Best-corrected Distance Visual Acuity Research Articles

Longitudinal changes in peri-papillary retinal nerve fiber layer thickness in patients with unilateral branch retinal vein occlusion.

Associations between retinal venous occlusion (RVO), elevated intraocular pressure, and glaucoma have been reported. Further investigations into structural alterations in the fellow eyes of individuals with unilateral RVO have revealed that the peripapillary retinal nerve fiber layer is thinner than in healthy eyes, suggesting that there may be systemic risk factors common to both RVO and glaucoma. We aimed to evaluate changes in peripapillary retinal nerve fiber layer thickness (pRNFLT) among individuals with unilateral branch retinal vein occlusion (BRVO). This prospective observational study recruited 30 individuals (60 eyes) with newly diagnosed unilateral BRVO and macular edema, and a control group of 30 healthy individuals (30 eyes) with no abnormalities on fundus examination or concurrent systemic comorbidities. After baseline measurements, the participants were reassessed at 6, 12, and 24 months by measuring global and sectoral pRNFLT using spectral-domain optical coherence tomography. The mean age and sex distributions were comparable between the patient and control groups (both P > 0.05). When compared to fellow eyes, global and sectoral pRNFLT in eyes with BRVO were significantly higher at baseline (all P < 0.05). Over time, pRNFLT decreased dramatically, and by the conclusion of the two-year follow-up, there was a significant reduction from baseline in the affected eyes (all P < 0.05). Likewise, affected eyes experienced a significant improvement in best-corrected distance visual acuity and central macular thickness over the two-year follow-up (both P ≤ 0.001). Comparing the global and all-sector pRNFLT of fellow eyes in the patient group with those of normal eyes in the control group, there were no significant differences at any visit, except in the temporal sector, which revealed a significant reduction in pRNFLT at 24 months in the fellow eyes of patients with unilateral BRVO (P = 0.02). Patients with unilateral BRVO experienced a significant reduction in pRNFLT in the affected eyes and, to a lesser extent, in the fellow eyes, compared with that of the control arm, suggesting that they are prone to retinal nerve fiber layer damage. The reduction in pRNFLT in the normal fellow eyes of patients with BRVO may be attributed to age or concurrent systemic comorbidities. Further studies with long follow-up periods are required to shed light on the etiology of functional and structural changes in both the retinal nerve fiber layer and ganglion cell complex in the normal and affected eyes of patients with unilateral BRVO.

Frequency and visual outcomes of herpes simplex keratitis in a Kuwaiti tertiary referral center.

Herpes simplex virus (HSV), a cause of many ocular pathologies, may affect the corneal epithelium, stroma, or endothelium, with the epithelium as the most frequently affected location. We aimed to determine the frequency and visual outcomes of HSV keratitis over a 1-year period at Farwaniya Hospital, Kuwait. This prospective observational case series included patients diagnosed with HSV keratitis who presented to the outpatient or eye casualty department between September 2022 and September 2023. Full history, demographic profile, detailed ocular and slit-lamp examinations, and visual acuity assessments were recorded prior to and after treatment. Baseline corneal sensation was assessed in the four corneal quadrants using the cotton wisp test. Of the 227 patients who presented with infectious keratitis, 72 (31.7%) were diagnosed with HSV keratitis. The mean (SD) age was 45.86 (16.06) years, and 48 (66.7%) patients were male. The subtypes of HSV keratitis were endotheliitis in 27 (37.5%) patients, dendritic ulcer in 22 (30.6%), stromal keratitis with ulceration in 9 (12.5%) and without ulceration in 8 (11.1%), and geographic ulcer in 6 (8.3%). The mean baseline best-corrected distance visual acuity (BCDVA) differed significantly between the HSV keratitis subtypes (P < 0.001). Most patients (n = 70, 97.2%) had unilateral eye involvement, were treated within 1 - 2 weeks, and demonstrated improved BCDVA. Despite the improvement in BCDVA in all HSV keratitis subtypes, a significant difference in the median BCDVA remained after treatment (P < 0.001). Pairwise comparisons revealed a significantly better BCDVA after treatment in eyes with dendritic epithelial ulcers than in eyes with HSV stromal keratitis with ulceration (P = 0.003) or geographic epithelial ulcers (P = 0.005). After treatment, corneal haze and neovascularization were detected in 54 (75.0%) and 24 (33.3%) patients, respectively. We detected a substantial frequency of HSV keratitis in one of the governorates of Kuwait, with endotheliitis as the most common manifestation. Timely standard treatment interventions based on valid guidelines resulted in BCDVA improvement in all subtypes of HSV keratitis in our series, indicating the importance of early treatment. However, the BCDVA in eyes with dendritic epithelial ulcers remained substantially better than that in eyes with geographic epithelial ulcers or HSV stromal keratitis with ulceration, signifying the effect of the initial HSV keratitis subtype on visual outcomes. To our knowledge, this is the first study to highlight the frequency of HSV keratitis in a Kuwaiti hospital, and larger-scale research in this region is needed to further understand and manage the condition.

