This prospective, cumulative, interventional, nonrandomized, case study included astigmatic patients undergoing cataract surgery with IOL implantation between October 2011 and February 2012. An informed consent form in accordance with the Helsinki Declaration was obtained from each patient. The institutional review board and the ethics committee of Ospedale Fatebenefratelli e Oftalmico, Milan, Italy, approved the study. Inclusion criteria were patients with cataract and Lens Opacity Classification System III severity of NO1, C1, P1, or more;25 (link) keratometric (K) astigmatism greater than 0.5 diopters (D); and no other ocular comorbidity that might influence visual outcome. Exclusion criteria were patients with active ocular diseases, significant level of corneal HOA exceeding 0.350 µm, using the Zernike polynomials from the topography map (OPD-Scan II; Nidek Co., Ltd., Gamagori, Japan), and a high irregular astigmatism index (>0.54). Irregular astigmatism index is the result of average sum of interring area-corrected dioptric variations along every semimeridian for the whole analyzed surface and normalized by average corneal power (ACP) and the number of all measured points. It describes the short-range semimeridional fluctuation of power distribution and increases along with local irregular corneal astigmatism.
Opd scan 2
Manufactured by Nidek
Sourced in Japan
The OPD-Scan II is a wavefront aberrometer that measures the optical properties of the human eye. It uses a Hartmann-Shack wavefront sensor to analyze the wavefront of light passing through the eye, providing detailed information about the eye's optical aberrations.
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8 protocols using opd scan 2
1
Cataract Surgery with IOL in Astigmatic Patients
2
Comprehensive Ocular Biometrics Assessment
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The ophthalmological examinations were begun at 15:00 h in all participants to minimize the daily fluctuation of the ocular biometrics by the biorhythm, and all of the data were collected in a non-cycloplegic state by well-trained examiners. The best-corrected visual acuity (BCVA) was measured with a Landolt C chart. The refractive error (spherical equivalent) was measured to the closest 0.25 diopter (D). The radius of curvature of the anterior surface of the cornea (corneal curvature) was measured with an auto-refractometer (RC-5000®; Tomey, Nagoya, Japan), and the average of the longest and the shortest radius of curvature of the anterior surface of the cornea was used for the statistical analyses. The axial length (AL) and the anterior chamber depth were measured by an optical biometer (OA 2000®; Tomey, Nagoya, Japan). The ACD was measured as the distance from the anterior corneal apex to the anterior apex of the crystalline lens in the images of the optical biometer. The corneal diameter was measured by a corneal topographer (OPD scan II®; NIDEK Co., LTD, Tokyo, Japan), the central corneal thickness, corneal endothelial cell density, the standard deviations of corneal endothelial cell density, and percentage of hexagonal endothelial cell were determined by a corneal endothelial cell analyzer (EM-4000®; Tomey, Nagoya, Japan).
3
Comprehensive Ophthalmological Examination Protocol
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All patients underwent comprehensive ophthalmological examinations, including uncorrected (UDVA) and corrected distance visual acuities (CDVA), manifest and cycloplegic refraction preoperatively, intraocular pressure, an anterior and posterior segment examination, corneal topography measured by a Scheimpflug scanning-slit topographer (Pentacam, Oculus Optikgerate GmbH, Wetzlar, Germany), and contrast sensitivity under photopic and mesopic conditions (CSV-1000E, Vector Vision Inc., Greenville, OH, USA) with correction by spectacles and ocular wavefront aberrometry (OPD-Scan II, Nidek Co. Ltd., Japan). These examinations were repeated 1, 3, 6, and 12 months after surgery.
4
Ocular Higher-Order Aberration Measurement
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We measured ocular higher-order aberrations (HOAs) for a 5-mm pupil using a standard wavefront aberrometer (OPD-Scan II, Nidek, Aichi, Japan). The root-mean-square (RMS) of the third-order Zernike coefficients was utilized to represent third-order aberrations. The RMS of the fourth-order coefficient was used to describe fourth-order aberrations. Total HOAs were calculated as the RMS of the third- and fourth-order coefficients.
