Preoperative Corrected Distance Visual Acuity Research Articles

Micropulse trans-scleral laser therapy outcomes for uncontrolled glaucoma: a prospective 18-month study

ObjectiveTo evaluate the efficacy and safety of micropulse trans-scleral laser therapy (mTLT) in glaucomatous patients. DesignProspective, interventional study in a university hospital setting. ParticipantsFifty-two eyes of 52 adult patients with uncontrolled glaucoma despite maximal tolerated medical treatment, and/or poor candidates for filtering surgery. MethodsParticipants received a 360-degree mTLT diode laser treatment (2000mW, 31.33% duty cycle), with duration adjusted to iris pigmentation and glaucoma severity (160–320 seconds). They were followed for 18 months to assess intraocular pressure (IOP), number of medications, corrected distance visual acuity (CDVA), glaucoma progression based on Humphrey Sita 24-2 perimetry and Cirrus high-definition optical coherence tomography, and complications. The primary outcome measure was the absolute success at 18 months. Absolute success was defined as an IOP 6–21 mm Hg and at least 25% IOP reduction, with equal or less number of IOP medications. Qualified success allowed for an increased number of IOP medications. Failure was defined as an inability to meet the criteria for success or the need for incisional glaucoma surgery. ResultsTreatment absolute success was 61.5% at 12 months and 59.6% at 18 months. Mean IOP was reduced by 35.6% at 18 months (23.6 ± 6.5 mm Hg at baseline; 15.2 ± 4.1 mm Hg at 18 months, p < 0.001). mTLT did not significantly reduce the number of topical glaucoma medications (p = 0.075); however, 15 eyes (29%) had systemic oral glaucoma treatment at baseline and 10 eyes (20%) at 18 months. Eight patients (15%) experienced vision loss of ≥2 lines after the procedure. Three patients (6%) regained their preoperative CDVA by 1 month, and 3 patients (6%) by 3 months, while 2 patients (4%) sustained persistent visual loss. No ocular complications were noted in 84.6%. Incisional surgery was required in 25% of eyes owing to inadequately controlled glaucoma despite mTLT. ConclusionsmTLT is a good therapeutic option for moderate IOP reduction, while being safe and predictable. This improved safety profile makes mTLT a treatment to be considered earlier in the management of glaucoma.

Toric phakic IOLs in keratoconus\u2014evaluation of preoperative parameters on the outcome of phakic anterior chamber lens implantation in patients with keratoconus

PurposeTo evaluate the influence of the type of the keratectasia and preoperative keratometry readings on the efficacy of implantation of iris-fixated phakic anterior chamber intraocular lenses (pIOL) in patients with keratoconus.MethodsIn this retrospective study, iris-fixated pIOLs (Artisan/Artiflex (Ophtec®), Verisyse/Veriflex (AMO®)) were implanted in 38 eyes of 22 patients with stable keratoconus. Thirty-six eyes underwent corneal crosslinking (CXL) prior to the lens implantation. The refractive outcome was evaluated 6 weeks postoperatively and the influence of preoperative refraction and topo- and tomographical factors were analyzed.ResultsThe mean postoperative uncorrected distance visual acuity (UDVApost) was 0.25 ± 0.15 logMAR and was not statistically different from the mean preoperative corrected distance visual acuity (CDVApre), which was 0.24 ± 0.13 logMAR. Twenty-seven eyes (71%) reached UDVApost/CDVApre ≥ 1 (efficacy index), whereas patients with PMD-like ectasia (n = 14) showed significantly (p = 0.003) higher efficacy index (100%) than patients diagnosed with keratoconus (n = 24) (54%). Higher eccentricity of the maximum posterior elevation showed a significant beneficial influence on the efficacy index (p = 0.021). Furthermore, a higher Amsler-Krumeich stage and preoperative MAE were correlated with a worse UDVApost. The mean absolute spherical equivalent was significantly decreased from 5.71 ± 4.96 D to 1.25 ± 1.20 D (p < 0.001). No significant difference was found in endothelial cell count.ConclusionThe results indicate that the implantation of phakic iris-fixated anterior chamber IOLs is a reasonable refractive option for patients with keratoconus. Keratoconus patients with a pellucidal marginal degeneration (PMD)-like appearance ectasia seem to benefit most from such procedures.

