Acuity Values Research Articles

Анти-VEGF-терапия диабетического макулярного отека: актуальные подходы к ведению пациентов с высокими и низкими исходными функциональными параметрами

Diabetic macular edema (DME) is a serious complication of diabetes mellitus (DM) and a vision-threatening condition which can lead to irreversible blindness. Its prevalence correlates with the number of cases of DM and diabetic retinopathy and demonstrates a stable upward trend. Though modern medicine has made tremendous strides and developed several options for DME treatment which comply with the efficacy and safety criteria from a perspective of evidence-based medicine, DME remains a challenge in the clinical practice. There is no doubt that the key role is played by anti-angiogenic (anti-VEGF) therapy which has become the gold standard treatment for DME and is supported by a strong evidence base. However, some aspects of this method application are understudied. Thus, most of the randomized clinical studies (RCSs) of anti-VEGF therapy included patients with the "averaged" baseline values of visual acuity (within the range of 23–79 letters using ETDRS chart / 0.06–0.7 in decimal system). But in real clinical practice ophthalmologists often observe atypical DME cases where the baseline visual acuity values fall outside the range described in RCSs. The present literature review is aimed at considering tactics of the rational management of patients with atypically low and high baseline visual functions and provides analysis of the recent publications in which the outcomes of anti-VEGF therapy are discussed in the context of this problem. Keywords: macular edema, anti-VEGF therapy, diabetic retinopathy, diabetes, diabetic macular edema, high visual acuity, low visual acuity. For citation: Bobykin E.V. Anti-VEGF therapy for diabetic macular edema: up-to-date approaches to the management of patients with high and low baseline functional parameters. Russian Journal of Clinical Ophthalmology. 2022;22(3):181–186 (in Russ.). DOI: 10.32364/2311-7729- 2022-22-3-181-186.

Corneal Haze Secondary to Corneal Collagen Cross-linking in Keratoconus Patients: Treatment and Outcomes.

The purpose of this study was to evaluate the outcome of patients presenting with mild-to-moderate corneal haze after undergoing corneal collagen cross-linking (CXL) for keratoconus (KCN) and their response to a proposed standardized topical steroid-based treatment. This study included 19 eyes of 14 patients presenting with corneal haze after undergoing CXL for KCN. Corrected distance visual acuity, corneal thickness and Kmax values by Pentacam® Scheimpflug tomography, as well as subjective corneal haze changes were evaluated before and after a topical steroid- and cyclosporine-based treatment. Visual acuity improved after the completion of the treatment by 0.043 logMAR (P = 0.017) and Kmax values decreased by 1.17D (P = 0.0024), while the corneal thinnest pachymetry remained stable. Data collected from the examiner's slit-lamp examination description revealed that seven eyes had a decrease in haze compared to 12 eyes with stable or no changes in the haze. Our findings suggest an improvement in visual acuity and possible corneal flattening with decreasing Kmax after the completion of topical steroids with taper course treatment in patients suffering from corneal haze post-CXL. This paper also highlights the importance of postcross-linking anti-inflammatory treatment and close follow-up.

Efficacy of autologous fibrin glue versus sutures in reducing astigmatism following pterygium surgery

AIM: To evaluate the astigmatic changes before and after pterygium surgery and to study the effect of autologous fibrin glue over sutures in terms of efficacy in reducing corneal astigmatism. SETTINGS AND DESIGN: Randomized controlled trial. SUBJECTS AND METHODS: Forty-four patients with primary pterygia were taken up and divided as follows: Conjunctival autograft with autologous fibrin glue as Group 1 (n = 22) and autograft with 8-0 vicryl sutures as Group 2 (n = 22). All patients were preoperatively assessed for visual acuity, anterior, posterior segments, and Keratometric values using Bausch-Lomb keratometer on postoperative day 1, 7, 1 month, and 3 months. STATISTICAL ANALYSIS: Mann–Whitney test was performed to compare the median keratometric astigmatic changes preoperatively and postoperatively between the groups. P < 0.05 was considered statistically significant. RESULTS: 50.5 was the mean age and 14.81 standard deviation (SD) in Group 1 and 48.86 was the mean and 13.23 SD in Group 2. Group 1 had 40.9% males and 59.1% females, Group 2 had 54.5% males and 45.5% females. The preoperative keratometric values significantly decreased postoperatively in both groups and the median postoperative keratometric value was significantly reduced in Group 1 (0.5) as compared to Group 2 (1.25). Pterygium excision using autologous blood was more effective in reducing corneal astigmatism. CONCLUSION: Pterygium excision surgery reduces corneal astigmatism and thus improves visual acuity. Autologous blood is better option to attach the conjunctival autograft than sutures in reducing astigmatism.

