Phakic Eyes Research Articles

Prediction of distance visual acuity in presbyopic astigmatic subjects

This study was aimed to determine the effect of the amount of astigmatism on distance visual acuity, and to provide a prediction formula of visual acuity according to astigmatism, in a presbyopic population. We comprised 318 eyes of 318 consecutive patients (158 phakic and 160 pseudophakic subjects) without any eye diseases, except for refractive errors with astigmatism of 3 diopter or less. We assessed the relationship of the spherical equivalent visual acuity (SEVA) with astigmatism, and also provided a regression formula of visual acuity according to astigmatism in such subjects. We found a significant correlation between the SEVA and the amount of astigmatism (r = 0.715, p < 0.001) in the entire study population. We obtained similar results, not only in phakic eyes (r = 0.718, p < 0.001), but also in pseudophakic eyes (r = 0.717, p < 0.001). The regression formula was expressed as follows: y = 0.017x2 + 0.125x − 0.116 (R2 = 0.544), where y = logMAR SEVA, and x = astigmatism. We also found no significant differences in the SEVA for matched comparison among the with-the-rule (WTR), against-the-rule (ATR), and oblique (OBL) astigmatism subgroups (p = 0.922). These regression formulas may be clinically beneficial not only for estimating the visual prognosis after astigmatic correction, but also for determining the surgical indication of astigmatic correction.

Comparison between two devices in the detection of corneal thickness changes after cataract surgery

This study compared corneal thickness (CT) changes obtained with specular microscopy (SM) and a rotating Scheimpflug camera (RSC) after conventional phacoemulsification surgery (PS). One hundred sixty six eyes of 83 patients were analyzed before and one month after PS. One eye underwent PS, while the fellow phakic one was used as control. CT was measured with SM at the center of the cornea and with RSC at the pupil center, at the corneal apex and at the thinnest point. In the operated eye, SM showed a larger CT mean increase than those one detected at the three different measurements’ points evaluated by RSC. Inversely, in the fellow phakic eye, SM showed a greater CT mean decrease than those one registered by RSC at its three measurement’s points. Thus, one month after surgery, even if cornea appears clear at the slit-lamp, a significant thickness increase is still present. This is even more evident if the slight decrease of the fellow phakic eye is considered. The differences between the two devices are probably related to the different measured areas.

Lower eyelid involutional entropion following cataract surgery.

To determine whether cataract surgery is associated with an increased risk of subsequent lower eyelid entropion and evaluate potential associated factors. This retrospective cohort study included consecutive patients undergoing first eye cataract surgery over a 10-year period at a single institution (n = 14,574). The fellow phakic eye served as control. Patient records were evaluated up until either the time of second eye cataract surgery or any other intraocular or adnexal surgery. The primary outcome was the rate of entropion repair in both the pseudophakic (exposed) group and the phakic control group. Groups were compared using relative risk and Kaplan-Meier analysis. Multivariate logistic regression was used to compare pre-specified characteristics of those patients that underwent entropion repair in their pseudophakic eye with those that did not. A fourfold higher relative risk of undergoing entropion repair was observed in eyes that had undergone cataract surgery compared with the fellow unoperated eye (95% confidence interval 1.6-9.8; P < 0.001) with an increased risk at all timepoints between 1 and 12 years according to Kaplan-Meier analysis (P = 0.001). Median time to entropion repair after cataract surgery was 58 months (range 3-124). Documented intraoperative patient factors such as patient or eye movement, eyelid squeezing, pain or anxiety were an independent risk factor for subsequent entropion (P < 0.0001). Cataract surgery is associated with an increased risk of subsequent lower eyelid entropion. Surgeons should be aware of this risk in the pre- and post-operative assessment of patients undergoing cataract surgery.

Effects of Miosis on Anterior Chamber Structure in Glaucoma Implant Surgery.

