Jorge L Alió

Minia University, Minya, Al Minyā, Egypt

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Publications (472)1124.86 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: To describe the main causes of explantation of phakic intraocular lenses (PIOLs) according to the anatomical site of implantation (angle supported, iris fixated, or posterior chamber). METHODS: This multicentrical, retrospective, and consecutive study sponsored by the Spanish Ministry of Health comprised a total of 240 eyes (226 patients) explanted due to PIOL complications. Clinical data of 144 angle-supported lenses, 24 iris-fixated lenses, and 72 posterior chamber lenses explanted were recorded preoperatively and postoperatively. RESULTS: Mean age of the patients at explantation was 46.30 ± 11.84 years (range: 25 to 80 years). The mean time between implantation and explantation was 381.14 ± 293.55 weeks (range: 0.00 to 1,551.17 weeks). It was 422.33 ± 287.81 weeks for the angle-supported group, 488.03 ± 351.95 weeks for the iris-fixated group, and 234.11 ± 4,221.60 weeks for the posterior chamber group. It was 8.10 ± 5.52 years for the angle-supported group, 9.36 ± 6.75 years for the iris-fixated group, and 4.49 ± 4.25 years for the posterior chamber group. This period of time was significantly shorter in the posterior chamber group (P < .001). Overall, the main causes of explantation were cataract formation (132 eyes, 55%), endothelial cell loss (26 eyes, 10.83%), corneal decompensation (22 eyes, 9.17%), PIOL dislocation/decentration (16 eyes, 6.67%), inadequate PIOL size or power (12 eyes, 5%), and pupil ovalization (10 cases, 4.17%). Cataract development was the cause of explantation in 51.39% of angle-supported cases, 45.83% of iris-fixated cases, and 65.28% of posterior chamber cases. Endothelial cell loss was the cause of explantation in 15.97% of angle-supported PIOLs, 8.33% of iris-fixated PIOLs, and 1.39% of posterior chamber PIOLs. CONCLUSIONS: Cataract is the main cause of PIOL explantation, especially in posterior chamber PIOLs. In the angle-supported group, endothelial cell loss was the second cause of explantation
    Journal of refractive surgery (Thorofare, N.J.: 1995) 12/2014; 31(1). · 2.47 Impact Factor
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    ABSTRACT: To describe the main causes of explantation of phakic intraocular lenses (PIOLs) according to the anatomical site of implantation (angle supported, iris fixated, or posterior chamber). This multicentrical, retrospective, and consecutive study sponsored by the Spanish Ministry of Health comprised a total of 240 eyes (226 patients) explanted due to PIOL complications. Clinical data of 144 angle-supported lenses, 24 iris-fixated lenses, and 72 posterior chamber lenses explanted were recorded preoperatively and postoperatively. Mean age of the patients at explantation was 46.30 ± 11.84 years (range: 25 to 80 years). The mean time between implantation and explantation was 381.14 ± 293.55 weeks (range: 0.00 to 1,551.17 weeks). It was 422.33 ± 287.81 weeks for the angle-supported group, 488.03 ± 351.95 weeks for the iris-fixated group, and 234.11 ± 4,221.60 weeks for the posterior chamber group. It was 8.10 ± 5.52 years for the angle-supported group, 9.36 ± 6.75 years for the iris-fixated group, and 4.49 ± 4.25 years for the posterior chamber group. This period of time was significantly shorter in the posterior chamber group (P < .001). Overall, the main causes of explantation were cataract formation (132 eyes, 55%), endothelial cell loss (26 eyes, 10.83%), corneal decompensation (22 eyes, 9.17%), PIOL dislocation/decentration (16 eyes, 6.67%), inadequate PIOL size or power (12 eyes, 5%), and pupil ovalization (10 cases, 4.17%). Cataract development was the cause of explantation in 51.39% of angle-supported cases, 45.83% of iris-fixated cases, and 65.28% of posterior chamber cases. Endothelial cell loss was the cause of explantation in 15.97% of angle-supported PIOLs, 8.33% of iris-fixated PIOLs, and 1.39% of posterior chamber PIOLs. Cataract is the main cause of PIOL explantation, especially in posterior chamber PIOLs. In the angle-supported group, endothelial cell loss was the second cause of explantation. [J Refract Surg. 2015;31(1):XX-XX.]. Copyright 2014, SLACK Incorporated.