred from 1 week to 1 year. No vision-threatening complications occurred at any time in this series.

Conclusions: According to our experience, the EVO-ICL performed well without significant complications throughout the 1-year observation period, even for the correction of low myopia. It is suggested that current ICL implantation is one of the viable surgical options for correcting low myopia.
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http://dx.doi.org/10.3389/fmed.2022.762153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9115804PMC
May 2022

Posterior chamber phakic intraocular lens implantation after laser in situ keratomileusis.

Eye Vis (Lond) 2022 Apr 11;9(1):15. Epub 2022 Apr 11.

Fujimoto Eye Clinic, Osaka, Japan.

Background: To assess the multicenter outcomes of posterior chamber phakic intraocular lens implantation with a central hole (EVO-ICL, STAAR Surgical) for patients undergoing previous laser in situ keratomileusis (LASIK).

Methods: This case series enrolled 31 eyes of 21 consecutive patients undergoing EVO-ICL implantation to correct residual refractive errors after LASIK at 7 nationwide major surgical sites. We investigated safety, efficacy, predictability, stability, and adverse events at 1 week, 1, 3, and 6 months postoperatively, and at the final visit.

Results: The mean observation period was 1.6 ± 1.8 years. Uncorrected and corrected visual acuities were - 0.14 ± 0.11 and - 0.22 ± 0.09 logMAR at 6 months postoperatively. At 6 months postoperatively, 81% and 100% of eyes were within ± 0.5 D and ± 1.0 D, respectively, of the targeted correction. We found neither significant manifest refraction changes of 0.05 ± 0.38 D from 1 week to 6 months nor apparent intraoperative or postoperative complications in any case.

Conclusions: Our multicenter study confirmed that the EVO-ICL provided good outcomes in safety, efficacy, predictability, and stability, even in post-LASIK eyes. Therefore, EVO-ICL implantation may be a viable surgical option, even for correcting residual refractive errors after LASIK. Trial registration University Hospital Medical Information Network Clinical Trial Registry (000045295).
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http://dx.doi.org/10.1186/s40662-022-00282-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008970PMC
April 2022

Hyperopia-Correcting Phototherapeutic Keratectomy and Its Comparison With Conventional Phototherapeutic Keratectomy.

Front Med (Lausanne) 2022 10;9:708188. Epub 2022 Mar 10.

Department of Ophthalmology, Kitasato University, School of Medicine, Sagamihara, Japan.

Purpose: To evaluate hyperopia-correcting phototherapeutic keratectomy (HC-PTK) and to compare the visual and refractive outcomes of HC-PTK and conventional PTK.

Methods: This study comprised a total of 72 eyes of 72 consecutive patients who underwent HC-PTK and conventional PTK for granular corneal dystrophy or band-shaped keratopathy. Preoperatively and 6 months postoperatively, we assessed visual acuity, manifest refraction, and mean keratometry, as well as postoperative corneal higher-order aberrations and adverse events in each PTK group, and compared these metrics between the two groups.

Results: LogMAR BSCVA significantly improved from 0.43 ± 0.47 preoperatively to 0.21 ± 0.38 postoperatively in the HC-PTK group (Wilcoxon signed-rank test, < 0.001). It was also significantly improved from 0.22 ± 0.21 preoperatively to 0.15 ± 0.12 postoperatively in the conventional PTK group ( = 0.031). Mean refraction significantly changed from 0.27 ± 1.55 diopter (D) preoperatively to 0.50 ± 1.77 D postoperatively, in the HC-PTK group ( = 0.313). By contrast, it was significantly hyperopic from -0.15 ± 2.41 D preoperatively to 1.45 ± 2.46 D postoperatively, in the conventional PTK group ( < 0.001). No significant complications occurred in any case during the follow-up period.

Conclusion: Both HC-PTK and conventional PTK showed a significant improvement of BSCVA and no vision-threatening complications at any time in this series. HC-PTK significantly reduced a hyperopic shift in refraction compared with conventional PTK, suggesting its viability for patients requiring PTK, especially in consideration of preventing this hyperopic issue.
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http://dx.doi.org/10.3389/fmed.2022.708188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8960048PMC
March 2022

Multicenter clinical outcomes of hole implantable collamer lens implantation in middle-aged patients.

Sci Rep 2022 03 10;12(1):4236. Epub 2022 Mar 10.

Department of Ophthalmology, Sanno Hospital, 8-10-16 Akasaka, Minato-ku, Tokyo, 107-0052, Japan.

To assess the multicenter clinical outcomes of the implantation of hole implantable collamer lens (Hole ICL, ICL KS-AquaPORTTM; STAAR Surgical, Nidau, Switzerland) in patients of 45 years or more. We retrospectively assessed the surgery's safety, efficacy, predictability, stability, and adverse events before surgery and after the surgery at 1 week; 1, 3, and 6 months; and 1 year, followed by once every year for approximately 2.2 years. A total of 118 eyes of 65 patients aged 45-65 years with myopic refractive errors ranging from - 2.13 to - 18.75 diopters (D) underwent hole ICL implantation and routine postoperative examinations. The average observation period was 2.2 ± 1.0 years. The safety and efficacy indices were 1.08 ±  0.21 and 0.87 ± 0.25, respectively. Manifest refraction changes of - 0.20 ± 0.43 D occurred from 1 month to the final visit after ICL implantation. Eight eyes (6.8%) developed asymptomatic anterior subcapsular cataract (ASC) immediately after surgery, and three eyes (2.5%) developed clinically significant symptomatic nuclear cataracts during the follow-up period. According to our experience, hole ICL implantation offered favorable outcomes in all measures of safety, efficacy, predictability, and stability, even in middle-aged patients, during the 2.2-year observation period.
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http://dx.doi.org/10.1038/s41598-022-08298-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8913835PMC
March 2022

Multicenter survey on implantable collamer lens dislocation.