We investigated changes in anterior chamber (AC) structure after miosis in phakic eyes and pseudophakic eyes with glaucoma. In this prospective study, patients scheduled for glaucoma implant surgery were examined using anterior segment optical coherence tomography before and after miosis. Four AC parameters (AC angle, peripheral anterior chamber (PAC) depth, central anterior chamber (CAC) depth, and AC area) were analyzed before and after miosis, and then compared between phakic and pseudophakic eyes. Twenty-nine phakic eyes and 36 pseudophakic eyes were enrolled. The AC angle widened after miosis in both the phakia and pseudophakia groups (p = 0.019 and p < 0.001, respectively). In the phakia group, CAC depth (p < 0.001) and AC area (p = 0.02) were significantly reduced after miosis, and the reductions in PAC depth, CAC depth, and AC area were significantly greater than in the pseudophakia group (all p < 0.05). Twenty-five patients (86.2%) in the phakia group and 17 (47.2%) in the pseudophakia group had reduced CAC depth (p = 0.004). Although miosis increased the AC angle in both groups, AC depth decreased in most phakic eyes and a substantial number of pseudophakic eyes. Preoperative miosis before glaucoma implant surgery may interfere with implant tube placement distant from the cornea during insertion into the AC.

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma - a retrospective interventional case series.

Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.

Phacoemulsification After Descemet Membrane Endothelial Keratoplasty: Incidence and Influence on Endothelial Cell Density.

To analyze the incidence of cataract extraction after Descemet membrane endothelial keratoplasty (DMEK) in phakic eyes and to evaluate the effect of phacoemulsification after DMEK on the donor endothelial cell density (ECD). The clinical data of phakic patients with DMEK were examined. From this cohort, all patients who subsequently underwent phacoemulsification after DMEK were reviewed. Data from a prospectively collected dataset were analyzed, including demographic profile, ECD, corrected distance visual acuity (CDVA), central corneal thickness (CCT), and complications. From a series of 261 phakic patients with DMEK, 35 eyes (13.4%) required cataract surgery within the mean follow-up period of 54.2 ± 28 months. The mean time from DMEK to phacoemulsification was 18 ± 13 months (range: 3 to 69 months). The probability of cataract extraction after DMEK was 0.06 (95% CI: 0.03 to 0.09) at 1 year and 0.17 (95% CI: 0.12 to 0.22) at 10 years, respectively. ECD decreased from 1,314 ± 524 cells/mm2 before phacoemulsification to 1,167 ± 443 cells/mm2 (-11%) at 1 to 6 months postoperatively (P = .333). CDVA improved from 0.27 ± 0.13 logMAR preoperatively to 0.07 ± 0.12 logMAR at 1 to 6 months postoperatively. CCT before phacoemulsification was 532 ± 46 µm and remained stable at 539 ± 56 µm at 1 to 6 months after phacoemulsification. Phacoemulsification did not elicit DMEK graft detachment in any of the eyes studied. The incidence and 10-year projection of cataract extraction in phakic eyes with DMEK was relatively low. Phacoemulsification after DMEK provided excellent CDVA outcomes, did not induce graft detachment, and was associated with an acceptable decrease in ECD. [J Refract Surg. 2021;37(2):119-125.].

Laser Treatment after Minimized Eye Movement for Repair of Retinal Detachment

Abstract Laser treatment with minimized eye movement (LTMEM) resulted in a 79% reattachment rate for retinal detachment in 39 phakic eyes with shallow subretinal fluid by decreasing subretinal fluid by minimizing reading, writing and physical activity. Purpose To evaluate the effectiveness of laser treatment (LT) to seal retinal breaks and resolve retinal detachment after decreasing subretinal fluid with minimized eye movement (MEM) by avoiding reading, writing, computer use, and physical activity, while allowing watching television. Methods Retrospective study of patients evaluated at the Retina Consultants of Hawaii, who developed retinal detachment and were willing to initially minimize eye movement prior to having a more invasive surgery for retinal detachment, such as pneumatic retinopexy, scleral buckle or vitrectomy. Charts were reviewed for baseline characteristics, success of retinal detachment repair, subsequent surgical procedures, and recurrence of retinal detachment with long term follow-up Results This study included 39 eyes of 35 patients with 31 patients having unilateral retinal detachment treated with LTMEM and four patients having bilateral retinal detachment treated with LTMEM. Follow up ranged from three months to 30 years. Reattachment of the retina with LTMEM was noted in 31 of 39 eyes (79%) and final reattachment rate following further surgery with scleral buckle resulted in 100% retinal reattachment rate (39 of 39 eyes). Conclusion LTMEM can provide a low risk, minimal intervention, low cost procedure that can be an effective means of treating selected retinal detachments, usually but not always with peripheral shallow detachment around the existing breaks.