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 12/2014; · 2.47 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate the long-term outcomes of laser in situ keratomileusis (LASIK) for high myopia with or without astigmatism. SETTING: Vissum Instituto Oftalmologico de Alicante and Miguel Hernandez University, Alicante, Spain. DESIGN: Retrospective-prospective case series. METHODS: Laser in situ keratomileusis was performed using the Visx 20/20 excimer laser. The minimum follow-up was 15 years. The main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and corneal topography. RESULTS: This study included 40 patients (40 eyes) with a mean age of 51.08 years ± 6.67 (SD) (range 41 to 60 years) with high myopia (-6.00 to -18.00 diopters [D]). At 15 years, the safety index was 1.23 and the efficacy index, 0.95. During the follow-up, a significant increase in the dioptric power of all keratometric variables was detected (P≤.028, Friedman test), the most notable increase occurring between 3 months and 1 year (P≤.005). At 15 years, 46.15% of the eyes were within ±1.00 D of the attempted spherical equivalent and 64.10% were within ±2.00 D. The UDVA at 15 years was 20/25 or better in 43.59% of eyes and 20/40 or better in 64.10% of eyes. The postoperative CDVA was significantly better than preoperatively (P<.001). The postoperative complications were minor except in 1 eye in which ectasia occurred. CONCLUSIONS: Laser in situ keratomileusis for high myopia was safe over the long term. However, significant myopic regression with time was detected. Low preoperative pachymetry and low residual stromal bed were predictors of keratometric regression. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 11/2014; · 2.75 Impact Factor
  • A Abbouda, I Abicca, J L Alio
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    ABSTRACT: Abstract Aim: To describe the infectious complications and the group of pathogens involved in the infection following corneal crosslinking, the visual outcome, and the treatment proposed. Methods: A Medline (National Library of Medicine, Bethesda, MD, USA) search from October 2000 to October 2013 was performed to identify all articles describing infectious keratitis following corneal crosslinking treatment. Nineteen articles were selected. Ten articles reported infectious complications of corneal crosslinking treatment were included. Nine articles were excluded, because seven described sterile keratitis, one article was in German, and one reported general complication without describing the infection complication. Results: A total number of infections reported included 10 eyes. The infectious keratitis was associated with bacteria in five eyes (50%): gram-positive bacteria in three eyes (30%) (staphylococcus epidermidis, S. aureus and streptococcus salivarius plus S. oralis, respectively) and gram-negative bacteria in two eyes (20%) (E. coli; P. aeruginosa); there was herpes virus in two eyes, fungus in two eyes (Fusarium and Microsporidia) (20%), and Acanthamoeba in one eye (10%). Conclusions: Only 10 cases of infectious keratitis following corneal crosslinking are published. The most virulent pathogens were Pseudomonas aeruginosa and Acanthamoeba. Less virulent organisms were Escherichia coli and S. epidermidis. Two cases of herpes keratitis were described, suggesting the possibility of systemic antiviral prophylaxis before corneal crosslinking treatment. The most common risk factor of infections identified was postoperative incorrect patient behavior.
    Seminars in ophthalmology 11/2014; · 1.09 Impact Factor
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    ABSTRACT: Advances in small incision surgery have enabled cataract surgery to evolve from being concerned primarily with the safe removal of the opaque crystalline lens to a procedure refined to yield the best possible postoperative refractive result. As the outcomes of cataract surgery have improved, the use of lens surgery as a refractive modality in patients without cataracts (clear lens extraction) has increased in popularity. The removal of the crystalline lens for refractive purposes, or so called refractive lens exchange (RLE), offers distinct advantages over corneal refractive surgery in selected cases. nevertheless, in some middle-aged patients with high refractive errors, corneal refractive surgery can be a safe and effective treatment. In addition, the use of multifocal lenses offers an alternative for the correction of presbyopia. A further advantage of RLE is that it simultaneously eliminates the need for cataract surgery in the future. The keys for success in RLE are effectiveness and consistency in the refractive outcome, providing at the same time surgical and postoperative safety. To achieve these goals, adequate indications following strict risk/benefit criteria and refractive precision based on accurate preoperative protocols for IOL calculation and selection are mandatory, together with a appropriate choice of surgical procedure based on the surgeon´s skills, minimizing complications.
    Survey of Ophthalmology 11/2014; · 2.86 Impact Factor
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    ABSTRACT: To provide a review of the recent literature on the indications and results of refractive and nonrefractive enhancements after cataract surgery.
