Increase In Uncorrected Visual Acuity Research Articles

Tактика хирургического лечения пациента с непроникающей травмой роговицы после ранее перенесенной операции ФемтоЛАЗИК

Abstract Tactics of surgical treatment of a patient with non-penetrating corneal trauma after previous FemtoLASIK V.A. Breev, E.G. Solodkova, D.D. Sibakin S. Fyodorov Eye Microsurgery Federal State Institution, Volgograd Branch, Volgograd, Russian Federation Purpose. To present the tactics of surgical treatment of the patient with non-penetrating corneal trauma after previously undergone FemtoLasik. Methods. The patient, operated by FemtoLASIK for middle degree myopia, had non-penetrating corneal trauma of the right eye. When applying to the Clinic of Volgograd branch he underwent corneal flap repositioning with removal of multiple corneal foreign bodies. Before and after the operation the patient underwent standard ophthalmologic examination. Results. According to the examination data, the uncorrected visual acuity of the right eye was reduced to 0.3 due to dislocation and linear defect of the corneal flap, multiple corneal foreign bodies, corneal opacity and mixed astigmatism. In 1 month after the surgical treatment there was noted restoration of transparency, correct position and integrity of the corneal flap, absence of corneal foreign bodies and increase of uncorrected visual acuity of the right eye up to 0.5. Conclusion. The correct sequence of surgical actions after trauma against the background of previously performed FemtolASIK provides qualitative corneal flap repositioning and restoration of visual functions. Key words: non-penetrating corneal trauma, corneal flap repositioning, FemtoLASIK For citation: Breev V.A., Solodkova E.G., Sibakin D.D. Tactics of surgical treatment of a patient with non-penetrating corneal trauma after previous FemtoLASIK.

Evaluation of Indicators of the Optical System and Hydrodynamics of Eyes With Myopia in the Treatment of Orthokeratological Lenses

Purpose. To study the features of changes in the parameters of the optical system and hydrodynamics of eyes with myopia during treatment with orthokeratological lenses. 80 patients (160 eyes) with mild myopia were examined — 30 patients (60 eyes) and 50 patients (100 eyes) with moderate myopia before and after treatment with orthokeratological lenses. Research methods. Visometry, autorefractometry, ophthalmometry, biometry, keratotopography, determination of accommodation indicators (AOA, ZOA) and hydrodynamics of the eyes. Results: It was revealed after the use of orthokeratological lenses in the night mode, a significant decrease in the true vg d (Po) and an increase in the coefficient of ease of outflow (C) with the activation of accommodation indicators — AOA and ZOA, contributing to a decrease in the degree of myopia and an increase in uncorrected visual acuity. Conclusion: One of the factors of the effectiveness of the treatment of myopia with orthokeratological lenses are the indicators of the hydrodynamics of the eyes and the strengthening of the functions of the accommodation apparatus — an increase in AOA and ZOA.

Clinical experience in rehabilitation of patients with Fuchs corneal dystrophy and cataract by ultrasonic phacoemulsification and descemetorhexis

BACKGROUND: The potential for peripheral corneal endothelial capabilities is a novel, poorly understood direction. The comprehensive development of various modifications of endothelial keratoplasty goes hand in hand with a lack of donor material. This explains the continuous search for safe tissue-preserving techniques.
 AIM: The aim of this study is to evaluate the clinical and functional results of treatment of patients with Fuchs corneal dystrophy and cataract using a combination of cataract ultrasound phacoemulsification and descemetorhexis.
 MATERIALS AND METHODS: The study included 3 patients (3 eyes), 3 women aged 65 to 78 (on average 73.6 7.5 years). The follow-up period in the postoperative period was 36 months. The inclusion criteria were: patient complaints about glare, blurred vision and cloudy vision in the morning; the location of the guttae in the central 5 mm zone, central corneal stromal edema less than 610 microns, the inability to count endothelial cells in the center, endothelial cells density on the periphery in the upper quadrant more than 1400 cells/mm2. All patients underwent phacoemulsification of cataract with IOL implantation and subsequent descemetorhexis in the 4 mm zone.
 RESULTS: At 1 month an increase in the central corneal thickness and a slight increase in uncorrected visual acuity (UCVA) and in best corrected visual acuity (BCVA). By the 3rd month, positive dynamics was present: an increase in UCVA and BCVA in all cases, a decrease in the central corneal thickness (559 20 m), resorption of stromal edema, increase in corneal transparency, possibility to calculate the endothelial cells density in the center (866 46 cells/mm2). At 36 months, the BCVA was 0.6, 0.4 and 0.5, respectively.
 CONCLUSIONS: Restoration of corneal transparency was achieved in 100% of cases (3 out of 3). An analysis of the clinical results of the descemetorhexis + phacoemulsification + IOL operation demonstrated an increase in visual acuity, an increase in corneal transparency and a decrease in stromal edema in patients with initial Fuchs corneal dystrophy and cataract. The possibility of not using donor material for the treatment of Fuchs corneal dystrophy is a promising trend. Further accumulation of material is required.

