logMAR Corrected Distance Visual Acuity Research Articles

Comparison of refractive surgeries (SMILE, LASIK, and PRK) with and without corneal crosslinking: systematic review and meta-analysis.

Corneal crosslinking (CXL) is used for treating keratoconus and post-laser in situ keratomileusis ectasia. However, refractive surgery is not usually performed with prophylactic CXL. Therefore, we performed a meta-analysis comparing outcomes of refractive surgeries with vs without prophylactic CXL. We systematically searched databases for studies comparing refractive surgeries for myopic correction with vs without prophylactic corneal crosslinking. Review Manager 5.4.1 was used to perform statistical analysis. We included 2820 eyes from 28 studies. Compared with refractive surgery alone, surgery with prophylactic CXL resulted in decreased central corneal thickness, corrected distance visual acuity logMAR, and safety and efficacy indices. There were no significant differences in postoperative uncorrected distance visual acuity of 20/20 or better at ≥12 months and other visual outcomes among both groups. More randomized controlled trials with standard crosslinking protocols are needed to analyze the prophylactic use of crosslinking with refractive surgeries.

Altering chromatic aberration: how this latest trend in intraocular-lens design affects visual quality in pseudophakic patients

BackgroundChromatic aberration of the eye results from the dispersion of polychromatic light at the interfaces of ocular media. An intraocular lens (IOL) based approach utilizing the diffractive-multifocal principle has been proposed for its correction, but the clinical evidence on the impact of reducing or increasing chromatic aberration on the visual quality of pseudophakic patients remains scarce.MethodsIn this cross-sectional study, longitudinal chromatic aberration (LCA) effects were studied monocularly in 37 patients implanted with a monofocal lens. LogMAR corrected distance visual acuity (VA) and defocus curve at the + 1.0 D to − 2.0 D range were assessed. Contrast sensitivity (CS) was evaluated at far and at four spatial frequencies. Measurements were performed with the eye's natural conditions, as well as with increased and corrected (by the same amount) LCA, which was altered by introducing zero-power trial triplets.ResultsThe mean (± standard deviation) logMAR VA was − 0.11 ± 0.07 for the natural condition, − 0.13 ± 0.07 for the LCA-corrected eye, and − 0.06 ± 0.08 for the eye with increased LCA. A sharp decline of the defocus tolerance was found after the LCA correction with the VA value of 0.38 ± 0.15 logMAR at − 1.5 D. However, for the natural and increased LCA, it was 0.32 ± 0.16 logMAR and 0.25 ± 0.13 logMAR, respectively. CS was improved at all spatial frequencies after the LCA correction, which was closely followed by the natural-eye performance. Increased LCA resulted in reduced CS, mainly at higher spatial frequencies.ConclusionsWe demonstrated that elevating chromatic aberration above the natural level of monofocal patients extends their depth of focus while causing a measurable albeit minimal reduction in visual function. Still, the observed changes indicate that neither correction nor increase of LCA yields a substantial clinical effect on distance VA and CS in monofocal pseudophakia.

Comprehensive approach for capsular bag fixation in subluxated crystalline lens: preserving the anterior/posterior anatomical segment barrier.

To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens. Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel. Retrospective, consecutive case series. This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt. 17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA ( P < .001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear. A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.

A data-driven approach to evaluate factors affecting resident performance in cataract surgery.

To evaluate the operative duration and clinical performance of ophthalmology residents performing standard phacoemulsification cataract surgeries using information available from electronic health records (EHR). This is a retrospective cohort study. De-identified surgical records of all standard phacoemulsifications performed in a tertiary institution between 1st January 2015 and 8th August 2018 were retrieved from the hospital EHR. The main outcome measures were improvement in operative duration with case experience, corrected distance visual acuity (CDVA) improvement, and intra-operative complication rates. Twelve ophthalmology residents performed a total of 1427 standard phacoemulsifications. The median operative duration was 27min (interquartile range, 22-34min), which improved from 31 to 24min (before the 101st case [Group 1] versus 101st case onwards [Group 2], p < 0.001). Gradient change analysis (non-linear regression) showed significant reduction until the 100th case (p = 0.043). Older patients (0.019), worse pre-operative CDVA (0.343), and surgery performed by Group 1 (1.115) were significantly associated with operative duration above 30min. LogMAR CDVA improved from a mean of 0.57 ± 0.52 pre-operatively to 0.10 ± 0.18 post-operatively (p < 0.001). Posterior capsule rupture (PCR) rate decreased from 4.0% [Group 1] to 2.1% [Group 2] (p = 0.096), while overall complication rate decreased from 8.9% to 3.1% (p < 0.001). The median operative duration reduced consistently with surgical experience for the first 100 cases. Older patients, poorer pre-operative VA, and surgical experience of less than 100 cases were significantly associated with an operative duration above 30min. There was a statistically significant decrease in complication rate between Group 1 and 2.