    Current opinion in ophthalmology. 10/2014;
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    ABSTRACT: Purpose: To improve the predictability of the visual and refractive outcomes of intrastromal corneal ring segment (ICRS) implantation in keratoconus patients and highlight the importance of internal astigmatism and its relationship to corneal and refractive astigmatism as prognostic factors. Setting: Vissum Corporación, Alicante, and Centro de Oftalmología Barrquer, Barcelona, Spain. Design: Retrospective case series. Methods: Visual, refractive, topographic, and aberrometric variables were evaluated in eyes having ICRS implantation. The eyes were divided into 2 groups according to the relative position of the keratometric axis and refractive axis; that is, coincident axis (0 degree ± 15 [SD]) or uncoincident axis. Internal astigmatism was calculated by vectorial analysis. The relationship between topographic astigmatism and refractive astigmatism was evaluated. The follow-up was 6 months. Results: Of the 127 eyes evaluated, 79 had grade II keratoconus and 48 had grade I keratoconus. Statistically significant differences were found in the relative position of the refractive axis and keratometric axis (P=.017). Internal astigmatism had a significant correlation with the gain in visual acuity in patients with grade II keratoconus (r = −0.455, P=.0001). This relationship was less significant in patients with grade I keratoconus (r = −0.391, P=.021). Conclusión: The predictability of visual and refractive outcomes can be significantly increased in grade II keratoconus patients when the relative position of the keratometric and refractive axes; the internal, corneal, and refractive astigmatism; and their combinations are used as prognostic factors. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 10/2014; 40(10):1633-44. · 2.75 Impact Factor
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    ABSTRACT: To study the tolerance and biocompatibility of micronised mineral pigments for corneal cosmetic pigmentation in an experimental animal model.
    The British journal of ophthalmology. 09/2014;
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    ABSTRACT: PURPOSE. To evaluate whether mouse adipose tissue mesothelial cells (ATMCs) share morphological and biochemical characteristics with mouse corneal endothelial cells (CECs) and to evaluate their capacity to adhere onto the decellularized basal membrane of human anterior lens capsules (HALCs) as a potential tissue engineered surrogate for corneal endothelium replacement. METHODS. ATMCs were isolated from the visceral adipose tissue of adult mice and their expression of several corneal endothelium markers was determined with qRT-PCR, immunofluorescence and Western blotting. ATMCs were shortly cultured in a Mesothelial Retaining Phenotype Media (MRPM) and further seeded and cultured on top of the decellularized basal membrane of HALCs. ATMCs-HALCs composites were evaluated by optical microscopy, immunofluorescence and transmission electron microscopy. RESULTS. MRPM cultured ATMCs express the corneal endothelium markers COL4A2, C0L8A2, SLC4A4, CAR2, Na+/K+-ATPase, β-catenin, Zona Occludens-1 and N-cadherin in a pattern similar to mouse CECs. Furthermore, ATMCs displayed strong adhesion capacity onto the basal membrane of HALCs and formed a confluent monolayer within 72 hours of culture in MRPM. Ultrastructural morphological and marker characteristics displayed by ATMCs monolayer onto HALCs clearly indicate that ATMCs retained their original phenotype of squamous epithelial-like cells. CONCLUSIONS. CECs and ATMCs share morphological (structural) and markers (functional) similarities. ATMCs adhered and formed structures mimicking focal adhesion complexes with the HALCs basal membrane. Monolayer structure and achieved density of ATMCs support the proposal of using adult human MCs as a possible surrogate of damaged corneal endothelium.
