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  • 10_3928_1081597X_20191211_02
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Colin Chan, Michael Lawless, Gerard Sutton, Chris Hodge

    Improvement in vision-related quality of life has been consistently reported following corneal laser refractive surgery.1–3 These benefits appear to continue long-term unless a patient experiences a reduction in uncorrected vision.4,5 Refractive regression, the leading cause of loss of uncorrected visual acuity, will occur in a minority of patients following laser surgery.6 The incidence will vary based on preoperative risk factors and surgical technique, with studies indicating regression rates as low as 0.48% in a large cohort of patients under the care of experienced surgeons to as high as

    更新日期:2020-01-15
  • 10_3928_1081597X_20191210_01
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Avi Wallerstein, Mathieu Gauvin, Mark Cohen

    We read with interest “Comparison of Wavefront-Optimized Ablation and Topography-Guided Contoura Ablation With LYRA Protocol in LASIK” by Ozulken et al.1 Eyes with 0.75 diopters or greater magnitude difference between clinically measured manifest refractive astigmatism and Contoura-measured anterior corneal astigmatism (ACA) and 10° or less axis difference received Contoura treatment (WaveLight Contoura; Alcon Laboratories, Inc., Fort Worth, TX), whereas contralateral eyes without these criteria were excluded from Contoura treatment and received wavefront-optimized (WFO) treatment. This

    更新日期:2020-01-15
  • 10_3928_1081597X_20191119_02
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Di Chen, Ge Cui, Xuejiao Wang, Ying Li, Yan Luo

    Implantation of the posterior chamber phakic Visian Implantable Collamer Lens (ICL) (STAAR Surgical AG, Nidau, Switzerland) has been proved to be an effective and predictable method of correcting high myopia.1–3 Numerous studies have proved its safety, and the incidence of moderate and severe complications is low.4–8 However, complications (eg, postoperative intraocular pressure [IOP] increase, endothelial cell loss, and inflammation) have been reported and may cause long-term safety concerns.2,9 Since the emergence of ophthalmic viscosurgical device (OVD) in the 1980s, endothelial cell

    更新日期:2020-01-15
  • 10_3928_1081597X_20191203_01
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Renan F Oliveira, Gabriel A Ferreira, Vinícius C Ghanem, Paulo Elias Corrêa-Dantas, Ramon C Ghanem

    Epidemic keratoconjunctivitis is a contagious adenoviral infection that is considered the most common ocular infectious disease.1–4 Subepithelial infiltrates may present within the second or third week of epidemic keratoconjunctivitis as multifocal, elevated, nummular opacities with inflammatory infiltrate in the anterior stroma. They are frequently associated with photophobia, conjunctival hyperemia, and ocular discomfort. Topical treatment with low-dose steroids, cyclosporin A 1%, or tacrolimus 0.03% reduces infiltrates and their associated symptoms in most cases, although they frequently

    更新日期:2020-01-15
  • 10_3928_1081597X_20191211_01
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Emilio A Torres-Netto, Bogdan Spiru, Sabine Kling, Francesca Gilardoni, Apostolos Lazaridis, Walter Sekundo, Farhad Hafezi

    Albeit rare, iatrogenic postoperative ectasia represents a major complication after laser visual correction.1 Although the evaluation of topography, tomography, epithelial thickness mapping, and corneal biomechanical properties have increased our ability to preoperatively detect corneal susceptibility,2,3 ectasia is occasionally being reported after corneal refractive laser surgeries. With the recent emergence and successful implementation of the femtosecond laser, several advances have emerged in refractive surgery. In 2011, the small incision lenticule extraction (SMILE) technique was

    更新日期:2020-01-15
  • 10_3928_1081597X_20191114_01
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Robert Edward Ang

    The small-aperture intraocular lens (IOL) (IC-8 IOL; AcuFocus, Irvine, CA) is a one-piece, hydrophobic acrylic, posterior chamber monofocal IOL that provides increased range of vision from far to near, by extending the depth of focus.1,2 It works by eliminating the unfocused peripheral light rays while the central rays pass unaffected and focus on the retina.3 Reducing the size of the blur circle from unfocused peripheral light improves the image resolution for intermediate and near vision, with minimal to no change to distance vision. The IC-8 IOL is indicated for contralateral implantation

    更新日期:2020-01-15
  • 10_3928_1081597X_20191223_01
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    TBD

    The article “Evaluation of Corneal Changes After Conventional Versus Accelerated Corneal Cross-linking: A Randomized Controlled Trial” by Hashemian et al., which was published in the December 2014 issue of the Journal of Refractive Surgery (volume 30, number 12, pp. 837–842), has been amended to include a factual correction. An error was identified subsequent to its original printing. In the Patients and Methods section, the sentence “In the accelerated group, irradiation was performed using 3 minutes of UVA 365-µm light with 30 mW/cm2 (5.4 J/cm2 dose in each group) irradiance” should be “In

    更新日期:2020-01-15
  • 10_3928_1081597X_20191114_02
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Shengbei Weng, Daoman Xiang, Limian Lin, Haiqin Lin, Fang Liu, Quan Liu

    Small incision lenticule extraction (SMILE), which is a flapless surgical technique for the correction of refractive errors, has been performed in a large number of cases.1,2 It has advantages over laser in situ keratomileusis (LASIK) in terms of dry eye in the early postoperative period.3,4 However, it has been postulated that a longer period of time is required for visual recovery after SMILE in comparison with LASIK.5,6 Moreover, recent research has confirmed that visual outcomes of SMILE for myopia were worse compared with femtosecond laser–assisted LASIK within 24 hours postoperatively.7

    更新日期:2020-01-15
  • 10_3928_1081597X_20191217_02
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Chenghua Wei, E Song, Lixin Mei