Comparative analysis of the correction of irregular postkeratoplastic astigmatism with scleral lenses and intrastromal ring implantation

Background. Many patients after penetrating keratoplasty (PK) experience induced postkeratoplastic astigmatism, which is often irregular and causes an increase in corneal aberrations that reduce visual acuity and quality. The aim of the study. To conduct a comparative analysis of the effect of rigid gas permeable scleral lenses and the MyoRing implantation method on clinical and functional parameters in patients with IPA. Material and methods. The clinical study included 60 patients (60 eyes). The age of patients with IPA was from 25 to 42 years. All patients underwent penetrating keratoplasty. All patients were divided into two groups depending on the method for irregular postkeratoplastic astigmatism correction. Group I included 30 patients (30 eyes) who were fitted with rigid gas permeable scleral lenses. Group II consisted of 30 patients (30 eyes) who underwent implantation of the MyoRing into a penetrating corneal graft. The observation period was 1 year. Results. After 12 months of observation, there was a greater increase in uncorrected visual acuity by an average of 3 lines, in corrected visual acuity – by 2 lines; a greater decrease in corneal aberrations in photo- (root mean square (RMS) of total aberrations (RMS total) by 0.30 ± 0.08 µm, RMS of higher order aberrations (RMS HOA) – by 1.01 ± 0.24 μm) and mesopic conditions (RMS total – by 0.33 ± 0.09 μm, RMS HOA – by 0.08 ± 0.03 μm) in patients wearing rigid gas permeable scleral lenses compared with patients after MyoRing implantation into a penetrating corneal graft. Conclusion. Patients of group I, wearing rigid gas permeable scleral lenses, showed a greater improvement in visual acuity and a decrease in corneal aberrations in photo- and mesopic conditions compared to the patients of group II (after MyoRing implantation) at a follow-up period of 12 months.

Наш опыт имплантации торических интраокулярных линз

Рurpose. To analyze the results of cataract phacoemulsification with implantation of toric intraocular lenses. Methods. We conducted a retrospective analysis of the results of cataract phacoemulsification with concomitant regular corneal astigmatism of 1.5 D or more. 32 patients (42 eyes) were implanted with toric intraocular lenses: 11 MX 60T lenses (BAUSCH+LOMB) and 31 Torica aAY lenses (HumanOptics). Results. Intraocular lens rotation less than 5 ° was recorded in 40 eyes (95.2 %). In 2 patients, the deviation of Torica aAY lenses was 10–15 °, which required their surgical reposition. All patients achieved an increase in uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). UCVA after surgery increased by an average of 0.5 (from 0.13±0.03 to 0.63±0.08), and then remained stable. BCVA increased by 0.33 (from 0.37±0.06 to 0.7±0.06) in the early postoperative period, and by another 0.09 (0.79±0.04) in the late period. Mean value of the spherical component of refraction decreased in the early postoperative period by 4.1 D (from 5.05±0.45 to 0.94±0.22), in the late period a slight increase by 0.09 D was recorded. The value of the cylindrical component decreased after the operation by an average of 2.24 D (from 3.31±0.22 to 1.07±0.37), further a decrease by another 0.1 D was observed. Conclusion. The implantation of toric intraocular lenses is a relatively inexpensive, technically uncomplicated, effective and safe method of cataract surgery and associated corneal astigmatism correction. Key words: phacoemulsification; astigmatism; toric intraocular lens.