Epiretinal membrane vitrectomy: outcomes with or without cataract surgery and a novel prognostic factor for cystoid macular edema.

To assess the outcomes of vitrectomy with or without cataract surgery for the treatment of idiopathic ERM in phakic eyes and evaluate predictors of functional and anatomical outcomes. Retrospective cohort of consecutive phakic ERM eyes distributed in three groups: a) combined (phacovitrectomy) group, b) PPV-only group, and c) consecutive group (PPV followed by cataract surgery). Main outcomes were final visual acuity (VA) and cystoid macular edema (CME) occurrence. Potential predictors of VA or CME included clinical variables and SD-OCT parameters. A total of 108 eyes were included in this study. There were no differences in the final VA between consecutive and combined groups (0.22 vs 0.10 logMAR, p= 0.851). Twelve eyes from the combined group (23%) and one eye from the PPV-only group presented CME (p= 0.001). There were no differences between postoperative CME occurrence in combined versus consecutive group (12 vs 7, p= 0.38). The presence of cotton-ball sign predicted the development of CME [OR 2.86 (95%CI 1.01-8.18), p= 0.049] while separated ERM-ILM complex was found to be protective [OR 0.25 (95%CI 0.08-0.77), p= 0.015]. Functional and anatomical results of PPV with ERM and ILM peeling combined with cataract surgery was equivalent to the consecutive procedure, with both strategies being effective. Separated ERM-ILM complex has prognostic value in these patients, as its presence at baseline was found to be protective for postoperative CME.

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma — a retrospective interventional case series

Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.

Prevalence of epiretinal membrane in the phakic eyes based on spectral-domain optical coherence tomography

The prevalence of epiretinal membrane (ERM) and associated factors in the phakic eyes have not been fully elucidated yet. This cross-sectional study included 2,354 phakic eyes without retinal diseases or surgical history. Ocular parameters, such as uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), intraocular pressure (IOP), white-to-white corneal diameter (WTW), mean keratometric value (Km) of total corneal refractive power at 4-mm diameter (TCRP4), astigmatism of TCRP4, total corneal irregular astigmatism (TCIA), pupil diameter, axial length (AXL), anterior chamber depth (ACD), lens thickness (LT), and posterior vitreous detachment (PVD) were compared between ERM group and control group. Additionally, an age-matched control group was selected by individual matching and compared with the ERM group to eliminate the confounders. Multiple logistic regression analysis was performed to evaluate the factors associated with the presence of ERM. Among 2,354 eyes, 429 eyes (18.2%) had ERM based on spectral-domain optical coherence tomography. The ERM group showed higher prevalence of PVD, worse CDVA, higher astigmatism of TCRP4, higher TCIA, smaller pupil size, longer AXL, and thicker LT than control group (P < 0.001, P < 0.001, P = 0.011, P < 0.001, P = 0.023, P < 0.001, and P < 0.001, respectively). Only PVD, CDVA, SE, astigmatism of TCRP4, TCIA, and AXL maintained the significance when compared with the age-matched control group (P < 0.001, P = 0.026, P < 0.001, P = 0.001, P = 0.003, and P < 0.001, respectively). Multivariate logistic regression analysis showed that age, PVD, CDVA, and TCIA were independently associated with the presence of ERM (P < 0.001, P < 0.001, P = 0.011, and P = 0.002). The prevalence of ERM detected using SD-OCT was 18.2% in the middle aged phakic population. Eyes with TCIA, in addition to older age and PVD, were more likely to have ERM.

Micro-incision vitrectomy surgery for primary rhegmatogenous retinal detachments with posterior vitreous detachments in elderly patients: Preoperative characteristics and surgical outcomes.