    We read with great interest the article by Brenner et al.1 in the February 2019 issue regarding early surface ablation on aborted laser in situ keratomileusis (LASIK) flaps. In femtosecond laser–assisted LASIK, the procedure was occasionally aborted due to various abnormal events that lead to complicated flaps. The rescue method reported in this article was photorefractive keratectomy or laser epithelial keratomileusis. These operations require a mechanical method to remove the corneal epithelium. However, in some cases with side cutting or lifting of the flap, the corneal flap did not adhere

    更新日期:2020-01-15
  • 10_3928_1081597X_20191204_01
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Karen L Christopher, D Claire Miller, Jennifer L Patnaik, Anne M Lynch, Richard S Davidson, Michael J Taravella

    Extended depth of focus intraocular lenses (EDOF IOLs) are becoming an increasingly popular technique to support spectacle independence following cataract surgery. However, patients report glare, halos, and starbursts at a much higher rate with EDOF IOLs than with monofocal lenses.1,2 For patients with previous laser refractive surgery (laser-assisted in situ keratomileusis [LASIK] or photorefractive keratectomy [PRK]) who are already known to have corneas with above average higher order aberrations and dysphotopsias,3–7 the combination of their previously ablated cornea with an EDOF IOL

    更新日期:2020-01-15
  • 10_3928_1081597X_20191119_01
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    Timur M Yildirim, Grzegorz Labuz, Ramin Khoramnia, Hyeck Soo Son, Sonja K Schickhardt, Ingo Lieberwirth, Michael C Knorz, Gerd U Auffarth

    Current multifocal intraocular lenses (IOLs) use diffractive or refractive optics to allocate the incoming light to two or three focal points or to create an elongated focus offering a greater number of patients spectacle independence than with monofocal IOLs. As a downside, patients with multifocal IOLs may suffer from unwanted visual symptoms, such as glare, halo, or decreased contrast sensitivity.1 Optical simulations have shown that angular zone designs offer better multifocal performance compared to radial zone designs.2 Among the bifocal IOLs, the Lentis MF IOL models (Oculentis GmbH,

    更新日期:2020-01-15
  • 10_3928_1081597X_20191120_01
    J. Refract. Surg. (IF 3.000) Pub Date : 2020-01-13
    TBD

    Each individual listed has donated time, effort, and thought toward reviewing manuscripts written by his or her colleagues. This is a labor of personal and academic dedication, as reviewers receive no pay or recognition for their efforts—except this simple listing. The peer-review process is an essential element in the veracity of papers published in the Journal of Refractive Surgery, an element that cannot be avoided, truncated, or subverted. The reviewers' comments help guide the editors in selecting articles for publication; we emphasize that it is the editors—not the reviewers—who make

    更新日期:2020-01-15
  • Pharmacological Strategies for Presbyopia Correction
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-12-12
    Robert Montés-Micó, W Neil Charman

    Following the invention of spectacles in the 13th century, the correction of presbyopia became one of the most important challenges faced by those concerned with the optimization of vision. It is estimated that approximately 30% of the whole world population is presbyopic, the proportion rising to nearly 50% in some developed countries.1,2 The inadequate amplitude of accommodation that characterizes uncorrected presbyopia reduces our ability to perform a wide range of daily near visual tasks. This visual disability that we suffer after reaching an age of approximately 40 years affects the

    更新日期:2019-12-13
  • Topography-Guided Ablation Targeting the Anterior Corneal Astigmatism Yields Inferior Outcomes vs Targeting the Manifest Refractive Astigmatism
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-12-12
    Avi Wallerstein, Mathieu Gauvin, Mark Cohen

    We read with interest the article by Zhang and Chen, “A Randomized Comparative Study of Topography-Guided Versus Wavefront-Optimized FS-LASIK for Correcting Myopia and Myopic Astigmatism” in the September issue.1 The authors state that “Kanellopoulos and Wallerstein et al. found that topography-modified refraction offered superior refractive and visual outcomes to standard clinical refraction in myopic TCAT LASIK [topography-guided customized ablation treatment laser in situ keratomileusis] (p. 580).”1 This statement is incorrect. Kanellopoulos does make that claim,2 but our study3 reports

    更新日期:2019-12-13
  • Comparison of Surgically Induced Astigmatism and Corneal Morphological Features Between Femtosecond Laser and Manual Clear Corneal Incisions
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-12-12
    Austin Pereira, Sohel Somani, Eric S Tam, Hannah Chiu, Raj Maini

    With progressively improving visual rehabilitation following cataract surgery, patient expectations of favorable refractive outcomes have increased, ultimately requiring accurate preoperative surgical planning.1 The innovation of intraocular lenses (IOLs) that take into account corneal morphology to correct for preoperative astigmatism has become an option in surgical assessments, but clear corneal incisions (CCIs) and their impact on corneal curvature may induce aberrant postoperative refractive results.2 There have been attempts to minimize surgically induced astigmatism (SIA) by a variety

    更新日期:2019-12-13
  • Refractive and Visual Outcomes and Rotational Stability of Toric Intraocular Lenses in Eyes With and Without Previous Ocular Surgeries: A Longitudinal Study
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-12-12
    Osama M Mustafa, Christina Prescott, Fares Alsaleh, Daliya Dzhaber, Yassine J Daoud

    Cataract surgery is one of the most commonly performed surgeries in modern medicine. Although vision is largely restored after surgery, a considerable proportion of patients with cataract may not achieve their best unaided visual potential due to the presence of concomitant corneal astigmatism.1,2 Fortunately, there are alternative techniques that could be used to correct astigmatism during cataract surgery, such as limbal relaxing incisions and toric intraocular lenses (IOLs). Of note, a recent systematic review and meta-analysis of the existing literature found that toric IOL implantation

    更新日期:2019-12-13
  • Prediction of Visual Acuity and Contrast Sensitivity From Optical Simulations With Multifocal Intraocular Lenses
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-12-12
    Joaquín Fernández, Manuel Rodríguez-Vallejo, Javier Martínez, Noemi Burguera, David P Piñero