Phacoemulsification in patients after previous implantation of a complete intrastromal ring into a corneal transplant

BACKGROUND: The MyoRing implantation into a corneal transplant can significantly compensate for irregular post-keratoplastic astigmatism. However, the cataract that occurs in this category of patients and the lack of information in the literature on its phacoemulsification and the calculation of a toric intraocular lens (tIOL) power in them determines the relevance of our study.
 AIM: The aim of the study is to conduct a clinical and functional analysis of phacoemulsification in patients after previously performed implantation of a MyoRing into a corneal transplant.
 MATERIALS AND METHODS: We operated on 21 patients (21 eyes) who had previously undergone the MyoRing implantation into a corneal transplant. According to keratotopography, all patients were diagnosed with a regular form of corneal astigmatism. All patients underwent phacoemulsification with tIOL implantation. When calculating the tIOL power, its diopter value was corrected depending on the average value of the corneal transplant keratometry according to the keratotopogram data. The observation period duration was 6 months.
 RESULTS: One month after the procedure, there was an increase in uncorrected visual acuity by 0.2 0.9 LogMAR, best corrected visual acuity by 0.3 1.0 LogMAR, the spherical component of refraction up to 0.4 0.44 D, the cylindrical component of refraction up to 0.62 0.18 D, all of which did not change later on.
 CONCLUSIONS: Phacoemulsification with tIOL implantation, with its power calculated taking into account an additional correction for its diopter value, is an effective, predictable and safe method of treating patients after previously performed MyoRing implantation into a penetrating corneal transplant.

Epithelial thickness mapping

Aim The aim of this study was to compare mechanical photorefractive keratectomy (PRK) to transepithelial photorefractive keratectomy (tPRK), used to correct mild and moderate myopia, with respect to the epithelial thickness mapping (ETM). Setting The study was carried out at Al-Mashreq Eye Center, Cairo, Egypt. Patients and methods This is a prospective comparative study that was carried out on 20 myopic patients (40 eyes), with spherical equivalent (SE) ranging from −1.0 to −5.0 D. The cases were divided into two groups: group A included the right eyes (OD) of all patients, and group B included the left eyes (OS). Group A underwent mechanical PRK using ‘hockey stick’ and excimer laser, using Mel-90 excimer laser with 250 Hz mode, and 0.7-mm spot scanning. Group B underwent tPRK using Mel-90 (8-mm lamellar ablation for 55 μm, 250 Hz). Uncorrected visual acuity (UCVA), manifest refraction, and ETM using AngioVue spectral domain optical coherence tomography systems were performed. The ETM was measured preoperatively and at 1 week, 1 month, and 3 months postoperatively. In addition, postoperative pain was assessed. Results The median preoperative UCVA was 0.3 (range, 0.2–0.4) in both eyes (OU), whereas the median preoperative best-corrected visual acuity was 1 (range, 0.8–1). There was a statistically significant increase in UCVA across the postoperative period in both groups (P<0.001). The median UCVA improved to 0.5 (OU) after 1 week, and to 0.9 (OD) and 1.0 (OS) after 1 month and remained almost the same at 3 months postoperatively. There was a statistically significant decrease in SE at all points of the follow-up period in both groups (P<0.001). A slight change in SE was observed between the first and third month postoperatively in both groups, which was statistically insignificant. Patients reported postoperative pain on the first postoperative day, which was more in the tPRK group. There was a statistically significant change in epithelial thickness across the study period in both groups (P<0.001). The ETM showed a faster epithelial regeneration in group B, which was statistically significant at 1 week postoperatively (P=0.004). The epithelial thickness continued to increase in both groups to reach almost the preoperative value at the third month postoperatively. All cases that showed postoperative haze were less than grade 1.0 (Hanna’s scale). Conclusion Mechanical PRK and tPRK provided very similar results 3 months postoperatively. Both procedures were predictable, effective, and safe. The patients reported postoperative pain on the first postoperative day that was more in the tPRK group. The tPRK group expressed a faster epithelial regeneration than the PRK group at 1 week postoperatively. However, at 3 months postoperatively, the corneal epithelium reached an almost normal thickness in both groups. Visual recovery was noted to be faster in the tPRK group.