Effect of larger corneal spherical aberration in improving the near visual acuity of eyes implanted with the TECNIS Symfony.

To explore the effect of corneal spherical aberration on the visual acuity and visual quality of eyes implanted with the TECNIS Symfony intraocular lens (IOL). A total of 43 patients with age-related cataract (60 eyes) undergoing phacoemulsification and TECNIS Symfony IOL implantation were enrolled in this study. The uncorrected distance (UDVA), intermediate (UIVA), near visual acuity (UNVA), corrected distance visual acuity (CDVA), contrast sensitivity, and ocular spherical aberration were recorded 3 months after surgery. Preoperative and postoperative corneal spherical aberration were also measured using the iTrace device. Objective scattering index (OSI), modulation transfer function cut-off frequency (MTF cut-off), and Strehl ratio (SR) were measured by the Optical Quality Analyzing System. Catquest-9SF questionnaire were applied too. Spearman's correlation analysis was used to evaluate the relationship between spherical aberration and visual quality parameters. Patients were satisfied with their postoperatively visual quality. And the postoperative logMAR UDVA, UIVA, UNVA, and CDVA was 0.05 ± 0.07, 0.04 ± 0.06, 0.15 ± 0.07, and 0.03 ± 0.05, respectively. The mean preoperative corneal spherical aberration was 0.24 ± 0.10 μm, which is the only factor influencing postoperatively UNVA, and it was negatively correlated with UNVA and glare contrast sensitivity under 18 cpd (cycle/degree, cpd) spatial frequency (r = -0.403, -0.300, -0.360; all P < 0.05). Additionally, the greater the residual spherical aberration of the cornea, the better the near vision after operation. The mean postoperative ocular spherical aberration was -0.03 ± 0.07 μm, it was not correlated with visual acuity, contrast sensitivity, and visual quality (all P > 0.05). Preoperative positive spherical aberration can benefit near vision while decrease contrast sensitivities at high spatial frequencies when implanted with the TECNIS Symfony IOL.

Deep anterior lamellar keratoplasty following thermokeratoplasty assisted epikeratophkia: A novel two-stage one-graft method to treat acute corneal hydrops.

To evaluate the clinical effects of deep anterior lamellar keratoplasty (DALK) using a single graft after thermokeratoplasty assisted epikeratophakia for the treatment of acute corneal hydrops. This novel surgical procedure was performed on seven eyes of seven patients between 2019 and 2020. The procedure combines a first-stage surgery of thermokeratoplasty assisted epikeratophkia with intracameral sterile air injection and a second-stage surgery of DALK using the same corneal graft for both procedures. Main outcome measures included pre- and postoperative corrected distance visual acuity (CDVA) and anterior segment optical coherence tomography (AS-OCT) parameters. Corneal transparency, epithelization, and the presence of neovascularization, were evaluated at the 1-year follow-up visit. Corneal edema resolved rapidly in six of the seven cases. The mean central corneal thickness was significantly reduced from baseline to 1 day, 1 week, 1 month, and 2 months after the first-stage surgery (P < 0.0001). At a mean of 2.1 ± 0.7 months after the first-stage surgery, DALK was successfully performed in all cases. Six months later, the mean central corneal thickness was 611 ± 31 μm and the mean thickness of the recipient's residual stroma bed was 20 ± 6 μm at the central corneal area. Mean LogMAR CDVA improved from 1.74 ± 0.34 at baseline to 0.20 ± 0.11 after DALK (P < 0.0001). No postoperative complications appeared in our case series during the 1-year observation period. Very good visual results were obtained with a novel technique (thermokeratoplasty assisted epikeratophakia followed by DALK using the same corneal graft) in the treatment of acute corneal hydrops.