    Interest in the prediction of the postoperative visual performance before the implantation of a multifocal intraocular lens (IOL) has increased in recent years.1 For individual predictions, new devices have emerged with the aim of simulating how the patient would see after surgery with the implantation of a multifocal IOL.2–6 However, the main drawback of these technologies is that they would underestimate the postoperative visual performance with increasing age, especially after 50 years of age.7 Another approach is to predict the mean visual performance of the population depending on

    更新日期:2019-12-13
  • Predictors of Visual Acuity Improvement and Supernormal Vision After Refined Single-Step Transepithelial Photorefractive Keratectomy
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-12-12
    Soheil Adib-Moghaddam, Ali A Haydar, Marjan Razi-Khosroshahi, Saeed Soleyman-Jahi, Ghazale Tefagh, Michael A Grentzelos, Samuel Arba-Mosquera, George D Kymionis

    Supernormal vision is significantly enhanced visual acuity superior to that achieved with conventional methods of correction (glasses, contact lenses, and traditional refractive surgeries).1 It is an important feature for best performance in occupations such as target discrimination, firing weapons, aviation, night vision, and medical and surgical fields. The rapidly expanding technologies suggest that current visual performance might not meet the needs of the future. The first attempts to achieve supernormal vision began as early as the 1990s by investigating its possible determinant

    更新日期:2019-12-13
  • Neuroprotective Effect of Citicoline Eye Drops on Corneal Sensitivity After LASIK
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-12-12
    Esat Cinar, Berna Yuce, Fatih Aslan, Gökhan Erbakan

    Citicoline (cytidine-5-diphosphocholine), an intermediate product of phospholipid biosynthesis, is believed to be transformed to cytidine monophosphate and phosphocholine by phosphodiesterases in the cell wall and taken up into neuronal cells.1,2 In addition to the synthesis of acetylcholine, cells use choline as a precursor of certain phospholipids (eg, phosphocholine) that are major constituents of all biological membranes.2 Exogenous citicoline has been used as a therapeutic drug to treat central nervous system disorders including ischemic stroke and Parkinson's disease.3,4 Furthermore,

    更新日期:2019-12-13
  • Effect of Anterior Corneal Higher-Order Aberration Ablation Depth on Primary Topography-Guided LASIK Outcomes
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-12-12
    Avi Wallerstein, Mathieu Gauvin, Mark Cohen

    Topography-guided laser vision correction regularizes the corneal surface, directly treating anterior corneal higher-order aberrations (HOAs).1–3 The Alcon platform for topography-guided treatments includes the WaveLight Topolyzer VARIO topographer to image the cornea and the Contoura software (Alcon Laboratories, Inc., Fort Worth, TX), which generates an ablation map that combines both lower and higher-order aberration ablation profiles into one treatment, with ablation depth data. By inputting the sphere and cylinder treatment to zero in the Contoura planning software, one can separate out

    更新日期:2019-12-13
  • Complications and Explantation Reasons in Intracorneal Ring Segments (ICRS) Implantation: A Systematic Review
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-11-11
    María José Bautista-Llamas, María Carmen Sánchez-González, Inmaculada López-Izquierdo, Alfredo López-Muñoz, Beatriz Gargallo-Martínez, Concepción De-Hita-Cantalejo, José María Sánchez-González

    Intracorneal ring segments (ICRS) were used in the 1980s1 for low and moderate myopia correction, and anterior cornea curvature flattening occurred by placing ICRS on the stroma. Previous studies reported that it was a safe, effective, and stable method to correct low myopia.2 Currently, the method has been extended to various pathologies, such as keratoconus, pellucid marginal degeneration, and iatrogenic corneal ectasia.3 Three types of ICRS are available: Intacs (Addition Technology, Sunnyvale, CA), Ferrara (Mediphacos, Belo Horizonte, Brazil), and Keraring (Mediphacos). Classic ICRS

    更新日期:2019-11-13
  • Corneal Viscous Properties Cannot Be Determined From Air-Puff Applanation
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-11-11
    Mathew Francis, Himanshu Matalia, Rudy M M A Nuijts, Bart Haex, Rohit Shetty, Abhijit Sinha Roy

    Corneal biomechanical properties have received significant attention in recent years due to their hypothesized role in predicting subclinical keratoconus and ectasia after refractive surgery.1–4 This prediction is possible only if in vivo quantification of properties exists. However, the human cornea exhibits both viscous and elastic responses to induced stress,5–7 and in vivo quantifications of both features in patients are challenging. The viscoelastic material assumption may be necessary to understand corneal deformation due to air-puff applanation.8 Porcine corneas are naturally thicker

    更新日期:2019-11-13
  • Depth-Dependent Reduction of Biomechanical Efficacy of Contact Lens–Assisted Corneal Cross-linking Analyzed by Brillouin Microscopy
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-11-11
    Hongyuan Zhang, Mehdi Roozbahani, Andre L Piccinini, Oren Golan, Farhad Hafezi, Giuliano Scarcelli, J Bradley Randleman

    Corneal cross-linking (CXL) is an effective treatment to halt progression of progressive keratoconus.1 With extrafibrillar covalent bonds induced by photosensitizer riboflavin and ultraviolet A (UV-A) light of 370 nm, corneal Young's modulus can be increased by a factor of 4.5 in human eyes.2 However, there is increased risk of endothelial damage in thin corneas.3–6 Several modified CXL protocols have been developed to address thin corneas, which are frequently observed in advanced keratoconus. These modified protocols can be categorized into two groups: decreasing UV exposure or increasing

    更新日期:2019-11-13
  • Stromal Rejection After SMILE for the Correction of Astigmatism After Graft
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-11-11
    Hassan Hashemi, Mohammadreza Aghamirsalim, Soheila Asgari

