Mean Best Spectacle-corrected Visual Acuity Research Articles

Femtosecond astigmatic keratotomy for postkeratoplasty astigmatism

PurposeTo evaluate the initial outcomes of femtosecond laser arcuate keratotomies (AK) to correct high astigmatism after keratoplasty. MethodsThis retrospective non-comparative interventional study included 52 consecutive patients (52 eyes) who underwent Intralase-enabled arcuate keratotomies. Changes in uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), mean refractive and keratometric astigmatism, preoperative and postoperative manifest refraction and complications were the main outcome measures. ResultsThe mean follow-up period was 13.77±4.17months. Mean BCVA and UCVA improved statistically significantly from 0.30±0.18 LogMAR and 0.90±0.43 LogMAR preoperatively to 0.20±0.14 and 0.60±0.39 postoperatively respectively (P<0.05, all comparisons). Mean subjective cylinder decreased statistically significantly from 7.15±1.32D preoperatively to 5.19±2.25D at the last postoperative visit (P=0.0002). Two eyes (4%) lost one line or more of BCVA. Three patients (5.8%) had corneal perforation and only one eye required resuturing of the AK wound. Twelve patients (23%) were overcorrected. ConclusionsAK performed with the femtosecond laser was relatively easy to perform, safe, and effective for treating post-keratoplasty astigmatism. There was a significant improvement in UCVA and BCVA with a very low rate of complications. A larger series is required to refine the nomogram to achieve a greater reduction in cylinder.

Outcomes of Same-Size Host and Donor Trephine in Deep Anterior Lamellar Keratoplasty for Keratoconus

To evaluate the efficacy of the same-size host and donor trephine on reducing myopic refractive errors for patients with keratoconus when deep anterior lamellar keratoplasty (DALK) was used. Randomized controlled clinical trial. One hundred eighteen eyes of 118 patients with keratoconus were enrolled. Using stratified blocked randomization, eligible eyes were allocated into the same-size trephine group or oversize trephine group. Postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE), topography data, and eye axial length were compared at each year for 5 years. The same-size trephine group had comparable UCVA to the oversize trephine group through 5 years after surgery. But the former had better BSCVA than the latter after 3 years of follow-up. At 5 years, mean BSCVA was 0.17 ± 0.10 logMAR in the same-size trephine group vs 0.25 ± 0.13 logMAR in the oversize trephine group (P= .03). The same-size trephine group had lower topographic power than the oversize trephine group after 3 years of follow-up. At 5 years, mean topographic power was 45.30 ± 2.28 diopters (D) in the same-size trephine group vs 46.75 ± 2.60 D in the oversize trephine group (P= .006). Eye axial lengths at 5 years were longer than those preoperatively as well as at 1 year follow-up after surgery in both groups. The same-size host and donor trephine could reduce late-stage myopic refractive errors for the patients with keratoconus after DALK. The mechanism may be late-stage axial length increase with time.

Visual management of aphakia with concomitant severe corneal irregularity by mini-scleral design contact lenses

PurposeTo evaluate visual results, comfort of use, safety, and efficacy of mini scleral contact lenses in optical management in patients with traumatic aphakia and severe concomitant irido-corneal injury. MethodsIn a case series, eight eyes with post traumatic aphakia and severe concomitant irido-corneal injury that were evaluated at the Contact Lens Clinic of Farabi Eye Hospital, Tehran, Iran for contact lens fitting and could not be corrected with conventional corneal RGP contact lenses were fitted with miniscleral contact lenses. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and BCVA (Best corrected visual acuity) with miniscleral lens were recorded. Slit lamp examination, comfortable daily wearing time, and any contact lens-related complication were documented in each follow-up visit. ResultsThe mean UCVA and BSCVA of the cases was >2.7 and 0.41 LogMAR, respectively (BSCVA could not be assessed in one case due to severe corneal irregularity). The mean final BCVA with the miniscleral lens was 0.05 LogMAR (range from 0.4 to −0.04 LogMAR). The mean follow-up period was 14.6 months. The mean comfortable daily wearing time (CDWT) was 11.6 h, ranging from 8 to 16 h. The only contact lens-related complication was mild redness and irritation that was observed in 2 patients during the follow-up visits. All patients were comfortable with handling these lenses. ConclusionMiniscleral contact lenses can be considered a safe and effective option in aphakia patients with concurrent corneal scarring secondary to ocular injury for whom surgical intervention would be complicated.