The Effects of Blepharoptosis Surgery on Meibomian Gland, Tear Film, and Corneal Topography.

The objective of this study was to evaluate the Meibomian gland (MG), tear film, and corneal changes in the post-operative period following ptosis surgery using corneal topography. This non-comparative, case series study analyzed 30 eyes of 23 patients undergoing blepharoptosis surgery with an external approach. Ocular surface and tear film evaluation was performed at baseline and post-operative 3rd month. The corneal topography was used to assess the MG, the noninvasive tear film break-up time (NI-TBUT), K values, astigmatism, and corneal aberrations. For the examination of dry eyes, the I-TBUT, Schirmer, and ocular surface disease index (OSDI) questionnaires were also performed. The study involved patients with a mean age of 55.1±18.11 years. Postoperatively, marginal reflex distance 1 is significantly increased (1.23±1.09 vs. 3.65±0.65; p=0.001). Results revealed no significant changes in Kmean (43.65±1.15 vs. 43.67±1.14; p=0.727), astigmatism (-1±0.74 vs. -0.99±0.68; p=0.910), and corrected distance visual acuity logMAR (0.09±0.1 vs. 0.07±0.11; p=0.497). There was a significant increase in MG loss area postoperatively (5.02±5.04-7.75±6.75; p=0.047), while the degree of MG loss did not significantly change (0.2±0.48 vs. 0.37±0.56; p=0.132). However, no significant differences were detected in Schirmer I test (17.4±4.7 vs. 16.1±5.5; p=0.711), I-TBUT (12.4±3.1 vs. 11.9±4.7; p=0.483), and OSDI questionnaire score (16.7±9.4 vs. 17.9±10.3; p=0.176) between baseline and post-operative measurements. Similarly, no significant changes were found in NI-TBUT (5.73±3.72 vs. 6.58 4.71; p=0.535) and NIAvg-TBUT (6.06±4.8 vs. 7.51±4.43; p=0.322) values. Surgical correction of blepharoptosis affects MG morphology without causing dry eye at the 3rd month. Post-operative corneal topography is useful in demonstrating changes in the MG.

Twelve-month clinical outcomes after implantation of a new, modular, anterior shape-changing fluid optic intraocular lens.

To report the initial safety and effectiveness profile for an anterior shape-changing, modular IOL, Juvene IOL (JIOL), for the treatment of aphakia and presbyopia after removal of the natural crystalline lens due to cataract. 2 private practices in Monterrey and Tijuana, Mexico. Exploratory prospective multicenter open-label noncomparative clinical trial. A convenience sample of patients aged 50 to 80 years with planned cataract surgery was recruited to undergo unilateral or bilateral implantation with the JIOL. Patients were required to complete an informed consent and be able to dilate to at least 6.0 mm pharmacologically, be in good overall health, and have no significant eye health history to qualify. Visual acuities, defocus curves, and contrast sensitivity were measured for all patients 12 months postoperatively. 51 of 58 eyes completed the 12-month visit. Intraoperative complication rates were extremely low (n = 1; missed base lens tab). The most frequent adverse events (AEs) were prolonged inflammation (N = 6) and cystoid macular edema (N = 4); all AEs were resolved without sequelae by the 12-month visit. The mean monocular logMAR corrected distance visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity were 0.01, 0.08, and 0.24, respectively. Defocus testing showed visual acuity > 20/40 from approximately +1.00 through -2.00 diopters. Binocular implantation (n = 16) provided superior performance over monocular implantation. The JIOL offers a new solution to treat presbyopia, providing clear functional vision performance across a range of distances with an acceptable initial safety profile.

Combined corneal wavefront-guided transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking following intracorneal ring segment implantation in management of moderate keratoconus.