Soczewka wewnątrzgałkowa o wydłużonej głębi ostrości AcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; – doświadczenia własne

PurposeTo present preliminary results of distance, intermediate and near visual acuity, objective and manifest refraction in two groups of patients: targeted on emmetropia and targeted on small myopia after cataract surgery with an implantation of Extended Depth-of-Focus AcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; DFT015 (Alcon Inc., Fort Worth, TX, USA) intraocular lens in three months follow-up.Material and MethodsA total of 18 eyes of 15 patients underwent 2.4 mm coaxial cataract surgery with an implantation of AcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; DFT015 intraocular lens (Alcon Inc., Fort Worth, TX, USA). Before surgery best-corrected distance visual acuity, objective and manifest refraction and corneal keratometry were evaluated. Three months after the surgery uncorrected and best-corrected distance visual acuity, uncorrected intermediate visual acuity uncorrected and best-corrected near visual acuity, objective and manifest refraction and corneal keratometry were analyzed in both groups.ResultsThree months after the surgery in the emmetropic group refractive outcomes were: mean uncorrected distance visual acuity 0.04 ± 0.05, mean best-corrected visual acuity 0.01 ± 0.04, mean uncorrected intermediate visual acuity 0,01 ± 0,03, mean uncorrected near visual acuity 0.15 ± 0.09 and mean best-corrected near visual acuity 0.00 ± 0. In the mini monovision group: mean uncorrected distance visual acuity was 0.13 ± 0.11, mean best corrected visual acuity 0.01 ± 0.02, mean uncorrected intermediate visual acuity 0.00 ± 0, mean uncorrected near visual acuity 0.09 ± 0.13 and mean best-corrected near visual acuity 0.00 ± 0. There was no significant change in corneal keratometry in flat and steep meridian (&lt;i&gt;p&lt;/i&gt; = 0.59 and &lt;i&gt;p&lt;/i&gt; = 0.4) in whole group. There were no intra- and post-operative complications in any of the patients.ConclusionsAcrySof&lt;sup&gt;®&lt;/sup&gt; IQ Vivity&lt;sup&gt;®&lt;/sup&gt; DFT015 (Alcon Inc., Fort Worth, TX, USA) provided good distance and intermediate visual acuity with the functional near. It is well tolerated with poor impact of post-operative optical phenomena. Significant gains in binocular near vision can be achieved by leaving the nondominant eye of patients with 0.50 D to 1.00 D of myopia.

Application of Femtosecond Laser + Piggyback Multifocal Intraocular Lens Implantation in Patients with Super-High Myopia Complicated with Cataract

ABSTRACT Objective To observe the clinical effect of piggyback multifocal intraocular lens (IOL) implantation in treating patients with high myopia complicated with cataract. Methods This was a prospective controlled study. We compared 32 eyes of 32 patients who underwent femtosecond laser-assisted cataract surgery with piggyback IOL implantation (two IOLs were implanted into the capsule) with 32 eyes of 32 patients who also underwent the same surgery (one IOL implanted into the capsule) due to high myopia complicated with cataract at the Wuhan Aier Eye Expert Hospital between January 2019 and October 2020. All patients were followed up for three months after surgery. Uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), best-corrected distance visual acuity, distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), postoperative spectacle independence, postoperative visual interference, equivalent spherical lens, defocus curve, and IOL tilt and eccentricity were evaluated. Results Three months after surgery, the patients’ UCIVA, UCNVA, DCIVA, and DCNVA were 0.49 ± 0.07, 0.38 ± 0.15, 0.47 ± 0.09, and 0.36 ± 0.12, respectively, in the research group and 0.56 ± 0.18, 0.72 ± 0.22, 0.55 ± 0.13, and 0.69 ± 0.15, respectively, in the control group; the differences between the two groups were statistically significant (P < .05). The spectacle independence rate was higher in the research group (93%) than in the control group (13%). The overall satisfaction regarding postoperative visual quality was also higher in the research group than in the control group. The absolute mean value of the spherical equivalents was 0.48 ± 0.28 D in the research group and 0.62 ± 0.33 D in the control group; the difference between the two groups was statistically significant (P < .05). Conclusion Piggyback multifocal IOL implantation can expand the multifocal IOL application range, and satisfy the desire of patients with high myopia complicated with cataract to see both near and far.