    Small incision lenticule extraction (SMILE) is a novel refractive lenticule extraction method for the correction of refractive errors in which an intrastromal lenticule is extracted without creating a flap. The efficiency of this technique in the correction of high astigmatism (≥ 2.50 diopters [D]) has been established.1 High astigmatism is a common complaint after corneal transplantation.2 Several methods are available for the treatment of this unwanted outcome, and two case reports suggest that SMILE can be an effective method for the treatment of post-transplantation astigmatism.3,4 We

    更新日期:2019-11-13
  • Influence of Extrinsic and Intrinsic Parameters on Myopic Correction in Small Incision Lenticule Extraction
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-11-11
    Samuel Arba-Mosquera, David Y S Kang, Michiel H A Luger, Suphi Taneri

    Laser corneal refractive surgery is based on the use of a laser to change the corneal curvature to compensate for refractive errors of the eye.1 For small incision lenticule extraction (SMILE), the lack of automated centration and cyclotorsion control in the current version of the laser system may result in undercorrections or overcorrections (or, in general, residual refractions) greater than current excimer-based refractive surgeries. Specific analyses of the age for refractive surgery outcomes also have been reported,2–4 suggesting older patients achieve more refractive change for the same

    更新日期:2019-11-13
  • SMILE, Topography-Guided LASIK, and Wavefront-Guided LASIK: Review of Clinical Outcomes in Premarket Approval FDA Studies
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-11-11
    Julie M Schallhorn, Stefanie Seifert, Steven C Schallhorn

    Laser vision correction enjoys a position as the most commonly performed elective surgery in the world,1 owing to its excellent safety profile and high patient-reported satisfaction rate.2 Currently, the three modalities that are widely used are laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE). In excimer laser surgery, conventional ablation simply corrects spherocylindrical error, but often results in induction of unwanted higher order aberrations.3 For that reason, different customized forms of ablations have been

    更新日期:2019-11-13
  • Comparison of FDA-Reported Visual and Refractive Outcomes of the Toric ICL Lens, SMILE, and Topography-Guided LASIK for the Correction of Myopia and Myopic Astigmatism
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-11-11
    Majid Moshirfar, Anisha N Somani, Mahsaw N Motlagh, Uma Vaidyanathan, Jorgen S Sumsion, James R Barnes, Yasmyne C Ronquillo

    Refractive error is the most common cause of correctable visual impairment and is estimated to affect nearly 6 billion people by the year 2050.1 Approximately 1 in 6 people in the world are myopic,2 and the increasing prevalence of myopia has important implications for non-surgical and surgical management. Laser in situ keratomileusis (LASIK) remains the dominant surgical procedure to correct refractive error. With an estimated economic productivity loss per annum cost of $202 billion,1 the economic argument alone is reason to consider visual outcomes in patients having refractive surgery.

    更新日期:2019-11-13
  • 10-Year Results of FLEx Refractive Surgery
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-11-11
    Marcus Blum, Kathleen S Kunert, Mathias Schulze, Walter Sekundo

    At the end of the 20th century, femtosecond laser technology entered the field of refractive surgery. Several sophisticated excimer laser systems are available, with laser in situ keratomileusis (LASIK) remaining the most popular procedure.1–3 Due to continuous improvements, the correction of myopia up to −8.00 diopters (D) is considered to be safe and predictable and excimer laser–based LASIK has gained wide acceptance worldwide. The long-term results of photorefractive keratectomy and LASIK have been published with up to 18 years of follow-up.4–6 A new procedure that no longer requires an

    更新日期:2019-11-13
  • Femtosecond Laser–Assisted Small Incision Sutureless Intrastromal Lamellar Keratoplasty (SILK) for Corneal Transplantation in Keratoconus
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-10-15
    Kishore R Pradhan, Dan Z Reinstein, Ryan S Vida, Timothy J Archer, Shashwat Dhungel, Purushottam Dhungana, Glenn I Carp

    Lamellar transplantation, both penetrating and non-penetrating, has proven to be effective in rehabilitating vision for a wide variety of conditions, including keratoconus.1–3 The risk of graft rejection has been shown to be lower when recipient endothelial tissue remains intact, as in deep anterior lamellar keratoplasty (DALK).2,4 Improved surgical techniques, including big-bubble and Descemet's bearing DALK, have made this technique the first-line choice for many corneal specialists.5–7 The first published femtosecond laser–assisted anterior lamellar keratoplasty (FALK)8 used the IntraLase

    更新日期:2019-10-16
  • Intracorneal Ring Segments Implantation Outcomes Using Two Different Manufacturers' Nomograms for Keratoconus Surgery
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-10-15
    Guilherme Rocha, Ludmila Nascimento Pinto Silva, Luís Fernando Oliveira Borges Chaves, Pedro Bertino, Leonardo Torquetti, Luciene Barbosa de Sousa

    Keratoconus is a non-inflammatory condition in which the cornea assumes a conical shape because of thinning and protrusion.1 It is bilateral, asymmetric, and progressive. The cornea thins, steepens, and protrudes, and its outer surface becomes irregular, distorted, and sometimes even scarred, resulting in blurry vision, even with visual correction.2 Keratoconus treatment has evolved significantly in the past few years. The benefits of intracorneal ring segments (ICRS) have been established in the current literature regarding visual acuity gain, reduction in spherical equivalent (SE), and

    更新日期:2019-10-16
  • Long-term Comparison of Combined t-PTK and CXL (Cretan Protocol) Versus CXL With Mechanical Epithelial Debridement for Keratoconus
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-10-15
    Michael A Grentzelos, Dimitrios A Liakopoulos, Charalambos S Siganos, Miltiadis K Tsilimbaris, Ioannis G Pallikaris, George D Kymionis

