Final Uncorrected Distance Visual Acuity Research Articles

Relentless bilateral accommodation spasm in an adolescent treated with clear lens extraction

Introduction: Pathologic accommodation spasm occurs when persistent contraction of the ciliary muscle of the eye induces pseudomyopia. The purpose of this report was to describe the case of an adolescent with recurrent ciliary spasm, refractory to medical treatment for several years. Patient and Clinical Findings: A 10-year-old girl was evaluated because of complaints of decreased visual acuity (VA) and frequent headaches. Diagnosis, Intervention and Outcomes: The diagnosis of pseudomyopia due to accommodation spasm was established. No organic causes were detected. She started treatment with cycloplegics, which were successively titrated at different doses, along with the use of spectacles, over the following years. After 7 years of follow-up, the lack of efficacy of treatment and intolerance to its side effects demanded further action, so a clear lens extraction was performed, with the implantation of continuous focus transition multifocal intraocular lenses. Her final uncorrected distance VA was 6/6 in each eye, with good intermediate vision and J1 near vision with +2.00 addition. Conclusions: In severe cases of ciliary spasm, medical therapy and spectacle prescription may not be sufficient to control the disease. Intraocular lens implantation may be the only remaining therapeutic option to provide quality of life to the patient.

DETERMINATION OF FACTORS ASSOCIATED WITH LONG-TERM ENDOTHELIAL LOSS AND REFRACTIVE RESULT IN PATIENTS WITH ARTISAN PHAKIC LENS.

To determine the changes in endothelial cell density, refractive results, and risk factors associated with endothelial loss in patients with irisclaw phakic intraocular lenses for myopia/myopic astigmatism (Artisan). Data collection was obtained from an existing database with information on patients with a phakic Artisan lens implant between 1998 and 2011 at the Virgilio Galvis Ophthalmology Centre, with at least 5 years of follow-up. As a second stage, an analysis was carried out to identify the change in endothelial cell density and its potential associated factors. A total of 80 eyes with myopic errors were included with a follow-up of 11.9 + 3.48 years. The percentage of total loss of endothelial cells was greater than 25% of the preoperative density in 43.8% of the eyes. A postoperative annual loss > 1.6% was found in 47.0% of the eyes with that information available. 41 eyes (51%) had final endothelial density < 2000 cells/mm2, and 7 (8.8%) eyes had endothelial cell density < 1000 cells/mm2. Among the variables studied, no associated factors for long-term endothelial loss were found. During the course of the study, 8 (10%) phakic intraocular lenses were explanted, including 3 with accelerated endothelial loss, and another 2 with cataract associated and a significantly low endothelial density. The last mean spherical equivalent was -0.81 (±1.01 D), and the final uncorrected distance visual acuity was 0.45 logMar (Snellen 20/56). Artisan-type phakic lenses are a good alternative for the correction of high myopic defects, with predictable refractive results in the long term. However, there is an increased loss of endothelial cells in the long term in a high percentage of patients. Strict postoperative follow-up, including endothelial evaluation, is required, and further studies are warranted.

Interrupted femtosecond laser delivery secondary to face mask–related fogging

Introduction: An increase in face mask utilization has been noted during the COVID-19 pandemic. A rare complication of keratorefractive surgery where interruption of femtosecond-laser delivery was noted secondary to face-mask related fogging of the patient interface is reported. Patient and clinical findings: Young patients with stable tear film and healthy ocular surface were advised femtosecond laser assisted laser in situ keratomileusis (3 eyes) and small-incision lenticule extraction (1 eye) for refractive errors. Intraoperative interruption of laser delivery was noted secondary to droplet condensation or fogging of the patient interface. The fogging developed secondary to the escape of humid exhaled breath. Diagnosis, intervention, and outcomes: Incomplete delivery of the laser required aborting the procedure with retreatment at a later date. In eyes where partial laser delivery was obtained, the flap was manually dissected from the underlying stroma and the procedure was completed in the same sitting. All eyes achieved a final uncorrected distance visual acuity of 20/20 with no long-term sequelae. Conclusions: Fogging of the patient interface is a rare complication secondary to face mask use. Sealing the top of the face mask with well-adhering micropore, readjustment of face masks, removing the mask prior to draping, and checking for droplet condensates on the interface prior to laser delivery may minimize the incidence.

Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK.