PLoS One 2022 14;17(2):e0264015. Epub 2022 Feb 14.

Department of Ophthalmology, Sanno Hospital, Tokyo, Japan.

This study aimed to investigate the incidence, patient background, and postoperative prognosis of implantable collamer lens (ICL) dislocation. We retrospectively reviewed all cases of ICL dislocation at four major refractive surgery centers in Japan until December 2019. The incidence, patient background, cause of dislocation, complications of repositioning surgery, and postoperative visual function were investigated. Seven ICL dislocations [0.072% of total ICL-implanted eyes (9775 eyes)] occurred at an average of 28.6 months (11-82 months) postoperatively. All patients were male. Five eyes were injured during sports activities, one due to a fall from a bicycle, and another due to ocular blunt trauma caused by a mortuary tablet. Two patients had re-dislocation in the same eye. Retinal detachment occurred after repositioning surgery in one patient, and scleral buckling surgery was performed without ICL removal. ICL dislocation is a rare complication of ICL surgery; repositioning surgery is effective, but retinal complications may occur.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264015PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8843229PMC
February 2022

Clinical evaluation of flat peripheral curve design with aspherical-curve and multi-curve hard contact lenses for keratoconus.

PLoS One 2022 8;17(2):e0263506. Epub 2022 Feb 8.

Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan.

Aspherical- and multi-curve rigid gas-permeable hard contact lenses (HCLs) have a flattened curve in the peripheral zone and are mostly used for patients with keratoconus who cannot wear glasses, soft contact lenses, or spherical HCLs. In this retrospective study, a total of 95 eyes of 77 patients who used aspherical- or multi-curve HCLs (mean age: 40.0 ± 11.0 years) were evaluated. This study examined the types of aspherical- and multi-curve HCLs, best-corrected visual acuity (BCVA) values before and after wearing HCLs, the association with the Amsler-Krumeich classification, duration of wear, corneal/conjunctival disorder, and the frequency of changing HCLs. There were 78 eyes that used aspherical-curve HCLs and 17 that used multi-curve HCLs. BCVA significantly improved from 0.42 logMAR to 0.06 logMAR after wearing either form of HCL. The Amsler-Krumeich classification showed that aspherical-curve HCLs were commonly used for patients with stage 2 keratoconus, and multi-curve HCLs were commonly used for stage 4 patients. The BCVA values were worse when the disease stage was more severe (stages 3 and 4) regardless of HCL type. The mean base curve of the lenses was steeper in multi-curve HCLs than in aspherical-curve HCLs. The more severe the disease stage, the steeper the base curve in both aspherical- and multi-curve HCLs. The duration of wear significantly improved from 2.1 h to 10.2 h, and corneal/conjunctival disorder similarly improved. The mean frequency of changing HCL types was 1.1 times. This study suggests that a flat peripheral curve design with aspherical- and multi-curve HCLs is useful for patients with keratoconus.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263506PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8824338PMC
February 2022

Vertically Fixated Posterior Chamber Phakic Intraocular Lens Implantation Through a Superior Corneal Incision.

Ophthalmol Ther 2022 Apr 4;11(2):701-710. Epub 2022 Feb 4.

Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan.

Introduction: To assess the 1-year outcomes of vertically fixated posterior chamber phakic intraocular lens implantation through a superior corneal incision.

Methods: This pilot study comprised 78 eyes of 53 consecutive patients undergoing vertically fixated implantable collamer lens (ICL) implantation through a superior corneal incision to correct moderate to high myopia and myopic astigmatism. We prospectively determined the safety, efficacy, predictability, stability, and adverse events preoperatively, and at 1 week and 1, 3, and 12 months postoperatively.

Results: The mean follow-up period was 10.4 ± 5.4 months. Uncorrected and corrected visual acuity were -0.20 ± 0.10 and -0.25 ± 0.07 logMAR, respectively, at 1 year postoperatively. At 1 year postoperatively, 98% and 100% of eyes were within 0.5 and 1.0 D, respectively, of the targeted correction. A nonsignificant change in manifest refraction of -0.01 ± 0.08 D occurred from 1 week to 1 year. The manifest astigmatism decreased significantly, from 0.69 ± 0.73 D preoperatively to 0.21 ± 0.27 D at 1 year postoperatively (Mann-Whitney U test, p < 0.001). No vision-threatening complications occurred at any time in this series.

Conclusions: According to our experience, the vertically fixated ICL through a superior incision achieved good results, without significant complications. Considering that younger patients requiring ICL surgery tend to have with-the-rule astigmatism, this surgical technique may be a viable option for reducing astigmatism without using toric ICLs.
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http://dx.doi.org/10.1007/s40123-022-00470-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8927518PMC
April 2022

Effect of Trabeculectomy on Mean and Centroid Surgically Induced Astigmatism.

J Clin Med 2022 Jan 3;11(1). Epub 2022 Jan 3.

Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara 252-0373, Japan.