Clinical Performance of Toris K Contact Lens in Patients with Moderate to Advanced Keratoconus: A Real Life Retrospective Analysis.

Objectives. To evaluate the visual performance of Toris K soft contact lenses in patients with moderate-to-advanced keratoconus and also to compare the results according to cone types, cone location, and severity of keratoconus. Materials and Methods. Sixty eyes of 40 participants were included in this retrospective study. Uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BCVA), best-contact lens corrected visual acuity (BCLCVA), and comfort rating via visual analogue scales (VAS) were measured. Results. The mean age was 27.3 ± 8.6 years (range: 18 to 54). The mean logMAR UCVA, BCVA, and BCLCVA were 0.85 ± 0.38 (range: 0.30–1.30), 0.47 ± 0.27 (range: 0.10–1.30), and 0.16 ± 0.20 (range: 0–1.00). There were significant increases in visual acuities with contact lenses (p < .05). BCLCVA was significantly better in oval type than globus type (p = .022). UCVA and BCLCVA were significantly better in moderate keratoconus group (p = .015, p = .018). The mean line gain in Snellen was 3.6 ± 1.8 lines (range: 0–7 lines). The mean line gain was higher in central cone group than paracentral cone group and oval group than globus group (p = .014, p = .045). The mean VAS score was 8.14 ± 1.88 (range: 6–10). Conclusions. Toris K can improve visual acuity of patients with keratoconus. Toris K is successful even in the moderate and advanced form of the disease.

Mini-scleral Contact Lens for Management of Poor Visual Outcomes after Intrastromal Corneal Ring Segments Implantation in Keratoconus.

Purpose:To evaluate the feasibility and efficacy of mini-scleral design (MSD) contact lenses to treat keratoconus patients who were unsatisfied with the results of corneal inlay.Methods:In this prospective interventional case series, 9 eyes of 6 keratoconus patients who were unsatisfied with the results of corneal inlay were fitted with MSD contact lenses. Demographic data, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and higher order aberrations (HOAs) were evaluated before contact lens fitting. Corrected visual acuity by placing the MSD contact lens with or without over-refraction, and HOAs were measured one hour after contact lens fitting. One month after contact lens wearing, corrected visual acuity by placing the MSD contact lens with over-refraction and possible contact lens related problems were assessed. Ocular comfort and contact lens handling problems were asked in follow-up visits. The data was analyzed using descriptive statistical tests.Results:Nine eyes of 6 patients were successfully fitted with the mini-scleral lens. Fitting was ideal in 7 eyes and acceptable in 2 eyes. Mean corrected visual acuity by placing the MSD lens without over-refraction was 0.09 (range, 0.00-0.15) LogMAR which was significantly better than the mean BSCVA of 0.38 (range, 0.2-0.6) LogMAR (P = 0.007). The mean root mean square (RMS) of third-order coma and trefoil significantly decreased after MSD contact lens fitting (P = 0.012 and P = 0.015, respectively); however, changes in the fourth-order spherical aberration were not statistically significant (P = 0.336).Conclusion:Mini-scleral contact lenses may be helpful in the management of visually unsatisfied patients after corneal inlay.

Descemet Stripping Endothelial Keratoplasty for Fuchs' Endothelial Corneal Dystrophy: Five-Year Results of a Prospective Study