    Corneal cross-linking (CXL) is a well-established surgical technique using riboflavin and ultraviolet-A (UVA) for the treatment of keratoconus to strengthen the corneal tissue, resulting in stabilization of the ectatic disorder.1–4 According to the Dresden protocol, the epithelium has to be removed during CXL to permit the penetration of riboflavin solution and the saturation of the corneal stroma.1 CXL without epithelial removal may impair the effectiveness of the procedure.5–7 Epithelial removal during CXL may be performed using several methods, such as mechanical debridement, use of

    更新日期:2019-10-16
  • Intraoperative Aberrometry Versus Preoperative Biometry for IOL Power Selection After Radial Keratotomy: A Prospective Study
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-10-15
    Sebastião Xavier Curado, Wilson Takashi Hida, César Martins Cortez Vilar, Virgílio Luiz Ordones, Mário Augusto Pereira Chaves, Patrick Frensel Tzelikis

    Radial keratotomy was the most frequently performed refractive procedure for the treatment of myopia in the late 1970s and 1980s.1 In 1981, the National Eye Institute began a multicenter prospective trial, the Prospective Evaluation of Radial Keratotomy (PERK) study, to establish the outcome of a single radial keratotomy technique and long-term predictability of a refractive procedure for which there was weak published data.2 The PERK study recruited 427 patients (793 eyes), and 374 patients (88%) returned for the 10-year examination. Between 6 months and 10 years, the refractive error of 43%

    更新日期:2019-10-16
  • Status of Residual Refractive Error, Ocular Aberrations, and Accommodation After Myopic LASIK, SMILE, and TransPRK
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-10-15
    Naren Shetty, Zelda Dadachanji, Raghav Narasimhan, Gairik Kundu, Pooja Khamar, Prerna Ahuja, Vijay Kumar, Vikas Kumar, Rohit Shetty, Rudy M M A Nuijts, Abhijit Sinha Roy

    Accuracy of any refractive surgery technique has always been a subject of intense study. Among them, laser-assisted in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), and photorefractive keratectomy (PRK) are the most commonly performed surgeries. Even with the latest LASIK platforms, the eyes may have some degree of residual refractive error, particularly cylindrical refractive error.1 If the discrepancy between the axis of refractive and corneal cylinder exceeds 20°, then the eyes have greater residual refractive error and inferior distance visual acuity after

    更新日期:2019-10-16
  • Corneal Cross-linking in Thin Corneas: 1-Year Results of Accelerated Contact Lens–Assisted Treatment of Keratoconus
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-10-15
    Boris Knyazer, Ran Matlov Kormas, Alexander Chorny, Tova Lifshitz, Asaf Achiron, Michael Mimouni

    Keratoconus is a bilateral ectatic disorder with progressive corneal thinning and reduced uncorrected (UDVA) and corrected (CDVA) visual acuity.1 Corneal cross-linking (CXL) has dramatically changed how ectatic corneal disorders, specifically keratoconus, are treated.2 CXL is a surgical intervention that stabilizes keratoconus progression3 and, in many cases, avoids the need for more drastic interventions such as deep anterior lamellar keratoplasty or penetrating keratoplasty.4 First reported by Wollensak et al. in 2003,3 the standard CXL protocol (Dresden) consists of epithelial removal and

    更新日期:2019-10-16
  • Corneal Epithelial Thickness Mapping After Photorefractive Keratectomy for Myopia
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-10-15
    Mohammad Reza Sedaghat, Hamed Momeni-Moghaddam, Mehrdad Gazanchian, Dan Z Reinstein, Timothy J Archer, J Bradley Randleman, Seyed Rafi Hosseini, Golshid Nouri-Hosseini

    As the outermost layer of the cornea, the epithelium has different functions, including the creation of a smooth and regular surface by changing its thickness profile or epithelial remodeling or reconstruction of the epithelial pattern.1 It is important to consider changes in the epithelial thickness profile before corneal refractive surgery. Original photorefractive keratectomy (PRK) ablation profile calculations assumed the epithelium would not change after PRK and would reconstruct with a uniform thickness.2 However, it became clear that epithelial hyperplasia after surgery was partly

    更新日期:2019-10-16
  • 10-Year Results of Small Incision Lenticule Extraction
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-10-15
    Marcus Blum, Anna S Lauer, Kathleen S Kunert, Walter Sekundo

    In the field of refractive surgery, the excimer laser has been the reliable workhorse for corneal surgery, with a large number of satisfied patients for more than three decades. In 2008, Sekundo et al.1–3 reported a new procedure using femtosecond laser technology called femtosecond lenticule extraction, which still required lifting of a flap to remove tissue (the refractive lenticule) from the anterior part of the cornea. The technique soon developed further to a minimally invasive procedure called small incision lenticule extraction (SMILE), which avoided using a corneal flap and all of its

    更新日期:2019-10-16
  • Simultaneous Implantation of Refractive Lenticule and Intracorneal Ring Segment in the Management of Pellucid Marginal Degeneration
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-09-10
    Yury Kalinnikov, Galina Leontyeva, Alexandra Zinovyeva, Denis Nevrov

    Pellucid marginal degeneration is a rare, bilateral, progressive ectatic disorder characterized by an arcuate band of thinning in the peripheral cornea with protrusion above the thinning. Although ectatic cornea maintains its transparency, patients with pellucid marginal degeneration suffer from visual deterioration due to high irregular astigmatism.1,2 Both ametropia and corneal thinning correction remain fundamental therapeutic targets because of common unsatisfactory rigid contact lens fitting and controversial outcomes of standard penetrating keratoplasty as a result of marked corneal

    更新日期:2019-09-11
  • Incidence and Risk Factors of Opaque Bubble Layer Formation According to Flap Thickness During 500-kHz FS-LASIK
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-09-10
    Dong Hui Lim, Joo Hyun, Eunhae Shin, Byung woo Ko, Eui Sang Chung, Tae Young Chung