Objective quantification of lens nuclear opacities using swept-source anterior segment optical coherence tomography

Background/aimsThe primary objective is to quantify the lens nuclear opacity using swept-source anterior segment optical coherence tomography (SS-ASOCT) and to evaluate its correlations with Lens Opacities Classification System III (LOCS-III)...

Chandelier-assisted pneumatic retinopexy for rhegmatogenous retinal detachment repair in young adults.

We describe the new technique of chandelier-assisted pneumatic retinopexy in repairing rhegmatogenous retinal detachments in a series of young adults. In the operating room, a 25-gauge trocar cannula is inserted at the pars plana 180° across the preoperatively detected retinal break followed by Chandelier light insertion, which is used in globe fixation and rotation. The retinal periphery is reexamined using scleral indentation and chandelier light endoillumination. Transconjunctival cryopexy is performed around the break followed by paracentesis and pure sulfur hexafluoride gas injection. Twelve eyes of 12 patients were repaired. Their mean (±SD) age was 29.4 (±3.4) years and preoperative corrected distance visual acuity (CDVA) was 0.36 (±0.32). Nine eyes had 1 break while 3 eyes had 2 breaks within 1 clock hour. Mean duration of operation was 11.7 (±1.8) min. No patient experienced major intraoperative complications, but one patient required reoperation. Mean CDVA 6 months postoperatively was 0.63 (± 0.21) (p < 0.05).

Low-Grade Versus Medium-Grade Nuclear Sclerotic Cataract Density Produces Identical Surgical and Visual Outcomes: A Prospective Single-Surgeon Study.

PurposeTo determine whether the incidence of major complications and postoperative corrected distance visual acuity are comparable for surgery on low-grade versus medium-grade nuclear sclerotic cataracts.DesignThis was a prospective, consecutive, single-surgeon, no-exclusion study of 1025 cataract cases with one-month follow-up.MethodsPatients were divided into two cohorts according to the nuclear sclerosis grade at presentation, as classified using the Lens Opacities Classification System (LOCS) III. Cohort A, representing low-grade nuclear sclerotic cataracts (grades 1-2), consisted of 739 eyes, while Cohort B, representing medium-grade nuclear sclerotic cataracts (grades 3-6), consisted of 286 eyes.ResultsThere was no significant difference in major intraoperative or postoperative complications (p>0.999) between Cohorts A and B. The mean logMar preoperative corrected distance visual acuity (CDVA) in Cohort A was 0.245 as compared with 0.346 in Cohort B (p<0.001). There was no significant difference between cohorts for postoperative CDVA at one day (-0.168 versus -0.118; p=0.070), one week (-0.180 versus -0.147; p=0.405), or one month (-0.185 versus -0.161; p=0.569).ConclusionsThere was no significant difference in the incidence of operative complications or postoperative CDVA between the cohorts. These findings suggest that, in experienced hands, surgery for medium-grade nuclear sclerotic cataracts is equally effective and safe as compared with that for low-grade nuclear sclerotic cataracts.

Three-year outcomes of mixed astigmatism correction with single-step transepithelial photorefractive keratectomy with a large ablation zone.

To evaluate refractive and visual outcomes of single-step transepithelial photorefractive keratectomy (transPRK) in the treatment of mixed astigmatism with the use of an aberration-neutral profile and large ablation zone. Nicolaus Copernicus University and Oftalmika Eye Hospital, Bydgoszcz, Poland. Retrospective, observational case series. This study included patients who underwent transPRK to correct mixed astigmatism and completed the 3-year follow-up. Procedures were performed with an Amaris 750S excimer laser using an aberration-neutral profile and optical zone of 7.2 mm or more. A total 48 eyes of 39 patients were included. Preoperatively, mean spherical manifest refraction was +1.37 ± 0.98 diopter (D) (0.25 to 4.00 D), and astigmatism was -4.00 ± 0.76 D (-2.25 to -6.00 D). Three years postsurgery, it was -0.17 ± 0.26 D and -0.41 ± 0.44 D, respectively. Attempted spherical equivalent correction within ±0.50 D was achieved in 45 eyes (94%) and cylindrical correction in 34 (71%). Preoperative corrected distance visual acuity (CDVA) was 20/20 or better in 38 eyes (79%), and postoperative uncorrected was 20/20 or better in 29 eyes (60.0%). No eye had lost 2 or more Snellen lines of CDVA, whereas 3 eyes (6%) gained 2 or more lines. In 4 eyes (8%), haze of low intensity was observed at the periphery, with scores between 0.5 and 1.0, and only 1 eye getting a score of 2 in 0- to 4-degree scale. Mixed astigmatism correction with large-ablation-zone transPRK provided good results for efficacy, safety, predictability, and visual outcomes in a 3-year follow-up.