    Investigative ophthalmology & visual science. 08/2014;
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    ABSTRACT: Currently available keratoprosthesis models (non biological corneal substitutes) have a less than 75% graft survival rate at two years. We aimed at developing a model for keratoprosthesis based on the use of polyethyl acrylate (PEA)-based copolymers, extracellular matrix-protein coating and colonization with adipose-derived mesenchymal stem cells. Human adipose tissue derived mesenchymal stem cells (h-ADASC) colonization efficiency of seven PEA-based copolymers in combination with four extracellular matrix coatings were evaluated in vitro. Then, macroporous membranes composed of the optimal PEA subtypes and coating proteins were implanted inside rabbit cornea. After a three-month follow-up, the animals were euthanized, and the clinical and histological biointegration of the implanted material were assessed. h-ADASC adhered and survived when cultured in all PEA-based macroporous membranes. The addition of high hydrophilicity to PEA membranes decreased h-ADASC colonization in vitro. PEA based copolymer containing 10% hydroxyethyl acrylate (PEA-HEA10) or 10% acrylic acid (PEA-AAc10) monomeric units showed the best cellular colonization rates. Collagen plus keratan sulfate-coated polymers demonstrated enhanced cellular colonization respect to fibronectin, collagen or uncoated PEAs. In vivo implantation of membranes resulted in an extrusion rate of 72% for PEA, 50% for PEA-AAc10, but remarkably of 0% for PEA-HEA10. h-ADASC survival was demonstrated in all the membranes after three months follow-up. A slight reduction in the extrusion rate of h-ADASC colonized materials was observed. No significant differences between the groups with and without h-ADASC were detected respect to transparency or neovascularization. We propose PEA with low hydroxylation as a scaffold for the anchoring ring of future keratoprosthesis.
    Journal of Biomedical Materials Research Part A 06/2014; · 2.83 Impact Factor
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    ABSTRACT: To describe femtosecond laser cataract surgery and discuss the published peer-reviewed articles to have a fair evaluation of this new technology and its comparisons to conventional phacoemulsification surgery.
    Journal of refractive surgery (Thorofare, N.J.: 1995) 06/2014; 30(6):420-427. · 2.47 Impact Factor
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    ABSTRACT: To provide a review of the recent literature on the management of residual refractive error after cataract surgery.
    Current opinion in ophthalmology. 05/2014;
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    ABSTRACT: Cataract surgery in cases with previous corneal surgery can be a major challenge for the ophthalmologist as the visual and refractive outcome can be seriously affected. The surgeon has to preoperatively evaluate whether it is the cataract or the previous corneal surgery that most affects the visual acuity. The surgical procedure should be then carefully planned, to evaluate if a corneal graft surgery should be performed coincidentally to the cataract procedure or whether cataract surgery alone may sufficiently restore the best corrected vision of the patient. If phacoemulsification is possible, it is better to perform cataract surgery first to avoid risks which may occur with simultaneous surgery. Keratoplasty should be postponed to a later date. The refractive outcome of the case deserves special attention in the preoperative planning process and the reduction or elimination of the already existing astigmatism will be a desirable result. The authors will try to provide the practical cataract surgeon a review on this topic aiming to give guidelines for good clinical practice in the decision making process of these challenging and difficult cases.
    Expert Review of Ophthalmology 04/2014;
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    ABSTRACT: To describe the corneal appearance on confocal microscopy after AcuFocus KAMRA Inlay (AcuFocus, Inc., Irvine, CA) implantation and evaluate the visual acuity compared to the confocal microscopy data. Twelve eyes of 12 patients implanted with one of three models of the AcuFocus KAMRA Inlay (ACI 7000, 7000T, and 7000PDT) were prospectively evaluated by confocal microscopy 6 months after implantation. Additionally, 4 eyes of 4 patients explanted during the follow-up period were evaluated. Among the eyes implanted, mean epithelial thickness was 54.6 ± 22 μm. The subbasal nerve plexus was detected in 10 patients. The corneal nerves per unit area were 2.73 ± 2.1 sprouts/mm(2). The branch pattern was found in 8 patients. The mean keratocyte density value was 540 ± 210 cells/mm(2). A low grade of keratocyte activation was found in all patients. Among the eyes explanted, the mean wound healing opacity was 1,092.75 ± 1,877.35 μm/pixel. The corneal tolerance to the KAMRA Inlay appeared to be good. The inlay modified the normal structure of the corneal layer, but it was not associated with severe complications of the eye. Keratocyte activation was the finding most associated with a negative visual outcome. Confocal microscopy can be useful to evaluate the long-term evolution of the corneal layer changes following KAMRA Inlay implantation. [J Refract Surg. 2014;30(3):172-178.].
    Journal of refractive surgery (Thorofare, N.J.: 1995) 03/2014; 30(3):172-8. · 2.47 Impact Factor
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    ABSTRACT: Purpose: To demonstrate the surgical application of a new model of epidescemetic keratoprosthesis. Methods: A 53-year-old man was referred to our center with severe alkali burns in both eyes and was treated by a combined corneal graft associated with KeraKlear implantation assisted by femtosecond laser and cataract surgery with implantation of an intraocular lens. Results: After 1 month, visual acuity was 0.6 logMAR in both eyes with -2 sphere correction. Slit-lamp examination and anterior segment optical coherence tomography revealed that the device was centered in the pupil area with no infection. No sign of extrusion was detected. Conclusions: The advantage of this device is that it involves nonperforating surgery, thus reducing the postoperative risk of infection and necrosis of tissue around the prosthesis. Large-scale studies with a long follow-up period are required to evaluate the outcome of use of this device.