Scheimpflug Corneal Densitometry Patterns at the Graft-Host Interface in DMEK and DSAEK: A 12-Month Longitudinal Comparative Study.

To compare corneal densitometry (CD) patterns at the graft-host interface between Descemet Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Corneal densitometry is a quantitative assessment that objectively evaluates corneal clarity and optical quality by measuring the light backscatter from the cornea. Fifty-one eyes that received DMEK or DSAEK surgery for corneal endothelium dysfunction were evaluated. The primary endpoint included CD patterns at the graft-host interface, which were assessed by the Pentacam HR device at the center point of the corneal horizontal meridian (CDcentral), and at six points on the central circumference of the cornea (with a total diameter of 4 mm) (CDI,II,III,IV,V,VI). Secondary endpoints included the best-corrected distance visual acuity (BCDVA), central corneal thickness (CCT), and graft thickness (GT). All of the evaluations were performed at follow-up appointments one, three, six and twelve months after the procedure. DMEK showed a significant overall CD reduction of -7.9 ± 8.5 grayscale unit (GSU) compared to DSAEK (p < 0.001). In addition, the DMEK group showed significantly lower CDCentral,I,II,III,IV,V,VI values at follow-up appointments one, three, six and twelve months after the procedure compared to the DSAEK group (p < 0.001). BCDVA, CCT and GT were in favor of the DMEK group with a mean value of 0.39 ± 0.35 LogMar, 552.2 ± 71.1 µm and 11.03 ± 1.4 µm, respectively (p < 0.001). CD patterns at the graft-host interface seem to be different depending on the endothelial keratoplasty procedure. This provides specific insight into CD changes in this critical region of surgery, which may provide a better understanding of the postoperative evolution of these patients.

Trabeculotomy (ab externo) as primary intervention for open-angle glaucoma : 5-year results

The published results of trabeculotomy ab externo (TOT), as an outflow channel surgery in adults with open-angle glaucoma, are underrepresented in comparison with other pressure-lowering glaucoma procedures. To determine the long-term pressure lowering effect and complications of TOT as astand-alone procedure or in combination with phacoemulsification with intraocular lens implantation (PIT) as aprimary pressure-lowering procedure in adult patients with forms of chronic open-angle glaucoma. This was aretrospective analysis of 121 eyes of 106 patients wherby 90eyes underwent TOT and 31eyes underwent PIT. The follow-up period was 5years. Follow-up was performed in the same center under standardized conditions. Preoperative as well as postoperative best-corrected distance visual acuity, intraocular pressure, pressure-lowering medication, and complications were recorded. For success criterion1, the intraocular pressure was not allowed to exceed 17 mm Hg at any control. For success criterion2, the intraocular pressure was allowed to be above 17 mm Hg at 1 control throughout the follow-up period. Preoperative intraocular pressure in the TOT group was 25.92 mm Hg (SD 6.58) and 26.32 mm Hg (SD 6.06) in the PIT group. The annual cumulative success rates with pressure-lowering medications for success criterion1 were 92.8%, 82.5%, 70.5%, 52.7% and 26.1%. For success criterion2 these were 97.9%; 94.9%, 93.2%, 91.3%, and 89%. We found no relevant difference in pressure reduction between TOT and PIT. Without pressure-lowering medications, success rates were significantly lower for both success criteria. No serious complications occurred. The most common postoperative complication was spontaneously resorbable hyphema. Performing TOT or PIT as aprimary glaucoma procedure for chronic open-angle glaucoma in adults is reasonable, has a significant pressure-lowering effect and very low complication rate.

Visual Impairment and Low Vision Aids-A Comparison between Children and Adults.