This study aimed to investigate the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) after standard trabeculectomy. We comprised 185 eyes of 143 consecutive patients (mean age ± standard deviation, 67.7 ± 11.6 years) who underwent trabeculectomy and completed at least a 3-month routine follow-up. In all cases, the scleral flap was made at the nasal-superior location. Corneal astigmatism was measured with an automated keratometer. We calculated the M-SIA and the C-SIA using vector analysis and applied the astigmatism double angle plot. The magnitude of corneal astigmatism increased significantly, from 1.17 ± 0.92 D preoperatively to 1.77 ± 1.05 D postoperatively (paired -test, < 0.001). The M-SIA was 1.12 ± 0.55 D, and the C-SIA was 0.73 D @64° ± 1.02 D in the right eye group, and the M-SIA was 1.08 ± 0.48 D and the C-SIA was 0.60 D @117° ± 1.03 D in the left eye group. The C-SIA showed an astigmatic shift toward the nasal-superior location of the scleral flap creation. Our results revealed that trabeculectomy induced the SIA in the direction of the scleral flap location and that the C-SIA was much lower than the M-SIA in eyes undergoing trabeculectomy.
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http://dx.doi.org/10.3390/jcm11010240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8745580PMC
January 2022

Eight-Year Outcomes of Implantation of Posterior Chamber Phakic Intraocular Lens With a Central Port for Moderate to High Ametropia.

Front Med (Lausanne) 2021 16;8:799078. Epub 2021 Dec 16.

Department of Ophthalmology, School of Medicine, Kitasato University, Tokyo, Japan.

To assess the 8-year clinical outcomes of implantation of an implantable collamer lens (ICL) with a central port (KS-Aquaport; EVO-ICL) for moderate to high myopia and myopic astigmatism. This retrospective study comprised a total of 177 eyes of 106 patients with spherical equivalents of -7.99 ± 3.33 D [mean ± standard deviation], who underwent EVO-ICL implantation. We evaluated the safety, efficacy, predictability, stability, and adverse events of the surgery, at 1 month, and 1, 2, 4, 6, and 8 years postoperatively. The logarithm of the minimal angle of resolution (LogMAR) uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were -0.07 ± 0.17 and -0.20 ± 0.09, respectively, at 8 years postoperatively. The safety and efficacy indices were 1.18 ± 0.24 and 0.89 ± 0.28, respectively. At 8 years, 83 and 93% eyes were within ± 0.5 D and ± 1.0 D of the targeted correction, respectively. Change in manifest refraction from 1 month to 8 years postoperatively was -0.13 ± 0.30 D. Three eyes (1.7%) that developed cataracts had a slight pre-existing peripheral anterior subcapsular cataract formation required simultaneous ICL extraction and cataract surgery at 2 or 3 years or ICL size change (1 size up) at 7 years postoperatively. We found that neither significant intraocular pressure (IOP) rise (including pupillary block) nor significant endothelial cell loss occurred in any case throughout the 8-year observation period. Current ICL implantation with central port technology offered good continuous outcomes for all measures of safety, efficacy, predictability, and stability for correcting moderate to high myopic errors over a long period, thereby suggesting its long-term viability as a surgical approach for the treatment of such eyes.
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http://dx.doi.org/10.3389/fmed.2021.799078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8716586PMC
December 2021

Effect of Platelet-Rich Plasma on Corneal Epithelial Healing after Phototherapeutic Keratectomy: An Intraindividual Contralateral Randomized Study.

Biomed Res Int 2021 27;2021:5752248. Epub 2021 Nov 27.

Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan.

Purpose: To assess the effect of platelet-rich plasma (PRP) on the healing response of the corneal epithelium in eyes undergoing phototherapeutic keratectomy (PTK).

Methods: We prospectively examined 20 eyes of 10 patients undergoing bilateral PTK for granular corneal dystrophy or band keratopathy. Patients were randomly assigned to start topical administration of PRP ophthalmic suspension (PRP group) or artificial tears (control group) 4 times daily for 2 weeks. Immediately, 1, and 2 days, and 1 week after PTK, we quantitatively measured the staining area of the corneal epithelium, using slit-lamp photography. We also determined the subjective symptoms and the satisfaction, using the visual analogue system (VAS).

Results: The staining area in the PRP group was significantly smaller than that in the control group on days 1 and 2 (Wilcoxon signed-rank test, = 0.022 and = 0.017, respectively), but not on day 7 ( = 0.317). The recovery rate of the corneal epithelium in the PRP group was significantly higher than that in the control group on days 1 and 2 ( = 0.022 and = 0.017, respectively), but not on day 7 ( = 0.317). We found no significant differences in pain ( = 0.139), foreign body sensation ( = 0.108), epiphora ( = 1.000), or satisfaction ( = 0.295), between the two groups. Postoperative complications did not occur in any of the eyes in the study.

Conclusions: The PRP treatment was effective for enhancing corneal epithelial recovery in the early postoperative period, without significant adverse events, in post-PTK-treated eyes, suggesting that it may hold promise as one of the treatment options for treating such postsurgical patients.
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http://dx.doi.org/10.1155/2021/5752248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8643227PMC
January 2022

Comparison of Visual Performance and Patient Satisfaction After Multifocal Intraocular Lens Implantation and During Multifocal Contact Lens Wear After Monofocal Intraocular Lens Implantation: A Pilot Study.

Ophthalmol Ther 2021 Dec 27;10(4):1119-1128. Epub 2021 Oct 27.

Department of Ophthalmology, Miyata Eye Hospital, Miyazaki, Japan.

Purpose: To compare the visual performance and patient satisfaction in multifocal intraocular lens (IOL)-implanted eyes and multifocal contact lens (CL)-wearing eyes undergoing monofocal IOL implantation.

