Mean Preoperative Corrected Distance Visual Acuity Research Articles

Ten-year results of scleral-fixated intraocular lens implantation: outcomes of ab externo scleral fixation with 10-0 polypropylene suture.

To describe long-term visual and anatomical outcomes of sutured scleral-fixated intraocular lens (SF IOL) implantation. Tertiary eyecare hospital in India. Retrospective interventional noncomparative study. Postoperative change in corrected distance visual acuity (CDVA) and occurrence of complications were assessed from the patient medical records. Long-term SF IOL survival rates and factors affecting the occurrence of postoperative IOL-related complications were assessed. Patients with postoperative follow-up less than 10 years or incomplete medical records were excluded. 64 eyes of 53 patients were included. Follow-up duration was 11.4 ± 1.2 years. Mean preoperative CDVA was 0.71 ± 0.43 logMAR (Snellen equivalent: 6/30), and mean CDVA at the final visit was 0.52 ± 0.49 logMAR (Snellen equivalent: 6/18) (P < .01). 48% cases had CDVA of 6/12 or better at the last follow-up. 58% cases had coexistent ocular pathology affecting the final visual outcome. IOL and suture-related complications were the commonest and included IOL decentration (17% cases), IOL drop (14%), and suture exposure (6%). The probability of IOL survival (postoperative period without IOL-related complications) was 90.6% at 8 years and 81.2% at 10 years (Kaplan-Meier analysis). Occurrence of postoperative IOL-related complications was unaffected by patient sex, age, indication for surgery (trauma or other), previous intraocular surgery, or technique of scleral fixation (2-point or 4-point) (multivariate regression analysis). Although sutured SF IOL implantation is viable with favorable long-term visual outcomes, there is a risk of postoperative IOL-related complications. Occurrence of postoperative IOL-related complications is unaffected by patient and ocular factors.

Allograft corneal ring segment for keratoconus management: Istanbul nomogram clinical results.

To evaluate the clinical feasibility and visual outcomes of allograft corneal ring segment implantation for the treatment of keratoconus. This case series, included forty-four eyes of 32 patients with a 6-month follow-up. All cases were treated according to the Istanbul nomogram. In the Istanbul Nomogram, corneal tunnels of 4 × 7.5 mm diameters are created at depth of 200 μm and implanted with sterile allograft corneal rings (KeraNaturalTM, Lions VisionGift, Portland, OR, USA) at the cone location. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and keratometric values were compared preoperatively versus postoperatively. There was significant improvement in UDVA, CDVA, SE and topographic keratometric values. The mean preoperative CDVA (Snellen, decimal) increased from 0.29 ± 0.20, to 0.56 ± 0.26 (P < 0.001), at the last visit. There was no statistically significant difference between preoperative and postoperative thinnest pachymetry values (P = 0.509). No major complications or adverse event were observed during and after the operation. The results of this pilot study show that sterile allograft corneal ring segments may be safe, effective and enhance the visual performance of keratoconus patients. Larger clinical studies are needed to demonstrate the effectiveness and safety with long term follow-up.

Effect of corneal epithelial remodeling on visual outcomes of topography-guided femtosecond LASIK.