(1) Background: This study aims to highlight differences in the etiology and fitting of low vision aids in visually impaired children and adolescents in comparison to adults. (2) Methods: A retrospective data collection from visually impaired patients presenting to obtain assistive devices from 1 January 2016 to 30 April 2020 was conducted. A total of 502 patients were included. Inclusion criteria were a minimum age of 4 years and the chart notation of a best-corrected distance visual acuity in the patient record prior to the fitting of magnifying visual aids. (3) Results: Of the 502 patients, 147 (29.3%) were children under the age of 18 years. The most common cause of visual impairment in children was albinism, and in adults, it was age-related macular degeneration (AMD). Children showed better distance visual acuity, with a median of 0.88 logMAR (Logarithm of the Minimum Angle of Resolution) compared to 1.0 in adults (p = 0.001). Near visual acuity was also significantly better, with a median of 0.54 logMAR in children compared to 0.9 in adults (p < 0.001). Near and distance visual acuity were significantly improved by fitting magnifying visual aids (p < 0.001). After fitting, near visual acuity averaged 0.3 logMAR, and distance visual acuity, 0.7. The most commonly prescribed aids were optical vision aids, which 68.5% of the patients received; 43.8% received electronic aids. In children, optical aids were more frequently prescribed, and in adults, electronic and acoustic aids (p < 0.001). (4) Conclusion: Visually impaired patients can regain the ability to read and improve distance vision by using individually adapted and tested magnifying vision aids, often with optical aids alone. Differences between children and adults could be discovered in the etiology and severity of visual impairment, as well as in the provision type of low vision aids.

12-year follow-up of the first endothelial keratoplasty without Descemet stripping in a 3-month newborn with Congenital Hereditary Endothelial Dystrophy (CHED)

BackgroundEndothelial Keratoplasty (EK) is now considered as the standard treatment for Congenital Hereditary Endothelial Dystrophy (CHED) by many surgeons. We present the 12-year clinical outcome of the youngest operated patient with CHED in which we successfully performed a bilateral EK procedure without removing the recipient endothelium-Descemet complex.Case presentationIn November 2010 we performed EK without Descemet Stripping in a 3-month female newborn, thinking that the lower manipulation obtained by leaving the recipient endothelium–Descemet complex could be the key factor for the success of our surgery. Such a particular technique was new in newborns. The surgery was a success, but the long-term visual result was not predictable at that time. We followed the patient at 4 months, and then yearly. At the latest visit in October 2022 the visual, cognitive, and motorial developments were normal, with Best-corrected Distance Visual Acuity of 0.4 LogMAR with − 0.75 D sf + 2.75 D cyl @ 105° in the right eye (RE) and 0.4 LogMAR with + 1.50 D sf + 2.50 D cyl @ 60° in the left eye (LE). The endothelial microscope showed an unexpected healthy endothelium, with a cell count of 2383 cells/mm2 in the RE and of 2547 cells/mm2 in the LE from a starting donor count of 2900 cells/mm2. No secondary procedures were performed during the 12-year follow-up.ConclusionEK without Descemet stripping has proved to be a successful procedure over time in our newborn. The unexpected healthy endothelium suggests a role of the Descemet membrane in CHED.

Routine use of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment.

To evaluate the safety and efficacy of filtered air as endotamponade in the management of primary rhegmatogenous retinal detachment (RRD) treated with pars plana vitrectomy (PPV) and complete drainage of subretinal fluid. For this retrospective study, we reviewed the medical charts of 273 patients (275 eyes) who consecutively underwent PPV, subretinal fluid drainage and filtered air tamponade to treat primary RRD between 2018 and 2022. As primary outcome we evaluated the anatomical success considered as retinal reattachment after single surgery. As secondary outcomes: final mean best corrected distance visual acuity (BCDVA), complications, and mean intraocular pressure (IOP) trends. The anatomical success was reached by 262 (95.6%) of cases. Mean BCDVA improved from 0.73 LogMAR at baseline, to 0.21 LogMAR at the end of follow-up. As complications we recorded: 5 cases of clinically relevant macular pucker, 1 full thickness macular hole, and 1 PFO bubble under the retina. The mean IOP remained on normal values during the overall follow-up period.

