High Astigmatism Research Articles

Long-Term Stability of Femtosecond Astigmatic Keratotomy After Treatment of High Postkeratoplasty Astigmatism.

The purpose of this study was to assess long-term stability and outcomes of femtosecond astigmatic keratotomy (FSAK) after treatment of high postkeratoplasty astigmatism. This retrospective study included patients who underwent FSAK for high astigmatism (≥4 D) after penetrating keratoplasty or deep anterior lamellar keratoplasty. Main outcome measures were corneal astigmatism, uncorrected visual acuity, and best-corrected visual acuity (BCVA) at 1 month and 1, 5, and 10 years. Overall, 61 eyes of 61 patients (mean age 56 ± 19 years, 54.1% male) were included in this study. Preoperative corneal astigmatism ranged from 4 to 25 D. One month after FSAK, mean corneal astigmatism was significantly reduced from 9.02 ± 3.97 D to 4.86 ± 3.10 D ( P < 0.001). Thereafter, corneal astigmatism remained stable at all visits up to 10 years ( P < 0.05 for all compared with baseline). After FSAK, there was a significant improvement in logMAR uncorrected visual acuity from 1.21 ± 0.48 to 0.87 ±0.54 ( P < 0.001) and logMAR BCVA from 1.03 ± 0.55 to 0.49 ± 0.45 ( P < 0.001) which remained stable up to 10 years. A mild reduction in BCVA improvement was seen between 1 month and 1 year. Femtosecond astigmatic keratotomy was effective and stable at reducing very high magnitudes of postkeratoplasty astigmatism over the long term. The procedure also had a stable effect on visual acuity, albeit some reduction in the degree of BCVA improvement was seen over the early postoperative period.

Managing a middle-aged patient with bilateral neglected keratoconus

The Orbscan's benefits include providing a thickness map and being noncontact for keratoconus screening. However, several developing countries have delayed keratoconus management due to a lack of resources and qualified examiners. Here we report a case of underdiagnosed and mistreated by high astigmatism, leading to a neglected case of keratoconus. A 34-year-old woman is bothered by her developing blurred eyesight and habit of scratching her eyes. The streak retinoscopy examination revealed the right eye was 5/20 cc S+7.75 C-6.00 Axis 150 became 5/15 and 5/20 cc S+7.25 C-6.00 Axis 80 became 5/15 for the left eye. The Placido test revealed irregular lines. The Schirmer test showed dry eyes. Slit-lamp examination revealed irregular thin cornea, Munson sign, Rizzuti's sign, and Vogt's striae were positive. The manual keratometer showed remarkably high corneal powers. The corneal topography showed characteristics of keratoconus. Scleral contacts with AS-OCT guiding were inserted into both eyes. Each eye's final BCVA improved to 5/12 and 5/6.5, respectively. The patient attained better visual performance and comfort. Detecting keratoconus by corneal topography and scleral contact lens fitting improved visual acuity. A skillful practitioner and accessible sources are essential to prevent these neglected cases.

Intrastromal corneal ring segments followed by PRK for postkeratoplasty high astigmatism: prospective study.

To evaluate refractive and topographic results of the association of intrastromal corneal ring segments (ICRS) with photorefractive keratectomy (PRK) for the correction of high (>6.0 diopters [D]) postkeratoplasty astigmatism (PKA). University of São Paulo, São Paulo, Brazil. Prospective interventional study. Postpenetrating keratoplasty patients, intolerant to contact lens fitting, and with corneal astigmatism higher than 6.0 D were treated by the combination of ICRS and PRK from January 2017 to June 2019. First, patients underwent femtosecond laser-assisted ICRS implantation to reduce and regularize corneal astigmatism, and 3 months later, submitted to PRK for the residual astigmatism. Outcomes were obtained 12 months after PRK. The study comprised 30 eyes of 29 patients. Mean uncorrected distance visual acuity (logMAR) changed from 1.16 ± 0.37 in the preoperative to 0.69 ± 0.40 after ICRS ( P < .0001) and to 0.34 ± 0.29 12 months after PRK ( P < .0001). Mean spherical equivalent decreased from -5.19 ± 4.81 D in the preoperative to -3.38 ± 4.51 D after ICRS ( P < .0001) and to -2.30 ± 2.84 D after PRK ( P = .132). Mean topographic astigmatism decreased from 7.88 ± 2.13 D in the preoperative to 5.47 ± 2.29 D after ICRS ( P < .0001) and to 4.12 ± 2.93 D after PRK ( P = .003). Mean refractive astigmatism decreased from 7.10 ± 1.13 D in the preoperative to 4.61 ± 1.61 D after ICRS ( P < .0001) and to 2.58 ± 1.49 D after PRK ( P < .0001). After PRK, the mean correction index (CI) for corneal astigmatism was 0.77 ± 0.36. The ICRS/PRK combination resulted in a higher CI than ICRS only, both for corneal and refractive astigmatism. 2 eyes (8%) presented clinically significant opacification. Other complications were endothelial rejection (n = 1, 4%), infectious keratitis (n = 1, 4%), and ICRS extrusion after corneal melting (n = 1, 4%). The association of ICRS and PRK was effective for treating high PKA. This strategy improved visual acuity, spherical equivalent, topographic and refractive astigmatism and resulted in a high CI. Safety questions remain open and must be balanced against benefits.

