The aspheric Tecnis IOL yielded better BCVA and better distance contrast sensitivity than the conventional IOL. The differences were clinically significant for higher spatial frequencies. The results give some suggestions for further studies.

Endothelial keratoplasty without endothelium removal has been successfully employed in a newborn with CHED for the first time. This procedure may be the best option for newborns with cloudy corneas.

PURPOSE: To evaluate and compare the objective and subjective outcomes between bilateral implantation of the extended depth of focus (EDOF) Mini Well intraocular lens (IOL) and the aspheric monofocal Mini-4-Ready IOL (both SIFI S.p.A., Catania, Italy). METHODS: This prospective comparative study included 25 patients (50 eyes) bilaterally implanted with an EDOF Mini Well IOL (EDOF group) and 25 patients (50 eyes) bilaterally implanted with a Mini-4-Ready IOL (monofocal group). Three-month follow-up data included corrected and uncorrected distance visual acuity at 4 m and 80, 67, and 40 cm. Defocus curves, subjective and objective contrast sensitivity, and objective optical quality (modulation transfer function cutoff and Strehl ratio calculated with Optical Quality Analysis System [OQAS]; Visiometrics SL, Terrassa, Spain), halometry, and reading performance were measured. Subjective visual quality was evaluated based on National Eye Institute Refractive Error Quality of Life Instrument 42 (NEI RQL-42) scores. RESULTS: Postoperative uncorrected and corrected monocular and binocular intermediate and near visual acuity was significantly better in the EDOF group ( P < .001). No differences were observed for distance visual acuity ( P ⩾ .312). Defocus curve outcomes for myopic values were better in the EDOF group ( P < .001). No significant differences were found in hyperopic (obtained in steps of +0.50 diopters [D] from emmetropia to 1.50 D) values ( P ⩾ .095), contrast sensitivity curves ( P ⩾ .087), or OQAS outcomes ( P ⩾ .138). Halometric values were significantly better in the monofocal group ( P < .05). There was a correlation between mean keratometry values and intermediate/near visual acuity. Significantly better NEI RQL-42 subscale scores for near vision, far vision, activity limitations, glare, dependence on correction, and suboptimal correction were noted in the EDOF group ( P < .05). CONCLUSIONS: Intermediate and near visual acuity was better after EDOF IOL than after aspheric monofocal IOL implantation while maintaining similar levels of visual quality, except for halo perception. [ J Refract Surg . 2020;36(4):214–222.]

Purpose To review recent progress, challenges, and future perspectives of stromal keratophakia for the treatment of advanced keratoconus. Methods We systematically reviewed the literature in the PubMed database, last update June 30, 2020. No language restriction was applied. The authors checked the reference lists of the retrieved articles to identify any additional study of interest. Results Several techniques have been proposed for the treatment of keratoconus in order to avoid or delay keratoplasty. This was primarily due to the lack of accessibility to donor corneas in many countries. The ease and predictability of the more advanced femtosecond lasers used to correct ametropias by stromal lenticule extraction lead to hypothesize that generated refractive lenticules could be implanted into corneal stromal layers to restore volume and alter the refractive properties of the cornea in patients with corneal ectasias. At the same time, new techniques for preservation, customization, and cellular therapy of the corneal stromal have been developed, directing to the valorization of otherwise discarded byproducts such as donor corneas unsuitable for either lamellar of penetrating keratoplasty. Conclusions Femtosecond laser-assisted stromal keratophakia could be a suitable therapeutic option for the treatment of corneal ectasias, especially in patients with advanced keratoconus, providing biomechanical support recovering the pachimetry to nearly normal value at the same time. The accuracy and predictability of the refractive outcome are yet a critical issue and the patient eligible for the procedure still has to be characterized.