    A femtosecond laser is commonly used in laser-assisted in situ keratomileusis (FS-LASIK) surgery. It generates ultrashort pulses and creates microplasma at the corneal stroma, which induces a plane of separation with gas bubbles (photodisruption).1 The use of a femtosecond laser results in thin and consistent flap creation, which allows for the treatment of higher myopia with sufficient residual stroma, referred to as thin-flap LASIK.2–4 The thin flap can be made with either a microkeratome or a femtosecond laser. Flap creation using a femtosecond laser is superior for controlling the

    更新日期:2019-09-11
  • Refractive and Visual Outcomes of SUPRACOR TENEO 317 LASIK for Presbyopia in Hyperopic Eyes: 24-Month Follow-up
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-09-10
    José María Sánchez-González, Federico Alonso-Aliste, Jonatan Amián-Cordero, María Carmen Sánchez-González, Concepción De-Hita-Cantalejo

    In the past decade, refractive surgery for presbyopia has been one of the most discussed subjects in refractive ophthalmology. There are currently different techniques for presbyopia treatment, including intraocular lens replacement,1 intrastromal implants (inlays),2 conductive keratoplasty,3 scleral expansion procedures,4 monovision laser in situ keratomileusis (LASIK),5 micro-monovision,6 contact lens,7 presbyopia drops,8 intrastromal femtosecond laser treatment (IntraCOR; Technolas Perfect Vision GmbH, Munich, Germany),9 and presbyopic laser-assisted in situ keratomileusis (PresbyLASIK).10

    更新日期:2019-09-11
  • Repeatability of Cornea and Sublayer Thickness Measurements Using Optical Coherence Tomography in Corneas of Anomalous Refractive Status
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-09-10
    Nan Ji Lu, Ding Chen, Le Le Cui, Lin Wang, Shi hao Chen, Qin Mei Wang

    Corneal thickness data can give indications of the diagnosis of keratoconus and postoperative ectasia. Both epithelial and stromal thickness data are critical because the corneal thickness may remain constant when stromal thinning takes place due to the mechanism of epithelial remodeling that compensates for the corneal surface irregularity. In keratoconic eyes, the corneal epithelial doughnut pattern—localized epithelial thinning surrounded by its annular thickening—can serve as a warning signal for the presence of an underlying stromal cone.1 Apart from the detection of postoperative

    更新日期:2019-09-11
  • Couching in Africa: Technique and Management of Comorbidities With Cataract Removal, Glued IOL, and Vitrectomy
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-09-10
    Smit Bavariya, Ashar Agarwal, Priya Narang, Amar Agarwal, Ashvin Agarwal

    Despite technological advances, couching is still a prevalent method of cataract removal in many parts of Africa.1–3 Lack of upgraded ophthalmic services and ignorance persuades patients to undergo the ancient and primitive practice of couching to attain practically useful vision. The concept of performing couching is to dislodge the mature cataract from the visual axis with a sharp instrument that pierces the eye approximately 3 to 5 mm away from the limbus (Figure 1 and Video 1, available in the online version of this article). A literature search described couching along with its side

    更新日期:2019-09-11
  • Individually Customized IOL Versus Standard Spherical Aberration-Correcting IOL
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-09-10
    Jens Schrecker, Simon Schröder, Achim Langenbucher, Berthold Seitz, Timo Eppig

    Wavefront analysis of the eye has widely expanded our knowledge of the complex refractive errors of this high-performance organ. The use of Zernike polynomials is the prevailing method to characterize these refractive deficiencies. The spherical aberration (SA) Z40 has the largest impact of the higher order aberrations (HOAs) on visual performance as shown by theoretical studies based on pseudophakic eye models1,2 and studies using adaptive optics vision simulators.3,4 With aberration-correcting IOLs, a significant improvement of contrast sensitivity and visual acuity and a decrease of

    更新日期:2019-09-11
  • Functional Outcomes and Reading Performance After Combined Implantation of a Small-Aperture Lens and a Segmental Refractive Bifocal Lens
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-09-10
    Hyeck Soo Son, Ramin Khoramnia, Timur M Yildirim, Isabella Baur, Grzegorz Labuz, Gerd U Auffarth

    There are currently numerous different multifocal intraocular lens (IOL) models available in the market. Some are bifocal or trifocal, whereas recent ones claim to generate a so-called extended depth of focus (EDOF), which describes the ability of the lens to provide a continuous range of vision across multiple distances. Typically, multifocal lenses are implanted bilaterally. Alternatively, surgeons can “mix-and-match,” a technique that describes an asymmetrical implantation of two different IOL models as an attempt to reinforce their advantages and thereby improve the visual

    更新日期:2019-09-11
  • A Randomized Comparative Study of Topography-Guided Versus Wavefront-Optimized FS-LASIK for Correcting Myopia and Myopic Astigmatism
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-09-10
    Yu Zhang, Yueguo Chen

    Refractive laser surgery is becoming more popular because of its increasing efficacy and safety. The main complaints of patients after surgery are decreased visual sharpness and problems with night vision, such as glare, halo, and starbursts.1 The main causes of these problems are the increase of corneal asphericity and the introduction of higher order aberrations (HOAs) due to ablation algorithm, decentration, optical role of the flap, wound healing, biomechanical effects, reflection losses, and non-normal incidence of the laser on the cornea.2–6 To further improve the postoperative visual

    更新日期:2019-09-11
  • Comparison of Mix-and-Match Implanted Bifocal IOLs and Bilateral Implanted Trifocal IOLs After Femtosecond Laser–Assisted Cataract Surgery
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-09-10
    Nilufer Yesilirmak, Yonca A Akova, Oya Donmez