Применение технологии комбинированного лазерного воздействия в лечении макулярной ретинальной складчатости

Purpose. To evaluate the possibility of using the technology of combined laser treatment of macular retinal folds in the late postoperative period of rhegmatogenous retinal detachment (RRD). Methods: Patient Z., 62 years old complained of metamorphopsia and decreased visual acuity of the right eye. Diagnosis: Operated RRD in the right eye complicated with macular retinal folding; epiretinal membrane; avitria; pseudophakia. Upon admission and at all stages of dynamic observation the patient underwent a comprehensive ophthalmological examination: standard diagnostic tests included visometry for uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) and indirect ophthalmoscopy with MaxField indirect lens (Ocular Inc.; USA). In addition, optical coherence tomography was performed using Spectralis HRA + OCT platform (Heidelberg Engineering; Germany). Laser photocoagulation was delivered using a VISULAS Trion laser work station (Carl Zeiss; Germany) operating at 577 nm wavelength. Results. On examination 6 months after combined laser treatment the patient noted the absence of metamorphopsia in the right eye. As a result, an increase in UCVA from 0.05 to 0.2 was determined; BCVA remains stable – 0.7, “smoothing” of the retinal folds according to ophthalmoscopy, a decrease in the height of the retinal folds, restoration of the macular profile and architectonics of the retinal layers according to OCT. Conclusions. The proposed combined laser treatment of macular folds developing in the late postoperative period after RRD repair significantly improved the morphofunctional characteristics of the eye. The application of transpupillary laser surgery to ophthalmological practice broadens the arsenal of methods for noninvasive correction of RRD associated with macular retinal folds Key words: macular retinal folds; combined laser technology; rhegmatogenous retinal detachment; micropulse laser.

Клинический случай замены помутневшей интраокулярной линзы на авитреальном глазу

Purpose. Using a clinical example, to analyze the possible causes of opacity of the Hydro-4 Aspheric IOL (Rumex, Great Britain). Materials and methods. Patient K., 32 years old, underwent the surgery for tractional retinal detachment in both eyes, which arose against the background of proliferative diabetic retinopathy of the retina. A history of type 1 diabetes mellitus from the age of 9. The visual acuity of both eyes before surgery was 0.03 n/k. Microinvasive (25G) vitrectomy with silicone oil tamponade of the vitreous cavity was performed. The second stage of surgical treatment is the removal of silicone oil from the vitreous cavity and phacoemulsification of cataract with partial excision of the posterior lens capsule with IOL implantation into the capsule bag of both eyes. A Hydro-4 Aspheric IOL (Rumex, UK) was implanted in the right eye, and Aspira-aAy (HumanOptic AG, Germany) – in the left one. After 3 months, on examination, attention was drawn to the diffuse opacity of the IOL of the right eye. The visual acuity was 0.01 n/k. The IOL replacement technique was as follows. Viscoelastic was injected into the anterior chamber and into the capsule bag through corneal paracentesis at 10 and 2 o'clock. The lens was dislocated into the anterior chamber and cut in half with vitreal scissors. The cut parts of the IOL were removed through a 2.2 mm tunnel at 12 o'clock. The Tecnis lens (AMO, USA) was chosen for implantation. Results and discussion. There was an increase in uncorrected visual acuity up to 0.4. There were no intra- and postoperative complications such as hemorrhagic, inflammatory, and also any from the cornea. The question remains open why, with the same tactics of the first two stages of surgical treatment of both eyes and implantation of lenses made of hydrophilic acrylic, only one IOL became cloudy. Accounting for the materials from which the IOL is made, which lens model is better to prefer to this day remains an urgent and unresolved problem for ophthalmic surgeons. Conclusion. The presence of a concomitant diabetes mellitus in the patient could influence the development of opacification of the hydrophilic acrylic IOL. Key words: IOL opacity, hydrophilic acrylic, IOL explantation, avitria.

Клинический случай успешного лечения внутриглазной гипертензии, вызванной органическим блоком угла передней камеры после сквозной кератопластики

Clinical case of successful treatment ocular hypertension caused by organic closure of anterior chamber angle after penetrating keratoplasty is presented. The patient underwent keratoplasty in the right eye and on the first day after the operation the clinic of acute glaucoma attack in the operated eye was revealed. In view lack of effect from medication and laser treatment carried out, the synechiae surgical removal was done. Carbachol Intraocular Solution (0.1 ml MIO-CHOL Sterile Solution, APPASAMY OCULAR DEVICES (P) LTD. (PHARMA DIVISION), India) was injected into anterior chamber to narrow the pupil. But its action turned out to be paradoxical – instead of constriction there was sharp pupil dilation. In addition to standard treatment, the patient received keratoprotection and reparative therapy. To restore neurotrophic processes in the iris, intravenous infusions of 1000 mg of gliatilin were first performed, followed by a switch to the tablet form of this drug. After 4 months, the patient experienced increase in uncorrected visual acuity to 0.1; best corrected visual acuity – up to 0.2 with diaphragm against the background of complete absence of signs of inflammation. The graft was completely transparent, the intraocular pressure – 19 mm Hg, mydriasis persisted 5–6 mm, the reaction of the pupil to light appeared, but was weakened. Key words: ocular hypertension after penetrating keratoplasty, acute glaucoma attack, synechiae surgical removal.