PURPOSE:Keratoconus (KC) leads to gradual progressive loss of vision in young and adult patients. For the purpose of visual rehabilitation and for hindering KC progression in patients, we designed this study. The main aim of this study is to help the KC patients to improve and stabilize their vision.METHODS:This prospective consecutive uncontrolled study includes 36 eyes of 36 patients with moderate degree of KC. All patients underwent combined wavefront-guided transepithelial photorefractive keratectomy (TPRK) and accelerated corneal collagen cross-linking (ACXL) after intracorneal ring segment (ICRS) implantation. Different measures will be evaluated at baseline, after ICRS implantation, and at one, 3, 6, and 12 months after combined (TPRK and ACXL). These measurements are uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), corneal indices based on Scheimpflug tomography, and higher-order aberrations (HOAs) based on (Sirius, Schwind) tomography.RESULTS:There were significant improvements in logMAR (UDVA and CDVA) and reduction in sphere, manifest cylinder, MRSE, maximal keratometry, and mean keratometry after ICRS implantation in the first stage. After TPRK and ACXL as the second stage, there were significant improvements in visual acuity of both logMAR UDVA and CDVA. Reduction in refractive outcomes, including MRSE, sphere, and manifest cylinder. All corneal indices including steep, flat, mean, and maximal keratometries had been decreased. Furthermore, there were significant improvements in the final root mean square, HOAs, and coma aberrations from baseline.CONCLUSION:In moderate KC, triple therapy of ICRS implantation followed by combined TPRK and ACXL appears to be a safe and effective approach. This approach provides an improvement in visual acuity, refraction, corneal indices, and HOAs. These improvements were maintained for 1 year postoperatively. It also halts KC progression.

Changes in retinal vessel and retinal layer thickness after cross-linking in keratoconus via swept-source OCT angiography.

To analyze the postoperative foveal avascular zone (FAZ) area, superficial capillary plexus (SCP), deep capillary plexus (DCP) vascular densities (VD), and retinal layers after cross-linking (CXL) for keratoconus treatment. Twenty-seven eyes with cross-linking treatment for keratoconus were included in the study. Foveal avascular zone (FAZ) area, SCP VD, DCP VD, and retinal layers were evaluated by using optical coherence tomography angiography (OCTA). OCTA measurements were made at preoperative, first week, and first and sixth months after the surgery. In addition, corneal topography measurements were also made. Although there was a decrease in corneal thickness in the follow-up of the patients, there was no significant difference in axial length and anterior chamber depth. There was no significant difference in full retinal thickness in the foveal and parafoveal areas. While there was a significant increase in retinal nerve fiber layer (RNFL) thickness in the foveal area (p = 0.032, p = 0.015, p = 0.017; preoperative values compared to first week, first month, and sixth month respectively), there was a decrease in ganglion cell layer (GCL) thickness in the parafoveal area in the postoperative sixth month (p = 0.028). There was no difference in FAZ measurements. In the parafoveal area, a decrease was observed in SCP VD in the sixth-month control (p = 0.019). There was a significant increase in DCP VD in the foveal area (p = 0.008, p = 0.043, p = 0.040). The preoperative mean CDVA (corrected distance visual acuity) was 0.37 ± 0.16 logMAR and postoperative sixth month mean CDVA was 0.39 ± 0.15. There was no significant difference in visual acuity(p = 0.71). Keratoconus patients successfully treated with CXL had significant changes in retinal layers and vessel density in the superficial and deep retinal plexus.

Ocular Aberrations in Eyes with Primary Congenital Glaucoma

Purpose To highlight the magnitude of ocular higher order aberrations (HOA) and lower order aberrations (LOA), including component contributions from corneal and internal planes in Primary Congenital Glaucoma (PCG) patients. Methods Consecutive treated PCG patients co-operative for ocular examination and aberrometry, were enrolled over two years for this cross-sectional, comparative, single-center, unmasked study. Best-corrected visual acuity, refraction, IOP, wavefront aberrometry and topography (iTrace) were performed and results were compared with unaffected fellow eyes of unilateral glaucoma patients as well as age and sex-matched controls with no ocular anomalies other than treatable refractive error. Results Both eyes of 32 consecutive PCG patients (17 unilateral, 15 bilateral) and 39 controls were enrolled. The median LogMAR corrected distance visual acuity of PCG eyes was 0.68 (IQR: 0.2–1.8). Total ocular (Root mean square (RMS) 1.7 µm vs 0.3 µm, p = 0.014), corneal (RMS 1.1 µm vs 0.3 µm, p = 0.004) and internal (RMS 1.1 µm vs 0.2 µm, p = 0.013) aberrations, as well as HOAs and LOAs at each plane, were significantly higher in PCG eyes than in controls. Component HOAs from corneal and internal planes were positively correlated with each other (p < 0.001; rs: 0.7). Total aberrations were greater in the affected eyes of PCG compared to the rest. The predominant subtype of HOAs in PCG was coma and trefoil. PCG with corneal opacity/Haab’s striae had significantly higher astigmatism than the affected eyes with clear corneae at the corneal plane (p = 0.02). The aberrations were not statistically associated with the corneal diameter or refractive error in PCG eyes. Conclusions Significantly greater aberrations (Total, HOAs and LOAs, at corneal as well as an internal plane) were seen among eyes affected with PCG. Though the exact impact of these aberrations on the final visual outcome is difficult to determine, these could play a pertinent role in compromising visual function, thus impacting the management of visual rehabilitation in these patients.