    Cataract is one of the leading causes of preventable blindness all over the world.1 It is commonly treated with phacoemulsification and intraocular lens (IOL) implantation.2 Monofocal IOLs are often used for clear vision at distance and also for monovision.3 With the introduction of multifocal IOLs, the need for spectacles for both distance and near has been reduced.4 AcrySof IQ ReSTOR (Alcon Laboratories, Inc., Fort Worth, TX) has been one of the most commonly used multifocal IOLs for years with its apodized, diffractive, single-piece, hydrophobic acrylic design.5 Although diffractive

    更新日期:2019-09-11
  • Cyclotorsion Compensation
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Bulent Kose, Yasar Sakarya

    We read with great interest the article by Chen et al.1 in the March 2019 issue. The authors evaluated the effect of cyclotorsion compensation during small incision lenticule extraction (SMILE) surgery on refractive outcomes. They first marked the peripheral cornea with a marker pen at the 3- and 9-o'clock positions at the slit lamp. After placing the patient on the surgical table of the VisuMax laser suite (Carl Zeiss Meditec, Jena, Germany), they activated the suction during the docking phase and measured the amount of cyclotorsion angle between the horizontal reticule of the eyepiece and

    更新日期:2019-08-13
  • Transepithelial Topography-Guided Ablation Assisted by Epithelial Thickness Mapping for Treatment of Regression After Myopic Refractive Surgery
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Wen Zhou, Dan Z Reinstein, Xiangjun Chen, Shihao Chen, Yangyang Xu, Tor Paaske Utheim, Aleksandar Stojanovic

    The enhancement rate after primary laser refractive surgery varies widely in the literature. Rates ranging from 1.8% to 22%,1–3 2.3% to 5.2%,4,5 and 1.1% to 4.39%6,7 have been reported for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE), respectively. Residual refractive errors after laser refractive surgery remain the most common reason for patients' dissatisfaction and re-treatment. In addition, laser refractive surgery can also induce stromal irregularities, resulting in higher order aberrations (HOAs)8,9 and

    更新日期:2019-08-13
  • Posterior Segment Visualization in Eyes With Small-Aperture Intraocular Lens
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Sathish Srinivasan, Lin Wei Khoo, Zachariah Koshy

    Modern cataract surgery allows surgeons to customize and tailor the refractive outcome to the visual needs of individual patients and this has led to increased patient expectation for spectacle independence following cataract surgery.1 Presbyopia-correcting intraocular lenses (IOLs) have been shown to provide good unaided vision at distance, intermediate, and near vision when implanted binocularly.2–4 However, due to issues such as glare, halos, and decreased contrast associated with diffractive optics, other options including presbyopic laser in situ keratomileusis and corneal inlays are

    更新日期:2019-08-13
  • Does Corneal Refractive Surgery Increase the Risk of Retinal Detachment? A Literature Review and Statistical Analysis
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Piotr Kanclerz, Andrzej Grzybowski

    Corneal refractive surgery is an elective procedure presenting a low risk of complications. Commonly, eyes with perfect corrected visual acuity are treated and so sight-threatening complications are a major concern. Although anatomical and refractive complications represent the majority of problems after surgery, retinal complications are potentially sight-threatening.1 Moreover, refractive surgery procedures are performed most commonly in myopic patients, and myopia is known as a relevant risk factor for rhegmatogenous retinal detachment.2 High volumes of corneal refractive surgery performed

    更新日期:2019-08-13
  • Treatment of Ocular Neuralgia After Refractive Surgery With Bilateral Orbital Steroid and Anesthetic Injections
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Siri P Yalamanchili, Richard W Hertle

    Ocular and periocular structures are innervated by fibers originating from the ophthalmic branch of the trigeminal nerve. Among the many functions of these fibers is maintaining the health of the ocular surface. Damage to these nerves can cause symptoms similar to dry eye (eg, blurred vision, photophobia, pain, redness, and foreign body sensation).1–4 This condition has been termed corneal neuralgia. These symptoms are produced by hypersensitive pacemakers in regenerating nociceptor fibers and dorsal root ganglia. Although most cases of corneal neuralgia resolve within several months, some

    更新日期:2019-08-13
  • Coordinated Modulation of Corneal Scarring by the Epithelial Basement Membrane and Descemet's Basement Membrane
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Steven E Wilson

    The central role of the epithelial basement membrane (EBM)1–4 and Descemet's basement membrane (DBM)4,5 in modulating scarring (stromal fibrosis) that may develop after surgeries, injuries, infections, and diseases of the cornea has been illustrated by numerous studies published over the past decade. Although the ultrastructure of EBM and DBM viewed with the transmission electron microscope is different (Figure 1),6 and many of their functions are distinctive, they share and coordinate in the critical function of limiting the entry of profibrotic growth factors, such as transforming growth

    更新日期:2019-08-13
  • Biomechanical Properties of Human Cornea Tested by Two-Dimensional Extensiometry Ex Vivo in Fellow Eyes: PRK Versus SMILE
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Bogdan Spiru, Emilio A Torres-Netto, Sabine Kling, Apostolos Lazaridis, Farhad Hafezi, Walter Sekundo

    The progress in the field of laser corneal refractive surgery observed during the past decade has been substantially due to the introduction of the femtosecond laser. The laser-assisted in situ keratomileusis (LASIK) procedure achieved a new level of safety once the microkeratome was replaced by the femtosecond laser. This evolutionary step made femtosecond laser–assisted LASIK (FS-LASIK) the most popular laser refractive surgery. In contrast, in 2008 Sekundo et al.1 introduced an entirely new modality of laser reshaping procedure, the small incision lenticule extraction (SMILE). SMILE offers

    更新日期:2019-08-13
  • Effect of Decentration on the Optical Quality of Monofocal, Extended Depth of Focus, and Bifocal Intraocular Lenses
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Jie Xu, Tianyu Zheng, Yi Lu