    European journal of ophthalmology 02/2014; · 0.91 Impact Factor
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    ABSTRACT: To evaluate the visual and refractive outcomes, predictability, and stability of phakic intraocular lens (pIOL) implantation in keratoconic eyes and compare the results of 2 pIOL models. Vissum Instituto Oftalmologico, Alicante, Spain. Retrospective case series. An iris-claw (Artiflex) or collagen copolymer posterior chamber pIOL (PC pIOL) (Implantable Collamer Lens) was implanted in eyes with stable keratoconus. The main outcome measures were postoperative changes from the preoperative manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography, and endothelial cell count. Alpins vectorial analysis was performed. Twenty eyes received an iris-claw pIOL and 28 eyes, a PC pIOL. The mean spherical equivalent was -9.31 diopters (D) ± 4.20 (SD) (range -20.75 to -2.75) preoperatively and -0.46 ± 0.88 D (range -3.25 to 1.00 D) postoperatively (P<.001). No patient lost lines of CDVA. The mean decimal UDVA was 0.08 ± 0.09 preoperatively and 0.71 ± 0.26 postoperatively and the mean decimal CDVA, 0.77 ± 0.24 and 0.87 ± 0.98, respectively (P<.001). The mean efficacy index was 0.90 ± 0.26 and the mean safety index, 1.19 ± 0.29. The mean efficacy index was not statistically different between the PC pIOL (0.88 ± 0.28) and the iris-claw pIOL (0.96 ± 0.22) (P=.058). Refraction was stable during the follow-up. Phakic IOL implantation is a suitable refractive surgical option for stable keratoconus. It may be especially indicated for the management of high ametropia and showed good efficacy and safety. Refractive and keratometric stability was confirmed. No author has a financial or proprietary interest in any material or method mentioned.
    Journal of Cataract and Refractive Surgery 01/2014; · 2.75 Impact Factor
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    ABSTRACT: Purpose: Anterior segment optical coherence tomography (OCT) is a relevant diagnostic tool in the evaluation of corneal changes following corneal crosslinking (CXL) treatment in patients infected by a severe fungal corneal infection. Methods: Two patients with severe fungal keratitis that was unresponsive to medical treatment were treated with CXL. Corneal melting was present in all cases. Anterior segment OCT showed the preoperative depth and extension of the infiltrate and the modification during the follow-up. Results: Blockage of the melting was achieved in one patient and one patient developed a corneal perforation. Anterior segment OCT allowed control of the evolution of fungal infection and evaluation of the corneal tissue response to the CXL. It is also able to identify the extent and depth of the inflammation. This parameter seems more important than corneal pachymetry to ensure the safety of CXL procedures in infectious keratitis. Conclusions: The different behavior of inflamed tissue with respect to UVA irradiance could be the main point to understand the different postoperative outcome.
    European journal of ophthalmology 01/2014; · 0.91 Impact Factor
  • Pawel Klonowski, Robert Rejdak, Jorge L Alió
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    ABSTRACT: Microincision cataract surgery (MICS) is an approach to cataract surgery through incision less than 1.8 mm with the purpose of reducing surgical invasiveness, improving at the same time surgical outcomes. The main confirmed advantages of MICS are the control and avoidance of surgically induced corneal astigmatism and the decrease of postoperative corneal aberrations. MICS has been demonstrated to be minimally traumatic surgery, providing better postoperative outcomes than standard small incision phacoemulsification. High degree of surgical innovation, use of advanced phacoemulsification surgical platforms with pressurized fluidic control and new surgical instrumentation, allow doing very sophisticated cataract surgery. MICS favors the use of fluidics, reducing the use of phacoemulsification power. Bimanuality provides opportunity to do manipulation in anterior chamber area easily and much more comfortably than with standard coaxial technique. Today, surgery is performed through 1 mm incision. The use of the modern MICS intraocular lens (IOL) requires incisions of 1.8 mm. The increased availability of MICS IOLs allows to select the best IOL as per the demand of the patient. Long-term stability of the MICS outcomes and wide range of surgical capacity makes MICS the most modern and adequate approach to minimally invasive cataract surgery.