Comparison of astigmatic correction with and without limbal marking during small-incision lenticule extraction.

To compare clinical outcomes after correction of moderate to high astigmatism through small-incision lenticule extraction (SMILE) with and without limbal marking. Tianjin Eye Hospital, Tianjin, China. Prospective randomized comparative case series. This prospective randomized control study included 240 unilateral eyes of 240 patients who underwent SMILE with astigmatism of more than 0.75 diopters (D). The eyes were randomly assigned to a marked group (120 eyes) or an unmarked control group (120 eyes). Manifest refraction was observed at the 3-month follow-up timepoint and evaluated using a vector analysis. Postoperative astigmatism differed statistically significantly in the marked group (-0.08 ± 0.15 D) and the control group (-0.16 ± 0.24 D) at 3 months ( P = .001), and correction index, index of success, angle of error (absolute value), and magnitude of error were also significantly better in the marked group ( P < .05). There was a significant positive correlation between index of success and angle of error (absolute value) ( P < .001). Limbal marking-based manual compensation prior to SMILE was associated with a statistically significant reduction in undercorrection and error of axis in cases of moderate to high astigmatism, although the magnitude of the difference was small.

Refractive Characteristics and Related Factors of Amblyopia after Lamellar Keratoscleroplasty in Children with Limbal Dermoids.

We examined the refractive characteristics and related factors of amblyopia in pediatric patients with limbal dermoids undergoing lamellar keratoscleroplasty. Forty-one children (mean age: 56.15 ± 22.47 months) were enrolled. Cycloplegic refraction, corneal topography, and anterior segment photography were performed. The corneal topographic and distribution characteristics of the refractive state were summarized, and the relationship between limbal dermoid invasion size and the refractive state was analyzed. The relationship between invasion size and amblyopia severity and the effect of clinical intervention at different times on amblyopia treatment were also analyzed. The spherical power distribution was −1.0–+10.75 D (average: +4.79 ± 3.09 D). The cylinder power was −1.25–−8.75 D (average: −4.19 ± 1.93 D). The axial range of astigmatism was 10–180° (average: 103.54 ± 58.16°). Equivalent spherical refraction was −3.88–+7.76 D (average: +2.70 ± 3.08 D). Twenty-five, fifteen, and one case had limboid dermoid invasion of the central circular zone (CCZ), paracentral annular zone (PCZ), and corneal limbus within 1 mm, respectively. Corneal topography of 39 patients showed flat, steep, and mean curvatures of 38.48 ± 2.12 D, 43.29 ± 1.97 D, and 40.70 ± 1.48 D, respectively. The mean astigmatism was 4.80 ± 2.93 D in the 3-mm optical region. Astigmatism was higher in CCZ than in PCZ invasion (p < 0.05). Postoperative visual acuity was positively correlated with patients’ age and amblyopia treatment duration (r = 0.392, p = 0.048; r = 0.488, p = 0.011), and was negatively correlated with astigmatism (r = −0.646, p < 0.001). High hyperopia and astigmatism are the dominant refractive errors in patients with limbal dermoids undergoing lamellar keratoscleroplasty.