Multimodal imaging in radiation retinopathy following orbital metastasis

Background: Radiation retinopathy is a major cause of vision loss in patients receiving radiotherapy to the head and orbit. Diabetic retinopathy is included in the differential diagnosis owing to similar clinical features, including microaneurysms, cotton-wool spots, hard exudates, and macular edema. The only significant pathological difference is that radiation retinopathy spares pericytes, unlike diabetic retinopathy. Multimodal imaging helps diagnose and predict the prognosis of radiation retinopathy, which is presented in this case report.&#x0D; Case Presentation: A 55-year-old woman diagnosed with stage-4 metastatic breast carcinoma presented with gradual diminution of vision in the left eye (OS) over 5 months. Vision in the right eye was lost because of orbital radiotherapy for orbital metastasis. The patient underwent multiple sessions of chemotherapy and radiotherapy. Examination of the left eye revealed a best-corrected distance visual acuity (BCDVA) of 20/30. Fundus examination of the OS revealed multiple cotton-wool spots and retinal hemorrhages. Fundus fluorescein angiography (FFA) showed diffuse macular leakage with capillary nonperfusion. Multicolor imaging (MCI) with Spectralis™ revealed black dots in the blue and green reflectance images, corresponding to capillary dilatation on FFA. Darker dots were more evident in the infrared images. BCDVA improved to 20/20 in OS after tapering the dose of oral steroids for 2 months, with improvements in hemorrhages and cotton-wool spots. Focal laser photocoagulation was recommended for the treatment of persistent macular edema. The patient declined further treatment, was lost to follow-up, and passed away 6 months later.&#x0D; Conclusions: This case highlights the importance of multimodal imaging for the identification and classification of radiation retinopathy. MCI using SpectralisTM has been described for the first time in radiation retinopathy and can be used to complement existing imaging modalities. Future studies involving more patients and a longer follow-up duration may provide better results for the applicability of these imaging modalities in the clinical setting.

Toxic optic neuropathy and acute angle closure secondary to divalproex sodium – A rare case report

This study aims to report the side effects of oral divalproex sodium in a 55-year-old woman presented with a bilateral sudden painless decrease of vision and frontal headache and nausea, causing unique development of optic neuropathy and secondary acute angle closure (AAC). She gave a history of taking oral divalproex sodium for her migraine headache for 2 weeks. On examination, the patient was found to have secondary AAC, optic neuropathy with high intraocular pressure, and optic disc edema in both eyes (BE). The patient was treated with topical medications. The best-corrected distance visual acuity revealed an improvement of 20/30 from hand movement in BE within 2 weeks from the initial presentation. The ocular side effect, induced by divalproex sodium and possibly even after withdrawal from the drug, on time early detection of secondary AAC, and optic neuropathy will improve the management and give optimal results.

Clinical Results of Cataract Surgery Using the Primus-HD® Intraocular Lens

Purpose: To compare the clinical outcomes of cataract surgery using the Primus-HD&lt;sup&gt;®&lt;/sup&gt; intraocular lens (IOL) and conventional ARTIS&lt;sup&gt;®&lt;/sup&gt; PL E IOL.Methods: The study retrospectively enrolled 242 eyes of 151 patients who had undergone cataract surgery with either ARTIS&lt;sup&gt;®&lt;/sup&gt; PL E (Group A) or Primus-HD&lt;sup&gt;®&lt;/sup&gt; (Group B) IOLs between April 19th, 2021 and November 30th, 2022 at Severance Hospital, Yonsei University College of Medicine. Eyes with a history of ocular surgery or trauma or ocular comorbidities that can affect postoperative visual outcomes were excluded. Finally, 69 eyes in group A and 36 eyes in group B were analyzed.Results: At postoperative 3 months, there was no significant difference in uncorrected (0.15 ± 0.17 vs. 0.17 ± 0.18 in group A and B, &lt;i&gt;p&lt;/i&gt; = 0.60) and best-corrected distance visual acuity (0.03 ± 0.06 vs. 0.02 ± 0.05 in group A and B, &lt;i&gt;p&lt;/i&gt; = 0.75) between groups A and B. Postoperative uncorrected intermediate and near visual acuity, spherical equivalent and amount of myopic shifting were also similar between the two groups. The mean absolute error of the Barrett Universal II (0.61 ± 0.42 D vs. 0.28 ± 0.17 D in group A and B, &lt;i&gt;p&lt;/i&gt; &lt; 0.01) and Haigis (0.51 ± 0.38 D vs. 0.33 ± 0.23 D in group A and B, &lt;i&gt;p&lt;/i&gt; = 0.01) formulas were significantly lower in group B compared with group A, showing good predictability. There was no significant difference between the higher order aberrations of the two groups at postoperative 3 months.Conclusions: The postoperative corrected and uncorrected distance visual acuity, predictability and higher order aberration outcomes of cataract surgeries using the Primus-HD&lt;sup&gt;®&lt;/sup&gt; were comparable with results to ARTIS&lt;sup&gt;®&lt;/sup&gt; PL E, whose efficacy and safety had previously been clinically verified.