Intravitreal injection of ranibizumab for treatment of macular edema secondary to retinal vein occlusion

ObjectiveThis study aims to evaluate the effect of ranibizumab for treatment of macular edema (ME) secondary to retinal vein occlusion (RVO).Patients and methodsThis is a prospective case series study that included 35 eyes of patients with ME due to RVOs. This study was conducted in Menoufia University Hospital during the period study from March 2018 till February 2020. The study protocol was approved by the medical research ethics committee of Faculty of Medicine, Menoufia University.ResultsThere was a significant improvement in the best-corrected visual acuity (VA) value in the fourth month postoperatively than preoperatively, whereas there was no change in the sixth month postoperatively than preoperatively (P1 < 0.025, P2 < 0.17, and P3 < 0.025, respectively). There was a significantly improvement in the central macular thickness (CMT) at 4 and 6 months postoperatively than preoperatively (P1 < 0.001, P2 < 0.001, and P3 > 0.037, respectively). Moreover, there was a significant positive correlation between preoperative CMT and Snellen VA, CMT at fourth month postoperatively, and CMT at sixth month postoperatively (P < 0.05).ConclusionsCMT and best-corrected VA were significantly improvement at 4 and 6 months postoperatively compared with preoperatively. In the current study, during the follow-up, no patients showed any severe local adverse events such as retinal detachment, retinal tears, endophthalmitis, or uveitis, and none showed progression to ischemia or rubeosis iridis. No patients experienced any systemic adverse effects. Finally, evaluation of the short-term effect of intravitreal ranibizumab injection can be used to predict the outcome of the therapy at 1 week and 1 month after injection for the ME secondary to RVO.

Comparison of astigmatism between glued and sutured scleral-fixated intraocular lens

Background Posterior chamber intraocular lens implantation in the bag is the preferred mode of correcting aphakia. But, in certain circumstances, this is not possible, thereby requiring modalities of secondary fixation of intraocular lens (IOL).Purpose The aim of this study was to compare the postoperative astigmatism till six months after surgery between the sutured scleral-fixated IOL and the glued scleral-fixated IOL.Patients and methods This is a single-center, prospective, observational, open-label study comparing the postoperative outcome (till 6 months), including astigmatism and best-corrected visual acuity (BCVA), of sutured scleral-fixated intraocular lens (SFIOL) (Group 1) and glued SFIOL (Group 2). There were 25 patients in each group. Patients were followed up on day 1, first week, first, second, third, and sixth month postoperatively. During each postoperative visit, slit-lamp biomicroscopy was performed to evaluate the status of the cornea, anterior chamber, IOL, and position of haptics. Uncorrected visual acuity, BCVA, refraction, and keratometry values (corneal astigmatism) were noted. Cylindrical refraction denoted total astigmatism. The IOL astigmatism was derived by subtracting the corneal astigmatism from the total astigmatism.Results The difference in corneal astigmatism between the two groups was statistically significant at 1, 3, and 6 months postoperatively (P=0.004, 0.002, and 0.012, respectively). The final values at 6 months were 3.00±1.68 diopters (D) in the sutured SFIOL group and 2.08±0.56 D in the glued SFIOL group. The glued SFIOL group required less cylindrical correction till 6 months of follow-up. The BCVA, 6 months postoperatively, was 0.36±0.19 in Group 1 compared with 0.32±0.17 in Group 2, with no statistically significant difference (P=0.404).Conclusion Both techniques proved to be good options for the implantation of SFIOL, but glued SFIOL was better as it led to less astigmatism and hence the need for less spectacle correction.

Comparison of sweep visual evoked potential of visual acuity and Snellen visual acuity in healthy and amblyopic children.