Impact on binocular visual function of small-incision lenticule extraction for high myopia.

To assess whether small-incision lenticule extraction (SMILE) for high myopia reduces the binocular visual function assessed by stereoacuity, binocular visual acuity, binocular contrast sensitivity, and binocular summation. University hospital. Prospective case series. Patients with a myopic spherical equivalent of at least 6.00 diopters (D) scheduled for SMILE aimed at emmetropia were included. Psychophysical testing was performed with correction preoperatively but no correction postoperatively. Stereoacuity was assessed with the Randot Circles test and the near Frisby test, visual acuity (monocular and binocular) was assessed with high-contrast Early Treatment Diabetic Retinopathy Study charts, and contrast sensitivity (monocular and binocular) was assessed with the Pelli-Robson chart and the Freiburg Acuity and Contrast Test. Binocular summation was calculated by comparing the binocular score against the best monocular score. A total of 138 eyes of 69 patients were included. The mean spherical equivalent changed from -7.46 D ± 1.06 (SD) to -0.23 D ± 0.40 postoperatively. Stereoacuity did not change significantly postoperatively; median change (interquartile range) was -0.32 (-6.21 to 1.55) seconds of arc with the Frisby test and 0.00 (-7.5 to 5.0) seconds of arc with the Randot test (P ≥ .06). Binocular postoperative uncorrected distance visual acuity was not different from the preoperative corrected distance visual acuity (P = .40). Contrast sensitivity declined slightly monocularly with both tests of contrast sensitivity but was unaltered binocularly (P ≥ .08). Binocular summation for visual acuity and contrast sensitivity was unaltered following surgery (P ≥ .09). SMILE for high myopia did not reduce the binocular function assessed by stereoacuity, binocular visual acuity, binocular contrast sensitivity, and binocular summation.

A perspective of biometric, visual and refractive outcomes of cataract surgery: a report of an ophthalmologist in compulsory governmental service

Objectives: Knowledge of normal values of biometric parameters in cohort and relationships of them is helpful for ophthalmologists who want to achieve successful results. The aim of this study is to define these parameters in the light of experiences of an individual cataract surgeon after her residency program. Methods: This is a retrospective, register-based study. Preoperative biometric and postoperative refractive data including axial length (AL), mean keratometry (K), anterior chamber depth (ACD), astigmatism, lens thickness (LT) of 310 patients who had cataract surgery were reviewed. Ultrasound and optical biometry were used to evaluate the biometric parameters of the eyes. Results: 0.5 D of refractive target (RT) was obtained in 52.1% (186 eyes) of eyes, 1.0 D of RT in 82.20% (293 eyes) and 2.0 D of RT in 98.3% (351 eyes). Analyses of visual acuity show that 43.7% and 86.3% of eyes reached 0.00 and 0.30 log MAR or better. Age, ACD, LT, AL, preoperative corrected distance visual acuity, preoperative astigmatism and preoperative K were correlated between each other significantly (p &amp;lt; 0.001). The longer AL was found associated with older age (β = .745, p = 0.003), and lower K (β = -0.327, p &amp;lt; 0.001). A significant association between K value and older age (β = .680, p = .029) and shorter AL (β = -.660, p &amp;lt; 0.001) was seen. Conclusions: These data show the normative parameters of biometry values for the Turkish population. These results may be helpful in calculating intraocular lens power and evaluating refractive error for young ophthalmologists who have to work with ultrasound biometry in compulsory service.

Outcomes of sequential intracorneal ring segment and phakic intraocular lens insertion for visual rehabilitation in keratoconus.