Phakic intraocular Lens implantation in keratoconus patients.

Both the anterior chamber and posterior chamber phakic intraocular lenses (pIOLs) implantation are acceptable refractive surgical approaches in keratoconus patients with high anisometropia, contact lens intolerance, or who prefer spectacle and contact lens independent. They are beneficial for correcting anisometropia in stable keratoconus cases or following corneal procedures such as intrastromal corneal ring segments (ICRS), collagen cross-linking (CXL), and keratoplasty. They are suitable for eyes without advanced keratoconus with acceptable best-corrected distance visual acuity (BCDVA) or without highly irregular astigmatism, high comma, and higher-order aberrations (HOAs). Combined procedures for irregular astigmatism reduction and corneal regularization with either ICRS or topography/wavefront-guided transepithelial PRK (with or without CXL) can be associated in advance with pIOLs implantation to improve BCDVA in these cases. To study and report the evidence regarding the safety and efficacy of pIOLs for KC patients' visual and refractive rehabilitation, we have analyzed the scientific evidence published within the last 10 years (from 2012 onwards). No randomized controlled trials but only eleven retrospective case series and two prospective case series were identified. Satisfactory visual rehabilitation was achieved regarding uncorrected and corrected distance visual acuity (CDVA) and predictability of the refractive correction. Both types of pIOL (iris claw and posterior chamber pIOLs) offer very good results in terms of safety and efficacy with indexes close to or even exceeding 1. pIOLs implantation is a valid refractive therapeutic approach for correcting stable keratoconus with moderate-to-high refractive errors, especially anisometropia associated with regular or mildly irregular astigmatism, and good CDVA.

Improved Intermediate Visual Function with New Monofocal Intraocular Lens in Combined Cataract and Vitrectomy Surgery for Retinal Disease.

To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients with various retinal diseases who underwent combined cataract and pars plana vitrectomy surgery. This prospective observational study included 33 patients with various retinal diseases. Monocular best-corrected distance visual acuity (BCDVA), uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), and contrast sensitivity were measured and compared with 40 age-matched patients in the standard monofocal IOL. The Eyhance IOL group demonstrated significantly better UCIVA at 6 months follow-up compared to the standard monofocal IOL group. No significant differences were observed between the two groups in contrast sensitivity, BCDVA, UCDVA, or UCNVA. The regression analysis showed a significant association between preoperative corrected distance visual acuity and improved UCIVA in the Eyhance IOL group. The Eyhance ICB00 IOL proved to be a valuable option for patients with retinal diseases undergoing combined cataract surgery and vitrectomy. It effectively improved intermediate vision without compromising contrast sensitivity or distance visual acuity.

Influence of the CleaRing intraocular open capsule device on refractive predictability in cataract surgery.

The marked improvement in cataract surgery and intraocular lens (IOL) quality has led to a decline in posterior capsular opacification (PCO) incidence; however, PCO remains a common complication of cataract surgery. The CleaRing intraocular capsule open device (IOCD) decreases PCO incidence. We aimed to investigate the influence of the CleaRing IOCD on refractive predictability in cataract surgery. We conducted this prospective pilot study at the Wolfson Medical Center, Holon, Israel. Ten eyes of patients who underwent cataract surgery and insertion of an IOL after IOCD implantation into the capsular bag were included. All patients completed 12 months of follow-up, including refraction, measurement of uncorrected (UDVA) and best-corrected distance visual acuity (CDVA), slit-lamp biomicroscopy, and ultrasound biomicroscopy. All the surgeries were uneventful, with no postoperative complications. The IOL was centred in the device and bag in all cases. The mean prediction error at 1 and 12 months postoperatively was +0.28 ± 0.32 D and +0.50 ± 0.32 D, respectively. The mean UDVA was 0.17 ± 0.13 and 0.15 ± 0.11 logMAR, and the mean CDVA was 0.04 ± 0.10 and 0.04 ± 0.06 logMAR, respectively. The manifest refractive cylinders at 12 months postoperatively were compatible with corneal astigmatism. Implantation of the IOCD resulted in a slight, predicted, and stable hyperopic shift with a low standard deviation. The standard deviation of the prediction error demonstrated excellent refractive accuracy and predictability using the IOCD, which was as low as 0.32 D at the 12-month follow-up.