Corneal astigmatism in patients with various ophthalmic pathologies

To analyze the prevalence, magnitude of corneal astigmatism, anatomical parameters of the eye and age of patients with the condition, as well as to assess the prospects of its correction with intraocular lenses (IOLs). The study involved a retrospective analysis of initial biometric data of 128 379 patients (256 630 eyes) referred to the S.N. Fedorov NMRC «MNTK «EYE MICROSURGERY» research center in the years 2013 to 2018. The patients previously operated for cataract were examined 6 months after surgery. In 5 years, corneal astigmatism of over 1.0 D was diagnosed in 66 610 (25.96%) eyes. Among them, low astigmatism was observed in 86.30% of cases, with-the-rule - in 56.10%, compound - in 78.72%, and astigmatism combined with myopic refraction - in 61.48%. More severe astigmatism is characterized by thinner cornea and lens (p<0.05). Cataract surgery with implantation of toric IOLs was performed only on 2.56% of eyes. The average age of the operated patients was 68.42±13.3. Patients with implanted toric IOLs had 23% better uncorrected visual acuity (UCVA), and 15% better corrected visual acuity compared with outcomes of spherical IOL implantation. Corneal astigmatism of more than 1.0 D was observed in 25.96% of examined subjects. Patients with corneal astigmatism apply for cataract surgery 10 years earlier, when they are still in the working age, due to inability to engage in professional activities; in most cases, those patients are female. Astigmatism of up to 0.75 D is more common on the right dominant eye, of 2.0 D and higher - on the left. The correlation coefficients determined for study data indicate a barely noticeable relationship between biometric parameters and the degree of astigmatism. The use of toric intraocular lenses provides a 2-fold increase in uncorrected visual acuity compared to spherical IOLs.

Five-Year Long-Term Results of Standard Collagen Cross-Linking Therapy in Patients with Keratoconus

Objectives:We aimed to demonstrate the 5-year visual, topographic, and aberrometry long-term results of standard collagen cross-linking (CCL) treatment in keratoconus patients.Materials and Methods:The files and topographic measurements of patients who underwent standard CCL treatment for progressive keratoconus were retrospectively reviewed. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction values, and topographic values were evaluated.Results:Thirty-seven eyes of 27 patients were included in the study. The female to male ratio was 15 (56%)/12 (44%) and the mean age was 22.16±6.4 (12-39) years. The increase in UCVA and BCVA was statistically significant at postoperative 1-5 years (all p values <0.05). The changes in the spherical equivalent after CCL were not statistically significant (p>0.05), but the decrease in the manifest astigmatism values were significant after CCL at 3-5 years (p<0.05). Decrease in K2 (steep keratometry) and K apex values were statistically significant at 1-5 years (p<0.05). There was a significant decrease in the thinnest corneal thickness compared to the preoperative values up to 6 months and 1-4 years (p<0.05), but the change at 5 years was not significant (p=0.08). Post-CCL reductions in high-order aberrations and spherical aberrations were significant at postoperative 5 years and 3-5 years (p<0.05).Conclusion:In long-term follow-up, CCL treatment is seen to arrest keratoconus progression, increase vision, and improve visual quality by reducing higher-order aberrations and spherical aberrations. For these reasons, CCL treatment continues to be the first treatment modality in patients with progressive keratoconus.

Analysis of Clinical and Functional Results of the Developed Technology of Combined Laser Treatment of Initial Stages of Idiopathic Epiretinal Membrane

