Purpose: The aim is to report long-term graft survival rates, clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK).Methods: In this study 150 eyes, that underwent DMEK whether for Fuchs endothelial corneal dystrophy (FECD) or for bullous keratopathy (BK), surveilled for 7 years at 6 time-points to evaluate graft survival rates and clinical outcomes of post-corneal transplantation.Results: Overall, the estimated survival probability of 95% con dence interval at 7 years of post-DMEK was 0.58 (0.72-0.77) and the survival probabilities of eyes operated for FECD (0.53) were higher than eyes operated for BK (0.42) (Log Rank 26.87, [p=0.197]). Post-transplant eyes with FECD achieved better visual acuity levels than eyes with BK (p=0.006). Primary graft failure occurred in 11.3% eyes. Secondary graft failure rate was 9.3%, and allograft rejection rate was 4.7%.Conclusion: Although DMEK is effective, safe in long-term, visual results and graft survival rates are better in cases with FECD.

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Purpose To report long-term visual and refractive results of small-incision lenticule extraction (SMILE) in treatment of high myopia. Materials and Methods Medical records of patients who underwent SMILE for surgical correction of myopia or myopic astigmatism were retrospectively reviewed. Only patients with a preoperative spherical equivalent of subjective manifest refraction (SE) ≥ 6 D and a postoperative follow-up of 5 years were included in the study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and SE were analyzed preoperatively and at 1-, 3-, and 5-year postoperative periods. Results Thirty-seven eyes of 37 patients were included in the study. The mean attempted SE was −7.47 ± 1.10 D (range −6.00 to −10.00 D). At the 5-year visit, the mean difference between achieved and attempted SE was −0.43 ± 0.47 (0.50 to −1.25 D). Mean postoperative UDVA and CDVA were 0.20 ± 0.18 and 0.06 ± 0.08 logMAR, respectively. At the 1-year visit, 70% and 97% of the eyes were within ±0.50 D and ±1.00 D of the intended correction. At the 5-year follow-up, 59% and 92% percent of the eyes were within ±0.50 D and ±1.00 D of the intended SE, respectively. At the 5-year visit, the efficacy index was 0.89 ± 0.26 and the safety index was 1.16 ± 0.20. Fifty-four percent of the eyes gained one or more lines of CDVA. Conclusion SMILE with an intended correction of up to a spherical equivalent of 10 D is safe and effective. However, there is regression of the refractive effect over extended follow-up.

Purpose: To evaluate long-term clinical results of 2 different accelerated corneal crosslinking (CXL) protocols in pediatric patients with keratoconus. Setting: Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey. Design: Retrospective case-control study. Methods: Patients who were younger than 18 years were included in the study. Group 1 received 4 minutes of illumination at 30 mW/cm2, and Group 2 received 5 minutes of illumination at 18 mW/cm2. Uncorrected and corrected distance visual acuities, manifest refraction, corneal topographic parameters, and corneal higher-order aberrations (HOAs) were evaluated at baseline and during 1-, 3-, and 5-year follow-up visits. Results: A total of 143 eyes from 86 patients were included in the study. There were 30 eyes in Group 1 and 113 eyes in Group 2. The mean follow-up time was 4.15 ± 0.99 years. Mean keratometry (K) and/or maximum K progressed ≥1.00 diopter (D) in 7 eyes (23.3%) in Group 1 and 19 eyes (16.8%) in Group 2 (P = .411). Mean K and/or maximum K decreased ≥2.00 D in 2 eyes (6.7%) in Group 1 and 24 eyes (21.2%) in Group 2 (P = .06). In Group 1, there were no statistically significant differences in topographic parameters during follow-up. In Group 2, there was a statistically significant reduction in total HOA and coma during the 5-year visit when compared with the preoperative visit (P = .005 and P = .045, respectively). Conclusions: Accelerated CXL is beneficial in terms of halting the progression of keratoconus in pediatric patients throughout 5 years of follow-up examinations. An increased irradiance with a reduced application time reduces the topographic effects of CXL.