To report the visual and refractive outcomes of sequential intracorneal ring segment (ICRS) and toric phakic intraocular lens (IOL) insertion for visual rehabilitation in keratoconus. A retrospective interventional cohort study was performed through the Corneoplastics unit and Eye Bank, Queen Victoria Hospital, East Grinstead, United Kingdom. 14 eyes of 12 patients had sequential ICRS and phakic IOL implantation for visual rehabilitation of keratoconus between June 2014 and February 2018. After at least 6 months follow-up, the number of eyes with an uncorrected distance visual acuity (UDVA) of 20/40 UDVA or better increased from zero (0%) to 10 (71%). 12 (85.7%) eyes achieved a post-operative UDVA equal to or better than the pre-operative corrected distance visual acuity (CDVA). The number percentage of eyes with a CDVA of 20/40 or better increased from 3 (31%) to 14 (100%). The mean final spherical equivalent improved from -4.07 to -0.17 (p ⩽ 0.001). The mean refractive astigmatism magnitude improved from 4.76D to 1.23D (p = 0.002). Seven (50%) eyes had 1.0D or less of refractive astigmatism post-operatively. In this cohort of eyes with keratoconus, sequential ICRS and phakic IOL implantation resulted in excellent visual and refractive outcomes after at least 6 months.

Correction of Moderate to High Hyperopia With Implantation of an Allogeneic Refractive Lenticule.

To describe the visual outcomes of correcting moderate to high hyperopia after two different surgical procedures of lenticular implantation. This prospective small case series study used epikeratophakia combined with transepithelial phototherapeutic keratectomy (PTK-EP) and femtosecond laser-assisted lenticule intrastromal keratoplasty (LIKE) using myopic small incision lenticule extraction (SMILE)-derived refractive lenticule for correcting hyperopia ranging from +3.00 to +10.00 diopters (D). The implanted refractive lenticule was matched with the recipient's manifest refraction. The visual, refractive, corneal tomographic, and epithelial thickness outcomes were analyzed after surgery. Four eyes underwent PTK-EP and 6 eyes underwent LIKE. At the last postoperative visit, 6 of 10 eyes had uncorrected distance visual acuity equal to or better than the preoperative corrected distance visual acuity (CDVA). No eyes lost one line or more of CDVA postoperatively. Postoperative spherical equivalent was within ±0.50 D of the target for 9 of 10 eyes. Posterior corneal curvature slightly steepened for PTK-EP and LIKE. Postoperative epithelial thickness demonstrated the expected doughnut pattern in both groups characterized by epithelium in the central zone (5 mm) thinner than that in the peripheral zone (5 to 7 mm). Visual outcomes, refraction, posterior corneal surface changes, and epithelial remodeling after PTKEP or LIKE show a potentially useful modality for correcting moderate to high hyperopia. [J Refract Surg. 2020;36(11):772-779.].

Effect of cataract surgery on quality of life for patients with severe vision impairment due to age-related macular degeneration.

BackgroundTo determine whether patients with severe vision impairment due to advanced age-related macular degeneration (AMD) benefit from bilateral cataract surgery in terms of vision-related quality of life (QoL).MethodsA prospective interventional single-center study. Ten patients with severe vision impairment due to advanced bilateral AMD were included. The preoperative corrected distance visual acuity (CDVA) was ≥1.0/≥1.0 LogMAR units on Snellen chart and <20/<20 points on Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Patients were not on active treatment for wet AMD as the treatment was expected to have no effect or benefit. The patients were scheduled for immediate sequential bilateral cataract surgery, with target refraction emmetropia (SN60WF, Alcon). Vision-related QoL was measured with National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) preoperatively, at 3 months and 1 year.ResultsThe mean age of the patients was 82.5±6.2 years. The mean NEI VFQ-25 overall composite score changed from 44.0±7.1 preoperatively to 54.9±13.7 at 3 months and to 56.9±15.6 at 1 year (P=0.045, Friedman test). During the 1-year follow-up, there was an improvement in the subscale scores indicating difficulty with peripheral vision, mental health symptoms, and role difficulties due to vision (P<0.05 for all, Wilcoxon sign-rank test).ConclusionsCataract surgery may improve the vision-related QoL in patients with severe vision impairment due to bilateral advanced AMD.

Clinical Outcomes and Lens Constant Optimization of the Zeiss CT Lucia 602 Lens Using a Modified Yamane Technique.