A comparative analysis of intraocular pressure measurement results by the TVGD-02 tonometer (EASYTON) and the Goldman tonometer in ethnic Asians residing in Kazakhstan

Purpose. To compare the results of IOP measurement by the TVGD-02 transpalpebral tonometer (EASYTON) and the Goldman to­ nometer in ethnic Asians of Kazakhstan in order to assess the influence of epicanthus on the results of transpalberal tonometry. Material and methods. A total of 150 patients (150 eyes) aged 39 to 65years were examined, including 120 patients (120 eyes) with primary open-angle glaucoma (POAG), and 30 patients (30 eyes) with high astigmatism and no POAG. All patients had their (IOP) measuredfirst with a Goldman tonometer, and then with a TVGD-02 transpalpebral tonometer (EASYTON). The correlation between the two methods was determined by the Pearson correlation coefficient. Results. According to the EASYTON tonometer, the average IOP over the whole group was 20.20 ± 0.45 mm Hg, whilst the respective figure for the Goldman tonometer was 19.90 ± 0.43 mm Hg, the difference being statistically insignificant (p&gt;0.05). In both groups and in varied IOP ranges the results of Easyton and Goldman tonometer data were comparable. No peculiarities in IOP mea­ surements taken from patients with epicanthus have been revealed. Conclusion. The absence of statistically significant differences between the data obtained by EASYTON and the Goldman tonometer in Asians implies that epicanthus does not affect the results of transpalpebral tonometry. The EASYTON tonometer may be considered an effective screening device in routine clinical practice. It is easy to use and can be recommended to ophthalmologists, general practitioners, nurses, optometrists, as well as glaucoma patients for IOP monitoring at home.

Surgical Rehabilitation of a Posttraumatic Iris Cyst, Cataract and Astigmatism Patient. Clinical Case

Injuries cause serious disturbance of the form and function of the organ of vision due to the damage and accompanying or remote complications and therefore have a high proportion to the structure of low vision, blindness and disability. One of the complications of penetrating wounds of the eye is iris cysts. Iris cyst can increase and cause pupillary block, secondary glaucoma, uveitis, corneal dystrophy, and therefore it requires surgical intervention. The goal of surgical treatment of an iris cyst is to ensure complete removal of the cyst.Objective: to estimate the clinical and functional results of treatment in a posttraumatic iris cyst, posterior subcapsular cataract and myopic astigmatism patient.Patient and methods. Patient B., 49 years old with posttraumatic retention iris cyst, posterior subcapsular cataract, compound myopic high astigmatism was examined. To determine the tactics of surgical treatment of the patient, a complex of General ophthalmology was perfomed (visometry, IOP measurement, autorefractometry, biomicroscopy, ophthalmoscopy), as well as special (B-scanning, optical coherence tomography of the retina) research methods. The follow-up period was 1 year.Results and discussion. To improve visual functions and prevent the development of secondary glaucoma, the patient was offered surgery - excision of the iris cyst and cataract phacoemulsification with toric intraocular lens. Simultaneous carrying out of two stages of the operation reduced the risks of postoperative complications and shorten the rehabilitation period.Conclusion. Positive optical and therapeutic effects were achieved as a result of the surgical treatment 44 years after an open eye injury: the eye is calm, the iris cyst is not detected, visual acuity has increased. The postoperative period showed the saving the stable and high visual and functional result with no recurrence of the iris cyst.

The Prevalence and Causes of Low Vision and Visual Impairment in School-Aged Children: The Shiraz Pediatric Eye Study.

To determine the prevalence and causes of visual impairment (VI) in Shiraz schoolchildren aged between 6 and 12 years. In the present population-based study, stratified random sampling was used to select 2400 schoolchildren aged 6-12 years from all four educational districts of Shiraz, Iran. Using the definitions of the World Health Organization, VI was defined as best-corrected visual acuity (BCVA) ≤0.5 logMAR (20/60) in the better eye, and blindness as BCVA worse than 1.3 logMAR (20/400) in the better eye. The low vision was defined as BCVA equal to or worse than 0.5 logMAR (20/60) in either eye. Data were recorded from a detailed interview and ocular examination of each eligible student. The mean age of the students was 9.1 ± 1.6 years. The prevalence of VI was 3/2001 (0.14%). The cause of VI in all these three patients (100%) was amblyopia due to high refractive errors (high ametropia and astigmatism). Regarding the main refractive errors leading to VI among these three patients, one patient had bilateral high hyperopia (compound hyperopic astigmatism), one of them had bilateral high astigmatism, and the other one had compound myopic astigmatism. According to a visual acuity of less than or equal to 20/60 in at least one eye, 9/2001 (0.4%) of children had low vision. This study revealed a low prevalence of VI in a sample of 6- to 12-year-old school-aged children. Amblyopia in the setting of high ametropia and astigmatism were the most common causes of VI.