To assess the effect of epithelial remodeling on visual outcomes over a 9 mm diameter corneal surface after topography-guided laser in situ keratomileusis (LASIK) for myopia correction using spectral-domain anterior segment optical coherence tomography (AS-OCT). Outpatient clinical practice at the Stanford University Byers Eye Institute in Palo Alto, California. Prospective nonrandomized observational study. Visual acuity, including uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), 5% and 25% contrast sensitivity CDVA, manifest refraction, and corneal epithelial thickness after topography-guided femtosecond LASIK were analyzed. Corneal epithelial thickness was mapped across 13 sections and 3 concentric zones using AS-OCT preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. 60 eyes of 30 patients with a mean age of 32.8 years (range 23 to 52 ± 7.03 years) undergoing myopic LASIK correction were assessed. In eyes with complete follow-up data (n = 30), mean preoperative UDVA was logMAR 1.48 ± 0.45 and logMAR -0.11 ± 0.08 at postoperative 12 months. Mean preoperative CDVA was logMAR -0.08 ± 0.11 and logMAR -0.13 ± 0.07 at 12 months. Linear mixed modeling demonstrated a significant correlation between improvement in UDVA and decreased superior and nasal corneal epithelial thickness and between improvement in CDVA and increased central epithelial thickness 12 months postoperatively. Improvement in UDVA and CDVA at 12 months after topography-guided femtosecond LASIK was correlated with nonuniform epithelial remodeling, including epithelial thickening in the central zone and thinning in the superior and nasal sections as measured by AS-OCT.

Phacoemulsification with double-in-bag intraocular lens implantation in nanophthalmic eyes with angle-closure glaucoma.

To report the outcomes of phacoemulsification with piggyback intraocular lens (IOL) implantation, with double-in-bag IOLs in the management of angle-closure glaucoma (ACG) in nanophthalmic eyes. This is a retrospective case series on nanophthalmic eyes with variable presentations of ACG. Phacoemulsification with double-in-bag IOL implantation was done for the included eyes. Baseline and follow-up corrected distance visual acuity (CDVA), spherical equivalent (SE), intraocular pressure (IOP), and the number of glaucoma medications were evaluated. Surgical details were extracted, and complications were recorded. Six eyes of three patients were included. The mean axial length was 17.24 ± 1.02mm. The mean preoperative IOP was 20 ± 2.7mmHg with medical treatment. The mean preoperative CDVA (logMar) was 0.83 ± 0.37 with mean SE 12.7 ± 1.77 diopters. The mean postoperative IOP at 3-month and 1-year follow-ups was 14 ± 5.3mmHg and 15.5 ± 4.1mmHg, respectively. Postoperative CDVA was 0.78 ± 0.41, with mean SE -0.04 ± 2 diopters. No significant intraoperative or postoperative complications were reported. One eye developed posterior capsule opacification (PCO), and another eye developed visually insignificant inter-lenticular opacification (ILO). In the evaluated nanophthalmic eyes with ACG, lens extraction with double-in-bag IOL implantation showed promising results regarding the IOP control as well as the visual and refractive outcomes.

Outcomes After Corneal Crosslinking for Keratoconus in Children and Young Adults.

The aim of this study was to assess the effect of corneal crosslinking on vision and keratometry in children and young adults with progressive keratoconus. A retrospective medical records review of patients aged 22 years or younger with keratoconus who underwent corneal crosslinking between January 2013 and November 2019 at Byers Eye Institute at Stanford University was conducted. Outcome measures included logarithm of the Minimum Angle of Resolution corrected distance visual acuity (CDVA); keratometry, including maximum keratometry (Kmax); pachymetry; and total wavefront aberration. Measurements were taken at baseline and at 12 and 24 months postoperatively. Fifty-seven eyes of 49 patients aged 12 to 22 years were assessed. The mean preoperative CDVA was logarithm of the Minimum Angle of Resolution 0.38 ± 0.32 (20/48), with a mean postoperative CDVA of 0.29 ± 0.31 (20/39) and 0.31 ± 0.31 (20/41) at 12 and 24 months postoperatively, respectively. Compared with preoperative mean Kmax, there was an improvement of -0.8 diopters (D) to a mean postoperative Kmax of 59.1 ± 9.1 D at 12 months and -1.3 D to 59.7 ± 8.8 D at 24 months. Subanalysis excluding the second eye of patients who underwent bilateral crosslinking showed similar results. Linear mixed modeling showed significant improvement in Kmax at both 12 and 24 months postoperatively. Minimum central corneal thickness initially decreased but stabilized at 24 months after crosslinking. Total wavefront aberration remained stable. Corneal crosslinking stabilizes, and in some cases improves, visual and corneal parameters in pediatric and young adult patients with keratoconus. The procedure is safe and well-tolerated and may prevent keratoconus progression in young patients.