Methods: We retrospectively assessed visual acuity at all distances (0.3, 0.5, 0.7, 1, and 5 m), contrast sensitivity function, patient satisfaction score, and the rate of spectacle independence in the multifocal IOL and multifocal CL groups.

Results: Binocular visual acuity at 0.3, 0.5, 0.7, 1, and 5 m was 0.05 ± 0.11, - 0.02 ± 0.09, - 0.02 ± 0.09, - 0.02 ± 0.09, and - 0.04 ± 0.07, respectively, in the multifocal IOL group and 0.25 ± 0.13, 0.04 ± 0.10, 0.01 ± 0.09, - 0.01 ± 0.07, and 0.00 ± 0.08, respectively, in the multifocal CL group. We found significant differences in visual acuity at all distances. The area under the log contrast sensitivity function was 1.32 ± 0.14 and 1.33 ± 0.16 in the multifocal IOL and CL groups, respectively (p = 0.444). The patient satisfaction score for overall vision was 80.2 ± 20.6 and 82.9 ± 10.5 (p = 0.889), and the rate of spectacle independence was 23.4% and 41.7% in the multifocal IOL and CL groups, respectively (p = 0.277).

Conclusions: According to our experience, both multifocal IOLs and CLs provided good near-to-distance binocular vision and subsequent high patient satisfaction in daily activities with acceptable contrast sensitivity, suggesting their viability for presbyopic correction in elderly subjects.
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http://dx.doi.org/10.1007/s40123-021-00414-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8589890PMC
December 2021

Diagnosability of Keratoconus Using Deep Learning With Placido Disk-Based Corneal Topography.

Front Med (Lausanne) 2021 4;8:724902. Epub 2021 Oct 4.

Department of Ophthalmology, Miyata Eye Hospital, Miyazaki, Japan.

Placido disk-based corneal topography is still most commonly used in daily practice. This study was aimed to evaluate the diagnosability of keratoconus using deep learning of a color-coded map with Placido disk-based corneal topography. We retrospectively examined 179 keratoconic eyes [Grade 1 (54 eyes), 2 (52 eyes), 3 (23 eyes), and 4 (50 eyes), according to the Amsler-Krumeich classification], and 170 age-matched healthy eyes, with good quality images of corneal topography measured with a Placido disk corneal topographer (TMS-4, Tomey). Using deep learning of a color-coded map, we evaluated the diagnostic accuracy, sensitivity, and specificity, for keratoconus screening and staging tests, in these eyes. Deep learning of color-coded maps exhibited an accuracy of 0.966 (sensitivity 0.988, specificity 0.944) in discriminating keratoconus from normal eyes. It also exhibited an accuracy of 0.785 (0.911 for Grade 1, 0.868 for Grade 2, 0.920 for Grade 3, and 0.905 for Grade 4) in classifying the stage. The area under the curve value was 0.997, 0.955, 0.899, 0.888, and 0.943 as Grade 0 (normal) to 4 grading tests, respectively. Deep learning using color-coded maps with conventional corneal topography effectively distinguishes between keratoconus and normal eyes and classifies the grade of the disease, indicating that this will become an aid for enhancing the diagnosis and staging ability of keratoconus in a clinical setting.
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http://dx.doi.org/10.3389/fmed.2021.724902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8520919PMC
October 2021

Prediction of keratoconus progression using deep learning of anterior segment optical coherence tomography maps.

Ann Transl Med 2021 Aug;9(16):1287

Department of Ophthalmology, Miyata Eye Hospital, Miyazaki, Japan.

Background: To predict keratoconus progression using deep learning of the color-coded maps measured with a swept-source anterior segment optical coherence tomography (As-OCT) device.

Methods: We enrolled 218 keratoconic eyes with and without disease progression. Using deep learning of the 6 color-coded maps (anterior elevation, anterior curvature, posterior elevation, posterior curvature, total refractive power, and pachymetry map) obtained by the As-OCT (CASIA, Tomey), we assessed the accuracy, sensitivity, and specificity of prediction of keratoconus progression in such eyes.

Results: Deep learning of the 6 color-coded maps exhibited an accuracy of 0.794 in discriminating keratoconus with and without progression. For a single map analysis, posterior elevation map (0.798) showed the highest accuracy, followed by anterior curvature map (0.775), posterior corneal curvature map (0.757), anterior elevation map (0.752), total refractive power map (0.729), and pachymetry map (0.720), in distinguishing between progressive and non-progressive keratoconus. The use of the adjusted algorithm by age subgroups improved to an accuracy of 0.849.

Conclusions: Deep learning of the As-OCT color-coded maps effectively discriminates progressive keratoconus from non-progressive keratoconus with an accuracy of approximately 85% using the adjusted age algorithm, indicating that it will become an aid for predicting the progression of the disease, which is clinically beneficial for decision-making of the surgical indication of corneal cross-linking (CXL).
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http://dx.doi.org/10.21037/atm-21-1772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422102PMC
August 2021

Comparison of magnitude and summated vector mean of surgically induced astigmatism vector according to incision site after phakic intraocular lens implantation.

Eye Vis (Lond) 2021 Sep 2;8(1):32. Epub 2021 Sep 2.

Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.

Background: To compare the arithmetic mean (M-SIA) and the summated vector mean of surgically induced astigmatism (SVM-SIA) according to the incision site after phakic intraocular lens (Visian implantable collamer lens (ICL), STAAR Surgical) implantation.

Methods: This study comprised 121 eyes of 121 consecutive patients undergoing ICL surgery through a 3.0-mm temporal or superior clear corneal incision. The magnitude and the axis of corneal astigmatism preoperatively and 3 months postoperatively were measured using an automated keratometer. The M-SIA and the SVM-SIA were determined according to the incision site.

