[Clinical outcomes of a monocular bi-aspheric ablation profile for the correction of refractive errors associated with presbyopia].

Visual and Refractive Outcomes of Corneal Refractive Surgery for Hyperopic and Mixed Astigmatism: A Systematic Review and Meta-Analysis.

TOPIC To evaluate the visual and refractive outcomes of corneal refractive surgery (PRK, LASIK, and SMILE) for hyperopic and mixed astigmatism. The clinical question addressed was: in adults with hyperopic or mixed astigmatism, how effective and safe are modern corneal refractive procedures, without alternative surgical comparators, in reducing refractive cylinder and improving uncorrected distance visual acuity? CLINICAL RELEVANCE Hyperopic and mixed astigmatism are less predictable to correct than myopic errors due to biomechanical and ablation-profile complexity. Historically, these treatments showed higher regression and retreatment rates. With advances in excimer and femtosecond platforms, updated evidence is needed to inform clinical decision-making and patient counseling regarding expected efficacy, predictability, and safety. METHODS A systematic review and meta-analysis were conducted following PRISMA 2020 and Cochrane guidelines. PubMed, Scopus, and Web of Science were searched from January 2010 to March 2025. Eligible studies included prospective, retrospective, or randomized human studies evaluating PRK, LASIK, or SMILE for hyperopic or mixed astigmatism. Case reports, small series (<10 eyes), intraocular procedures, and presbyopia treatments were excluded. Risk of bias was assessed using the NIH Quality Assessment Tool for Case Series Studies. Random-effects meta-analyses were performed, and heterogeneity was quantified with I2 statistics. RESULTS Twenty-three studies (3,561 eyes) were included. Mean preoperative cylinder was 2.45 ± 1.23 D. Pooled residual astigmatism was 0.47 D (95% CI, 0.04-0.90) for hyperopic and 0.67 D (95% CI, 0.37-0.97) for mixed astigmatism. Approximately 66% (hyperopic) and 50% (mixed) achieved ≤ 0.50 D residual cylinder; 81% and 83%, respectively, were within ≤ 1.00 D. Uncorrected distance visual acuity (UDVA) of 20/20 or better was achieved in 60% (hyperopic) and 63% (mixed). Loss of ≥1 line of corrected distance visual acuity (CDVA) occurred in 6% (95% CI, 0.01-0.14) of hyperopic and 5% (95% CI, 0.03-0.15) of mixed eyes (pooled random-effects estimates). No significant differences were found between groups in comparative meta-analysis. CONCLUSION Modern corneal refractive surgery provides substantial cylinder reduction, high predictability, and excellent safety in hyperopic and mixed astigmatism. Although heterogeneity and predominantly non-randomized designs limit certainty, current laser technologies achieve clinically meaningful outcomes comparable between groups, supporting their use in appropriately selected patients.

Clinical outcomes of combined presbyopia and astigmatism correction following hydrophilic trifocal toric intraocular lens implantation in cataract patients: a prospective clinical study

A clearer understanding of the Liberty 677MTY trifocal toric IOL’s performance is offered, supporting its use as a safe and effective solution for achieving spectacle independence and enhancing postoperative quality of life.

Clinical performance of a segmented refractive multifocal IOL: visual outcomes, rotational stability, and the role of higher-order aberrations

[Visual outcomes and satisfaction-related factors after laser blended vision surgery for myopia with presbyopia].

LBV surgery provided favorable UNVA and UDVA and good refractive predictability, with a high level of spectacle independence and overall satisfaction in patients with myopia and presbyopia, suggesting that preoperative assessment of the ocular surface status and accommodative function may be useful for patient selection and perioperative management.

[Evaluation of visual function and patient satisfaction 5 years after SMILE with micro-monovision in myopic patients with presbyopia].

SMILE with micro-monovision had an impact on accommodative function in the early postoperative stage in myopic patients with presbyopia, and patients exhibited good distance and near vision, maintained binocular visual functions, and reported high subjective satisfaction.

Enhanced predictability and axis precision of SMILE Pro, a retrospective analysis of myopic astigmatism correction.

AIM To evaluate three-month visual and refractive outcomes after small incision lenticule extraction (SMILE) Pro with the VISUMAX 800 femtosecond laser for myopic astigmatism correction and to compare results with previously reported VISUMAX 800 and VisuMax 500 outcomes. METHODS Retrospective, observational clinical study. Records of 64 patients (128 eyes) who underwent SMILE Pro using the VISUMAX 800 laser (Carl Zeiss Meditec AG, Jena, Germany) between June and November 2024 were reviewed. Preoperative and 3-month postoperative data were analyzed in eyes with corrected distance visual acuity (CDVA) of 1.0 or better, including spherical equivalent (SE), refractive astigmatism, and vector analysis. Patients were classified into low (≤1.50 D) and high (>1.50 D) astigmatism subgroups. RESULTS The mean age of 64 patients (128 eyes) was 26.10±4.25y (19-36y). Attempted and achieved SE were strongly correlated (r=0.97, P<0.001). At 3mo, 36.7% and 87.5% of eyes were within ±0.50 and ±1.00 D of target refraction, respectively. Mean residual astigmatism was -0.56±0.27 D, lower in the low-astigmatism group (-0.39±0.23 D) than in the high group (-0.72±0.21 D; P<0.001). The mean absolute astigmatic angle of error was 4.47°±4.68°, with 97.6% ≤15°. No intraoperative or postoperative complications occurred. CONCLUSION SMILE Pro using the VISUMAX 800 femtosecond laser provides safe and predictable correction of myopic astigmatism with good axis alignment. However, the observed undercorrection in higher cylinders suggests that further optimization of astigmatic nomograms may improve refractive accuracy.