Aim. To analyze the clinical and functional results of the combined technology for laser treatment of patients with the initial stages of idiopathic epiretinal membrane.Methods. This study included 3 groups of patients: the main group (32 patients) after the combined laser technology (subthreshold “grid” laser photocoagulation (LP) and subthreshold micropulse LP); control group (30 patients) which did not receive any treatment; comparison group (30 patients) after subthreshold “grid” LP. The assessment uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), central retinal thickness (CRT) and central retinal sensitivity (CRS) was performed. The follow-up period was 5 years.Results. In the control group a slow decrease of UCVA, BCVA, CRS (p &lt; 0.05) and an increasing CRT (p &lt; 0.05) were observed. In the main group maximal UCVA, BCVA, CRS (p &lt; 0.05) were marked from 3 to 6 months after laser treatment and there was a gradual decrease in the CRT indices. In the comparison group, a short-term positive effect was achieved up to 3 months with an increase of UCVA, BCVA, CRS (p &lt; 0.05). 12 months post op there was an increase in CRT with a decrease of UCVA, BCVA, and CRS until the end of study.Conclusion. The technology of combined laser treatment showed high efficiency in control and comparison groups, with stabilization/increase of UCVA, BCVA, CRS and stabilization/improvement of the morphological parameters of the retina – the decrease of CRT with ERM involution.

Mini-Descemet Membrane Endothelial Keratoplasty for the Early Treatment of Acute Corneal Hydrops in Keratoconus.

To describe a new surgical option for the treatment of acute corneal hydrops in keratoconus and to present the first results. This is a retrospective analysis of 3 patients who presented to our clinic with a massive corneal hydrops in acute keratoconus and were treated by mini-Descemet membrane endothelial keratoplasty (DMEK). According to the size and the shape of the gap in the patient's Descemet membrane (DM), 1 DMEK graft was trephined with a round 5-mm punch. The other grafts were trimmed with a razor blade to a width of about 3 mm and a length adjusted to the length of the defect of the recipients' DM. The graft was inserted with a regular intraocular lens shooter. Correct unfolding of the graft was controlled by using intraoperative optical coherence tomography. At the end of the surgery, the graft was attached to the posterior corneal surface by a small air bubble. Thereafter, the complete anterior chamber was filled with 20% SF6 gas. All 3 patients (age 32 ± 3 years on average) showed a rapid increase in uncorrected visual acuity from the logarithm of the minimum angle of resolution (LogMAR) 1.66 (±0.46) before mini-DMEK to the LogMAR 1.2 (±0.3) within 6 to 8 weeks after mini-DMEK. The thickest corneal point within the edematous cornea decreased in all 3 patients (1088 ± 280 μm before surgery vs. 630 ± 38 μm 1 week after surgery). One mini-DMEK failed in a first attempt. In this patient, the recipient DM was under strong tension and showed a pronounced dehiscence. Therefore, a small part of the recipient's DM around the preexisting gap in DM was removed before a second mini-DMEK graft was placed successfully. The other 2 patients developed partial graft detachment within 1 to 2 weeks after surgery. However, the corneas of these patients were dehydrated to physiological levels after mini-DMEK, and despite partial detachment, there was no relapse of the hydrops. Mini-DMEK could be helpful in patients with larger defects and detachments of DM in very ectatic corneas in the acute phase of corneal hydrops in acute keratoconus. These patients may not be successfully treated by intracameral gas application alone or in combination with pre-Descemetal sutures. Further investigations are needed to identify factors helping to decide on the best surgical approach in hydrops in acute keratoconus.

Therapeutic effectiveness of toric implantable collamer lens in treating ultrahigh myopic astigmatism

With a rapid increase in the prevalence of Ultra-High Myopic Astigmatism (UHMA), especially in the youth, there have been many studies on visual correction. In our study, we investigated the clinical value of the Toric Implantable Collamer Lens (TICL) in UHMA. We conducted a retrospective study between 2011 and 2013. TICL implantation was performed on fifteen UHMA patients (30 eyes), and all these patients were regularly followed up for 12 months. The preoperative and postoperative data, including Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), Intraocular Pressure (IOP), and corneal endothelial counts, were all analysed using the paired-sample t-test. The 12-month spherical mirror (SPH) of the surgical eye was -0.25~+0.25 D, and the Cylinder mirror (CYL) was 0~-0.50 D. Twenty patients exhibited an increase in UCVA by one level in comparison to the preoperative BCVA, amounting to a 66.7% increase; 20.0% of patients exhibited an increase in UCVA by two levels. A comparison between the preoperative and postoperative IOP showed no statistically significant difference. No difference was also found in mean corneal endothelial counts before and after the operation. A decrease in visual acuity was observed in one eye at the 3rd-month of review; this was corrected by TICL position adjustment. Precisely measuring the preoperative parameters, selecting the appropriate TICL, more thoroughly aspirating sodium hyaluronate intraoperatively, and maintaining a stable IOP were important for maintaining the effectiveness, safety and stability of TICL in treating UHMA.