PurposeTo assess the preoperative characteristics and surgical outcomes of using micro-incision vitrectomy surgery (MIVS) to treat RRD with posterior vitreous detachment (PVD) in an older and a younger patient group.MethodsThis retrospective cohort study included 407 eyes from 397 patients with primary RRD with PVD who were consecutively treated in our hospital from February 2016 to February 2020. PVD was diagnosed clinically by the presence of a Weiss ring, or was diagnosed morphologically via optical coherence tomography and subsequently confirmed during surgery. The main outcome measures were preoperative RRD characteristics, best-corrected visual acuity (BCVA), and postoperative complications.ResultsData were analysed from 55 eyes in the elderly group (age 70 and older), and 352 eyes in the young group (age 69 and younger). There was no significant inter-group difference in the initial reattachment rate. Preoperative characteristics indicated that elderly patients had a significantly lower rate of phakic eyes, shorter mean axial length, lower lattice incidence, and longer time spans from onset to surgery. There were no significant between-group differences in the incidence of the following complications: fibrin formation, intraocular pressure elevation, epi-retinal membrane on the macula, intraocular lens optic capture, proliferative vitreoretinopathy, and vitreous haemorrhage. While the elderly patients had significant postoperative improvements in BCVA, these improvements were significantly lower than those of the younger patients.ConclusionsThis study highlighted the characteristics and surgical outcomes of MIVS in elderly patients with RRD. Although the time from onset to surgery was longer, MIVS still can be performed safely to improve older patients’ postoperative BCVA.

The Postoperative Course of Choroidal and Central Retinal Thickness in Epiretinal Membranes with Respect to Membrane Severity

Introduction: The aim of this study was to evaluate the relation between choroidal thickness (CT), central retinal thickness (CRT) and best-corrected visual acuity (BCVA) after surgery for idiopathic epiretinal membrane (iERM). Methods: Patients with 4 severity stages of iERM, who underwent vitrectomy with membrane- and internal limiting membrane peeling, were included in this prospective study. CRT, CT, and BCVA were assessed at baseline (BSL), 1 week, 1 and 3 months postoperatively. Results: Twenty-one eyes were phakic, 11 eyes pseudophakic at BSL, in 14 cases combined cataract surgery was performed. BCVA was highest in stage 1 and 2, lowest in stage 4 iERM (p < 0.001) and correlated with CRT. After surgery, CRT decreased and BCVA increased significantly (p < 0.05). CT did not show significant differences among stages (p = 0.23). BSL CRT did not differ between phakic and pseudophakic eyes, the least reduction after surgery was detected in patients who underwent combined cataract surgery and vitrectomy. BSL CT was greater in phakic than in pseudophakic eyes (p = 0.033). Postoperative CT decreased in pseudophakic and phakic eyes, but remained higher after combined surgery (p = 0.0048). Conclusion: CT is not related to the severity of iERM. Choroidal changes did not influence the BCVA. Additional cataract surgery seems to cause longer recovery in CT and CRT.

Corneal and anterior chamber morphology in patients with nonınfectious ıntraocular ınflammation.

To evaluate the corneal and anterior chamber morphology in phakic eyes with noninfectious intraocular inflammation. This study included 59 eyes with active uveitis, 62 with inactive uveitis, and 95 healthy eyes. Corneal endothelial cell density, hexagonal cell ratio, coefficient of variation (CV), corneal thickness and volume, maximum keratometry, and anterior chamber volume and depth (ACD) measurements were performed using a specular microscope and Pentacam HR. The mean duration of uveitis was 24.6 ± 40.5 (0-180) months. The mean number of uveitis attacks was 2.8 ± 3.0 (1-20). Coefficient of variation was significantly higher in the active uveitis group compared with inactive uveitis group (p=0.017, Post Hoc Tukey). Anterior segment parameters other than coefficient of variation were not significantly different between active/inactive uveitis and control groups (p>0.05). Multiple linear regression analysis showed that coefficient of variation was greater in active uveitis compared with inactive uveitis after adjusting for the duration of uveitis, type of uveitis, having a rheumatologic disease, and having immunosuppressive treatment (p=0.003). The duration of uveitis and number of attacks were not significantly correlated with ocular parameters (p>0.05, Spearman's correlation). The difference in parameters was not significant based on uveitis type (p>0.05). Coefficient of variation was higher in eyes with active uveitis than that in eyes with inactive uveitis, whereas corneal endothelial cell density and anterior chamber morphology did not significantly differ between active/inactive uveitis and control groups.