Visual and Topographic Outcomes of Corneal Collagen Cross Linking for Post LASIK Ectasia

PurposeTo assess the topographic and visual outcomes of corneal cross-linking (CXL) for post-LASIK ectasia.MethodsA retrospective case series of patients who had progressive post-LASIK ectasia, with at least 2 years of follow-up. They had epithelium-off CXL. Topographical and visual changes were recorded.ResultsThe study included 21 eyes of 11 patients. At month 24, the final logMAR corrected distance visual acuity (CDVA) and spherical equivalent (SE) were stable compared to baseline (0.16, and −2.0 diopter (D), respectively). The final Kmean and Kmax were 42.5 and 47.4 D, respectively. Stability or improvement in CDVA, SE, and Kmax was seen in 17 eyes (81%). Significant corneal thinning was seen (438 vs 457 microns, p = 0.003). Thinning by 2% or more was seen in 12 eyes (57.1%). Failure of CXL was seen in 4 eyes (19%). No other ocular complications were seen.ConclusionCXL for post LASIK ectasia is a safe and effective modality. Despite corneal thinning, there was stability or improvement in topographic parameters and CDVA over the 2-year follow-up period.

Changes in visual outcomes and ocular morphometrics after foldable myopic and toric intraocular lens implantation: 5-year results.

To evaluate the refractive, visual, and morphometric changes after implantation with a foldable iris-fixated phakic intraocular lens (pIOL) to correct myopia or astigmatism. University Eye Clinic Maastricht, the Netherlands. Prospective case series. We evaluated patients implanted with the Artiflex Myopia Toric (Ophtec B.V.) iris-fixated pIOL as of January 2004. Measurements were performed annually and reported after 1 and 5 years. The study included 481 eyes (277 patients; age 39.8 ± 10.9 years [SD]). 5 years postoperatively, 91% of eyes were within ±1.0 diopter (D) of target, and the mean myopization over a 5-year period was 0.22 D (P < .001). The logMAR corrected distance visual acuity (CDVA) increased by a mean 0.015 (P = .015) over 5 years; 88% of eyes had a CDVA of 20/20 or better, and 5.5% lost 2 or more lines of CDVA. Mean uncorrected distance visual acuity (UDVA) increased by 0.045 logMAR over 5 years (P < .001); 96% reached an UDVA of 20/40 or more. Anterior chamber depth (ACD) decreased by 0.04 mm (P < .001), and axial length (AL) increased by 0.23 mm (P < .001) over 5 years. Chronic endothelial cell loss showed a 5-year decline of 320 cells/mm2 in the myopic and 310 cells/mm2 in the toric subgroups (P < .001). Cataract resulted in pIOL explantation in 4.0% of eyes (mean survival 59.0 ± 40.0 months); higher preoperative age (hazard ratio [HR], 1.13; P < .001) and smaller ACD (HR, 6.80; P = .035) were risk factors for shorter survival due to cataract formation. Over 5 years, logMAR CDVA and UDVA decreased significantly due to myopization caused by lenticular changes and AL elongation.

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.

Changes in post-keratoplasty astigmatism after suture removal: refraction vs tomography vs aberrometry.