PurposeTo report the clinical and refractive outcomes of a modified Yamane technique for scleral fixation of the CT Lucia 602 lens.DesignRetrospective case series.PatientsOne hundred twenty-one eyes with dislocated posterior chamber lens implants, surgical aphakia, subluxed crystalline lenses, capsular tear, anterior chamber, or iris sutured posterior chamber lens intolerance were included.MethodsSecondary implantation of the Zeiss CT Lucia 602 lens was performed by a single surgeon using a modified Yamane technique employing a single needle, rather than the double-needle approach. One hundred twelve eyes underwent simultaneous 3 port pars plana vitrectomy and 9 eyes had previously undergone posterior vitrectomy surgery. Exclusion criteria were age <18, simultaneous glaucoma or corneal procedures, staged corneal transplantation, and follow-up <30 days.Main Outcome MeasuresA paired t-test was used to compare pre- and post-operative corrected distance visual acuity (CDVA), the mean predictive error, and the mean absolute predictive error between the manufacturer’s and optimized constants for Hoffer Q, Holladay I, and SRK/T. Complication rates were reported.ResultsOne hundred twenty-one consecutive eyes with a mean follow-up of 237 days were included. The pre-operative CDVA was 0.871 ± 0.785 logMAR (mean ± standard deviation, Snellen equivalent 20/149), which improved to 0.401 ± 0.608 (Snellen equivalent 20/50) post-operatively. In 109 eyes with reliable postoperative refractions, the mean predictive refractive error (D) ± std was +0.74 ± 1.37 for Hoffer Q, +0.66 ± 1.41 for Holladay 1, and +0.47 ± 1.49 for SRK/T (p<0.05). Refractive outcome analysis yielded a mean optimized personalized anterior chamber depth (pACD) of 5.69, Surgeon Factor of 1.79, and A constant of 118.56. Vision-limiting complications occurred in 11 eyes (9.1%).ConclusionScleral fixation of the CT Lucia 602 lens using a single-needle modification of the Yamane technique resulted in very good visual acuity, predictable postoperative refractive errors, but some vision-limiting complications in this heterogeneous group of eyes with significant comorbidities.

Safety and Efficacy of a New Posterior Chamber Phakic Intraocular Lens in Cases of High Myopia: Early Results.

PurposeTo demonstrate the visual outcomes of a foldable, hydroxy ethyl-methacrylate, single-piece, posterior chamber phakic intraocular lens (pIOL).Study TypeRetrospective study.Materials and MethodsPatients presenting with moderate to high myopia who underwent surgical correction with a posterior chamber phakic IOL (refractive intraocular lens, phakic intraocular lens, Appasamy Associates, Chennai, India) were retrospectively reviewed. Only patients with at least one-year follow-up were included. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), endothelial cell density (ECD), and pIOL vault were analyzed 1, 3, 6, and 12 months after surgery. Intraoperative and postoperative events were recorded in all cases.ResultsThe study included 30 eyes from 15 patients. The mean patient age was 25.8 ± 3 years. The spherical equivalent of manifest refraction was −11.47 ± 4.38 D preoperatively and −0.44 ± 0.55 D postoperatively. The preoperative CDVA was 0.17 ± 0.12 logMAR. The postoperative UDVA was 0.053 ± 0.11 logMAR (min: −0.17 and max: 0.2) and 0.019 ± 0.091 logMAR (min: −0.17 and max: 0.2) at the end of 1 month and 6 months, respectively. At the end of the 12-month visit, the postoperative UDVA was 0.032 ± 0.094, and the safety index was 2.42. The mean ECD was 2639 cells/mm2 (min: 2389 and max: 2993 with SD: 139.53) at the preoperative visit and 2445 cells/mm2 (min: 2050 and max: 2701) at the 12-month visit (5.8% loss, p less than 0.001). ECD loss from 6 months to 12 months was not statistically significant. No significant cataract formation, significant endothelial cell loss, glaucoma, uveitis, or any other vision-threatening complication were observed.ConclusionBased on postoperative experience, we found that RIL phakic IOLs are safe and effective for treating high myopia at short-term follow-up.

Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac.

Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.

Cataract surgery in eyes with congenital ocular coloboma.