Corneal cross-linking for treatment of keratoconus relapse in post-keratoplasty eyes.

Keratoconus relapse after penetrating keratoplasty is a rare condition that may result in severe visual deterioration and corneal graft thinning. Therefore, treatment to stabilize the cornea should be considered. The purpose of this study was to evaluate the safety and efficacy of Corneal Cross-Linking (CXL) in eyes with relapse of keratoconus after penetrating keratoplasty for keratoconus. A retrospective review of eyes that developed keratoconus relapse following a penetrating keratoplasty and treated with CXL. The main outcome measures were change in maximal keratometry (Kmax), best-corrected distance visual acuity (BCVA), thinnest corneal thickness (TCT) and central corneal thickness (CCT), and complications. We identified 10 consecutive eyes of 9 patients. Preoperative median BCVA before the CXL and 1year after the CXL procedure remained stable (p = 0.68). The median (IQR) of Kmax improved from 63.2 (24.9) D before the CXL procedure to 62.2 (27.1) D at 1year postoperatively (P = 0.028). Median TCT and CCT also remained with no significant change 1year after CXL. No complications were noted following the procedure. CXL in eyes with keratoconus relapse after keratoplasty is a safe and effective procedure enabling not only visual stabilization but also might bring keratometry improvement. Routine follow-up after keratoplasty should be performed for early detection of keratoconus relapse and CXL is timely advised when such a relapse is documented.

Stereopsis after bilateral implantation of Toric intraocular lenses in high myopic cataract patients with astigmatism

PurposeTo evaluate near, intermediate, distance visual acuity and stereopsis after bilateral implantation of Toric intraocular lenses (IOLs) in high myopic patients with astigmatism. MethodsBilateral Toric or non-Toric IOL implantation (n ​= ​40 eyes each) was performed on high myopic cataract eyes with astigmatism. Best-corrected distance visual acuity (BCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), residual refractive astigmatism (RRA), and near, intermediate, and distance stereoacuity were measured postoperatively at 7 days, 1 month, and 3 months. ResultsThe three-month postoperative BCDVA, UCIVA, and UCNVA of the Toric group were 0.08 ​± ​0.07, 0.30 ​± ​0.11, and 0.23 ​± ​0.14 LogMAR. All improved over the preoperative assessments (P ​< ​0.05). The RRA, UCIVA, and UCNVA were significantly better in the Toric group than the non-Toric group at all follow-up examinations (all P ​< ​0.05). At 3 months, the median near and intermediate stereoacuity of the Toric group were 100 (range 40 – 400) and 120 (range 50 – 400) arcsec, which were better than the non-Toric group (both P ​< ​0.05). Fine near stereopsis ≥100 arcsec was present in 65% of the Toric patients, and 50% had good intermediate stereopsis of ≥100 arcsec. However among non-Toric patients, only 15% and 5% achieved fine near and intermediate stereopsis. The postoperative BCDVA and best-corrected distance stereoacuity were similar in the two groups (P ​> ​0.05). ConclusionsIn bilateral high myopic cataract patients with astigmatism, Toric IOLs not only improved UCIVA, UCNVA, and RRA, but also enhanced near and intermediate stereopsis acuity.

The Relationship between Fixation Stability and Retinal Structural Parameters in Children with Anisometropic, Strabismic and Mixed Amblyopia.