Comparison of donor corneas obtained from hospital cornea retrieval program and voluntary eye donation in South India - A prospective study

Background: The aim of this study was to compare the donor characteristics, quality of tissues, and utilization rate of corneas collected through Hospital cornea retrieval program (HCRP) and voluntary eye donation (VED). Methods: A prospective nonrandomized comparative study of all consecutive donor corneas collected through HCRP and VED during December 2015 to November 2016 was performed. Details of the donor such as age, sex, cause of death, need for medicolegal clearance, death to enucleation time, slit-lamp grading, specular microscopy, and tissue utilization were documented. Results: Nine hundred and eighty-five eyes of 493 donors were included in the study, of which 606 (61.5%) eyes belonged to HCRP and 379 (38.5%) eyes in VED. HCRP donors were significantly younger (HCRP: 43.87 ± 19 years; VED: 72.8 ± 13 years; P < 0.001). Males were more common in HCRP (HCRP: 236, 77.6%; VED: 99, 52.2%; P < 0.001). The most common cause of death was road traffic accident (132, 43.6%) in HCRP and cardiovascular disease (93, 49%) in VED. 73.3% (222) of HCRP donors needed medicolegal clearance. Phakic donor eyes were significantly higher in HCRP (HCRP: 561, 92.6%; VED: 184, 48.6%; P < 0.001). Specular microscopy was possible in 396 (65.3%) eyes of HCRP and 129 (34%) eyes of VED. The mean endothelial cell density was 2931 ± 431.1 in HCRP and 2668.6 ± 381.1 in VED. The tissue utilization rate was significantly higher in HCRP (HCRP: 481, 79.4%; VED: 201, 53%; P < 0.001). Eighty-two percent of endothelial keratoplasty, 78.5% of optical penetrating keratoplasty, and 58% of therapeutic keratoplasty were from HCRP donors. Conclusion: Donor corneas collected through HCRP have higher tissue utilization.

İris Arkasına İntraoküler Lens İmplantasyonu Uzun Dönem Sonuçlarımız ve Diğer Gözle Karşılaştırılması

Objective: To evaluate the long-term results of primary and secondary posterior iris-claw intraocular lens (IOL) implantation and a comparative analysis with the fellow eye Material and Methods: One hundred-one eye of 99 patients who underwent iris-claw IOL implantation were included in this retrospective study. Data recorded for each subject consisted of preoperative and postoperative spherical equivalent (SE), best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell count (ECC) values, and biomicroscopic findings. Patients were divided into two main groups according to primary (complicated cases) and secondary (aphakic cases) implantation. The comparison of the groups was made in terms of SE, BCVA, IOP, CCT, and ECC values. Also, postoperative CCT and ECC comparison was made between the fellow eye and irisclaw IOL implanted eyes. Results: Median duration of follow-up was 44.6 (range 1-83) months. While postoperative SE, IOP, CCT values were similar in two groups (p=0.754, p=0.621, p=0.520, respectively), postoperative BCVA and ECC values were statistically higher in the aphakic group than the complicated group (p=0.048, p=0.004, respectively). ECC values in iris-claw IOL-implanted eyes were lower than the same patients' fellow phakic eyes (p=0.003), but there was no statistically significant difference between iris-claw IOL-implanted eyes and the fellow pseudophakic eyes for ECC values (p=0.520). Conclusion: Although retropupillary iris-claw IOL fixation with scleral tunnel might be challenging, it is a safe and effective method with better visual and refractive outcomes.

Visual acuity assessment in phakic and pseudophakic eyes under red, green, and blue illumination