Outcomes of Cultivated Oral Mucosal Epithelial Transplantation in Eyes With Chronic Stevens-Johnson Syndrome Sequelae

To study the outcomes of cultivated oral mucosal epithelial transplantation (COMET) in eyes with chronic Stevens-Johnson syndrome (SJS) sequelae. Prospective interventional case series. Forty-five eyes of 41 patients with chronic SJS sequelae were recruited and evaluated from 2013 to 2017 in an institutional setting. All patients underwent COMET, with an aim of fornix reconstruction and visual rehabilitation. Change in corrected distance visual acuity (CDVA), severity scores of various ocular surface parameters, and the occurrence of complications were documented during a follow up period of 2 years. Attainment and maintenance of a stable ocular surface, as assessed by change in the ocular surface severity scores was the primary outcome measure, while change in CDVA was the secondary outcome measure. The mean preoperative CDVA was 2.7± 0.5 logMAR, which improved to 1.5± 0.7 logMAR and 1.49± 0.98 postoperatively, at 1- and 2-year follow-up visit. Overall, 82.2% eyes (37/45) had improvement in visual acuity, 13.3% (6/45) experienced no change, whereas 2 eyes (4.4%) had worsening of visual acuity. The total ocular surface severity scores improved from a mean preoperative value of 29.1± 9.7 to 18.7± 7.2 postoperatively, at 2-year follow-up. Two eyes developed persistent epithelial defects, with progression to corneal melting requiring keratoplasty. COMET allows successful and sustained restoration of ocular surface anatomy with functional improvement, in eyes with chronic sequelae of SJS.

Refractive Outcomes After Femtosecond Laser-Assisted Cataract Surgery in Eyes With Anterior Chamber Phakic Intraocular Lenses.

To report the efficacy, predictability, and safety of femtosecond laser-assisted cataract surgery (FLACS) in eyes with anterior chamber phakic intraocular lenses (IOLs). This retrospective case series included eyes with previous implantation of an angle-supported and an iris-fixated phakic IOL for the correction of myopia that underwent a combined procedure of phakic IOL ex-plantation and FLACS with in-the-bag implantation of a posterior chamber IOL. Postoperative corrected distance visual acuity (CDVA), predictability of refractive outcome, and occurrence of intraoperative and postoperative complications were analyzed. Ten eyes of 7 patients with significant cataract were included: 5 eyes with an angle-supported foldable hydrophobic phakic IOL, 4 eyes with an angle-supported polymethylmethacrylate (PMMA) phakic IOL, and 1 eye with an iris-fixated PMMA phakic IOL. Mean follow-up after FLACS was 8.4 ± 5.8 months. Mean interval between phakic IOL implantation and FLACS was 11.9 ± 4.0 years. After the combined procedure of phakic IOL explantation and FLACS, mean manifest refractive spherical equivalent (MRSE) was -0.11 ± 0.49 diopters (D) and MRSE was within ± 0.75 D of target refraction in all eyes. Four eyes received a toric posterior chamber IOL after phacoemulsification. Mean preoperative CDVA of 0.40 ± 0.23 logMAR improved significantly to 0.22 ± 0.11 logMAR postoperatively (P = .027). No intraoperative or postoperative complications occurred. The results in this series showed that FLACS in eyes with previous implantation of both rigid and foldable anterior chamber phakic IOLs offers good refractive outcomes with a high level of predictability and safety. [J Refract Surg. 2018;34(5):338-342.].