    Expert Review of Ophthalmology 01/2014; 8(4).
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    ABSTRACT: To investigate the visual and refractive outcomes, safety, efficacy and stability of cataract surgery in eyes with stable keratoconus. 17 eyes (10 patients) diagnosed as stable keratoconus, aged from 34 to 73 years (56.63±12.47), underwent micro-incision cataract surgery (MICS) followed by implantation of toric intraocular lens (IOL). Seven of them were operated bilaterally and three unilaterally. A complete ophthalmological examination was performed preoperatively and postoperatively. The main outcome measures were: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry and manifest refraction. Sphere changed from -1.77±6.57D (-11.00 to 7.00) preoperatively to 0.08±0.79D (-1.25 to 1.75) postoperatively (p=0.211), and cylinder changed from -2.95±1.71D (-7.00 to -0.75) to -1.40±1.13D (-3.25 to 0.00) (p=0.016). UDVA (logMAR) changed from 1.33±0.95 (0.40 to 2.77) to 0.32±0.38 (0.00 to 1.30) (p=0.008) and CDVA (logMAR) changed from 0.32±0.45 (0.01 to 1.77) to 0.20±0.36 (-0.03 to 1.30) (p=0.013). Efficacy and safety indexes were 1.38±0.58 and 1.17±0.66, respectively. Refraction and corneal topography were stable during the follow-up (9.10±5.54 months, 3-15) CONCLUSIONS: MICS surgery using corneal topography data and standard formulas for the calculation of the IOL power is a safe and effective procedure regarding keratometric stability, visual and refractive results.
    The British journal of ophthalmology 01/2014; · 2.92 Impact Factor
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    Jorge L Alio, Felipe Soria, Ahmed A Abdou
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    ABSTRACT: This review outlines the advantages and the differences of femtosecond laser-assisted cataract surgery (FLACS) following a coaxial or microincision cataract surgery phacoemulsification in the surgical outcome and greater control of cataract surgery. FLACS offers minimal tissue damage and extreme precision during corneal incision creation, continuous circular capsulorhexis (CCC) and nuclear fragmentation. It also allows diminishing the mean average ultrasound power to emulsify the nucleus followed by a coaxial or a biaxial procedure. The impact of reduced phacoemulsification energy on the corneal endothelium is an interesting topic that is being investigated. Despite its benefits, this technology has relevant financial issues and a high learning curve. FemtoMICS appears to be surgically and statistically more efficient than the FemtoCoaxial technique and Femtoincisions prove to be stable and do not change the corneal high order aberration significantly with favorable results of the triplanar configuration.
    Current opinion in ophthalmology 01/2014; 25(1):81-8. · 2.49 Impact Factor

Publication Stats

6k Citations
1,124.86 Total Impact Points

Institutions

  • 2014
    • Minia University
      Minya, Al Minyā, Egypt
  • 1999–2014
    • Universidad Miguel Hernández de Elche
      Elche, Valencia, Spain
  • 1997–2014
    • VISSUM Instituto Oftalmológico de Alicante
      • Department of Research and Development
      Alicante, Valencia, Spain
  • 2012–2013
    • Universidad de Valladolid
      • Institute for Applied Ophthalmobiology (IOBA)
      Valladolid, Castille and León, Spain
    • Hospital Universitario de Getafe
      Madrid, Madrid, Spain
    • Hospital Universitario "Rio Hortega"
      Valladolid, Castille and León, Spain
  • 2009–2011
    • Universidad de Almería
      Unci, Andalusia, Spain
    • Universidad de Navarra
      • Oftalmología
      Pamplona, Navarre, Spain
    • University of Padova
      • Department of Neurosciences
      Padua, Veneto, Italy
  • 2007–2011
    • Hospital Virgen de los Lirios
      Alicante, Valencia, Spain
  • 1989–2011
    • University of Alicante
      • • Optics, Pharmacology and Anatomy
      • • Departamento de Ecología
      Alicante, Valencia, Spain
  • 2004–2008
    • University of Valencia
      • Departamento de Óptica
      Valencia, Valencia, Spain
  • 2005
    • University of Castilla-La Mancha
      Toledo, Castille-La Mancha, Spain
  • 1987–1988
    • Hospital Universitario de Salamanca
      Helmantica, Castille and León, Spain