MONITORING OF FUNCTIONAL PARAMETERS IN THE PATIENTS WITH EARLY STAGE OF AGE-RELATED MACULAR DEGENERATION

Purpose: clinical monitoring of functional parameters in patients with early stage of age-related macular degeneration (AMD) receiving the dietary supplement Retinorm. Patients and methods: clinical monitoring was conducted during 5 months in 40 patients aged 42–75 years with AMD-manifestations in the form of dry drusen and pigment epithelium defects typed as «geographic atrophy». The main group (20 subjects, 35 eyes) received dietary supplement Retinorm (1 capsule 3 times daily for two months with a month break and repeated admission rate, similar to the first). Patients also received instillations of Visomitin® with3 time daily by such mode: using of instillations 2 months, 1 month break, after that — continuation of instillations during 2 months. The control group (20 subjects, 34 eyes) received only Visomitin® instillations 3 times daily by the same scheme as group I. Checking of visual acuity with maximal correction, static computer perimetry, the optical coherent tomography of retina central area, definition of critical flicker frequency (CFF), retinal electrical sensitivity and optic nerve electrical lability were used as the examination methods. Results: Indicated therapy in the main group improved the monitored functional parameters. Increase of uncorrected visual acuity and the best corrected visual acuity, decrease of relative and absolute scotomas amount in central area of the visual field, increasing of CFF (p&lt;0,05) and tendency to increasing of electrical lability (p&lt;0,5) and lowering the threshold electrical sensitivity (p&lt;0,2) were obtained. The changes of the pointed parameters in the control group were irrelevant and unreliable. Conclusions: The findings suggest a positive effect of Retinorm for the neurosensory cells of retina and for metabolism of the crystalline lens, which contributes to the stabilization of the pathological process in AMD and initial senile cataract. Supplement Retinorm can be recommended for widespread use in patients with early stage-AMD especially in the possible association with initial senile cataract.

Refractive and visual outcomes after Keraring intrastromal corneal ring segment implantation for keratoconus assisted by femtosecond laser at 6 months follow-up.

PurposeWe attempted to evaluate the efficacy of femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus (KC).Patients and methodsA retrospective interventional consecutive clinical study was conducted on patients with KC who were treated with femtosecond laser Keraring implantation. All procedures were performed at Ebsar Eye Center in the period from January 5, 2015, to February 28, 2016.ResultsThirty eyes of 20 patients were included in this study. The mean age of patients was 27.43±3.57 years. Eleven patients (55%) were female and nine patients (45%) were male. Keraring segments were successfully implanted in all eyes. There were no complications or need for ring repositioning. The follow-up period was 6 months postoperatively. There was a significant improvement in the mean logarithm of the minimum angle of resolution (LogMAR) of uncorrected visual acuity (UCVA) after Keraring segment implantation from 1.5±0.23 preoperatively to 0.54±0.16 at 6 months postoperatively (P=0.001). The preoperative mean LogMAR of best-corrected visual acuity (BCVA) was 0.85±0.17. At 1 month postoperatively, it was 0.35±0.15; at 3 months postoperatively, it was 0.26±0.11, and at 6 months postoperatively, it was 0.14±0.07 (P=0.001). The mean preoperative maximum keratometric value for 3 mm pupil in diopters (K max) significantly decreased from 55.85±5.44 preoperatively (N=30) to 44.05±1.64 D at 6 months postoperatively (P=0.001). There was a statistically significant reduction in the mean preoperative spherical equivalent from −5.43±1.76 D preoperatively to −2.43±0.95 D at 6 months postoperatively. No statistically significant differences were detected between 1 and 3 months of follow-up regarding the visual and refractive outcomes.ConclusionAnalysis of the outcomes after Keraring ICRS implantation showed a significant postoperative corneal flattening with a subsequent increase in UCVA and BCVA. Using the femtosecond laser for tunnel creation made the procedure easy and fast with an accurate precise depth of implantation and reduced the risk of operative and postoperative complications.

Corneal Changes After Collagen Crosslinking for Keratoconus Using Dual Scheimpflug Imaging.