To analyse the changes in magnitude and orientation of astigmatism after suture removal (SR) in keratoplasty eyes as measured by refraction, tomography, and aberrometry. Twenty-six eyes of 25 patients after optical keratoplasty requiring SR to reduce the astigmatism during the follow-up period were prospectively included. Eyes with poor quality topography scans or if there were no sutures in the steepest semi meridian were excluded. Corrected distance visual acuity (CDVA), manifest refraction, corneal tomography and aberrometry were performed on all patients before and after SR. The mean age of the patients was 40.8±14.4y. Penetrating keratoplasty was performed in 23 eyes (89%) and deep anterior lamellar keratoplasty was done in 3 eyes (11%). There was a statistically significant reduction in the magnitude of refractive, tomographic and aberrometry astigmatism after SR (P<0.001) at 2h after suture removal. The mean net reduction of the astigmatism was greater as measured by corneal tomography compared to refractive astigmatism (P<0.05). There was no statistically significant change in refractive astigmatism between 2h and 2mo after SR (P=0.55). Vector calculations demonstrated a greater amount of undercorrection in the tomography group and the rotational error was more towards counterclockwise direction. Mean monocular logMAR CDVA improved from 0.57 D to 0.49 D after SR (P=0.002). The net reduction in the magnitude of astigmatism after SR is greater in the tomography and aberrometry groups. With one episode of SR, there is no difference in the aberration profile.

Cases of replacing diffractive bifocal intraocular lens with extended depth of focus intraocular lens due to waxy vision.

PurposeTo investigate the postoperative course of patients who explanted a diffractive bifocal intraocular lens (IOL) due to waxy vision and implanted with an extended depth of focus IOL.MethodsThis study evaluated 29 eyes of 25 patients who underwent diffractive bifocal IOL explantation followed by TECNIS Symfony® implantation because of dissatisfaction due to waxy vision at the Takabatake West Eye Clinic between January 2018 and November 2019. The indication criteria for this surgery were patients with uncorrected distance visual acuity of 0.05 logMAR or better, without eye diseases that may affect visual function, and no dissatisfactions about photic phenomena. We investigated patient demographics, uncorrected and corrected visual acuity, manifest refraction, contrast sensitivity, subjective symptoms, time to IOL explantation, explanted IOL type, and spectacle independence.ResultsThe time to the IOL exchange after the initial IOL implantation was 55.3 ± 50.4 days (range: 14–196 days). The logMAR corrected distance visual acuity before and after IOL exchange were −0.13 ± 0.06 and −0.14 ± 0.06, respectively (p = 0.273). After IOL exchange surgery, the area under log contrast sensitivity function increased significantly from 1.07 ± 0.12 to 1.21 ± 0.12 (p < 0.001), and the waxy vision symptoms improved. The spectacle independence rate at the last visit was 88.0%.ConclusionFor patients who complain of waxy vision despite good visual acuity after diffractive bifocal IOL implantation, exchange to extended depth of focus IOL was considered one of the useful surgical options.

Accelerated versus Standard Corneal Cross-linking for Progressive Keratoconus in Syria.

PurposeTo compare the outcomes of accelerated versus standard corneal cross-linking for the treatment of progressive keratoconus.Methods In this retrospective comparative study, 63 eyes of 40 patients with progressive keratoconus were divided into two groups; 27 eyes in group one were treated with an accelerated protocol (10 mW/cm, 9 min) and 36 eyes in group two were treated with the standard method (3 mW/cm, 30 min). Visual acuity, refraction, corneal topography, corneal tomography, and anterior and posterior corneal higher-order aberrations (HOAs) were assessed preoperatively and 18–30 months postoperatively.ResultsThe LogMAR uncorrected and corrected distance visual acuity values were improved in both groups postoperatively. However, the improvement was significantly higher in group one (P 0.05, all). The flattening in the anterior keratometry readings, flat K, steep K, and average K were significantly higher in group two (P 0.001, all). The maximum anterior keratometry (AKf) values significantly decreased in both groups, whereas the maximum posterior keratometry (AKb) values increased. The reduction in the minimum corneal thickness (ThKmin) was significantly greater (36.49um) in group two, compared to 10.85um in group one. There was a significant increase in the posterior average keratometry, and a significant decrease in the posterior astigmatism, along 3 mm meridian in S-CXL (P = 0.03, P = 0.008, respectively), while the corresponding values showed no statistical significance in group one (P 0.05). The anterior corneal trefoil was significantly reduced in group one (P = 0.002), whereas anterior total HOAs and coma were significantly improved in group two (P 0.0014, all). The posterior corneal spherical aberration decreased significantly in group one (P = 0.02), while group two revealed significant reduction in the posterior trefoil values (P = 0.011). The change in the anterior maximum keratometry was significantly and positively correlated to the preoperative maximum keratometry in group two (P = 0.53, P = 0.003).ConclusionAn accelerated cross-linking protocol using 10 mW/cm for 9 min showed more visual improvement and less pachymetric reduction when compared to the standard protocol, however, anterior corneal flattening, posterior corneal steepening, and the change in the posterior astigmatism were significantly higher in the standard protocol; while corneal HOAs were improved in both protocols.