Long-term outcome of scleral-fixated posterior chamber intraocular lens implantation with the knotless Z-suture technique

To assess the long-term results and complications of scleral-fixated posterior chamber intraocular lenses (PC IOLs) with the knotless Z-suture technique. University Eye Hospital, Tübingen, Germany. Retrospective case series. Records of consecutive patients who had implantation of scleral-fixated PC IOLs with the knotless Z-suture technique with a minimum follow-up of 3years were reviewed. Sixty-six eyes of 62 patients were included. The meanpreoperative corrected distance visual acuity (CDVA) was0.71 logarithm of the minimum angle of resolution (logMAR)±0.58 (SD). The mean CDVA was 0.67±0.54 logMAR (P=.257; n=66) after 3years, 0.73±0.55 logMAR (P=.399; n=60) after 5years, 0.8±0.68 logMAR (P=.348; n=30) after 8years, and 1.09±0.76 logMAR (P=.069; n=13) after 10years. Failure because of suture breakage was observed in 11 eyes (16.7%) after a mean of 7.5years. Kaplan-Meier time-to-event analysis showed a 40% failure probability after 10years. Traumatic aphakia was the only risk factor for failure (odds ratio 4.1; 95% confidence interval, 1.0-18.3; P=.049). Complications included retinal detachment (15%), cystoid macular edema (9%), increased intraocular pressure requiring surgical intervention (7.6%), corneal edema (4.5%), and posterior iris-chafing syndrome with microhyphema (3%). Implantation of scleral-fixated PC IOLs using the knotless Z-suture was a safe technique resulting in good visual outcomes. The long-term success of the procedure was dependent on the material properties of the suture.

Consecutive case series of 244 age-related macular degeneration patients undergoing implantation with an extended macular vision IOL.

To determine safety and visual outcomes in eyes with age-related macular degeneration (AMD) implanted with a novel intraocular lens (IOL) that delivers an optimized retinal image to all macular areas within 10 degrees of retinal eccentricity. This was a consecutive case series of 244 eyes with dry/stable wet AMD and logMAR visual acuity ≥0.3 implanted with iolAMD Eyemax monoTM (London Eye Hospital Pharma), a single-piece, injectable, hydrophobic acrylic IOL sited in the capsular bag. Primary outcome was safety. Secondary outcomes were changes in corrected distance visual acuity (CDVA) and corrected near visual acuity (CNVA) (logMAR). Mean age at surgery was 80 years. Mean duration of follow-up was 3 months (range 1-16 months). No eyes had worsening of CDVA. Frequency of perioperative complications was equivalent to standard IOL implantation. Postoperative refractive outcomes were within ±1 D of the target refraction in 88% of cases. Mean preoperative CDVA improved from 1.06 to 0.71 postoperatively (mean of differences -0.35; 95% confidence interval [CI] -0.3886 to -0.3223; p<0.0001), equating to an approximate Early Treatment Diabetic Retinopathy Study gain of 18 letters. Mean preoperative CNVA (N-point; logMAR conversion) improved from 1.36 to 0.88 postoperatively (mean of differences -0.48; 95% CI -0.53 to -0.44; p<0.0001). This novel IOL appears safe in the short to medium term. Improvements in postoperative CDVA and CNVA exceed those observed with standard implants.

Intraoperative Macula Protection by Perfluorocarbon Liquid for the Metallic Intraocular Foreign Body Removal during 23-Gauge Vitrectomy.