The tale of torn Descemet's membrane

To report three cases of late presentations of forceps birth trauma leading to DM tear and their management. Forceps delivery has become a rare method of child delivery in the modern clinical era. However, in the clinics, we still see patients with Descemet's membrane (DM) tear who have had ocular birth trauma with forceps. Most of the time, it is an incidental finding. Forceps injuries are usually unilateral and affect the left eye as the most common fetal head position is left occiput anterior. In the immediate postpartum period, the rupture in the DM leads to corneal edema, which eventually disappears, leaving the visible edges of the break. In the late presentations, patients can have high myopic astigmatism (steep cornea) and secondary amblyopia, which can mimic unilateral keratoconus and, later in life, can lead to corneal endothelial decompensation leading to bullous keratopathy. Here we report three cases of DM tear due to forceps injury with three late presentations. Patient 1 came with bullous keratopathy; patient 2 presented with high myopic astigmatism, amblyopia, and beaten metal appearance in between the torn edges; and patient 3 presented as keratoconus. To conclude, this case series highlights the various clinical features and signs of forceps induced birth injury to the cornea. In this report, the clinical history, ocular examination, and optical coherence tomography scan confirmed the diagnosis. Early rehabilitation with glasses or contact lenses can prevent the development of deep amblyopia. Corneal decompensation can be a presentation later in life; thus, these patients should have a close follow up. Endothelial keratoplasty helps in visual rehabilitation in cases where bullous keratopathy has developed, which can be up to the preoperative amblyopia state.

Objective and Subjective Quality of Vision After SMILE for High Myopia and Astigmatism.

To report subjective and objective quality of vision (QoV) results for high myopic small incision lenticule extraction (SMILE) between -9.00 and -13.00 diopters (D). This was a prospective study recruiting 114 patients undergoing SMILE with attempted spherical equivalent refraction (SEQ) correction from -9.00 to -13.00 D, and cylinder up to 5.00 D. Patients were informed before surgery of the increased risk of QoV symptoms. Patients completed the Rasch validated QoV questionnaire. Objective QoV was assessed by corneal and whole eye aberrations, HD Analyzer Objective Scatter Index (OSI) (Keeler), and contrast sensitivity. Patient satisfaction was assessed on a scale from 0 (very dissatisfied) to 10 (very satisfied). Individual item and total Rasch-scaled scores for the three subscales (frequency, severity, and bothersomeness) of the QoV questionnaire were calculated before and 12 months after surgery. The mean patient satisfaction score was 9.27 ± 1.18 (range: 2 to 10), 8 or higher in 93%, and 7 or higher in 98% of patients. One patient with a satisfaction score of 2 had a simple refractive error re-treatment and then reported a satisfaction score of 10. The total mean ± standard deviation Rasch-scaled QoV score for the frequency, severity, and bothersomeness subscales before surgery was 24 ± 19, 20 ± 16, and 19 ± 18, respectively. Scores increased after surgery to 41 ± 18, 32 ± 16, and 30 ± 21, respectively (P < .001). Corneal aberrations (6 mm, OSI) increased on average by 0.39 µm for spherical aberration, 0.41 µm for coma, and 0.56 µm for higher order aberrations root mean square. OSI increased on average by 0.58. There was a small but statistically significant improvement in contrast sensitivity at 3, 6, 12, and 18 cycles per degree. There were no statistically significant correlations found between subjective scores for starbursts and objective measurements. Satisfaction was high following SMILE for high myopia. As expected, there was an increase in QoV symptoms, mainly glare and starbursts. The acceptance of QoV symptoms for high myopic SMILE was high, indicating that residual refractive error and visual acuity are the major drivers for patient satisfaction with appropriate preoperative informed consent. [J Refract Surg. 2022;38(7):404-413.].

Effective Optical Zone Following Small Incision Lenticule Extraction for Myopia Calculated With Two Novel Methods.