To evaluate the visual acuity of healthy and amblyopic children using sweep visual evoked potential and compare the results with those of Snellen visual acuity testing. A total of 160 children aged 6-17 years were included in the study. Of these, 104 (65%) were aged 7-17 years old, able to verbally communicate, and did not have any systemic or ocular pathology (Group 1). Group 2 included 56 (35%) children aged 6-17 years, able to verbally communicate, and had strabismus or anisometropic amblyopia whose best corrected visual acuity was between 0.1 and 0.8. All subjects underwent a detailed ophthalmological examination and sweep visual evoked potential measurement. Demographic characteristics, ocular findings, best corrected visual acuity, and sweep visual evoked potential results were recorded. In Group 1, the mean and maximum visual acuity values for sweep visual evoked potential were lower than the Snellen best corrected visual acuity (p<0.001, for both, respectively). Bland-Altman analysis revealed that in Group 1, the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.11 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.023 logMAR. In Group 2, the mean and maximum sweep visual evoked potential visual acuity were lower than the Snellen best corrected visual acuity (p<0.001 and p=0.009, respectively). Bland-Altman analysis revealed that the distribution of the differences between the Snellen best corrected visual acuity and mean sweep visual evoked potential visual acuity was ±0.16 logMAR, and the distribution of the differences between the Snellen best corrected visual acuity and maximum sweep visual evoked potential visual acuity was ±0.19 logMAR. Sweep visual evoked potential visual acuity measurements have comparable results with Snellen visual acuity measurements. This technique is an objective and reliable method for evaluating visual acuity in children.

Comparison of efficacy and safety of accelerated trans-epithelial crosslinking for keratoconus patients with corneas thicker and thinner than 380μm

ABSTRACT Purpose Accelerated trans-epithelial cross-linking (ATE-CXL), a therapy to halt keratoconus progression, has the merit of widening the indications for thinner corneas (<380 μm). Since a hypotonic solution affects the swollen cornea, corneas of <380 μm thickness at preoperative measurement can be an indication for ATE-CXL. The aim of this retrospective study was to compare the efficacy and safety of ATE-CXL for keratoconus between corneas with thicknesses <380 μm and ≥380 μm. Materials and Methods Thirty-four eyes of 27 patients who underwent ATE-CXL (30 mW/cm2; 3 minutes) with completion of a 24-month follow-up, were enrolled and divided into two groups: Group 1, thinnest corneal thickness (TCT), <380 μm (n = 10) and Group 2, TCT, ≥380 μm (n = 24). A hypotonic solution was administered to Group 1 until the corneal thickness increased by >380 μm before UV-A irradiation. We measured uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), maximum and average keratometric values (Kmax and AveK), central corneal thickness (CCT), TCT by anterior segment optical coherence tomography, and corneal endothelial cell density (ECD) using specular microscopy. The changes from baseline to 24 months postoperatively between the two groups were compared accordingly. Results The changes in Kmax and AveK from baseline to 24 months in Group 1 (ΔKmax: −7.8 ± 7.7 D, ΔAveK: −4.3 ± 6.1 D) showed significant decreases compared to those in Group 2 (ΔKmax: 0.2 ± 3.0 D, ΔAveK: 0.6 ± 2.7 D) (p = .004 and p = .001), and there were no significant changes from baseline to 24 months postoperatively in UCVA, BCVA, CCT, TCT, and ECD in both groups. Conclusion ATE-CXL is effective and safe for keratoconic corneas in both groups. The effect of reducing keratometric values was greater in the group with thinner corneas.