Results: The magnitude of corneal astigmatism significantly increased from 1.23 ± 0.59 D preoperatively to 1.46 ± 0.72 D postoperatively in the temporal incision group (Wilcoxon signed-rank test, P < 0.001), but it significantly decreased from 1.09 ± 0.36 D preoperatively to 0.86 ± 0.41 D postoperatively in the superior incision group (P < 0.001). The M-SIA was 0.48 ± 0.30 D, and the SVM-SIA was 0.23 ± 0.52 D at a meridian of 82° in the temporal incision group. The M-SIA was 0.57 ± 0.30 D, and the SVM-SIA was 0.47 ± 0.45 D at a meridian of 1° in the superior incision group.

Conclusions: ICL implantation induces the M-SIA by approximately 0.5 D, but the SVM-SIA decreased to 50% and 80% of the M-SIA in magnitude through temporal and superior incisions, respectively. The direction of the SVM-SIA showed a tendency toward corneal flattening to the incisional site. It should be noted that the M-SIA is somewhat different from the SVM-SIA according to the incision site. Trial registration University Hospital Medical Information Network Clinical Trial Registry (000044269).
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http://dx.doi.org/10.1186/s40662-021-00257-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411523PMC
September 2021

Corneal Cross-Linking for Paediatric Keratoconus: A Systematic Review and Meta-Analysis.

J Clin Med 2021 Jun 15;10(12). Epub 2021 Jun 15.

Department of Ophthalmology, School of Medicine, Keio University, Tokyo 160-8582, Japan.

All corneal cross-linking techniques attenuated disease progression in patients with pediatric keratoconus for at least one year based on a meta-analysis. A standard and accelerated technique led to marked improvement in visual acuity. We determined the efficacy and safety of corneal cross-linking (CXL) in pediatric keratoconus by conducting a systematic review and meta-analysis. The PubMed and Cochrane databases were searched for relevant studies on the effects of standard, transepithelial, and/or accelerated CXL protocols in patients aged 18 years or younger. Standardized mean differences with 95% confidence intervals were calculated to compare the data collected at baseline and 12 months. The primary outcomes were maximum keratometry (Kmax) and uncorrected visual acuity (UCVA), and the secondary outcomes were the thinnest corneal thickness (TCT), best-corrected visual acuity (BCVA), and manifest refraction spherical equivalent or cylindrical refraction. Our search yielded 7913 publications, of which 26 were included in our systematic review and 21 were included in the meta-analysis. Standard CXL significantly improved the Kmax, UCVA, and BCVA, and significantly decreased the TCT. Accelerated CXL significantly improved UCVA and BCVA. In the transepithelial and accelerated-transepithelial CXL methods, each measurable parameter did not change after treatments. All CXL techniques attenuated disease progression in patients with pediatric keratoconus for at least one year. Standard and accelerated CXL led to marked improvement in visual acuity.
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http://dx.doi.org/10.3390/jcm10122626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232120PMC
June 2021

Comparison of Mean and Centroid of Surgically Induced Astigmatism After Standard Cataract Surgery.

Front Med (Lausanne) 2021 4;8:670337. Epub 2021 Jun 4.

Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan.

To compare the arithmetic mean of surgically induced astigmatism (M-SIA) and the centroid of surgically induced astigmatism (C-SIA) after standard cataract surgery. We retrospectively examined 200 eyes of 100 consecutive patients undergoing bilateral cataract surgery through a 2.8 mm temporal clear corneal incision. We quantitatively measured the magnitude and axis of corneal astigmatism preoperatively and 3 months postoperatively using an automated keratometer (TONOREFF-II, Nidek). We assessed the M-SIA, the C-SIA, and the double angle plots for the display of the individual SIA distributions. For bilateral data analysis, the magnitude of corneal astigmatism significantly increased from 0.66 ± 0.39 D preoperatively to 0.74 ± 0.46 D postoperatively (paired -test, = 0.012). The M-SIA was 0.50 ± 0.36 D. On the other hand, the C-SIA was 0.18 ± 0.60 D at an axis of 97°. For unilateral analysis, we obtained similar outcomes between the right and left eye groups. According to our experience, standard cataract surgery induces the M-SIA by approximately 0.5 D. The magnitude of the C-SIA largely decreased to approximately 40% of the M-SIA, and the direction of the C-SIA showed a tendency toward with-the-rule astigmatism. It should be noted that the M-SIA was considerably different from the C-SIA, especially when selecting the appropriate toric IOL model and power.
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http://dx.doi.org/10.3389/fmed.2021.670337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212985PMC
June 2021

Development of a Web-Based Ensemble Machine Learning Application to Select the Optimal Size of Posterior Chamber Phakic Intraocular Lens.

Transl Vis Sci Technol 2021 05;10(6)

B&VIIT Eye Center, Seoul, South Korea.

Purpose: Selecting the optimal lens size by predicting the postoperative vault can reduce complications after implantation of an implantable collamer lens with a central-hole (ICL with KS-aquaport). We built a web-based machine learning application that incorporated clinical measurements to predict the postoperative ICL vault and select the optimal ICL size.

Methods: We applied the stacking ensemble technique based on eXtreme Gradient Boosting (XGBoost) and a light gradient boosting machine to pre-operative ocular data from two eye centers to predict the postoperative vault. We assigned the Korean patient data to a training (N = 2756 eyes) and internal validation (N = 693 eyes) datasets (prospective validation). Japanese patient data (N = 290 eyes) were used as an independent external dataset from different centers to validate the model.