To determine 5-year outcomes of Descemet stripping endothelial keratoplasty (DSEK) for Fuchs' endothelial corneal dystrophy (FECD). Prospective cohort study. Fifty-two eyes of 45 subjects with FECD undergoing primary DSEK. Subjects were examined before and at fixed intervals through 60 months after DSEK. At each visit, graft survival was determined by slit-lamp examination; best spectacle-corrected visual acuity (BSCVA) was measured using the electronic Early Treatment Diabetic Retinopathy Study (ETDRS) protocol; total anterior corneal higher-order aberrations (HOAs) were derived from corneal topography; and corneal backscatter, corneal thickness, and endothelial cell density were measured from confocal microscopy images. Corneal thickness also was measured by ultrasonic pachymetry. Changes after DSEK were analyzed using generalized estimating equation models. Best-corrected visual acuity, HOAs, endothelial cell loss, corneal thickness, and corneal backscatter. Complete 60-month follow-up was possible in 34 eyes. Mean BSCVA±standard deviation improved from 0.45±0.19 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent, 20/56) before DSEK to0.09±0.13 logMAR (Snellen equivalent, 20/25) at 5 years (P < 0.001). Between 1 and 5 years, BSCVA improved by 0.06 logMAR (or 3 ETDRS letters; 95% confidence interval, 0.05-0.07 logMAR) per year (P < 0.001), and 56% of eyes were 0.1 logMAR (20/25) or better at 5 years. Graft thickness (approximately 155 μm) and corneal thickness (approximately 700 μm) did not change after surgery. Anterior corneal HOAs and backscatter decreased between 1 and 5 years (P ≤ 0.002). Six grafts failed, of which 4 were primary (iatrogenic); mean endothelial cell loss±standard deviation was 55±15% at 5 years. Between 1 and 5 years after DSEK, BSCVA continues to improve such that at 5 years, more than half of eyes see better than 20/25 with a mean total corneal thickness of 700 μm. Improvement in vision is accompanied by continued reduction in corneal haze and aberrations, suggesting ongoing remodeling of the cornea after restoration of endothelial function.

Terrien Marginal Degeneration: Clinical Characteristics and Outcomes.

To describe outcomes of patients with Terrien marginal degeneration. Retrospective case series. Database review of 25 patients (43 eyes) seen over 10 years (2004-2013) at Toronto Western Hospital cornea clinic. Outcome measures included demographics, location of disease, topographic astigmatism, visual acuity, coexisting ocular disease, and surgical management. Mean age at presentation was 44 years (range, 20-82 years) and 54% were male. Eighteen patients (72%) had bilateral disease. Mean follow-up was 30.3months. Mean topographic astigmatism was4.02 diopters (D) at 5 degrees. Mean change in astigmatism 1 year from baseline was 0.75 D; at 2 years was 1.22 D; and at 3 years was 1.68 D. Mean best spectacle-corrected visual acuity (BSCVA) at presentation was 20/46 and 20/48 at last follow-up. Eyes requiring surgery (23.3%) had mean BSCVA of 20/81 at presentation and 20/106 after surgery. Five eyes perforated: 4 spontaneously, and 1 from trauma. Three eyes (6.9%) presented with pseudopterygium. Two eyes (4.7%) had intracorneal cysts. Fourteen patients (56%) presented with ocular surface inflammation. Terrien marginal degeneration is a slow-progressing, bilateral but asymmetric degeneration of the peripheral cornea. Men over 40 are more commonly affected. Stromal thinning, vascularization, lipid deposition, and against-the-rule astigmatism are classic signs. Though typically noninflammatory, a variant form characterized by prominent inflammation exists. Surgery (lamellar graft) can preserve corneal integrity and is indicated when conventional options fail to maintain vision or if perforation is imminent. Perforations are rare but can result in significant vision loss.

Deep layers of the cornea and basic research in Spain

To evaluate the clinical outcome of mid-stromal isolated Bowman layer transplantation, a new surgical technique to reduce and stabilize ectasia in eyes with advanced keratoconus, to postpone penetrating keratoplasty or deep anterior lamellar keratoplasty, and to enable continued daily contact lens wear.Prospective, nonrandomized cohort study at a tertiary referral center.Twenty-two eyes of 19 patients with progressive, advanced keratoconus not eligible for ultraviolet cross-linking.The mid-stroma was manually dissected and an isolated donor Bowman layer was positioned within the stromal pocket.Before and up to 36 months after surgery (mean follow-up, 21±7 months), best spectacle-corrected visual acuity (BSCVA), best contact lens–corrected visual acuity (BCLVA), Scheimpflug-based corneal tomography measurements, endothelial cell density, biomicroscopy, refraction, and intraoperative and postoperative complications were recorded.Two surgeries were complicated by an intraoperative perforation of Descemet membrane; no other intraoperative or postoperative complications were observed. Maximum keratometry decreased on average from 77.2±6.2 diopters (D) to 69.2±3.7 D (P < 0.001) at 1 month after surgery and remained stable thereafter (P ≥ 0.072). Mean BSCVA improved from 1.27±0.44 logarithm of the minimum angle of resolution units before surgery to 0.90±0.30 logarithm of the minimum angle of resolution units 12 months after surgery (P < 0.001), whereas BCLVA remained stable (P = 0.105). Mean thinnest-point pachymetry increased from 332±59 μm before surgery to 360±50 μm at the latest follow-up (P = 0.012), and no change in endothelial cell density was found (P = 0.355).With isolated Bowman layer transplantation, reduction and stabilization of corneal ectasia was achieved in eyes with progressive, advanced keratoconus. Given the low risk for complications, the procedure may be performed to postpone penetrating or deep anterior lamellar keratoplasty.