Purpose. To evaluate visual and safety outcomes of 23-gauge (G) pars plana vitrectomy (PPV) with application of perfluorocarbon liquid (PFCL) for intraoperative protection of the macula during intraocular foreign body (IOFB) removal. Methods. Retrospective study of 42 patients who underwent 23 G PPV for IOFB removal from posterior segment with intraoperative PFCL application for the macula shielding. Collected data included corrected distance visual acuity (CDVA), size of IOFB, and complication rate. The mean follow-up period was 12 months. Results. The mean preoperative CDVA was 0.54 logMAR (SD 0.46), and the final mean CDVA was 0.68 logMAR (SD 0.66). All IOFBs were metallic with mean dimensions of 4.6 mm × 2.1 mm. Twenty-two IOFBs were removed through the corneal tunnel and 20 IOFBs through the sclerotomy. No intraoperative iatrogenic lesion of the macula was observed. As a tamponade, silicon oil was applied in 31 eyes, SF6 gas in 5 eyes, air in 4 eyes, and 2 eyes required no tamponade. Secondary retinal detachment was observed in 17% of cases, but at the end of the follow-up, all the retinas were attached. Conclusion. PFCL application during PPV is a safe method of protecting the macula from unexpected falling of the metallic IOFB during its removal.

Cataract surgery in patients with chronic severe graft-versus-host disease

To evaluate the surgical outcomes of cataract extraction with phacoemulsification and intraocular lens implantation in patients with severe chronic ocular graft-versus-host disease (GVHD). University of South Florida Eye Institute, Tampa, Florida, USA. Retrospective case study. A chart review was performed to identify patients with clinically severe, biopsy-proven chronic ocular GVHD who had cataract extraction. Outcome parameters included preoperative andpostoperative corrected distance visual acuity (CDVA), type of cataract, postoperative complications, type of underlying malignancy, and time from bone marrow transplant to cataract extraction. This study comprised 10 eyes of 6 patients with severe GVHD. Posterior subcapsular cataract accounted for all cataracts that were surgically removed in this patient cohort. The mean preoperative CDVA was 20/84, which improved to 20/30 at the 1-month postoperative visit and remained stable at 20/28 at the final visit noted in the charts (both P<.05). Two patients developed postoperative corneal melting. All but 1 patient had improved visual acuity after surgery. With meticulous preoperative biometric measurements and calculations and aggressive assessment and treatment of dry-eye syndrome, patients with severe ocular GVHD who had cataract extraction had excellent postsurgical refractive outcomes. Postoperative corneal melting was a complication seen with greater frequency than anticipated in this patient cohort. None of the authors has a financial or proprietary interest in any material or method mentioned.

Subluxated cataract lens surgery using sutured segments or rings and implantation of toric intraocular lenses

To evaluate the intraoperative performance and postoperative outcomes of toric intraocular lens (IOL) with suture ring implantation in adult patients with subluxated lenses. Department of Ophthalmology, Kaiser Permanente, Santa Clara, California, and the Eye Institute of Utah, Salt Lake City, Utah, USA. Retrospective case review. Eyes with subluxated cataractous lenses and preoperative corneal astigmatism having toric IOL implantation with a sutured ring or segment were studied. Preoperative and postoperative analyses included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and cylindrical power postoperatively and 3, 6, and 12 months postoperatively. Twenty-one eyes of 15 patients were studied. The median follow-up was 14.6 months. The mean CDVA at the final follow-up (0.10 logMAR ± 0.15 [SD]) was significantly improved from the mean preoperative CDVA (0.73 ± 0.40 logMAR). Postoperative cylindrical power was significantly improved in all patients (mean reduction in astigmatism 2.37 ± 1.46 diopters). Patients who required postoperative enhancement had anterior laser capsulotomy for bilateral capsule phimosis (2 eyes), photorefractive keratectomy (1 eye), pupilloplasty (1 eye), and posterior laser capsulotomy (2 eyes). Cataract removal and implantation of a toric IOL combined with a sutured ring or segment capsule stabilizing device was a safe and efficacious long-term solution for patients with subluxated cataract lenses and corneal astigmatism.