Efficiency and Safety of Binocular Cataract Phacoemulsification

A literature review is presented on the comparative assessment of two options for conducting cataract phacoemulsification — monocular phacoemulsification of cataract, (delayed sequential bilateral cataract surgery, DSBCS) and binocular phacoemulsification of cataract (immediate sequential bilateral cataract surgery, ISBCS). It has been established that to date in the literature there is a sufficient amount of data indicating the positive aspects of ISBCS, associated with faster rehabilitation, better functional results, as well as time, financial, and economic aspects. The safety of ISBCS is determined by the minimum likelihood of postoperative bilateral endophthalmitis with careful selection of patients, the required surgeon qualifications and strict adherence to the surgical protocol. Comparatively, in accordance with the results obtained, postoperative refractive indices, the value of the maximum corrected distance visual acuity, the frequency of complications and the degree of patient satisfaction were the same regardless of whether the bilateral cataract surgery was performed simultaneously or sequentially. The effectiveness of ISBCS is determined by quick rehabilitation, the need for only one pair of glasses, a decrease in visits to the clinic, the absence of anisometropia between operations, as well as only one general anesthesia (if necessary). The experience of clinics where such procedures were carried out shows that after ISBCS, minor refractive errors occur, while they are almost always symmetrical, characterized by a slight deviation from the target refraction and rapid recovery of binocular and stereoscopic vision. In financial terms, in accordance with the calculations carried out, the cost of DSBCS in various countries may be higher than the cost of ISBCS by 10.8–47.9 %. In absolute terms, simultaneous cataract surgery on two eyes (Finland) saved €449 per patient in medical costs and €739 after travel and home care costs were included. Taking into account the cost of lost work time, the savings were €849 per patient. The wider distribution of ISBCS is associated with the approval of the ophthalmological community and insurance companies, as well as the development of standardized teaching materials for practicing ophthalmologists.

Regarding the Question of Postoperative Asthenopia

Relevance. It is well known that asthenopic complaints, such as increased visual fatigue when working at close range, lacrimation, eye pain and headache after corneal refractive operations in recent years are increasingly common at routine ophthalmological practice. They cause significant subjective discomfort in patients and reduce the satisfaction of the surgery. The pathogenesis of asthenopia is a violation of the coordinated work of the accommodation and binocular systems as a result of their overstrain with excessive visual loads.Purpose. To study the role of the lack of adequate optical correction before surgery in the development of asthenopia in patients with mild and moderate myopia after ReLEx SMILE surgery, as well as to evaluate the effectiveness of drug correction of this condition.Patients and methods. This study included 84 patients (128 eyes) who spend more than 8 hours at a computer due to their professional activity, without pathology of the visual organ that prevents keratorefractive operations, whose average age was 33.2 ± 1.9 years.Results and discussion. The ReLEx SMILE operations in all patients were carried out without complications with the achievement of uncorrected visual acuity equal to the preoperative values of the maximum corrected visual acuity in the period of 1 week and 1 month. In the group with a preoperative lack of adequate optical correction, signs of asthenopia were more often manifested than in patients using full eyeglass or contact correction before surgery. The appointment of the drug Mydrimax® allows to improve the subjective state of patients with asthenopia and leads to the normalization of functional parameters.Conclusion. Corneal refractive operations in patients with the lack of adequate correction of refractive disorders before surgery leads to a significantly significant increase in the initially impaired functional parameters compared to preoperative values, however, it does not reach normal values in most cases and is accompanied by a greater probability of developing postoperative asthenopia.

Comparative analysis of postoperative results of cataract surgery using monofocal IOLs

One of the most common surgical interventions in ophthalmology today is lens replacement surgery. But there is still no consensus on whether the choice of a monofocal IOL affects the postoperative functional outcome.The aim: to conduct a comparative analysis of values of visual acuity without correction in the early postoperative period after cataract surgery using monofocal IOLs.Material and methods. The study included data of 2643 eyes operated for cataract, into which one of the monofocal IOLs, included in the top ten most frequently implanted IOLs in the Orenburg Branch of the S. Fyodorov Eye Microsurgery Federal State Institution, was implanted for the period 2019–2021. Statistical analysis was performed using the program Statistica 13.0.Results. The performed analysis of variance showed that the established differences between the compared groups are statistically signifi cant (p &lt; 0.05). However, the subgroup analysis showed that there were statistically signifi cant differences between pairs such as Tecnis and Hydro-4; Tecnis and Rayner. In all other cases, statistically signifi cant uncorrected visual activity (UCVA) values after surgery were not established. It has also been reliably established that the presence of subluxation of the lens affects the value of UCVA after surgery.Conclusion. The results of the performed analysis in general indicate that the value of UCVA in patients in the early postoperative period after the performed surgical intervention does not depend on the manufacturer of the used IOL.

Comparison of trifocal toric and bifocal toric intraocular lens implantation in patients with cataract and high corneal astigmatism.