To evaluate the effective optical zone (EOZ) following small incision lenticule extraction in myopic eyes using two novel methods and investigate factors influencing postoperative EOZ. In this prospective study, 45 patients (45 eyes) with a mean spherical equivalent of -5.82 ± 1.58 diopters underwent SMILE and were observed during a 6-month follow-up. Postoperative EOZ was calculated using custom software that automatically distinguishes EOZ on the tangential curvature difference map (EOZc) and total corneal refractive power map (EOZp) of the Pentacam HR (Oculus Optikgeräte GmbH). The agreement between the two methods, the difference between postoperative EOZ and programmed optical zone (POZ), and its relationship with parameters including corrected spheres, cylinders, ablation ratio (ablation depth/central cornea thickness), and Q-value change were investigated. The EOZc area was 20.76 ± 2.43 mm2 (diameter: 5.04 ± 0.60 mm) and the EOZp area was 20.22 ± 4.70 mm2 (diameter: 5.13 ± 0.30 mm). Both were significantly smaller than POZ (P < .001). Bland-Altman plots showed 4.44% (2/45) points located outside the 95% limits of agreement. EOZc and EOZp reductions were negatively related to corrected cylinders (r = -0.631, P < .001 and r = -0.594, P < .001, respectively). EOZp reduction was positively correlated with corrected spheres (r = 0.336, P = .024). Subgroup analysis revealed significant differences in EOZc and EOZp reduction between low and high astigmatism groups despite myopia degree. EOZ after incision lenticule extraction, measured using two novel methods, was smaller than POZ. The reduction of EOZ was negatively correlated with the corrected cylinders. [J Refract Surg. 2022;38(7):414-421.].

Comparison of refractive and visual outcomes between image-guided system-assisted small-incision lenticule extraction and wavefront-optimized FS-LASIK in treatment of high astigmatism.

To compare the refractive and visual results of image-guided system-assisted small-incision lenticule extraction (IGA-SMILE) and wavefront-optimized femtosecond laser in situ keratomileusis (FS-LASIK) in the treatment of high astigmatism. Osmangazi Aritmi Hospital, Bursa, Turkey. Retrospective. This retrospective case-matched study included 64 eyes that had undergone IGA-SMILE and 64 eyes that had undergone wavefront-optimized FS-LASIK. The mean preoperative myopia and astigmatism were -4.05 ± 1.98 diopter (D) and 3.11 ± 1.06 D in the IGA-SMILE group and -4.21 ± 2.23 D and -3.15 ± 0.62 D in the FS-LASIK group, respectively. One year later, visual and refractive results were compared in the groups. Vector analysis based on Alpins method was performed to evaluate astigmatic treatment. 128 eyes of 128 patients were included in this study. At 1 year, the residual astigmatism was -0.21 ± 0.25 D in the IGA-SMILE group and -0.21 ± 0.24 D in the FS-LASIK group ( P = .305). In the IGA-SMILE group, 57 eyes (89.1%) achieved uncorrected distance visual acuity of 20/20 or better, as did 56 eyes (85.9%) in the FS-LASIK group. Vector analysis results demonstrated that the difference vectors were 0.22 ± 0.24 D and 0.21 ± 0.22 D ( P = .230), the correction indexes were 0.95 ± 0.08 and 0.95 ± 0.08 ( P = .239), and the indices of success were 0.08 ± 0.09 and 0.08 ± 0.09 ( P = .248) in the IGA-SMILE and the FS-LASIK groups, respectively. The combination of an image-guided system with SMILE resulted in high efficacy and safety indices that were comparable with FS-LASIK surgery.

Astigmatism analysis and reporting of surgically induced astigmatism and prediction error.