Large-diameter deep anterior lamellar keratoplasty for keratoconus: visual and refractive outcomes.

To investigate the difference in clinical outcomes between large-diameter deep anterior lamellar keratoplasty (L-DALK) and standard DALK (S-DALK) for the treatment of keratoconus. 132 patients (132 eyes) from the Zhongshan Ophthalmic Center with a clinical diagnosis of keratoconus were enrolled. The participants were featured by the intolerance to rigid gas-permeable contact lenses or unsuccessful fitting of contact lenses. Using stratified blocked randomisation, eligible eyes were allocated into the L-DALK group or the S-DALK group (66 eyes, respectively). Postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refractive sphere, manifest cylinder and spherical equivalent refractive error were tested at 6, 12, 18 and 24 months after surgery. After surgery, the L-DALK group had better UCVA and BSCVA than the S-DALK group (p=0.000 and 0.021, respectively). At 24 months, mean BSCVA was 0.17±0.10 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent, 20/25) in the L-DALK group vs 0.22±0.10 logMAR (Snellen equivalent, 20/32) in the S-DALK group. Differences were observed between the L-DALK group and the S-DALK group in terms of refractive sphere (p=0.015), manifest cylinder (p=0.014) and spherical equivalent refractive error (p=0.034) at any time interval postoperatively. At 24 months, the mean spherical equivalent refractive error was -3.5±3.2 D and -5.2±2.6 D in the L-DALK and S-DALK groups, respectively. L-DALK can reduce the degree of postoperative myopia and manifest astigmatism and improve visual acuity outcomes in keratoconus compared with S-DALK. Chinese Clinical Trial Registry (TRC-13003122).

Bowman Layer Transplantation to Reduce and Stabilize Progressive, Advanced Keratoconus

To evaluate the clinical outcome of mid-stromal isolated Bowman layer transplantation, a new surgical technique to reduce and stabilize ectasia in eyes with advanced keratoconus, to postpone penetrating keratoplasty or deep anterior lamellar keratoplasty, and to enable continued daily contact lens wear. Prospective, nonrandomized cohort study at a tertiary referral center. Twenty-two eyes of 19 patients with progressive, advanced keratoconus not eligible for ultraviolet cross-linking. The mid-stroma was manually dissected and an isolated donor Bowman layer was positioned within the stromal pocket. Before and up to 36 months after surgery (mean follow-up, 21±7 months), best spectacle-corrected visual acuity (BSCVA), best contact lens-corrected visual acuity (BCLVA), Scheimpflug-based corneal tomography measurements, endothelial cell density, biomicroscopy, refraction, and intraoperative and postoperative complications were recorded. Two surgeries were complicated by an intraoperative perforation of Descemet membrane; no other intraoperative or postoperative complications were observed. Maximum keratometry decreased on average from 77.2±6.2 diopters (D) to 69.2±3.7 D (P < 0.001) at 1 month after surgery and remained stable thereafter (P ≥ 0.072). Mean BSCVA improved from 1.27±0.44 logarithm of the minimum angle of resolution units before surgery to 0.90±0.30 logarithm of the minimum angle of resolution units 12 months after surgery (P < 0.001), whereas BCLVA remained stable (P = 0.105). Mean thinnest-point pachymetry increased from 332±59 μm before surgery to 360±50 μm at the latest follow-up (P = 0.012), and no change in endothelial cell density was found (P = 0.355). With isolated Bowman layer transplantation, reduction and stabilization of corneal ectasia was achieved in eyes with progressive, advanced keratoconus. Given the low risk for complications, the procedure may be performed to postpone penetrating or deep anterior lamellar keratoplasty.