To investigate and compare the quality of life, satisfaction, contrast sensitivity, glare, depth perception, and intraocular lens (IOL) rotation in patients who underwent trifocal toric and bifocal toric IOLs. A total of 80 eyes of 40 patients were included in this prospective study. Twenty patients in each group were implanted with trifocal toric and bifocal toric IOL, respectively. Preoperative and postoperative 6-month measurements were recorded for both patient groups. Comprehensive anterior and posterior segment examinations, distance-intermediate-near visual acuity values and the visual function scale questionnaire results were evaluated at these examinations. Patient satisfaction, contrast sensitivity, glare, intermediate-near and distance stereopsis and IOL rotation were also evaluated. No significant difference was found between the groups in terms of distance and near visual acuities (P=0.269, P=0.451). Intermediate visual acuity was significantly increased in the trifocal toric group (P<0.001). The visual function scale results were increased after surgery in both groups (P=0.001 and P<0.001), with no difference determined between them (P=0.158 and P=0.691). The number of patients wearing glasses was low in both groups and there was no significant difference between the groups (P>0.05). The overall satisfaction in the trifocal toric group was significantly higher than in the bifocal toric group (P=0.03). The highest sensitivity was observed at 6 cpd spatial frequency in all patients under photopic conditions (1.80±0.24 logU, 1.74±0.20 logU). Distance-intermediate-near binocular depth perception results in both groups were higher in the trifocal toric group (P=0.02, 0.048, 0.003, respectively). Although there was no significant difference for 3 meters stereopsis, the trifocal toric group had higher depth perception (P=0.577). Mean rotation was 5.76°±3.93° in the trifocal toric group and 12°±7.1° in the bifocal toric group. Better results in the middle distance are obtained in the trifocal toric group and less IOL rotation due to digital system-coordinated surgery. Moreover, the overall satisfaction in the trifocal toric group is significantly higher than in the bifocal toric group.

Association of Microalbuminuria and Bevacizumab Therapy Outcomes in Diabetic Retinopathy Patients

Background: Diabetic retinopathy (DR) is a visual impairment-related eye disease developed by long-term hyperglycemic status. Diabetic condition in DR patients leads to diabetic organopathies (e.g., renal failure). Albuminuria, as a hallmark of renal failure, can be correlated with visual indicators in DR patients. Objectives: This study aimed to investigate the role of albuminuria status in visual acuity (VA) and bevacizumab therapy outcomes in DR patients. Methods: In this retrospective study, 48 DR patients were admitted to the Ophthalmology Center of Ayatollah Rouhani Hospital, affiliated with Babol University of Medical Sciences, Babol, Iran. The retinopathy status and VA were identified before and after treatment through 45 days of bevacizumab therapy. In addition, fast blood sugar, hemoglobin A1c, urine albumin, and urine creatinine were evaluated using standard laboratory methods. Results: The VA value before treatment in microalbuminuric DR patients (0.106 ± 0.036) was significantly lower than non-microalbuminuric DR patients (0.347 ± 0.286; P &lt; 0.001). Furthermore, VA value after treatment in microalbuminuric DR patients (0.115 ± 0.071) was significantly lower than non-microalbuminuric DR patients (0.355 ± 0.272; P &lt; 0.001). There was no significant difference in the percentage of VA increase between microalbuminuric and non-microalbuminuric patients. Moreover, the albumin-to-creatinine ratio (ACR) was correlated with a lower VA level before and after treatment (P &lt; 0.001 for both). There was no correlation between the percentage of VA increase with ACR, albumin, and creatinine. Conclusions: The current study results showed that different VA before and after bevacizumab therapy status was correlated with microalbuminuria status. Additionally, microalbuminuria status did not affect the percentage of VA increase in the treatment of DR patients.