Purpose:To evaluate corneal changes after collagen crosslinking (CXL) therapy for keratoconus (KCN) using the Galilei dual Scheimpflug analyzer.Methods:This prospective, nonrandomized clinical study included 35 eyes of 32 keratoconus patients who had undergone CXL. The eyes were saturated with riboflavin solution and were subjected for 30 minutes to ultraviolet-A (UV-A) light with irradiance of 3 mW/cm2. Effectiveness of the treatment was assessed by measuring uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest cylinder/sphere, keratometry, pachymetry, posterior and anterior elevations by the Galilei dual Scheimpflug analyzer. Prior to treatment and 8 months after therapy, Scheimpflug analysis was performed using the Galilei system. The four sets of data including keratometry values, pachymetry, elevation parameters and surface indices were statistically analyzed and compared.Results:Mean patient age was 22.3 ± 3.8 years and mean postoperative follow-up was 8.1 ± 3.2 months. There was a significant increase in UCVA (0.54 ± 0.35 Log MAR preoperatively to 0.49 ± 0.34 LogMAR postoperatively, P = 0.01) and BCVA (0.21 ± 0.19 Log MAR preoperatively to 0.16 ± 0.17 LogMAR postoperatively, P = 0.01). Mean cycloplegic spherical equivalent refractive error was −4.13 ± 2.65 Diopter (D) preoperatively and − 4.67 ± 2.96 D postoperatively (P < 0.001). During the follow-up period, no significant difference was observed in pachymetric and elevation data postoperatively.Conclusion:Corneal stabilization could be achieved by collagen crosslinking therapy for keratoconus in terms of corneal thickness, keratometry values, elevation parameters and surface indices.

The efficacy and safety of modified Snyder–Thompson posterior scleral reinforcement in extensive high myopia of Chinese children

To observe the efficacy and safety of modified Snyder-Thompson posterior scleral reinforcement in extensive high myopia of Chinese children. We had a retrospective design, and included a control group of children with natural progression of high myopia. This study included 64 eyes in 41 Chinese children with extensive high myopia who underwent modified Snyder-Thompson posterior scleral reinforcement surgery (PSR group), and 17 eyes in 11 age- and myopia-matched children who wore spectacles (control group). The mean follow-up was 4.99 ± 1.3 years in the PSR group and 4.48 ± 1.3 years in the control group. Axial length, spherical equivalent (SE), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA) and fundus examinations were recorded before and after treatment, and complications were noted. The mean change in SE at the end of the follow-up period was 1.5 ± 1.44 diopters (D) and 3.02 ± 1.57D in the PSR and control groups respectively. These changes were equivalent to an increase in axial length of 1.27 ± 0.54 mm and 2.05 ± 0.91 mm respectively. The PSR group showed less myopic progression and less eye elongation (p < 0.001). A notable increase in UCVA was only found in the PSR group (p = 0.0001). The improvement in BCVA was significantly greater in the PSR group (p = 0.0354). There were no serious complications of PSR surgery. The modified Snyder-Thompson PSR surgery was effective and safe in controlling extensive high myopia of Chinese children.

Posterior chamber phakic intraocular lens implantation for correcting high myopia

Objective To evaluate the efficacy and safety of implanting a posterior chamber phakic intraocular lens to correct high myopia. Methods There were 117 eyes of 63 patients with high myopia. The range of preoperative myopia diopters was -5.25 - - 19.0D. The best corrected vision was ≥0.8 in 101 eyes and 0.5 - 0.6 in 15 eyes, and 〈 0.3 in one eye, The examine included uncorrected visual acuity （UC- VA） , corrected visual acuity, corneal endothelium, UBM,intraocular pressure, refraction, tonometry, kerame- ter, pachometer, axial length, depth of anterior chamber, horizontal corneal diameter （ white to white ）, and posterior mean evaluation after indirect ophthalmoscope examination. The posterior chamber phakic intraocu- lar lens manufactured with STAAR collamer was implanted though 3.0 mm sutureless temporal clear corneal incision under topical anesthesia. YAG laser peripheral iridectomy was performed before surgery to avoid pu- pil block glaucoma. The follow-up examination included visual acuity, refrection, tonometer, cornea, and space between crystal lens and IOL. Results 117 eyes implanting were successful , all eyes had a signifi- cant increase in uncorrected visual acuity, and a same or better corrected visual acuity, All eyes maintained a low negative power of refraction, but the patients managed most activities without spectacles. 2 case （ 2 eyes） were found cataract genesis under anterior capsular membrane. Conclusion The posterior chamber phakic IOL was predictable, safe, and efficacious in the correction of high myopic. Key words: High myopia ; Surgery ; Lens, artifical; Phakic eye