Outcomes of anterior chamber intraocular lenses placed by surgeons in training

To evaluate risk factors and outcomes of unplanned, primary anterior chamber intraocular lenses (AC IOLs) placed by surgeons in training. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. Retrospective case series. Cataract surgeries performed primarily by a resident surgeon that resulted in an unplanned AC IOL were included. Cases that had concomitant retinal surgery were excluded. Preoperative data gathered included corrected distance visual acuity (CDVA), intraocular pressure (IOP), and ocular comorbid conditions. Operative times and complications requiring an AC IOL were assessed. Postoperative CDVA, IOP, corneal edema, persistent intraocular inflammation, macular edema, and need for additional surgery were analyzed for the first postoperative year. Twenty-two eyes were included. The mean preoperative CDVA was 1.24 logMAR ± 0.92 SD and the mean preoperative IOP was 17.55 ± 3.88 mm Hg. The mean operative time was 103 ± 30 minutes. The most common operative complications necessitating an AC IOL were 7 (32%) capsule tears with vitreous prolapse requiring anterior vitrectomy and 7 (32%) capsule tears, zonular dehiscence, and vitreous prolapse requiring anterior vitrectomy. By the first postoperative year, the mean visual acuity was 0.40 ± 0.58 logMAR and the IOP was 15.05 ± 6.01 mm Hg. The most common complications 1 year postoperatively included persistent macular edema (23%) and need for additional surgery (18%). This group of patients who received unplanned primary AC IOLs by surgeons in training had improved visual acuity and well-controlled IOP 1 year postoperatively. No author has a financial or proprietary interest in any material or method mentioned.

Photorefractive keratectomy in 22 adult eyes with infantile nystagmus syndrome

To analyze visual and refractive outcomes of photorefractive keratectomy (PRK) in adult patients with infantile nystagmus syndrome. Ophthalmology Unit, Department of Experimental Diagnostic and Specialty Medicine, Saint Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Retrospective case series. Photorefractive keratectomy was performed in both eyes of patients with infantile nystagmus syndrome under topical anesthesia using an eye-tracking excimer laser. Patient satisfaction was tested using a questionnaire. The main outcomes were a decrease in refractive error, an improvement in postoperative corrected distance visual acuity (CDVA), and an uncorrected distance visual acuity (UDVA) equal to or better than the preoperative UDVA. Twenty-two eyes of 11 patients with infantile nystagmus syndrome were evaluated. The mean patient age was 30.82 years (range 22 to 42 years). All eyes had simple, compound, or mixed astigmatism (mean -3.40 D; range -0.75 to -6.00 diopters [D]). The mean postoperative astigmatism (-0.70 D ± 0.81 [SD]) and spherical equivalent (-0.420 ± 0.652 D) were statistically significantly better than the preoperative values (-3.40 ± 1.31 D and -3.426 ± 3.343 D, respectively (P < .0001 and P = .0002, respectively). The mean monocular postoperative CDVA (0.24 ± 0.19 logMAR) and UDVA (0.25 ± 0.18 logMAR) were better than the mean preoperative CDVA (0.32 ± 0.28 logMAR) (P = .0045 and P = .0338, respectively). The mean binocular postoperative UDVA was better than the mean preoperative CDVA (0.15 ± 0.14 logMAR versus 0.23 ± 0.23 logMAR) (P = .05). No patient required repeat surgery. Nystagmus patients are eligible for PRK. The results were promising; gaining a few Snellen lines in visual acuity can be very important to these patients for their daily life. No author has a financial or proprietary interest in any material or method mentioned.

Long-term refractive outcomes of posterior chamber phakic (spheric and toric implantable collamer lens) intraocular lens implantation