To provide a method for determining the vector that, when added to the preoperative astigmatism, results in no prediction error (PE) and to specify statistical methods for evaluating astigmatism and determining the 95% confidence convex polygon. Baylor College of Medicine, Houston, Texas, and University of Southern California, Los Angeles, California. Retrospective consecutive case series. An analysis of 3 clinical trials involving toric intraocular lenses was performed. 3 formulas were evaluated (generic vergence formula with zero surgically induced astigmatism, the Barrett toric formula, and the Holladay toric formula). Scalar and vector analyses were performed on each dataset with each formula and the results compared. Since the PE was not a Gaussian distribution, a 95% convex polygon was used to determine the spread of the data. The mean values for the vector absolute astigmatism PEs were not different for the 3 formulas and 3 datasets. The Barrett and Holladay toric calculators were statistically superior to the zero formula for 3 intervals (0.75, 1.0, and 1.25) in the high astigmatism dataset. Residual astigmatism and vector absolute astigmatism PE mean values and SDs are useful but require extremely large datasets to demonstrate a statistical difference, whereas examining percentages in 0.25 diopters (D) steps from 0.25 to 2.0 D reveals differences with far fewer cases using the McNemar test for a P value. Double-angle plots are especially useful to visualize astigmatic vector PEs, and a 95% confidence convex polygon should be used when distributions are not Gaussian.

High Prevalence of Astigmatism in Children after School Suspension during the COVID-19 Pandemic Is Associated with Axial Elongation.

During the COVID-19 pandemic, the Hong Kong Government enforced a “school from home” policy between February and September 2020. This cross-sectional epidemiological study was conducted to investigate the prevalence of astigmatism and visual habits after the home confinement period. Vision screenings were conducted at three local government-funded primary schools in Hong Kong from October 2020 to December 2020. A total of 418 ethnically Chinese primary school children completed the eye examination and returned questionnaires concerning demographic information and visual habits. It was found that 46.5% (95% CI, 41.7–61.4%) of the children aged 8 to 11 years had astigmatism ≥ 0.75 D, which was predominately With-The-Rule astigmatism. The prevalence of astigmatism reported in these children is generally higher than that of studies conducted before COVID. Compared to their non-astigmatic peers, astigmatic children had a longer axial length (p < 0.001) and engaged in fewer outdoor activities (p = 0.04). Multiple linear regression analyses also revealed significant relationships between axial length and both cylindrical error and J0 astigmatism. Due to the high astigmatism prevalence, there is a pressing need for further studies on the long-term impact of the pandemic on children’s vision.

Клинический случай эксимерлазерной коррекции смешанного астигматизма высокой степени

Aim. To describe a clinical case of excimer laser correction of high degree mixed astigmatism with high visual results and a history of stable postoperative refraction. Case report. A 22-year-old patient with high degree mixed astigmatism in the right eye and moderate myopia with compound moderate myopic astigmatism in the left eye was treated with LASIK technology using the Aspheric ablation program. High visual functions were obtained in both eyes (1.0) and the results were stable during three years of follow-up. Conclusions. Modern technologies of refractive surgery provide high functional results and safety in patients with high degrees of astigmatism, improve the quality of life and can be the method of choice when determining the method of astigmatism correction. Key words: excimer laser correction; astigmatism; LASIK.

Clinical Outcomes of Toric Implantable Collamer Lens (T-ICL) and Toric Implantable Phakic Contact Lens (IPCL) for High Myopia with Astigmatism: A Comparative Study

Background: Our study aimed to compare the clinical, visual outcomes, and efficacy of toric Implantable Collamer Lens (T-ICL) and toric implantable phakic contact lens (IPCL) in patients with high myopia and astigmatism over a follow-up period of 6 months. Methods: A prospective interventional randomized comparative study included 60 myopic eyes divided into 2 groups, group A including 30 eyes that were implanted with T-ICL, and group B, including 30 eyes that were implanted with toric IPCL. The refractive results, visual acuity, central corneal endothelial cell count, and intraocular pressure (IOP) were evaluated at baseline and at 1 and 6 months post-surgery. Any complications either during or after surgery were assessed. Results: In both study groups, the mean central corneal endothelial cell count was significantly decreased after 1 month and improved to reach near pre-operative values after 6 months postoperatively, indicating good lens biocompatibility. A statistically significant increase in IOP was found in both groups during the early follow-up, and a significant decrease after 6 months postoperatively (p=0.036) was reported in group A. A significant reduction in both spherical and cylindrical refractive errors with good predictability was reported in both groups compared with pre-operative values. Regarding the predictability, In T-ICL group (A), the median spherical and cylindrical errors were significantly improved from (-10 D &amp; -4.5 D) pre-operatively to (-0.3 D &amp; - 0.3 D) at the end of 6 months follow up period. Similarly, in the toric IPCL group (B), the median spherical and cylindrical errors were significantly improved from (-11 D &amp; -4.5 D) pre-operatively to (-0.3 D &amp; - 0.3 D) by the end of follow up period. A statistically significant improvement of UCDVA at 6 months postoperatively was found in both groups, as median preoperative LogMAR UCDVA was 1.1 and 1.3 in groups A and B respectively, which was improved to 0.3 in both groups at the end of follow-up period. There were no reported intra- or postoperative complications such as cataract, keratitis, or lens decentration. Conclusion: Toric IPCL is a suitable alternative to T-ICL for the management of high myopia with astigmatism, especially in developing countries, as it is cheaper and easier to implant than T-ICL. However, data over longer follow-up periods are needed to confirm its safety and stability.