Pellucid marginal degeneration classification development based on investigation of relationship between functional and refractive changes

BACKGROUND: One of the problems in the diagnosis and treatment of pellucid marginal degeneration of the cornea is the difficulty of systematizing its manifestations due to the lack of classification. This is due to the low frequency of pellucid marginal degeneration in the structure of primary keratectasia, the main type of which is keratoconus. The developed classifications of keratoconus cannot be fully applied to pellucid marginal degeneration.&#x0D; AIM: The aim was to develop a classification of pellucid marginal degeneration based on investigation of relationship between functional and refractive changes.&#x0D; MATERIALS AND METHODS: The study included 42 people (42 eyes) with pellucid marginal degeneration. Keratometry and refractometry were performed, uncorrected and best corrected visual acuity, as well as cylindrical and spherical components of subjective refraction were studied, and retinal visual acuity was determined. The 1st group 12 patients (12 eyes) with fully corrected induced ametropia (best corrected visual acuity 0.8), the 2nd group 17 patients (17 eyes) with partially corrected induced ametropia (0.8 and 0.3), the 3rd group 13 patients (13 eyes) with uncorrected induced ametropia (0.3).&#x0D; RESULTS: To develop a clinical classification of pellucid marginal degeneration by stages, we selected: the values of corneal astigmatism, best corrected visual acuity and Index of difference between the values of maximum and minimum keratometry (K), all of which had good separation of obtained data, and their demarcate values in groups.&#x0D; CONCLUSION: The study showed the presence of relationship between functional and refractive changes indices of eyes with pellucid marginal degeneration. The leading parameters of refractive status, objectively determining the value of best corrected visual acuity, are induced corneal astigmatism and K. The developed classification of pellucid marginal degeneration is easy to use and makes it possible to determine the stage of keratectasia even if there is only induced corneal astigmatism or K values.

P.0328 Adult bipolar disorder and attention deficit/hyperactivity disorder - a common comorbidity?

To explore the cost utility of cataract surgery in patients with stabilized vision-threatening diabetic retinopathy (DR).Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.Prospective case series.Patients diagnosed with cataracts combined with stabilized vision-threatening DR had successful phacoemulsification with foldable posterior chamber intraocular lens implantation. The corrected distance visual acuity (CDVA) and utility value obtained using the time tradeoff method at 3-month postoperative intervals were compared with those preoperative values. The cost per quality-adjusted life year gained was calculated using the bootstrap method. Sensitivity analyses were performed to test the robustness of the results.The study comprised 126 patients (153 eyes). All surgeries were successful. The weighted logMAR CDVA changed from 0.82 logMAR ± 0.34 (SD) to 0.58 ± 0.30 logMAR (P < .001). The utility values increased from 0.58 ± 0.14 to 0.72 ± 0.14 (P < .001). The gain in utility values was correlated with the postoperative weighted logMAR CDVA, the change between the postoperative and preoperative weighted logMAR CDVA, performance of bilateral cataract surgery, and duration of DR or diabetic macular edema. The patients gained 1.50 quality-adjusted life years by cataract surgery. The cost per quality-adjusted life year was US $768. This surgery was cost-effective at the threshold of US $22 526 per quality-adjusted life year in China. The cost per quality-adjusted life year varied from US $630 to US $8707 in sensitivity analyses.Cataract surgery was a cost-effective intervention for patients with coexisting, stabilized, vision-threatening DR.

Penetrating Excimer Laser Keratoplasty with vs without the Homburg Cross-Stitch Marker in Inexperienced Surgeons.

Background and ObjectivesThe Homburg cross-stitch marker, according to Suffo, was developed in 2017 in the Department of Ophthalmology at Saarland University Medical Center. With this instrument, a surgeon can precisely define and mark the points of the first and second continuous cross-stitch sutures, according to Hoffmann. The aim of this retrospective study was to compare the functional outcomes of Hoffmann’s double continuous cross-stitch suture in penetrating keratoplasty (PKP) with vs without the Homburg cross-stitch marker in inexperienced surgeons.MethodsA total of 130 eyes from 130 patients with central corneal scars, corneal dystrophies and advanced keratoconus were included. All eyes underwent elective excimer laser-assisted penetrating keratoplasty (excimer laser PKP) with a diameter of 8.0/8.1mm. In 65 eyes each, surgery was performed without (group 1) or with (group 2) the Homburg cross-stitch marker. Corrected distance visual acuity, topographic astigmatism, and refractive cylinder were obtained 6 weeks, 10 months post-PKP as well as 6 weeks after the first and after the second suture removal, respectively. The rate of early postoperative single interrupted suture addition was compared between the two groups.ResultsVisual acuity, astigmatism and refractive cylinder values were significantly more favorable in group 2 (with device) compared to group 1 (without device) before and after suture removal. Postoperative single interrupted suture addition was performed in 34.4% of patients in group 1 compared to 10.6% in group 2 (P = 0.001, Fisher's Exact Test).ConclusionThe use of the Homburg cross-stitch marker for excimer laser PKP in young cornea specialists results in significantly better visual acuity before and after suture removal, significantly lower astigmatism and cylinder value before suture removal, as well as a reduced necessity of early postoperative single interrupted suture addition.