Results: We developed an ensemble model that showed statistically better performance with a lower mean absolute error for ICL vault prediction (106.88 µm and 143.69 µm in the internal and external validation, respectively) than the other machine learning techniques and the classic ICL sizing methods did when applied to both validation datasets. Considering the lens size selection accuracy, our proposed method showed the best performance for both reference datasets (75.9% and 67.4% in the internal and external validation, respectively).

Conclusions: Applying the ensemble approach to a large dataset of patients who underwent ICL implantation resulted in a more accurate prediction of vault size and selection of the optimal ICL size.

Translational Relevance: We developed a web-based application for ICL sizing to facilitate the use of machine learning calculators for clinicians.
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http://dx.doi.org/10.1167/tvst.10.6.5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107636PMC
May 2021

Nationwide multicentre comparison of preoperative biometry and predictability of cataract surgery in Japan.

Br J Ophthalmol 2021 Jun 9. Epub 2021 Jun 9.

Ophthalmology, Kanazawa Medical University, Kahoku-gun, Japan.

Aim: To compare the preoperative biometric data and the refractive accuracy of cataract surgery among major surgical sites in a nationwide multicentre study.

Methods: We prospectively obtained the preoperative biometric data of 2143 eyes of 2143 consecutive patients undergoing standard cataract surgery at major 12 facilities and compared the preoperative biometry as well as the postoperative refractive accuracy among them.

Results: We found significant differences in most preoperative variables, such as axial length (one-way analysis of variance, p=0.003), anterior chamber depth (p<0.001), lens thickness (p<0.001) and central corneal thickness (p<0.001), except for mean keratometry (p=0.587) and corneal astigmatism (p=0.304), among the 12 surgical sites. The prediction error using the Sanders-Retzlaff-Kraff/Theoretical (SRK/T formula was significantly more hyperopic than that using the Barrett Universal II formula (paired t-test, p<0.001). The absolute error using the SRK/T formula was significantly larger than that using the Barrett Universal II formula (p=0.016). The prediction error using the SRK/T formula was significantly more hyperopic than that using the Barrett Universal II formula at 10 of 12 institutions, but significantly more myopic at one institution. The absolute error using the SRK/T formula was significantly larger than that using the Barrett Universal II formula at 4 of 12 institutions but significantly smaller at two institutions.

Conclusions: Regional divergences of the preoperative biometry were not necessarily negligible, and the optimised intraocular lens power calculation formula was individually different among the 12 facilities. Our findings highlight the importance of individual optimisation of these formulas at each facility, especially in consideration of these biometric variations.Trial registration numberClinical Trial Registry; 000039976.
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http://dx.doi.org/10.1136/bjophthalmol-2021-318825DOI Listing
June 2021

Clinical outcomes of simultaneous phototherapeutic keratectomy and photoastigmatic keratectomy.

Sci Rep 2021 05 4;11(1):9504. Epub 2021 May 4.

Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.

This study was aimed to assess the outcomes of simultaneous phototherapeutic keratectomy (PTK) and photoastigmatic keratectomy (PAK), with special attention to astigmatic correction. We comprised 70 eyes of 70 patients who underwent simultaneous PTK and PAK in patients having granular corneal dystrophy and band keratopathy with refractive astigmatism of 1 diopter (D) or more. Preoperatively and 6 months postoperatively, we assessed corrected uncorrected distance visual acuity (UDVA), distance visual acuity (CDVA), manifest spherical equivalent, refractive astigmatism, corneal astigmatism, and higher-order aberrations (HOAs). LogMAR CDVA significantly improved, from 0.27 ± 0.27 preoperatively, to 0.13 ± 0.21 postoperatively (Paired t test, p < 0.001). LogMAR UDVA also significantly improved, from 0.70 ± 0.32 preoperatively, to 0.57 ± 0.41 postoperatively (p = 0.043). Refractive astigmatism significantly decreased, from 2.12 ± 0.95 D preoperatively, to 0.89 ± 0.81 D postoperatively (p < 0.001). Corneal astigmatism also significantly decreased, from 2.17 ± 0.90 D preoperatively, to 1.08 ± 0.71 D postoperatively (p < 0.001). Corneal HOAs did not significantly change, from 0.54 ± 0.30 µm preoperatively, to 0.48 ± 0.20 µm postoperatively (p = 0.140). No significant complications occurred in any eye. Simultaneous PTK and PAK treatment is effective not only for improving visual acuity, but also for reducing astigmatism.
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http://dx.doi.org/10.1038/s41598-021-89044-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096838PMC
May 2021

Factors Influencing Contrast Sensitivity Function in Eyes with Mild Cataract.

J Clin Med 2021 Apr 4;10(7). Epub 2021 Apr 4.

Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa 2520374, Japan.

This study was aimed to evaluate the relationship between the area under the log contrast sensitivity function (AULCSF) and several optical factors in eyes suffering mild cataract. We enrolled 71 eyes of 71 patients (mean age, 71.4 ± 10.7 (standard deviation) years) with cataract formation who were under surgical consultation. We determined the area under the log contrast sensitivity function (AULCSF) using a contrast sensitivity unit (VCTS-6500, Vistech). We utilized single and multiple regression analyses to investigate the relevant factors in such eyes. The mean AULSCF was 1.06 ± 0.16 (0.62 to 1.38). Explanatory variables relevant to the AULCSF were, in order of influence, logMAR best spectacle-corrected visual acuity (BSCVA) ( < 0.001, partial regression coefficient B = -0.372), and log(s) ( = 0.023, B = -0.032) (adjusted R = 0.402). We found no significant association with other variables such as age, gender, uncorrected visual acuity, nuclear sclerosis grade, or ocular HOAs. Eyes with better BSCVA and lower log(s) are more susceptible to show higher AULCSF, even in mild cataract subjects. It is indicated that both visual acuity and intraocular forward scattering play a role in the CS function in such eyes.
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http://dx.doi.org/10.3390/jcm10071506DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038429PMC
April 2021

Prediction of distance visual acuity in presbyopic astigmatic subjects.