An epidemiologic analysis of the association between eyelid disorders and ocular motility disorders in pediatric age

Aim of the study was to assess: (a) the prevalence and type of strabismus, ptosis and eyelid dynamic disorders features, (b) the prevalence of refractive errors, amblyopia and, (c) their association with ocular/systemic syndromes in a cohort of patients. This is a retrospective observational multicenter cohort study. Patients with coexisting ocular motility disorders, comitant and incomitant strabismus, ptosis and dynamic eyelid disorders who have never undergone surgery were enrolled throughout a 3-years a study period. 137 out of 19,089 patients were enrolled, of which 97 with uniocular and 40 with binocular disease. Isolated congenital ptosis was observed in 84 patients. A polymalformative syndrome was present in almost one third of cases, whilst among strabismus type, esotropia was slightly more prevalent. Most patients were hypermetropic. In monocular disease, myopia mainly affected older patients, who were characterized by a worse ptosis margin reflex distance and levator function, and significantly higher astigmatism. Amblyopia occurred in 67.4% of the study sub-population. Of note, in monocular disease this was mild in 25.8%, moderate in 24.2% and severe in 11.3% of cases, whilst in binocular disease it was mild in 25%, moderate in 41.7% and severe in 16.7%. All patients with coexisting eyelid and ocular motility dysfunctions in pediatric age need ophthalmologic and systemic evaluation to accurately assess amblyopia, refractive errors and systemic/ocular disorders.

The influence of residual astigmatism on the postoperative visual quality in patients with implantation of an extended depth of focus intraocular lens

Objective: To investigate the influence of residual astigmatism on the postoperative visual acuity in cataract patients with implantation of an extended depth of focus intraocular lens (IOL). Methods: Retrospective cohort study. A total of 56 eyes of 56 cataract patients who underwent phacoemulsification combined with extended depth of focus IOL implantation from January 2019 to December 2020 at Eye & ENT Hospital of Fudan University were included. There were 29 males and 27 females in all patients, and the age was (65±9) years. Patients were divided into two groups according to their postoperative residual astigmatism: low astigmatism group (<0.75 D, 28 eyes) and high astigmatism group (0.75 to 1.50 D, 28 eyes). At 3 months after surgery, measurements were completed, including postoperative uncorrected distance (5 m) visual acuity, uncorrected intermediate (80 cm) visual acuity, uncorrected near (40 cm) visual acuity, best corrected visual acuity (all the visual acuity was converted to the logarithm of the minimum angle of resolution visual acuity), defocus curves, quick contrast sensitivity function, wavefront aberration, and VF-14 questionnaire scores. The independent samples t-test and Mann-Whitney U test were used for data analysis. Results: The low astigmatism group and high astigmatism group's uncorrected distance visual acuity [M (Q1, Q3)] were 0.05 (-0.06, 0.10), 0.08 (0.00, 0.22), their uncorrected intermediate visual acuity were 0.11 (0.00, 0.20), 0.14 (0.10, 0.21), their uncorrected near visual acuity were 0.28 (0.20, 0.32), 0.26 (0.20, 0.30), and their best corrected visual acuity were 0.17 (0.05, 0.30), 0.14 (0.04, 0.22), respectively. The differences were not statistically significant (all P>0.05). No significant difference was found in the defocus curves from +1.00 to -4.00 D, at intervals of +0.50 D, between the two groups (all P>0.05). No significant difference was found in the quick contrast sensitivity of low, middle and high frequency of dark vision between the low astigmatism group and high astigmatism group (all P>0.05), and the area under Log contrast sensitivity function of the two groups were 0.87±0.28 and 0.77±0.30 (P>0.05). The total whole-eye aberrations were 0.59±0.18 and 0.74±0.51, and the total higher-order aberrations were 0.30±0.13 and 0.37±0.25 in the two groups at 4.0-mm pupil diameter. The differences were not statistically significant when the total whole-eye aberration, total higher-order aberration, coma, cloverleaf aberration, and spherical aberration were compared (all P>0.05). The differences of the total VF-14 visual scores, near visual acuity scores and the distance visual acuity scores of the two groups were not statistically significant (all P>0.05). Conclusion: Cataract patients with residual postoperative astigmatism 0.75 to 1.50 D can obtain as good visual quality as those with postoperative residual astigmatism<0.75 D after implantation of an extended depth of focus IOL.