Scleral fixation of subluxated or dislocated multifocal and multifocal toric intraocular lenses.

To evaluate the feasibility of scleral fixation of subluxated or dislocated multifocal/multifocal toric intraocular lenses (IOLs) to rescue the IOL and restore both near and far vision. A total of 18 eyes of 17 patients who underwent transscleral or intrascleral fixation of subluxated or dislocated multifocal or multifocal toric IOLs at 2.5mm posterior to the limbus were enrolled. Preoperative uncorrected distance visual acuity (UDVA) and postoperative UDVA values were compared in this retrospective cross-sectional study. The postoperative corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA) at 40cm, residual sphere, cylinder, spherical equivalent, and IOL centration were evaluated. The mean follow-up period was 4.0 ± 5.0months. The mean preoperative UDVA was 0.73 ± 0.71 logMAR and the postoperative UDVA was 0.05 ± 0.10 logMAR, which was significantly improved relative to the preoperative UDVA. The mean postoperative CDVA was 0.00 ± 0.00 logMAR and the mean postoperative UNVA at 40cm was 0.05 ± 0.07 logMAR. The mean postoperative residual sphere, cylinder, and spherical equivalent values were - 0.21 ± 0.41 D, - 0.29 ± 0.26 CD, and - 0.33 ± 0.39 D, respectively. Postoperative anterior segment photographs showed good centration of optics in all cases of single-piece foldable multifocal IOLs but a slight inferior decentration in one case of a three-piece multifocal IOL. Scleral fixation of subluxated or dislocated multifocal and multifocal toric IOLs could be one of the treatment options to rescue subluxated or dislocated multifocal IOLs and restore both near and far vision.

Femtosecond Laser and Mechanical Dissection for ICRS and MyoRing Implantation: A Meta-Analysis.

The aims of this meta-analysis were to evaluate the results of intracorneal ring segments (ICRSs) and MyoRing in the management of corneal ectasia and to compare the clinical outcomes and complication rates between mechanical and femtosecond (FS) laser-assisted surgery. An online electronic search was performed for pre-post studies published until April 2020. Uncorrected distance visual acuity, corrected distance visual acuity, sphere, cylinder, spherical equivalent, steep, flat, and mean keratometry values were considered as outcomes. Weighted mean difference with 95% confidence interval was used as a pooled estimation of intervention efficacy. Of 1484 potentially related studies, 115 studies were finally included in the meta-analysis. Findings of this meta-analysis demonstrated considerable improvement in visual, refractive, and keratometric outcomes in all ICRS models and MyoRing. Intrastromal tunnel creation with both methods yielded similar results. Complication rates were without exception higher when mechanical dissection was used. ICRS and MyoRing are appropriate treatment options for patients with corneal ectasia. Both techniques for tunnel creation are efficacious in achieving good visual, keratometric, and refractive results. Mechanical intrastromal tunnel creation is associated with much higher complication rates when compared with FS laser-assisted technique.

Clinical results after single asymmetrical shark fin for graft orientation in DMEK.

Evaluating the effect of a single peripheral triangular mark to ensure the correct anterior-posterior graft orientation in DMEK. Retrospective study of patients scheduled for DMEK due to Fuchs endothelial dystrophy and divided into 2 study groups: Group -M (n = 184) had no mark of the EDM (Endothelial Descemet membrane) and group + M (n = 193) had a triangular peripheral mark. Follow-up time was 1year after surgery. The postoperative graft turning and Re-DMEK rate could be significantly reduced by the use of a peripheral mark (p = 0.002, p = 0.001, respectively). Re-DMEK due to primary graft failure was significantly associated with prior graft turning (p < 0.001). Both groups showed comparable values for visual acuity, central corneal thickness and endothelial cell count after a follow-up of 1year. Single peripheral triangular marking is a simple and cost-saving addition to EDM preparation to ensure the correct orientation of the graft intraoperatively and could lead to a significant reduction in graft turning and re-DMEK rate in this study.