(1) Background: Amblyopia is an ocular condition leading to structural and functional changes. The relationship between these changes is complex and remains poorly understood. (2) Methods: Participants included 31 children aged 5 to 9 years with strabismic (n = 9), anisometropic (n = 16) and mixed (n = 6) unilateral amblyopia, and 14 age-matched non-amblyopic children. The 95% and 63% Bivariate Contour Ellipse Area (BCEA), axial length, Foveal Avascular Zone (FAZ) area, center macular thickness and volume were assessed. The relationship between these parameters was explored. (3) Results: Statistically significant differences were found among the four groups in best corrected distance visual acuity (BCVA) (p < 0.001), BCEA 95% (p = 0.002) and BCEA 63% (p = 0.002), but not in the FAZ area, central macular thickness, central macular volume and axial length. Eyes with amblyopia had poorer BCVA and larger fixation instability than controls. Inter-ocular differences were more significant in patients with strabismic amblyopia, particularly in BCVA (p = 0.003), central macular thickness (p < 0.001) and central macular volume (p = 0.002). In amblyopic eyes, BCEA 95% and 63% were correlated with BCVA, but not with the FAZ area. (4) Conclusion: Amblyopia is associated with a reduction in fixation stability and BCVA, although there is a general lack of correlation with structural changes, suggesting a complex interaction between anatomy and function in amblyopia.

Effect of Multifocal Intraocular Lens on Contrast Sensitivity in Primary Angle-Closure Patients

Objective: To study the effect of multifocal intraocular lens (MIOL) implantation on contrast sensitivity (CS) compared to monofocal intraocular lens (mIOL) in primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) patients. Materials and Methods: This prospective study included patients with PAC or PACG and visually significant cataract. Phacoemulsification with MIOL or mIOL (patient preference) was performed. Collected data included best-corrected distant visual acuity (BCVA), intraocular pressure (IOP), anterior chamber depth (ACD), and contrast sensitivity (CS) measured at spatial frequency 1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (CPD) preoperatively, and at 2-6 months postoperatively. Preoperative and postoperative parameters were then compared. Results: Of the 45 eyes from 35 patients that were enrolled, 33 eyes (15 PAC, 18 PACG) from 26 patients completed the study. Fourteen eyes (11 patients) received diffractive MIOL, and 19 eyes (15 patients) received aspheric mIOL. Preoperative CS was not significantly different between groups. Postoperatively, BCVA, and CS at each spatial frequency were significantly improved in both groups (all p&lt;0.001). Mean postoperative CS at spatial frequency 1.5, 3.0, 6.0, 12.0, and 18.0 CPD was 28.03, 42.63, 44.84, 10.82, and 2.86 in the MIOL group, and 29.55, 49.63, 46.20, 16.83, and 7.09 in the mIOL group, both respectively. Postoperative CS was not significant different between groups at any spatial frequencies. IOP was decreased (p=0.001) and ACD increased (p&lt;0.001) postoperatively in both groups. Conclusion: No significant difference in visual acuity or contrast sensitivity was observed between MIOL and mIOL after cataract removal in patients with PAC/PACG.

Comparative study of small incision refractive lenticule extraction with 5 mm versus 6.5 mm optic zone for myopia.

To compare residual stromal thickness (RST) in eyes undergoing small incision refractive lenticule extraction (SMILE) using a lenticular diameter of 6.5 mm versus those with a diameter of 5 mm. comparative case series. patients who underwent SMILE between 2016 and 2021 with at least 6 months of follow-up were included. Preoperative best-corrected distance visual acuity (BCDVA), refractive error, contrast sensitivity, central corneal thickness, keratometry, higher order aberrations, and scotopic pupil size were recorded using a Placido disk topography with Sheimpflug tomography-based system. Patients underwent SMILE with a lenticular diameter of 6.5 mm until 2018 (n = 372 eyes). Thereafter, the lenticular diameter was reduced to 5 mm (n = 318). The RST, postoperative refraction, aberrations, subjective glare, and halos were compared across groups at 1 and 6 months. The mean age of participants was 26.8 ± 5.8 years with a mean preoperative spherical equivalent of -4.48 D ± 2.16 D (range: -0.75 to -12.25 D) and mean scotopic pupil of 3.7 ± 0.75 mm. Eyes in the 5 mm group had 30.6 m (95% confidence interval [CI] = 28 to 33 m, P < 0.001) greater RST compared to the 6.5 mm group after adjusting for spherical equivalent and preoperative pachymetry. There were no differences in vision, contrast sensitivity, aberrations (wavefront error of 0.19 ± 0.2 vs. 0.25 ± 0.2, P = 0.19) or glare between the two groups. SMILE performed with a lenticular diameter of 5 mm leads to greater RST across the myopic range, but without inducing significant higher-order aberrations.