    With the evolution of surgical techniques and increased patient awareness, cataract surgery has recently become a refractive procedure. The main goal has shifted from restoring eyesight to improving visual performance over the greatest variation of distances possible. To date, monofocal intraocular lenses (IOLs) are the most common type of lenses used after phacoemulsification surgery and can provide excellent uncorrected distance vision (UDVA). However, these patients often need spectacle correction for near vision, which is associated with a decline in quality of life.1 Previous studies

    更新日期:2019-08-13
  • Long-Term Effect of Anterior Chamber Depth on Endothelial Cell Density in Patients With Iris-Fixated Phakic Intraocular Lenses
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Alaa M Eldanasoury, Mehdi Roozbahani, Sherif Tolees, Christina Arana

    Iris-fixated phakic intraocular lenses (pIOLs) are available for a wide range of refractive errors and in two diameters.1 The Artisan and Artiflex pIOLs (also known as Verisyse and Veriflex, respectively, in the United States; OPHTEC BV, Groningen, The Netherlands) are primarily used for correction of refractive errors in patients who are not suitable candidates for laser refractive surgeries. However, other interesting applications such as improving visual acuity in adult amblyopic eyes2 and keratoconus3 have been reported. As an intraocular implant, safety features of pIOLs have always been

    更新日期:2019-08-13
  • Ten-Year Outcomes of Progressive Keratoconus Management With the Athens Protocol (Topography-Guided Partial-Refraction PRK Combined With CXL)
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-08-12
    Anastasios John Kanellopoulos

    Corneal cross-linking (CXL) using riboflavin and ultraviolet-A radiation has become the standard of care in stabilizing ectatic corneal disease by increasing corneal rigidity.1–5 Nevertheless, CXL fails to adequately address visual rehabilitation effectively in many patients who may require but cannot tolerate contact lens fitting and use. Therefore, a series of customized anterior surface normalization techniques have been combined with CXL in an attempt to address both the progression and the underlying cornea asymmetry by further improving topographic and refractive parameters.6,7 The

    更新日期:2019-08-13
  • Gas Bubble Escape Sign: A New Intraoperative Sign to Predict Immediate Visual Quality After Small Incision Lenticule Extraction
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-07-12
    Sri Ganesh, Sheetal Brar, Raghavender Reddy Arra

    Various reasons have been attributed to the relatively slower visual recovery after small incision lenticule extraction (SMILE) compared to laser in situ keratomileusis (LASIK),1,2 such as experience of the surgeon, surgical technique, degree of manipulation, and energy settings.3–6 Energy optimization is considered to be a crucial factor determining the visual recovery following SMILE, and recent reports have suggested better visual outcomes with the use of lower energies.7 However, energy optimization is a stepwise approach, in which the surgeon needs to find the optimum energy at which the

    更新日期:2019-07-13
  • Varifocal Versus Monofocal LASIK in Presbyopic Hyperopic Eyes
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-07-12
    Suphi Taneri, Saskia Kiessler, Anika Rost, Shwetabh Verma, Samuel Arba-Mosquera, H Burkhard Dick

    Refractive surgeons have faced challenges in effectively combining the treatment of refractive errors and presbyopia.1,2 Good near vision should be accompanied by minimal detrimental effect on the distance vision. Charman3 proposed that the main aim of presbyopia treatments was to extend the binocular depth of focus to yield adequate distance and near vision with good retinal contrast at lower spatial frequencies. Surgical presbyopia corrections have seen several developments from the monovision and multifocal ablation techniques to the modern hybrid methods combining the benefits of several

    更新日期:2019-07-13
  • Intrastromal Lenticule Rotation for Treatment of Astigmatism Up to 10.00 Diopters Ex Vivo in Human Corneas
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-07-12
    Iben Bach Damgaard, Anders Ivarsen, Jesper Hjortdal

    High postoperative astigmatism remains a leading factor influencing the visual rehabilitation following penetrating keratoplasty (PKP) and lamellar keratoplasty. The Australian Corneal Graft Registry including more than 18,000 eyes treated with PKP and lamellar graft reported a postoperative astigmatism of 5.00 diopters (D) or greater in 18% of the cases.1 Other studies have described an average postoperative astigmatism of 2.00 to 4.00 D following keratoplasty, ranging up to 10.00 diopters.2 Surgical management of high astigmatism remains a challenge when spectacles and rigid contact lenses

    更新日期:2019-07-13
  • Small Incision Lenticule Extraction (SMILE) for Hyperopia: 12-Month Refractive and Visual Outcomes
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-07-12
    Kishore R Pradhan, Dan Z Reinstein, Glenn I Carp, Timothy J Archer, Purushottam Dhungana

    Small incision lenticule extraction (SMILE) is a well-established procedure for correcting myopia. Application of this method to treat hyperopia has been the subject of a study at the Tilganga Institute of Ophthalmology in Nepal.1 This was a multiphase study, with the initial phases designed as a feasibility study in poorly sighted eyes to optimize energy settings and demonstrate topographic safety before proceeding to investigate visual and refractive outcomes in sighted eyes. Topographic centration,2 achieved optical zone diameter,3 and spherical aberration changes3 were found to be similar

    更新日期:2019-07-13
  • Visual Outcomes and Patient Satisfaction for Trifocal, Extended Depth of Focus and Monofocal Intraocular Lenses
    J. Refract. Surg. (IF 3.000) Pub Date : 2019-07-12
    Luba Rodov, Olga Reitblat, Adi Levy, Ehud I Assia, Guy Kleinmann

    Currently, there are several options for achieving relative spectacle independence in cataract surgery. One is the monovision method, in which monofocal intraocular lenses (IOLs) are implanted in both eyes, one aiming for distance and the other for intermediate/near vision. Previous studies have shown that monovision reduces spectacle dependence for both distance and near while retaining good stereopsis and contrast sensitivity. However, only 25% of the patients were completely spectacle independent.1 Another solution is multifocal IOLs, which simultaneously provide several images in each

    更新日期:2019-07-13
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