Although the use of femtosecond lasers instead of mechanical devices has decreased the incidence of flap complications following laser-assisted in situ keratomileusis (LASIK), dislocations and striae still occur. Flap repositioning is an effective intervention to improve visual outcomes after acute flap complications in both microkeratome-assisted and femtosecond-assisted LASIK. This retrospective case series included patients undergoing flap repositioning secondary to acute flap dislocation and/or visually significant striae within the first two weeks following femtosecond LASIK (FS-LASIK) from 2015 to 2020 at a single institution. Preoperative, intraoperative, and postoperative de-identified data were analyzed for incidence, risk factors, and visual acuity outcomes. The incidence of flap repositioning was 0.35% in 21,536 eyes (n = 70). Indications for repositioning included acute flap dislocation (35.7%) and visually significant striae (64.3%). High myopia (OR = 3.04, p = 0.001) and patient age over 50 years (OR = 3.69, p = 0.001) were the strongest risk factors for these complications. Prior to flap repositioning, uncorrected distance visual acuity (UDVA) of 20/20 or better and 20/40 or better occurred in 19% and 57% of eyes, respectively. After repositioning, a final UDVA of 20/20 or better and 20/40 or better occurred in 78% and 98% of eyes, respectively. After repositioning, one line of UDVA was lost in two eyes (2.8%) and two lines were lost in one eye (1.4%). Risk factors for acute flap dislocation included high myopia and age over 50 years. Flap repositioning was effective in salvaging visual outcomes.

Oral l-Cysteine Supplementation Enhances the Long Term-Effect of Topical Basic Fibroblast Growth Factor (bFGF) in Reducing the Corneal Haze after Photorefractive Keratectomy in Myopic Patients.

We aimed at evaluating the long-term effects of l-cysteine oral supplementation to basic fibroblast growth factor (bFGF) eye-drops on corneal re-epithelization and transparency in myopic patients subjected to photorefractive keratectomy (PRK). Forty patients subjected to bilateral PRK for myopia were enrolled and randomly divided into two groups receiving an additional therapy together with the standard postoperative treatment consisting in local tobramycin 0.3%, dexamethasone 0.1%, diclofenac 0.1%, and 0.2% hyaluronate. Group 1 included 20 patients (11 males and 9 females; 34.09 ± 8 years of age) receiving only bFGF eye-drops (10 μg/10 μL) four times a day for 7 days starting from the day of surgery; Group 2 included 20 patients (12 males and 8 females; 37.35 ± 11.5 years of age) who were postoperatively administered with topical basic fibroblast growth factor (bFGF; 10 μg/10 μL) four times a day for 7 days plus oral l-cysteine supplementation (500 mg/capsule) once a day for 15 days, starting 7 days before PRK. Patients were followed-up for 12 months. Clinical ophthalmologic parameters were recorded for all the 80 examined eyes. The corneal transparency was evaluated in vivo by slit lamp and confocal microscopy. The data showed that: (a) the corneal haze occurred in a smaller percentage of the patients who were postoperatively administered with topical bFGF plus oral l-cysteine supplementation (Group 2) compared to patients who received only bFGF (Group 1); (b) at 6 months of follow-up, the stromal mean image brightness of the patients belonging to Group 2 was significantly lower than that of the Group 1 (p < 0.03), and, interestingly, the difference was even more evident at 12 month from the treatment (p < 0.001). Moreover, the final mean of the spherical equivalent refraction was −0.06 ± 0.2 D in Group 1 and −0.08 ± 0.3 D in Group 2, whereas the final uncorrected distance visual acuity (UDVA) was equal or superior to 20/25 in 100% of eyes in both Group 1 and 2. Post refractive patients can benefit from the administration of l-cysteine before the surgery and in association with bFGF in the early postoperative period, showing a faster corneal re-epithelization able to prevent corneal haze in the long-term recovery.

Topical cyclosporine A for postoperative photorefractive keratectomy and laser in situ keratomileusis

To compare the stability and predictability of the refractive outcomes in eyes treated with photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) with and without postoperative use of topical cyclosporine A emulsion. Naval Medical Center San Diego Refractive Surgery Center, San Diego, California, USA. Randomized clinical trial. Patients had PRK or LASIK and were randomized, pairwise, to a standard postoperative treatment regimen with or without the addition of topical cyclosporine A 0.05% emulsion twice daily for 3 months postoperatively. Visual acuity, mesopic contrast acuity, refractions, and ocular symptoms were assessed through the 3-month examination. Tear-film samples (cytokines and chemokines) were analyzed preoperatively and 1 week and 1 and 3 months postoperatively. The PRK group comprised 70 patients and the LASIK group, 54 patients. The addition of topical cyclosporine A twice a day after PRK or LASIK did not confer special benefits in terms of achievement of target refraction, final uncorrected distance visual acuity (UDVA), or rate of visual recovery (all P>.05, multivariate analysis of variance [MANOVA]). There was no significant difference in tear-film composition based on measurement of matrix metalloproteinase-9, interleukin (IL)-6, or IL-8 recovery (all P>.05, MANOVA). The addition of topical cyclosporine A twice daily for 3 months after PRK or LASIK did not provide a significant benefit in the rate of visual recovery, final UDVA, or patient symptoms, nor did it significantly change measured inflammatory mediators (cytokines) present in the tear film.