Post Penetrating Keratoplasty Ectasia: Incidence, Risk Factors, Clinical Features, and Treatment Options.

BACKGROUND: Corneal transplantation in keratoconus (KC) patients is generally considered to be successful with a high grade of patient satisfaction. Long-term studies suggest a 6% to 11% probability of KC recurrence manifested by keratometric instability and progressive corneal ectasia. METHODS: We propose to review the frequency, risk factors for the development, and the surgical options for the correction of high irregular astigmatism due to late graft ectasia following penetrating keratoplasty (PK). RESULTS: Post-keratoplasty ectasia is characterized by increasing corneal steepening with myopic shift and high irregular astigmatism, developing years or decades after PK, mostly occurring in KC patients. Contact lenses may adequately improve the visual acuity; however, because these patients are often elderly and intolerant to hard contact lenses, ultimately a surgical correction is proposed to the patient. Compressive suture and corneal wedge resection may improve corneal astigmatism, but the outcomes are unpredictable and often temporary. For this reason, a larger PK graft is often proposed for surgical rehabilitation with the consequence of removing more of the recipient’s healthy endothelium and exposing the patient to a renewed immunogenic stimulus and short-term graft failure for endothelial decompensation. More recently, lamellar keratoplasty using various techniques has been proposed as an alternative to PK in order to maximize the visual outcomes and minimize the complications. CONCLUSIONS: Management of advanced corneal ectasia is a significant challenge for corneal surgeons. Many surgical approaches have been developed, so there is a large arsenal of surgical operations to correct post-PK ectasia. Among them, large-diameter anterior lamellar keratoplasty may be a viable, safer, and effective alternative to PK for the correction of post-keratoplasty ectasia.

Outcome of Phacoemulsification and Extracapsular Cataract Extraction

Objective: Aim was to compare the visual results of patients who received ECCE and phacoemulsification for the treatment of age-related cataracts. Study Design: Prospective study Place and Duration: Conducted at Jinnah International Hospital during from Jan, 2021 to Dec, 2021. Methods:There were 130 patients of both genders presented for cataract surgery. Patients were aged between 35-75 years.When patients signed an informed permission form, demographic information such as age and sex were recorded. Patients were equally divided in two groups. Group I received phacoemulsification (phaco) cataract surgery and group II received conventional extracapsular cataract extraction. Intraoperative and post-operative complication among cases was assessed. At last follow up best corrected visual acuity was assessed and compared among both groups. SPSS 24.0 was used to analyze complete data. Results:Among 130 cases, majority of the cases 85 (65.4%) were males and 45 (34.6%) were females. 15 (11.5%) patients were aged between 35-45 years, 45 (34.6%) patients were aged between 46-55 years, 38 (29.2%) were aged between 56-6 years and 32 (24.6%) had age &gt; 65years. Post-operative we found significantly good vision among patients of phaco group in 54 (83.1%) cases as compare to group II in 31 (47.7%) cases. Frequency of intraoperative complications was higher in group II 9 (13.8%) as compared to group I 3 (4.6%) cases. Post-operative complications in group I was corneal decompensation, high astigmatism and posterior capsule opacity but in group II high astigmatism and corneal decompensation were the complications. Conclusion:We came to the conclusion that the visual outcome was considerably better in the Phaco operation compared to the ECCE technique (p = 0.003). As a result, we advocate for the provision of Phaco equipment in hospitals that have sufficient capabilities for the performance of intraocular surgery. Keywords:PhacoemulsificationSurgery, Extracapsular cataract extraction, Complications, Vision Acuity