To report the long-term refractive outcomes, safety, predictability, efficacy and complications of 349 eyes treated with posterior chamber phakic intraocular lenses (pIOLs). A retrospective review of consecutive clinical cases of patients who underwent spheric implantable collamer lens (ICL) and toric ICL (TICL) implantation. The study included 349 eyes of 216 patients with sphere between +8 to −24 diopters (D) and 0 to −6.5 D of astigmatism. Statistical analysis was performed to identify differences between preoperative and postoperative refractive outcomes. Main outcome measures were preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical errors and spherical equivalent and significant postoperative complications. 194 eyes were treated with TICL and 155 eyes with ICL. The mean age of the patients was 29 ± 6.7 years. The mean preoperative sphere was −10.35 ± 5.1 D (+8 to −24) and the postoperative sphere was −0.09 ± 1.06 D (+3.25 to −6.5), p < 0.001. Preoperative cylinder was −2.63 ± 1.44 (0 to −6.5 D) and postoperative cylinder was −0.97 ± 0.89 D (0 to −3.5), p < 0.001. The preoperative mean spherical equivalent was −11.6 ± 5.12 D (+7.875 to −25.625) and postoperative spherical equivalent was −0.52 ± 1.03 (+2.25 to −6.75), p < 0.001. The mean preoperative UDVA was 1.72 ± 0.49 and postoperative UDVA was 0.23 ± 0.22, p < 0.001. The mean preoperative CDVA was 0.21 ± 0.17 and postoperative CDVA was 0.12 ± 0.138, p < 0.001. The implantation of posterior chamber pIOLs is a safe, predictable and effective strategy to manage refractive errors during long-term follow-up.

Evaluation of intrastromal corneal ring segments for treatment of keratoconus with a mechanical implantation technique

Purpose:To evaluate the clinical outcomes of intrastromal corneal ring segment (ICRS) implantation in patients with keratoconus using a mechanical implantation technique.Materials and Methods:Thirty eyes of 17 patients with keratoconus were enrolled. ICRSs (Keraring) were implanted after dissection of the tunnel using Tunc's specially designed dissector under suction. A complete ophthalmic examination was performed, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, keratometric readings, inferosuperior asymmetry index (ISAI), and ultrasound pachymetry. All 3-, 6-, and 12-month follow-ups were completed, and statistical analysis was performed.Results:The mean preoperative UDVA for all eyes was 1.36 ± 0.64 logMAR. At 12 months, the mean UDVA was 0.51 ± 0.28 logMAR (P = 0.001), and the mean preoperative CDVA was 0.57 ± 0.29 logMAR, which improved to 0.23 ± 0.18 (P = 0.001) at 1 year. There was a significant reduction in spherical equivalent refractive error from –6.42 ± 4.69 diopters (D) preoperatively to –1.26 ± 1.45 D (P = 0.001) at 1 year. In the same period, the mean K-readings improved from 49.38 ± 3.72 D to 44.43 ± 3.13 D (P = 0.001), and the mean ISAI improved from 7.92 ± 3.12 to 4.21 ± 1.96 (P = 0.003). No significant changes in mean central corneal thickness were observed postoperatively. There were no major complications during and or after surgery.Conclusion:ICRS implantation using a unique mechanical dissection technique is a safe and effective treatment for keratoconus. All parameters improved by the 1-year follow-up.

Long-term safety and visual outcomes of anterior chamber intraocular lens implantation in patients with a history of chronic uveitis

To compare the visual outcomes and prevalence of long-term complications in patients with quiescent uveitis after phacoemulsification with traditional in-the-bag intraocular lens (IOL) implantation versus primary or secondary anterior chamber (AC) IOL implantation due to inadequate capsule support. Single-center private practice. Retrospective observational cohort study. Patients with quiescent uveitis who had cataract surgery with subsequent AC IOL implantation were identified through an electronic medical record database. They were age matched with patients with uveitis who had conventional placement of a posterior chamber (PC) IOL. The rate of postoperative complications and corrected distance visual acuity (CDVA) were reviewed preoperatively and 1, 3, and 6 months and 1, 2, 3, and 4 years postoperatively. The incidence of postoperative complications was not statistically different for any criterion except posterior capsule opacification development in the PC IOL cohort (relative risk, 0.071). The mean follow-up was 36.11 months ± 17.3 (SD) in the AC IOL group and 53.72 ± 20.4 months in the PC IOL group. The mean preoperative CDVA was 1.49 ± 1.07 logMAR in the AC IOL group and 0.5 ± 0.26 logMAR in the PC IOL group. Both groups had a significant improvement in CDVA visual acuity 3 years postoperatively (P=.001 and P=.010 respectively). In uveitic eyes with inadequate capsule support, AC IOL implantation was safe and effective in providing satisfactory improved CDVA without a significant increase in long-term complications compared with eyes that had PC IOL placement.