Short-term outcome after artisan phakic intraocular lens implantation for treatment of high myopia

Purpose The aim of this study was to evaluate the efficiency and safety after artisan phakic intraocular lens (IOL) implantation for treatment of high myopia. Setting The study was conducted in Qena University Hospital. Methods This was a prospective nonrandomized interventional case study. A total of 28 eyes in 24 patients having myopia ranging from −13 to −21 D underwent implantation of artisan phakic IOL (Ophtec; polymethylmethacrylate lens). Eyes were examined at day 1, 1 week, 1, 2, and 4 months after surgery. At each visit, the following data were recorded: manifest refraction, uncorrected visual acuity, best spectacle corrected visual acuity (BSCVA), change in BSCVA, slit lamp examination, applanation tonometry, as well as any adverse effects. Results At 4 months postoperatively, the mean spherical equivalent was −1.5 D ± 0.6. The mean uncorrected visual acuity was 0.33 ± 0.17 and mean BSCVA was 0.48 ± 0.15. As regards the safety of artisan phakic IOL, the BSCVA remained the same or improved for all eyes; an average gain of 1.8 ± 0.62 lines of improvement was observed in 15 cases compared with preoperative BSCVA. Night glare/halos were noted in 10% of the eyes. Corneal edema was observed in one eye during the immediate postoperative period. Conclusion Artisan phakic IOL is a safe (short-term), efficient, and predictable modality for the treatment of high myopia. Improvement of postoperative vision is a valuable outcome.

Re-Evaluation of the Safety of Laser-Assisted Subepithelial Keratectomy

Purpose: Additional analyses of outcomes of laser-assisted subepithelial keratectomy (LASEK) are still necessary to improve the safety of LASEK. Therefore, in our study, outcomes were assessed retrospectively in 561 eyes that underwent LASEK treatment. Methods: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA) and residual spherical equivalent were analyzed at 3 and 6 months postoperatively. We assessed four subgroups based on the degree of preoperative myopia considering mean BSCVA and loss of two or more lines. Results: Mean UCVAs and BSCVAs were obtained at 3 and 6 months postoperatively (1.23/1.35 and 1.23/1.37, respectively). The mean predictability was within ±0.125 diopters. Conversely, the safety indexes were 0.94 and 0.96 respectively, and the efficacy indexes were 0.86 and 0.86 at 3 and 6 months postoperatively, respectively. 8.4% eyes and 5.2% eyes lost two or more lines of BSCVA at 3 and 6 months postoperatively, respectively. The mean BSCVAs of the high or ultra-high groups were significantly lower than those of the low or mild groups both 3 months and 6 months postoperatively. The incidence rates of losing two or more lines of BSCVA in the high or ultra-high myopia groups were significantly greater than in the low or mild groups at 3 months and 6 months postoperatively. Conclusion: LASEK predictably corrected myopia achieving >1.2 in UCVA and BSCVA. However, the safety and efficacy indexes were

Nicotinic Acid Treatment for Retinal Vein Occlusion

Objectives: To evaluate the effect of nicotinic acid in management of retinal vein occlusions (CRVO or BRVO). Materials and Methods: This prospective nonrandomized pilot study included 20 patients (21 eyes) with CRVO or BRVO that received nicotinic acid (3 g/day) for 3 months. A complete ophthalmologic examination uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), testing for a relative afferent pupillary defect (RAPD), slit-lamp examination, gonioscopy, intraocular pressure (IOP) measurement, fundoscopy and fundus photography was performed. Results: Four patients did not appear for follow-up and hypersensitivity reaction to nicotinic acid and severe hyperglycemia happened in two patients. Therefore, the results of treatment in 16 eyes of 15 are reported. These patients had a mean age of 59.56 ± 11.12 years. The average length of follow-up was 8.6 ± 2.7 months. The mean BSCVA was 1.56 ± 0.66 before treatment, 1.38 ± 0.72 (p >0.05) at one month and 0.88 ± 0.69 (p<0.01) at three months. The last BSCVA of all 16 eyes averaged 0.97 ± 0.73 (p<0.01). All patients had reduction of hemorrhagic events, cotton wool spots, edema in macula and disc, venous tortuosity, and dilation on basis of fundus photographs 3 months after treatment. Conclusion: Nicotinic acid usage provides enough time for development of collateral vessels, by induction of vasodilatation. Nicotinic acid use is tolerable and is related with mild systemic side effects.