espanolProposito: Valorar el impacto de la iluminacion cuasi-monocromatica en la agudeza visual (AV) en ojos faquicos y pseudofaquicos utilizando diferentes longitudes de onda. Metodo: El trabajo se realizo con 61 ojos clasificados en dos grupos: 31 faquicos jovenes y 30 pseudofaquicos implantados con una lente intraocular acrilica monofocal. La AV lejana fue medida usando un optotipo expresamente disenado para el trabajo iluminandolo secuencialmente con tres luces LED de longitud de onda nominal de (B) 455nm, (G) 530nm, (R) 625nm y blanca (W) (CCT= 6500K). Adicionalmente se midio la AV cercana usando las mismas iluminaciones en el grupo de jovenes faquicos. Resultados: La mejor AV lejana en ojos faquicos se obtuvo con las iluminaciones roja y blanca mientras que en el grupo de pseudofaquicos esta se obtuvo con las iluminaciones verde y blanca. La AV con iluminacion azul fue la que obtuvo peores resultados en ambos grupos. No se encontraron diferencias estadisticamente significativas en la AV cercana para las iluminaciones R, G y B, pero fue significativamente mejor con iluminacion W que con iluminacion B. Conclusion: Los valores de AV lejana revelan el impacto de la diferencia cromatica de refracion (CDRx) provocada por la aberracion cromatica longitudinal de los ojos evaluados. Con iluminacion roja, la capacidad acomodativa de los ojos jovenes faquicos compensa la aberracion. En ojos pseudofaquicos, se observa una disminucion natural de la AV. En estos casos, ademas, la perdida de la acomodacion y un resultado refractivo postoperatorio calculado para una longitud de onda de diseno verde, hacen que la AV obtenida con luz verde sea igual a la obtenida con luz blanca. La AV cercana media obtenida en ojos faquicos jovenes revela un equilibrio en la capacidad de acomodacion con iluminacion R, G y B, si bien la AV cercana es significativamente superior con luz blanca que con luz azul. EnglishPurpose: To assess the impact of the quasi-monochromatic illumination on visual acuity (VA) in phakic and monofocal pseudophakic eyes using different wavelengths. Methods: Sixty-one eyes classified in two groups (phakic and pseudophakic) participated in this study: 31 young phakic and 30 pseudophakic implanted with an acrylic monofocal intraocular lens. Distance VA was measured with custom optotype illuminated sequentially with three LED lights of nominal wavelengths (B) 455nm, (G) 530nm, (R) 625nm and white (W) LED light (CCT= 6500K). Near VA was additionally assessed in young phakic eyes under the same illuminations. Results: Best mean distance VA was obtained under red and white lights in young phakic eyes, whereas it was obtained under white and green lights in pseudophakic eyes. For both groups, the blue illumination led to the worst mean distance VA outcomes. No significant differences were found among mean near VA for R, G an B lights, but it was significantly better under W light than under B light. Conclusion: The measured distance VA values reveal the impact of the chromatic difference of refraction caused by the longitudinal chromatic aberration of the tested eyes. This aberration, is compensated by the accommodation capability of young phakics under red light. In the case of monofocal elderly pseudophakic eyes, a natural age-related decrease in the VA is observed. Additionally, the lack of accommodation, and a postoperative refraction outcome likely targeted for a green design wavelength, make the mean distance VA under green light match the one under white light. The mean near VA results in young phakic subjects revealed a balanced accommodation capability to every R, G, B illumination, but significantly higher under W light than under B light.

Lens and Peripheral Retinal Relationships During Vitrectomy: Comparison of 23-, 25-, and 27-Gauge Vitrectomy and Curved Endolaser Probes.

This work aims to compare spatial relationships between the crystalline lens and vitrectomy instruments of different gauges. Eight phakic eyes recovered from deceased donors were used after fixation. Valved trocars (27-gauge, 25-gauge, and 23-gauge) were sequentially placed in the superotemporal quadrant 4 mm posterior to the limbus in each eye. Intraocular relationships of vitrectomy and curved endolaser probes were measured for each gauge. There were no significant differences in maneuverability between instruments of different gauges. The mean distance from instrument to lens at the geometric center of the globe was 5.5 mm. Vitrectomy probes of all gauges could access the peripheral retina on both sides of the sclerotomy in the 3 to 4 o'clock position adjacent to the sclerotomy without touching the lens. The instruments could be advanced without lens touch to contact the retina within at least 2 mm of the ora serrata 180° away from the insertion site. Vitrectomy and curved endolaser probes achieved similar maneuverability relative to the lens regardless of gauge. This study confirms that small-gauge vitrectomy instruments have a considerable range of safe access to the peripheral retina in phakic eyes from a single sclerotomy.

Proposal for the management of myopic traction maculopathy based on the new MTM staging system.