Sci Rep 2021 03 26;11(1):6958. Epub 2021 Mar 26.

Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara, Japan.

This study was aimed to determine the effect of the amount of astigmatism on distance visual acuity, and to provide a prediction formula of visual acuity according to astigmatism, in a presbyopic population. We comprised 318 eyes of 318 consecutive patients (158 phakic and 160 pseudophakic subjects) without any eye diseases, except for refractive errors with astigmatism of 3 diopter or less. We assessed the relationship of the spherical equivalent visual acuity (SEVA) with astigmatism, and also provided a regression formula of visual acuity according to astigmatism in such subjects. We found a significant correlation between the SEVA and the amount of astigmatism (r = 0.715, p < 0.001) in the entire study population. We obtained similar results, not only in phakic eyes (r = 0.718, p < 0.001), but also in pseudophakic eyes (r = 0.717, p < 0.001). The regression formula was expressed as follows: y = 0.017x + 0.125x - 0.116 (R = 0.544), where y = logMAR SEVA, and x = astigmatism. We also found no significant differences in the SEVA for matched comparison among the with-the-rule (WTR), against-the-rule (ATR), and oblique (OBL) astigmatism subgroups (p = 0.922). These regression formulas may be clinically beneficial not only for estimating the visual prognosis after astigmatic correction, but also for determining the surgical indication of astigmatic correction.
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http://dx.doi.org/10.1038/s41598-021-85313-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997907PMC
March 2021

Prediction of Phakic Intraocular Lens Vault Using Machine Learning of Anterior Segment Optical Coherence Tomography Metrics.

Am J Ophthalmol 2021 06 9;226:90-99. Epub 2021 Feb 9.

Department of Ophthalmology, Tsukazaki Hospital, Hyogo, Japan.

Purpose: To compare the achieved vault using the conventional manufacturer's nomogram and the predicted vault using machine learning, in a large cohort of eyes undergoing posterior chamber phakic intraocular lens (EVO implantable collamer lens [ICL]; STAAR Surgical) implantation.

Design: Reliability and validity assessment and comparison.

Methods: Our study comprised a total of 1,745 eyes of 1,745 consecutive patients (mean age ± standard deviation, 26.2 ± 6.8 years) undergoing ICL implantation. At 1 month postoperatively, we quantitatively measured the actual vault, and compared it with the predicted vault using machine leaning of anterior segment optical coherence tomography metrics.

Results: All machine learning methods, such as support vector regressor (SVR), gradient boost regressor (GBR), random forest regressor (RFR), and linear regressor (LR), showed significantly less mean absolute error and higher percentages of eyes within 50-200 µm of the targeted ICL vault than the conventional nomogram (P < .001). The RFR provided the lowest mean absolute errors and the highest percentages of eyes within 50 to 200 µm, followed by the GBR, the LR, and the SVR (P < .01).

Conclusions: Machine learning of the preoperative anterior segment optical coherence tomography metrics, especially the RFR, provided significantly higher predictability of the ICL vault than the conventional manufacturer's nomogram, suggesting that it will become an aid for predicting the ICL vault and subsequently selecting the proper ICL size in daily practice.
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http://dx.doi.org/10.1016/j.ajo.2021.02.006DOI Listing
June 2021

Comparison of Phakic Intraocular Lens Vault Using Conventional Nomogram and Prediction Formulas.

J Clin Med 2020 Dec 18;9(12). Epub 2020 Dec 18.

Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa 252-0374, Japan.

This study aimed to compare the achieved vault using a manufacturer's nomogram and the predicted vault using the currently available prediction formulas after posterior chamber phakic intraocular lens (EVO Implantable Collamer Lens; ICL, STAAR Surgical) implantation. We included 200 eyes of 100 consecutive patients (mean age ± standard deviation, 34.3 ± 7.8 years) undergoing ICL implantation with a central hole. Three months postoperatively, we quantitatively measured the actual vault, and we compared it with the predicted vault using anterior segment optical coherence tomography (CASIA 2, Tomey). The agreement rate of the recommended ICL size using the manufacturer's nomogram, the NK formula, and the KS formula was 50.0%. The achieved vault was 477.1 ± 263.7 µm, which was significantly smaller than the predicted vaults of 551.2 ± 335.1 and 606.4 ± 212.2 µm, using the NK and KS formulas, respectively (Dunnett test, = 0.014, < 0.001). The achieved vault was not significantly different from the predicted vault using the NK or KS formula ( = 0.386, = 0.157) when selecting a 12.1 mm ICL size. It was not significantly different from the predicted vault using the NK formula ( = 0.962), but it was significantly smaller than that using the KS formula ( = 0.033) when selecting a 12.6 mm size. It was significantly smaller than the predicted vault using the NK and KS formulas ( < 0.001) when selecting 13.2 mm size. The total agreement rate of the recommended ICL size was approximately 50%. The predicted ICL vault tended to overestimate the actual ICL vault, especially when selecting a larger ICL size.
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http://dx.doi.org/10.3390/jcm9124090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765914PMC
December 2020

Etiology and outcomes of current posterior chamber phakic intraocular lens extraction.