Perioperative complications and clinical outcomes of intraocular lens exchange in patients with opacified lenses

To evaluate the perioperative complications and the outcomes of intraocular lens (IOL) exchange in patients with opacified lenses. Retrospective multicentrical consecutive series of cases that comprised 22 eyes from 21 patients who had previous phacoemulsification with implantation of an IOL in the capsular bag and developed severe late opacification of the IOL. All patients had loss of vision and reported light disturbances. The IOLs were explanted and replaced with new IOLs. The perioperative complications were evaluated. The best spectacle-corrected visual acuity (BSCVA) before and after the surgery was compared. The mean time lapsed between the original cataract surgery and the IOL exchange surgery was 89.1 ± 33.6 [48-216] months. The IOL exchange was uneventful in 14 eyes (63.6 %). Anterior vitrectomy was needed in seven cases (31.8 %). Other complications included zonular dehiscence in one case (4.5 %). In most of the cases, 14 eyes (63.6 %), the IOL was implanted in the sulcus. The most explanted IOL was the Hydroview H60M (Bausch & Lomb). The mean BSCVA (LogMAR) before and after the surgery were 0.57 ± 0.69 (0.10-3) and 0.18 ± 0.22 (0.0-1.10) respectively (t paired test, p < 0.001). After the operation, 20 eyes (90.9 %) achieved a BSCVA ≤ 0.3. No eye lost 1 or more lines of corrected vision after the surgery. IOL exchange surgery, although associated with a high incidence of complications, restores and significantly improves the visual acuity of patients with opacified IOLs.

Ultrathin Descemet's Stripping Automated Endothelial Keratoplasty with the Microkeratome Double-Pass Technique: Two-Year Outcomes

To evaluate the outcomes and graft survival rates after ultrathin (UT) Descemet's stripping automated endothelial keratoplasty (DSAEK) using the microkeratome-assisted double-pass technique. Prospective, consecutive, interventional case series. Patients with endothelial decompensation of various causes (Fuchs endothelial dystrophy, pseudophakic or aphakic bullous keratopathy, failed previous graft, herpetic endotheliitis, or buphthalmus; n = 285 grafts). Donor preparation was performed using the microkeratome-assisted double-pass technique. Stripping of the Descemet's membrane was performed under air and the graft was delivered into the anterior chamber using the pull-through technique through a 3-mm clear-cornea incision using a modified Busin glide. Best spectacle-corrected visual acuity (BSCVA), manifest refraction, endothelial cell density, and graft thickness (GT). Excluding all eyes with pre-existing ocular comorbidities, mean BSCVA at 3, 6, 12, and 24 months was 0.16, 0.11, 0.08, and 0.04 logarithm of the minimum angle of resolution units, respectively. The percentage of patients achieving BSCVA of 20/20 or better at 3, 6, 12, and 24 months was 12.3%, 26.3%, 39.5%, and 48.8%, respectively. A statistically significant (P < 0.0001) hyperopic shift of 0.78 ± 0.59 diopters (D; range, -0.75 to 1.75 D) was found at 1 year. The endothelial cell loss at 3, 6, 12, and 24 months was 29.8 ± 14.3%, 33 ± 15.5%, 35.6 ± 14.1%, and 36.6 ± 16.0%, respectively. The mean central GT recorded 3 months after surgery was 78.28 ± 28.89 μm. Complications included microkeratome failure to achieve perfect dissection in 21 donor tissues (7.2%), with 6 (2.1%) being discarded; total graft detachment in 11 cases (3.9%); primary failure in 4 cases (1.4%); and secondary failure in 4 additional cases (1.4%). Kaplan-Meier cumulative probability of a rejection episode at 3, 6, 12, and 24 months was 0%, 0.4%, 2.4%, and 3.3%, respectively. The visual outcomes of UT DSAEK are comparable with those published for Descemet's membrane endothelial keratoplasty and better than those reported after DSAEK in terms of both speed of visual recovery and percentage of patients with 20/20 final visual acuity. However, unlike with Descemet's membrane endothelial keratoplasty, preparation and delivery of donor tissue are neither difficult nor time consuming. Complications of UT DSAEK do not differ substantially from those recorded with standard DSAEK but are much less frequent than those reported after Descemet's membrane endothelial keratoplasty. Proprietary or commercial disclosure may be found after the references.