Bilateral Fusarium oxysporum keratitis after laser in situ keratomileusis

We report the successful management of a rare case of bilateral post-laser in situ keratomileusis (LASIK) Fusarium oxysporum keratitis and propose a therapeutic strategy. A 19-year-old white man with no systemic diseases was referred to our emergency service 3 days after microkeratome-assisted myopic bilateral LASIK correction. He complained of blurred-vision, photophobia, and ocular pain. Clinical findings (satellite lesions, hypopyon) suggested fungal keratitis. Flaps were immediately lifted and rinsed with povidone-iodine 10%, and intensive topical and systemic and combined antifungal and antibacterial treatment was introduced. Topical cortisone drops were administered after 3 days. Despite initial deterioration of the clinical picture, all symptoms resolved quickly. Polymerase chain reaction indicated F oxysporum. Relapse occurred in the left eye, which was successfully managed. The final uncorrected distance visual acuity was 20/20 in both eyes. Fusarium oxysporum post-LASIK keratitis may occur in the early phase. Prompt diagnosis, interface irrigation with povidone-iodine solution, and intensive long-term treatment contribute to a favorable outcome. No author has a financial or proprietary interest in any material or method mentioned.

Excimer laser photorefractive keratectomy for low to moderate myopia using a 5.0 mm treatment zone and no transitional zone: 16-year follow-up

To evaluate the safety and efficacy of photorefractive keratectomy (PRK) 16 years postoperatively. Refractive Laser Suite, Mater Private Hospital, Dublin, Ireland. Cohort study. Myopic PRK was performed using the UV200 excimer laser with a 5.0 mm ablation zone. The following were evaluated in patients returning 16 years postoperatively: refractive stability, refractive predictability, corrected visual acuity, corneal haze, and subjective patient symptoms (eg, glare, halos). Most of the 120 eyes (80 patients) were followed for 2 years or more; 23 patients (39 eyes) were followed for 16 years. Preoperatively, the spherical equivalent (SE) ranged from -1.75 to -7.25 diopters (D) and astigmatism from 0.00 to 1.50 D. At 2 years, the mean SE was -0.25 D and at 16 years, -0.58 D. Overall, 31 eyes (79.5%) were within ± 1.00 D of emmetropia, with 6 eyes (15.4%) between 1.00 D and 2.00 D and 2 eyes (5.1%) between 2.00 D and 3.00 D. The final uncorrected distance visual acuity was 20/20 or better in 27 eyes (69.2%) and 20/30 or better in 36 eyes (92.3%). Eight eyes (20.5%) lost 1 line of corrected distance visual acuity. Four eyes (10.3%) had visible haze and 7 eyes (17.9%) had hemosiderin. All patients stated they would have the procedure again. Photorefractive keratectomy was safe and effective in the treatment of myopia up to -7.00 D, and all patients reported being satisfied. There appeared to be slight regression over the follow-up period. No author has a financial or proprietary interest in any material or method mentioned.

Psoriatic intraepithelial keratitis after laser in situ keratomileusis treatment

A 36-year-old woman with chronic psoriasis developed blurring of vision and intraepithelial infiltrates within the flap in the left eye concurrent with the appearance of acute psoriatic generalized skin lesions 14 days after bilateral laser in situ keratomileusis. After treatment with topical antibiotic and steroid agents and topical artificial tears, the intraepithelial infiltrates within the flap completely resolved. The final uncorrected distance visual acuity was 1.0 in both eyes, along with complete resolution of the dermatologic psoriatic lesions. No author has a financial or proprietary interest in any material or method mentioned.

Oral moxifloxacin and topical amikacin for Mycobacterium abscessus keratitis after laser in situ keratomileusis

We report a case of Mycobacterium abscessus keratitis after elective laser in situ keratomileusis in a 19-year-old woman. The infection started 3 weeks after uneventful surgery, and the patient received multiple antimicrobial treatments without response. A corneal scrape isolate showed an acid-fast bacterium that was subsequently confirmed by culture to be M abscessus. Prompt treatment of oral moxifloxacin 400 mg twice daily and hourly topical amikacin 2.5% was started. Recovery occurred within the first week of treatment, with complete resolution 3 weeks after presentation. The final uncorrected distance visual acuity was 6/9. We comment on other reports of post-LASIK keratitis caused by M abscessus, the in vitro sensitivity to antibiotic agents described in the literature, and the use of oral moxifloxacin as a potential good alternative treatment based on its good ocular bioavailability, which in our case allowed resolution without the need for surgical intervention.