Формирование роговичного тоннельного разреза с пересечением кератотомических рубцов у пациентов после радиальной кератотомии при факоэмульсификации

Purpose. A clinical study of safety and changes of refraction during intersection of a keratotomy scar while performing the corneal tunnel incision in phacoemulsification with IOL implantation. Material and methods. The clinical study included 11 patients (19 eyes) suffering from cataract and patients with previously performed anterior radial keratotomy. A tunnel incision 2.2 mm wide was performed with the location of the scar in its center. In case of insufficient area of the corneal tissue between the scars to involve only one keratotomy scar into the tunnel incision, the adjacent scar was transected at the final stage of tunnel formation when entering the anterior chamber. The other stages of phacoemulsification were carried out in a standard way. During the operation, the state of the keratotomy scar was assessed. A day, a week and a month later after the operation, the patients underwent biomicroscopy, autorefractokeratometry, visometry with an assessment of the values of subjective and objective cylindrical correction. In order to assess the postoperative state of the keratotomy scar and the incision zone, OCT of the cornea was performed using an RTVue 100 optical coherence tomograph (Optovue, Inc, USA) in Line, Crossline, 3D cornea modes. Results. In all cases, during the operation and also the next day, biomicroscopically the cornea was transparent, there was no keratotomy scar dehiscence. There is a dynamic of the best corrected visual acuity value by 1 month after surgery and the difference between the value for subjective and objective cylinder correction as well. The next day after the operation, in all cases the keratotomy scar on the OCT scans is uniform, comparable in width, the architectonics of the tunnel incision does not differ from that of standard phacoemulsification. Conclusion. Performing a corneal tunnel incision with the beginning of the formation outside the zone of the keratotomy scar and with further intersection of the scar with the plane of the blade so that most of it is in the projection of the center of the tunnel incision, as well as the intersection of the adjacent keratotomy scar at the end of the formation of the tunnel incision when entering the anterior chamber in case of insufficient the area of the corneal tissue between the incisions is safe at all stages of phacoemulsification and in the postoperative period. Changes in the values of best corrected visual acuity over time and the difference between the values of subjective and objective cylinder correction require further study on a larger sample and using various keratometry methods. Key words: radial keratotomy, phacoemulsification, tunnel incision, intersection of the keratotomy scar, cornea optical coherence tomography.

Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration.

Previous studies based on clinical trial data have demonstrated that greater fluctuations in retinal thickness during the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) is associated with poorer visual acuity outcomes. However, it was unclear whether similar findings would be observed in real-world clinical settings. This study aimed to evaluate the association between retinal thickness variability and visual outcomes in eyes receiving anti-VEGF therapy for nAMD using pro re nata treatment regimen. A total of 64 eyes which received intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept) for the treatment of nAMD were evaluated. Variability in spectral-domain optical coherence tomography (OCT) central subfield thickness (CST) was calculated from the standard deviation (SD) values of all follow-up visits after three loading doses from month 3 to month 24. Eyes were divided into quartiles based on the OCT CST variability values and the mean best-corrected visual acuity values at 2 years were compared. At baseline, the mean ± SD logMAR visual acuity and CST were 0.59 ± 0.39 and 364 ± 113 µm, respectively. A significant correlation was found between CST variability and visual acuity at 2 years (Spearman’s ρ = 0.54, p < 0.0001), indicating that eyes with lower CST variability had better visual acuity at 2 years. Eyes with the least CST variability were associated with the highest mean visual acuity improvement at 2 years (quartile 1: +9.7 letters, quartile 2: +1.1 letters, quartile 3: −2.5 letters, quartile 4: −9.5 letters; p = 0.018). No significant difference in the number of anti-VEGF injections was found between the four CST variability quartile groups (p = 0.21). These findings showed that eyes undergoing anti-VEGF therapy for nAMD with more stable OCT CST variability during the follow-up period were associated with better visual outcomes. Clinicians should consider adopting treatment strategies to reduce CST variability during the treatment course for nAMD.