5
Progression Keratoconus Diagnosis Criteria
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Fifty-six eyes of 56 patients aged 18–50 years with progressive KC were enrolled in the study. The diagnosis of KC was based on corneal topographic map and anterior and posterior elevation pattern by optical path difference Scan II (OPD-Scan II; Nidek Co., Ltd., Gamagori, Japan) as well as at least one of the clinical diagnostic signs such as Fleischer ring, Vogt's striae, Munson's sign, Rizzuti's sign, conical protrusion of the cornea at the apex, or corneal thinning by means of slit-lamp biomicroscopy. KC progression was defined as an increase of 1.00 diopter (D) or more in the steepest keratometric measurement, an increase of 1.00 D or more in manifest cylinder, or an increase of 0.50 D or more in manifest refraction spherical equivalent (MRSE) in a 24-month period. Patients with thinnest corneal thickness <400 μm, history of ocular trauma or surgery, corneal scarring or corneal opacities, history of any concurrent ophthalmic disorders such as glaucoma, severe dry eye, or corneal infections, history of autoimmune or connective tissue disorders, patients with pregnancy or nursing women, and patients with poor compliance were excluded from the study.
6
Evaluating Visual Changes after LASIK
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Postoperative examinations were performed at the time of questionnaire response collection. All the subjects underwent slit lamp microscopy, including fundus examination, non-corrected visual acuity (NCVA) assessment, best-corrected visual acuity (BCVA) assessment, pupil diameter measurement (OPD-Scan II; NIDEK Co. Ltd.), and axial length measurement (IOLMaster 500; Carl Zeiss Meditec AG, Jena, Germany). The ocular surface was stained with 2 μL of 1% preservative-free fluorescein solution instilled into the conjunctival sac. Tear break-up time (BUT) was defined as the interval between the last complete blink and the first disturbance of the stained corneal tear film. Fluorescein staining was graded from 0 to 3 for each cornea, according to the extent of staining: 0, negative; 1, scattered minute; 2, moderate spotty; and 3, diffuse blotchy staining. We measured BUT and fluorescein staining preoperatively and 1 month after LASIK. The patients were asked to report any history of systemic or ocular disease and any medications they were taking before LASIK. The changes in NCVA, BCVA, BUT, and fluorescein scores are listed in Table 2 .
7
Corneal Imaging in Keratoconus and Controls
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The participants were recruited from previously diagnosed keratoconus patients referred to the Eye Department of the University Hospital North Norway in Tromsø, Norway for corneal collagen cross-linking (CXL)-treatment and from healthy subjects seeking preoperative evaluation for refractive surgery at SynsLaser Kirurgi AS Tromsø, Norway. Patients were examined by the RTVue100 (OptoVue Inc. Fremont, California, USA) 26000-Hz SD-OCT using an add-on lens (CAM-L) mode, by Precisio (iVIS Technologies, Taranto, Italy) Scheimpflug-based topo/tomography, and by OPD-scan II (Nidek CO, LTD, Aichi, Japan) Placido-based topography. We analyzed SD-OCT corneal scans of 20 consecutive eyes with keratoconus (nine eyes categorized as stage 1, 7 eyes stage 2, and 4 eyes stage 3 on the Krumeich scale) (group 1) and of 20 consecutive healthy eyes with corneal astigmatisms ≥2 D, used as controls (group 2).
8
Postoperative Pain Assessment in Refractive Surgery
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Pre- and postoperative examinations consisted of slit lamp biomicroscopy, tonometry (Icare tonometer, Revenio Group Corporation, Helsinki, Finland), Precisio topo-/tomography, Placido disk-based topography and wavefront aberrometry (OPD-Scan II, Nidek. Co., Ltd. Aichi, Japan), uncorrected (UDVA) and corrected (CDVA) distance visual acuity measurement, and manifest refraction measurement (Nidek RT 2100 system, Nidek Co. Ltd., Aichi, Japan). The patients were examined preoperatively and 1, 6, and 12 months postoperatively. The verbal rating scale [23 (link)] was used in patients' evaluation of pain. The patients were asked to denote the postoperative pain intensity with a list of adjectives; these adjectives were assigned numbers from 0 to 5 (Table 1 ). The patients were also questioned on how many hours after the surgery the pain occurred, when it was most intense, and which of the two eyes was considered the most comfortable.
The regional ethics committee (REK Nord) approved the study. The research complied with the tenets of the Declaration of Helsinki. Written informed consent was obtained from each participant before examination.
The regional ethics committee (REK Nord) approved the study. The research complied with the tenets of the Declaration of Helsinki. Written informed consent was obtained from each participant before examination.
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