Evaluation of intrastromal corneal ring segments for treatment of post-LASIK ectasia patients with a mechanical implantation technique

Aim:To evaluate the clinical outcomes of Keraring segment implantation in patients with post- laser-assisted in situ keratomileusis (LASIK) ectasia, using a mechanical implantation technique.Materials and Methods:Twelve eyes of 10 patients with post-LASIK ectasia were enrolled. Intracorneal ring segments (ICRS) were implanted after dissection of the tunnel using Tunc's specially designed dissector under suction. A complete ophthalmic examination was performed, including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, keratometric (K) readings, inferosuperior asymmetry index (ISAI), and ultrasound pachymetry. All 3, 6, and 12-month follow-ups were completed, and statistical analysis was performed.Results:The mean preoperative UDVA for all eyes was 1.28 ± 0.59 logMAR. At 12 months, the mean UDVA was 0.36 ± 0.19 logarithm of the Minimum Angle of Resolution (logMAR) (P=0.002), and the mean preoperative CDVA was 0.58 ± 0.3 logMAR, which improved to 0.15 ± 0.12 (P=0.002) at 1 year. There was a significant reduction in cylindrical refractive and spherical equivalent refractive error from –5.29 ± 2.47 diopters (D) and –5.54 ± 5.04 D preoperatively to –1.47 ± 0.71 D and –0.74 ± 1.07 D (P=0.001, P=0.002), respectively, at 1 year. In the same period, the mean K- readings improved from 47.93 ± 4.84 D to 40.87 ± 2.36 D (P=0.002), and the mean ISAI improved from 5.34 ± 3.05 to 2.37 ± 1.68 (P=0.003). No significant changes in mean central corneal thickness were observed postoperatively. There were no major complications during or after surgery.Conclusion:ICRS implantation using a unique mechanical dissection technique is a safe and effective treatment for post-LASIK ectasia. All parameters showed improvement at 1-year follow-up.

Comparison of endothelial changes and power settings between torsional and longitudinal phacoemulsification

To compare the intraoperative and postoperative outcomes of conventional longitudinal phacoemulsification and torsional phacoemulsification. Department of Ophthalmology, University of Leipzig, Germany. Randomized single-center clinical trial. Eyes with senile cataract were randomized to have phacoemulsification using the Infiniti Vision System and the torsional mode (OZil) or conventional longitudinal mode. Primary outcomes were corrected distance visual acuity (CDVA) and central endothelial cell density (ECD), calculated according to the Conference on Harmonisation-E9 Guidelines in which missing values were substituted by the median in each group (primary analysis) and the loss was then calculated using actual data (secondary analysis). Secondary outcomes were ultrasound (US) time, cumulative dissipated energy (CDE), and percentage total equivalent power in position 3. Postoperative follow-up was at 3 months. The mean preoperative CDVA was 0.41 logMAR in the torsional group and 0.38 logMAR in the longitudinal group, improving to 0.07 logMAR postoperatively in both groups. The mean ECD loss was 7.2% ± 4.6% in the torsional group (72 patients) and 7.1% ± 4.4% in the longitudinal group (76 patients), with no statistically significant differences in the primary analysis (P = .342) or secondary analysis (P = .906). The mean US time, CDE, and percentage total equivalent power in position 3 were statistically significantly lower in the torsional group (98 patients) than in the longitudinal group (94 patients) (P<.001). The torsional mode was as safe as the longitudinal mode in phacoemulsification for age-related cataract.