Split Cornea Transplantation: Relationship between Storage Time of Split Donor Tissue and Outcome

To analyze the relationship between storage time of split donor tissue and outcomes after deep anterior lamellar keratoplasty (DALK) and Descemet's membrane endothelial keratoplasty (DMEK). Retrospective analysis of a nonrandomized, consecutive, interventional case series. One hundred ten eyes with anterior stromal disease suitable for DALK and 110 eyes with endothelial disease suitable for DMEK underwent surgically successful split cornea transplantation combining both procedures within 7 days after splitting. Split donor storage times (splitting to grafting) and total storage times (death to grafting) were correlated with the 1-year functional and morphologic outcomes after DALK and DMEK surgery using a Spearman correlation coefficient and a Mann-Whitney U test. Best spectacle-corrected visual acuity (BSCVA), endothelial cell density, and complication rates within 12 months of follow-up. The mean split donor storage time was 35 ± 47 hours (range, 0-162 hours) after splitting for anterior donor grafts and 21 ± 40 hours (range, 0-158 hours) for posterior grafts. The mean total storage time was 352 ± 108 hours (range, 108-678 hours) for anterior lamellas and 339 ± 109 hours (range, 96-630 hours) for posterior lamellas. One year after DALK, the mean BSCVA was 20/30 (range, 20/50-20/20), endothelial cell loss was 8% (range, 2%-16%), and the complication rate (Descemet's folds, epitheliopathy, loose sutures) was 18%. One year after DMEK, the mean BSCVA was 20/25 (range, 20/40-20/16), endothelial cell loss was 41% (range, 17%-63%), and the complication rate (partial graft detachment) was 62%. For DALK and DMEK, no significant association was observed between split donor storage time as well as total storage time and BSCVA (P ≥ 0.409), endothelial cell loss (P≥0.236), or complication rate (P ≥ 0.647) within 1 year of follow-up. Anterior and posterior donor tissue may be stored safely for up to 1 week in organ culture before use in DALK and DMEK surgery. This simplifies the clinical feasibility of split cornea transplantation to reduce donor shortage and cost in corneal transplantation in the future. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Comparison of Outcomes of Posterior Chamber and Iris-Claw Anterior Chamber Phakic Intraocular Lens Implantation for Moderate to High Myopia

Purpose: To compare visual acuity and contrast sensitivity between Posterior Chamber Phakic Intraocular Lens (ICL) and Iris-Claw Anterior Chamber Phakic Intraocular Lens (Artiflex) implantation for moderate to high myopia. Setting: Dr. Lutfi Kirdar Kartal Training and Research Hospital, Eye Clinic, Istanbul, Turkey. Participants: Sixty eyes of 30 myopic patients were included in the study. Thirty eyes of 15 patients underwent implantation of ICL (24)/ toric ICL (6) and 30 eyes of 15 patients underwent implantation of Artiflex. Methods: Preoperative and postoperative 1, 6 and 12 months, logarithm of the minimum angle of resolution (log MAR) uncorrected visual acuity (UCVA), log MAR best spectacle-corrected visual acuity (BSCVA), manifest refraction, intraocular pressure (IOP), endothelial cell density (ECD) and complications were evaluated. Contrast sensitivity (CS) was also evaluated at 1.5, 2.52, 4.23, 7.10 and 11.91 cycles per degree spatial frequencies by CC-100 Topcon LCD preoperative and postoperative 1-year. Main outcome measures: Improvement in visual acuity (VA) and CS, percentage change in ECD and IOP. Results: Preoperatively, there was no significant difference in the mean UCVA, BSCVA and CS between the ICL and Artiflex groups (p=0.798; 0.672; 0.510) and the mean spherical equivalent (SE) was significantly better in the ICL group than the Artiflex group (p=0.003). One year postoperatively, the mean UCVA and BSCVA were significantly better in the ICL group than the Artiflex group (p=0.002; 0.0001). We found no significant difference in the mean SE between the ICL and Artiflex groups (p=0.809). The mean photopic CS increased considerably at all spatial frequencies compared with preoperative levels in the ICL and Artiflex groups (p=0.0001) Conclusion: After 1-year follow-up, the phakic IOLs performed well in correcting moderate to high myopia. Preoperatively and 1-year postoperatively, there was no significant difference in the mean photopic CS between the ICL and Artiflex group at all spatial frequencies. No vision-threatening complications occurred during the observation period.