Sci Rep 2020 12 10;10(1):21686. Epub 2020 Dec 10.

Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan.

This study was aimed to review the etiology and the outcomes of current posterior chamber phakic intraocular lens (Visian ICL, STAAR Surgical) extraction. This review comprised 770 eyes of 403 consecutive patients undergoing ICL extraction. We evaluated prevalence, etiology, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), predictability, and patient satisfaction. ICL extraction was required in 8 of 770 (1.0%) eyes. The most common reason was the progression of the pre-existing cataract formation in 5 eyes (63%), followed by residual refractive errors in 3 eyes (38%). Of the 7 eyes targeted for emmetropia, 7 (100%) and 6 (86%) achieved UDVAs of 20/40 and 20/20 or better, respectively. Three eyes (38%) showed no change in CDVA, 3 eyes (38%) gained 1 line, 2 eyes (25%) gained 3 or more lines. 88% and 100% were within ± 0.5 and 1.0 diopter (D), respectively, of the targeted correction. Patient satisfaction improved significantly, from 3.0 ± 1.4 preoperatively, to 8.0 ± 2.4 postoperatively. No vision-threatening complications occurred. ICL extraction was required in approximately 1% of ICL-implanted eyes. Visual and refractive outcomes were good, and patient satisfaction was overall high, even in ICL-extracted eyes.
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http://dx.doi.org/10.1038/s41598-020-78661-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730447PMC
December 2020

Visual and Topographic Improvement with Epithelium-On, Oxygen-Supplemented, Customized Corneal Cross-Linking for Progressive Keratoconus.

J Clin Med 2020 Oct 8;9(10). Epub 2020 Oct 8.

Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa 252-0374, Japan.

Customized cross-linking has been proposed as an alternative to conventional cross-linking in patients with progressive keratoconus, targeting greater flattening of the cone region and improved visual function. Epithelium-on cross-linking aims to reduce complications associated with epithelial removal, while the addition of oxygen aims to maintain treatment effect. Our study evaluates the combination of these novel treatment strategies to achieve a minimally invasive treatment targeting maximal functional outcomes. This prospective study included 42 eyes undergoing epithelium-on, accelerated, oxygen-supplemented, customized corneal cross-linking for progressive keratoconus. Outcome measures, including refraction, visual acuity, and corneal tomography were obtained at baseline and at 1, 3, and 6 months, and 1 year postoperatively. Logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity was significantly improved, from 0.87 ± 0.53 preoperatively, to 0.78 ± 0.56 1 year postoperatively (Wilcoxon rank sum test, = 0.016). LogMAR best spectacle-corrected visual acuity was also significantly improved, from 0.19 ± 0.36 preoperatively, to 0.11 ± 0.33 postoperatively ( = 0.004). Manifest refractive cylinder was significantly decreased, from 4.50 ± 2.96 D preoperatively, to 3.27 ± 2.61 D postoperatively ( = 0.004). The baseline maximum keratometry (Kmax) was 53.04 ± 7.91 D, significantly flattening to 52.25 ± 7.31 D by 1 month, and remaining relatively stable at 1 year postoperatively (52.31 ± 7.50 D) ( < 0.001). No significant adverse events occurred in any eye. Epithelium-on, accelerated, oxygen-supplemented, customized corneal cross-linking is a promising new treatment approach, with reduced maximum keratometry, reduced astigmatism, and improved visual acuity at 1 year, with a favorable safety and patient comfort profile.
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http://dx.doi.org/10.3390/jcm9103222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600308PMC
October 2020

Effect of Angle Opening Parameters on Corneal Endothelial Cell Density and Intraocular Pressure after Posterior Chamber Phakic Intraocular Lens Implantation.

J Clin Med 2020 Aug 21;9(9). Epub 2020 Aug 21.

Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa 252-0374, Japan.

This study aimed to investigate the time courses of angle opening parameters and the relationships of these with the corneal endothelial cell density (ECD) and the intraocular pressure (IOP) after posterior chamber phakic intraocular lens (Visian ICL, STAAR Surgical) implantation. We evaluated 116 eyes of 59 consecutive patients (mean age ± standard deviation, 34.0 ± 8.8 years) who underwent V5 implantable collamer lens (ICL) implantation. Preoperatively and 1 day, 1 week, and 1, 3, and 18 months postoperatively, we quantitatively measured the angle opening distance at 500 µm (AOD500), the trabecular-iris space area (TISA500), and the trabecular iris angle (TIA500), using anterior segment optical coherence tomography (CASIA 2, Tomey), and assessed the relationships of these measurements with ECD and IOP in ICL-implanted eyes. All angle parameters (AOD500, TISA500, and TIA500) significantly decreased 1 day postoperatively but remained stable thereafter. At 18 months postoperatively, we found no significant correlations of the angle parameters with ECD (Pearson correlation coefficient = -0.108, = 0.249 for AOD500; = -0.162, = 0.083 for TISA500; = -0.022, = 0.815 for TIA500) or between the angle parameters and IOP ( = -0.106, = 0.256 for AOD500; = -0.021, = 0.826 for TISA500; = -0.018, = 0.850 for TIA500). The angle opening metrics significantly decreased immediately after ICL implantation but remained stable thereafter. Narrowing of the angle did not significantly affect ECD or IOP in ICL-implanted eyes during the 18-month postoperative period.
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http://dx.doi.org/10.3390/jcm9092704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565728PMC
August 2020
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