Purpose To report clinical results of a foldable, hydrophilic acrylic, single-piece, injectable, posterior chamber phakic intraocular lens (pIOL). Material and Methods Medical records of patients who underwent posterior chamber phakic IOL (Eyecryl Phakic IOL, Biotech Vision Care, Ahmedabad, India) implantation for surgical correction of myopia were retrospectively reviewed. Only patients with at least a one-year follow-up were included. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), endothelial cell density (ECD), and pIOL vault were analyzed at 1, 3, 6, and 12 months after surgery. Complications observed during and after surgery were also recorded. Results The study included 58 eyes of 29 patients. Mean patient age was 32 ± 7 years. Spherical equivalent of manifest refraction was −13.41 ± 3.23 D preoperatively and −0.44 ± 0.55 D postoperatively. Preoperative CDVA was 0.29 ± 0.71 logMAR. Postoperative UDVA and CDVA were 0.21 ± 0.66 and 0.15 ± 0.69 logMAR, respectively, at the 12-month visit. At the 12-month visit, the efficacy index was 1.20 and the safety index was 1.39. Mean ECD was 2713 ± 339 cells/mm2 at the preoperative visit and 2608 ± 362 cells/mm2 at the 12-month visit (3.9% loss, p < 0.001). ECD loss from 3 months to 12 months was not statistically significant. No significant cataract formation, significant endothelial cell loss, glaucoma, uveitis, or any other vision-threatening complication was observed. Conclusion Based on postoperative experience, we have found that Eyecryl Phakic IOL is safe and effective for treating high myopia.

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Purpose: To compare the long-term safety, efficacy, and complications of small-incision lenticule extraction (SMILE) and flexible iris-fixated anterior chamber phakic intraocular lens (pIOL) implantation for the treatment of high myopia. Setting: University of Health Science Turkey, Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey. Design: Retrospective comparative case series. Methods: Data of patients who underwent SMILE or pIOL (Artiflex) implantation for myopia were retrospectively reviewed. Only patients with preoperative manifest refraction spherical equivalent from −6.00 to −10.00 diopters (D) were included in the study. Results: There were 47 eyes of 32 patients in the SMILE group and 52 eyes of 29 patients in the pIOL group. The mean postoperative follow-up was 63.75 ± 18.40 months in the SMILE group and 65.38 ± 16.22 months in the p-IOL group (P = .71). At 6 years postoperatively, refractive predictability was slightly better in the pIOL group, and the percentages of eyes within ±0.50 D of the attempted correction were 77% and 83% in the SMILE and pIOL groups, respectively. Although mean uncorrected distance visual acuity was comparable (SMILE, 0.12 ± 0.06 logarithm of the minimum angle of resolution [logMAR]; p-IOL, 0.09 ± 0.05 logMAR), the safety indices (1.08 ± 0.22 vs 1.11 ± 0.20; P = .02) and the efficacy indices (0.92 ± 0.24 vs 1.11 ± 0.22; P = .03) were statistically significantly higher after pIOL implantation. Despite a mean of 11.09% of the endothelial cell being lost at 6 years after pIOL implantation, no pIOL was explanted due to endothelial cell loss. Conclusions: In this comparative and long-term study, iris-fixated anterior chamber pIOL implantation for high myopic correction showed slightly better safety and efficacy profiles but with statistically significant endothelial cell loss.

Purpose: To compare the long-term refractive and visual outcomes and the corneal higher-order aberrations of contralateral eyes of patients who received small-incision lenticule extraction (SMILE) in one eye and femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK) in the other eye. Setting: Refractive Surgery Clinic of the University of Health Sciences Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey. Design: Retrospective case series. Methods: The medical files of patients who received SMILE in one eye and FS-LASIK in the contralateral eye for myopia and myopic astigmatism were reviewed. Postoperative examinations at 1 year, 3 years, and 5 years were evaluated. The main outcome measures were the comparison of the refractive and visual outcomes and the effect on corneal higher-order aberrations between the procedures. Results: This study included 44 eyes from 22 patients. At the 5-year follow-up, the mean uncorrected distance visual acuity improved to 0.03 ± 0.06 and 0.02 ± 0.05 logarithm of the minimum angle of resolution (range 0.15 to −0.08 and 0.10 to −0.08) for SMILE and FS-LASIK groups, respectively. There was no statistically significant difference between the groups (P = .572). At 5 years, all eyes in both groups were within ±1.00 diopter of attempted spherical equivalent refraction, and no statistically significant difference was found between the intended and achieved correction comparing the groups at any time points. None of the aberrations showed a difference between the groups at any time. Conclusions: Both SMILE and FS-LASIK were safe and similar in terms of efficacy and predictability at long-term follow-up for the correction of myopia and myopic astigmatism.