Preliminary Results of Femtosecond Laser Assisted Corneal Ring Segment Implantation for Keratoconus

ABSTRACT Purpose To present refractive, visual and topographic outcomes of femtosecond laser assisted intrastromal ring segments (ISRS) implantation. Settings Bascom Palmer Eye Institute, Miami, FL, USA. Materials and methods Nineteen eyes of 15 patients with keratoconus, clear central corneas, and contact lens intolerance had implantation of a symmetrical 0.45 mm Inta cs segment (Addition Technology Inc, California, USA) using 200 kHz femtosecond laser (WaveLight GmbH, Erlangen, Germany). The outcomes of the procedure were evaluated in terms of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), average keratometry value (K-value) and spheric equivalent (SE). Results Femtosecond laser assisted ISRS implantation could be performed with ease, while no intra- or postoperative complications were encountered. Mean UCVA improved from 0.95 ± 0.39 to 0.66 ± 0.28 logMAR, mean BSCVA improved from 0.46 ± 0.13 to 0.29 ± 0.21 logMAR, mean spherical equivalent considerably reduced from −7.15 ± 4.57 to −4.38 ± 4.07 and K value reduced from 52.39 ± 5.79 to 49.78 ± 6.84 D at the last follow-up. Conclusion Using a 200 kHz femtosecond laser is a safe procedure providing optimal refractive, visual and topographic outcomes in our preliminary study. How to cite this article Ozulken K, Cabot F, Kankariya VP, Yoo SH. Preliminary Results of Femtosecond Laser Assisted Corneal Ring Segment Implantation for Keratoconus. Int J Kerat Ect Cor Dis 2013;2(2):47-50.

Comparative Evaluation of Topical versus Intrastromal Voriconazole as an Adjunct to Natamycin in Recalcitrant Fungal Keratitis

To compare the efficacy of topical voriconazole and topical natamycin with that of intrastromal voriconazole and topical natamycin in patients with recalcitrant fungal keratitis. Randomized clinical trial. Forty eyes of 40 patients with fungal keratitis (positive smear or culture results or both) larger than 2 mm, involving up to two thirds of the stromal depth, and not responding to topical natamycin therapy for 2 weeks were recruited. The patients were randomized to receive either topical 1% voriconazole therapy (n = 20) or intrastromal injections of voriconazole 50 μg/0.1 ml (n = 20). The patients in both groups continued topical natamycin 5% every 4 hours until the ulcer healed. Primary outcome measure was best spectacle-corrected visual acuity (BSCVA) 3 months after intervention, and secondary outcome measures were time to healing and the size of the scar. The patients in both groups had comparable baseline parameters. The mean BSCVA after treatment was 1.295 ± 0.5 logarithm of the minimum angle of resolution (logMAR) units in the topical group and 1.692 ± 0.29 logMAR units in the intrastromal group. The visual acuity after treatment was significantly better in the topical voriconazole group (P = 0.008). Nineteen patients receiving topical voriconazole and 16 patients who were given intrastromal voriconazole healed with therapy. Topical voriconazole seems to be a useful adjunct to natamycin in fungal keratitis not responding to topical natamycin. Intrastromal injections did not offer any beneficial effect over topical therapy.

OPTICAL AND FUNCTIONAL PERFORMANCE OF PHAKIC ANGLE-SUPPORTED INTRAOCULAR LENS FOR THE CORRECTION OF HIGH MYOPIA IN 18-MONTHS FOLLOW-UP STUDY

To investigate the safety, the efficacy and stability of the AcrySof phakic angle-supported intraocular lens (IOL) (Alcon Laboratories, Inc., Fort Worth, TX) for correction of moderate-to-high myopia in adults. 12 patients (18 eyes) with moderate-to-high myopia underwent implantation of the AcrySof phakic angle-supported IOL. Best spectacle-corrected visual acuity (BSCVA), uncorrected distance visual acuity (UCVA), predictability and stability of mean manifest refraction spherical equivalent (MRSE), adverse events, endothelial cell density, corneal and total ocular aberrations and rotation of the IOL were measured. The mean follow-up was 18 months (± 4 months). At 18 months, the mean UDVA was 0.83 and the mean BSCVA was 0.97. The mean MRSE was -0.29 D. The mean percentage change in central endothelial cell density 18 months after surgery was -3.4%. No adverse events were observed. Wavefront measurements revealed a significant reduction in terms of high order aberrations between pre-operative and post-operative 18 months values. The analysis of the rotation showed a little variation (mean rotation of 5.4°) between postoperative 1 month and postoperative 18 months visits. The AcrySof phakic angle-supported IOL yielded excellent refractive correction and predictability with optimal safety. The study demonstrates preliminary support for an high stability of the IOL at 18 months follow-up.