To propose the Myopic Traction Maculopathy (MTM) management Table, based on the MTM Staging System (MSS). A retrospective review of 157 eyes affected by MTM, operated with pars plana vitrectomy (PPV), or macular buckle (MB) or combined surgery (MB + PPV). Each case was classified according to the MSS. Anatomical results were evaluated with OCT at an intermediate follow-up (3-6 months) and at a final follow-up (2-8 years), considering changes both in the foveal and in the retinal pattern. The number and type of operations needed were noted. The surgical complications were reported. Primary surgery was MB for 83 eyes (52%), PPV for 36 (23%) and MB + PPV for 38 (24%). At intermediate follow-up, the retinal pattern was restored in 55.41% and foveal in 42.68%.Further surgery was indicated as PPV in 25.48%, MB in 14.65%. At the final follow-up, the retinal pattern was restored in 96.16% and the foveal pattern in 87.90%.BCVA improved at the final follow-up (p < 0.05). The complications of MB were not sight-threatening. The complications of PPV were FTMH in 67% cases in stages 2, 3, and 4. Cataract developed in 60% of phakic eyes. The complications of combined MB+PPV were cataract (56%) and PVR (5%). Both PPV and MB may be used to treat MTM. PPV addresses the changes in the foveal pattern while MB addresses the changes in the retinal pattern. The MTM management table offers a proposal for the choice of type and timing of treatment customized per each stage of MTM.

Functional results of surgical treatment of retinal detachment

The article analyzes the state of patients visual acuity after successful surgical treatment of retinal detachment. On the basis of gathered data, it was concluded that in case of detachment of the macula only in 50% of cases it is possible to increase visual acuity to 0.4 and higher. Restoration of visual functions continues for at least 6 months after the operation and is determined by the restoration of the structure of the outer segments of the photoreceptor cells. During this time, it is advisable to conduct drug therapy aimed at normalizing blood flow and functional activity of the retina. Visual functions recovery continues for at least 6 months after the operation and is connected with the restored structure of the outer segments of the photoreceptor cells. Important prognostic factors of central vision restoration in the postoperative period are visual acuity before surgery, duration of existence and height of macular detachment. Data on which of the methods of surgical treatment of retinal detachment allows to achieve higher visual acuity are contradictory. There is practically no data on the comparison of the effect on visual acuity of scleral buckling and vitrectomy in the long-term period, in patients with phakic eyes and with artiphakia. On visual acuity after fitting detachment of the macula may affect macular edema, epiretinal membrane formation and retinal folds, and edema of the peripapillary optic nerve head, progressive deterioration of blood flow in the basin of the central retinal artery, short posterior ciliary arteries and ophthalmic artery. It is believed that these factors are significantly more pronounced after scleral buckling than after vitrectomy. Some indicators of optical coherence tomography correlate with visual acuity after surgical treatment of retinal detachment: the state of the articulation line of the external and internal segments of the photoreceptors, as well as the state of the external limiting membrane.

Long-Term Outcomes of Retinal Detachment in Phakic Eyes After Implantation of Implantable Collamer Lens V4c for High Myopia Correction.

Aim: To estimate whether implantable collamer lens (V4c ICL) implantation increases the risk of retinal detachment in high myopia comparing with myopes with Rigid Gas-Permeable (RGP) correction.Methods: This prospective study was comprised of an ICL group (704 eyes) and an RGP group (628 eyes). Patients were enrolled according to the inclusion criteria and exclusion criteria, then divided into the ICL group and RGP group. Patients in the ICL and RGP groups received V4c ICL implantation and RGP fitting respectively. Retinal details, spherical equivalent refraction (SE), uncorrected distance visual acuity (UDVA), corrected distance vision acutivity (CDVA), axis length (AL), anterior chamber depth (ACD) and other relevant parameters were recorded at different time points. Rhegmatogenous retinal detachment (RRD) morbidity and incidence, RRD morphology and relevant parameters were analyzed.Results: All enrolled patients were followed for 3–6 years. Patients characteristics before the refractive procedure did not show a statistical difference. At the end of the follow up, all the RD cases were RRD. The RRD morbidity of the ICL group and RGP group was 1.99% (14 eyes) and 0.96% (6 eyes) respectively, which did not show statistical difference (P = 0.12). During the first year after refractive procedure, the RRD incidence of the ICL group was 0.85% (6/704), while this number of the RGP group was 0.16% (1/628). It did not show statistical difference (P = 0.08).Conclusion: Compared with RGP fitting, V4c ICL implantation for high myopia correction does not add RRD risk in the long term. V4c ICL implantation is a safe method for high myopia correction.