Complications and visual outcomes of cataract surgery in patients with pseudoexfoliation.

To compare outcomes of cataract surgery performed by ophthalmic trainees and consultants in patients associated with pseudoexfoliation (PXF) METHODS: Retrospective review of medical records of all patients with PXF who had undergone cataract surgery from January 2016 to December 2018 at L V Prasad Eye Institute, Hyderabad, India, were analysed RESULTS: A total of 914 eyes were included in the study; surgeries on 501 (54.8%) eyes with PXF were performed by trainees, while 413 (45.2%) were performed by consultants. Posterior capsule rupture (PCR) with vitreous loss (VL) occurred in significantly fewer eyes operated on by consultants (n = 8, 1.9%) than those operated on by trainees (n = 23, 4.5%) (p = 0.002). Eyes that underwent small incision cataract surgery (n = 100, 21.2%) had a significantly greater number of complications than those that underwent phacoemulsification (n = 31, 7.1%) (p = 0.00001). Multivariate logistic regression analysis shows that chances of a complication are higher when operated on by a trainee (OR = 1.59, 95% CI: 1.09-2.34, p = 0.02).The mean logMAR corrected distance visual acuity of patients one month post-surgery was significantly higher for patients in the consultant group (0.15 ± 0.3) than for those in the trainee group (0.2 ± 0.4) (p = 0.003). Patients with PXF operated on by trainees for cataract had a relatively higher risk of developing PCR with VL and had poorer visual outcomes than those operated on by consultants.

Transepithelial versus epithelium-off corneal crosslinking for progressive keratoconus.

Transepithelial versus epithelium-off corneal crosslinking for progressive keratoconus.

Pars Plana Vitrectomy versus Intravitreal Injection of Ranibizumab in the Treatment of Diabetic Macular Edema Associated with Vitreomacular Interface Abnormalities.

Purpose To compare the efficacy of pars plana vitrectomy (PPV) versus intravitreal injection (IVI) of ranibizumab (RBZ) in the treatment of diabetic macular edema (DME) associated with vitreomacular interface abnormalities (VMIA). Methods The records of patients presenting with DME and VMIA throughout 2016 to 2018 were retrospectively analyzed. The patients were divided into 2 groups: group I received IVIs of RBZ and group II underwent PPV with internal limiting membrane peeling. The main outcome measures were the change in the LogMAR corrected distance visual acuity (CDVA) and central subfield thickness (CSFT) on optical coherence tomography over 6 months. Results At 6 months, mean CDVA improved by 0.22 ± 0.21 in group I patients (p < 0.001), while in group II, it improved only by 0.09 ± 0.22 (p < 0.115). Fifty-five percent of group I and 60% of group II patients had stable CDVA (within 2 lines from baseline) at 6 months. Significant improvement in vision (gain of 2 or more lines) was seen in 45% and 30%, respectively. Worsening of vision (loss of 2 or more lines) was seen only in 2 patients in group II, but none in group I. The mean CSFT improved significantly in both groups (by 162 µ and 216 µ, respectively; p < 0.001). The mean CSFT at 6 months was similar in both groups (354 µ and 311 µ, respectively; p=0.172). Conclusions Both treatments resulted in anatomical improvement of DME with concurrent VMIA. Visual improvement was more pronounced in the IVI group, although this may have been affected by other confounding factors.