To assess the safety, efficacy, and complication rate of phacoemulsification and intraocular lens (IOL) implantation in patients with congenital uveal coloboma and to evaluate the role of pupilloplasty. A retrospective review of 41 eyes (31 patients) with congenital coloboma that underwent phacoemulsification and IOL implantation between September 2012 and September 2018. Preoperative, intraoperative, and postoperative data were collected for analysis. The mean patient age at surgery was 53.9years (range 15-82). The primary indication for surgery was cataract removal for visual improvement, and lens subluxation was additionally present in two eyes (5%) preoperatively. The mean preoperative corrected distance visual acuity (CDVA) was 0.90 LogMAR. Phacoemulsification surgery was performed in all cases and nine eyes (22%) had pupilloplasty for pupil reconstitution at the time of the procedure. Surgeon grade varied from trainee surgeon under supervision to consultant. Eight patients (19.5%) had posterior capsular rupture (PCR) with or without vitreous loss requiring anterior vitrectomy. Of these, 2 cases (5%) had dropped nuclear fragments requiring subsequent pars plana vitrectomy and lens fragment removal. The mean postoperative CDVA was 0.62 LogMAR (p = 0.0003). Patients with iridolenticular choroidal coloboma appear to be more at risk of complications, as were cases performed by non-consultant surgeons. Contrary, patients with phakodonesis, preoperative anterior chamber vitreous, dense cataracts, and cases were iris hooks used had no significant difference at PCR rate. The risk of postoperative glare and pupilloplasty needs to be considered in cases with good visual potential to avoid a possible second procedure.

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.

Results 5 to 10 years after cataract surgery with primary IOL implantation in juvenile idiopathic arthritis-related uveitis.

To evaluate the results of cataract extraction with primary intraocular lens (IOL) implantation in patients with juvenile idiopathic arthritis (JIA) and uveitis-related cataract. Department of Ophthalmology, Helsinki University Hospital, Finland. Retrospective case series. All consecutive patients younger than 20 years with JIA-uveitis-related cataract undergoing cataract extraction with primary IOL implantation in 1 or both eyes at the Department of Ophthalmology, Helsinki University Hospital, Finland, from February 2000 to April 2012 were included. Twenty eligible patients with 26 operated eyes were identified; 14 were girls and 6 were boys. All patients had a follow-up of 5 years and 13 patients (16 eyes [65%]) reached 10 years of follow-up. Twenty-six eyes of 20 patients were studied. Preoperative median corrected distance visual acuity (CDVA) was 0.05 in decimal notation. Median CDVA was 1.0 at 5 years and 0.9 at 10 years of follow-up. Two eyes did not reach CDVA 0.5 with the operation, and in 2 eyes, CDVA decreased below 0.5 over the period of 3 to 5 years after the operation. Active uveitis during 3 and 12 months preoperatively was a risk indicator for postoperative CDVA <0.5 at 5 years (P = .005 and P = .007, respectively). Cataract extraction with primary IOL implantation provides long-standing good visual acuity for young patients with well-controlled JIA-related uveitis.

Impact of the possible prognostic factors for visual outcomes of traumatic cataract surgery.

This study aimed to investigate the impact of the possible prognostic factors for postsurgical success on visual acuity (VA) in traumatic cataract patients. The files of 92 patients (19 women[20.6%]-73 men[79.4%], 44 right-48 left total 92 eyes) who underwent surgery for traumatic cataracts between 2004 and 2018 were retrospectively reviewed for preoperative and final corrected distance VA(CDVA), laterality of trauma, time of admission to a hospital after trauma(TAH), type of injury, location of the injury (zone 1 [corneal], zone 2 [corneal and scleral], zone 3 [scleral]), additional ocular injury, simultaneous or secondary surgery, surgical cataract techniques, and complications. Of the 92 patients enrolled in the study, the mean CDVA was improved from preoperative 1.95 ± 0.49 logMAR to postoperative 0.73 ± 0.72 logMAR.(p < 0.001) In 36.7% of cases, the final CDVA was ≥ 20/40; it was ≥ 20/60 in 58.7%, ≥ 20/200 in 73.9%, and ≥ 20/400 in 94.5%. The strongest correlation was found between postoperative CDVA and preoperative CDVA (Pearson's R = 0.969, p = 0.0001). No correlation was found between CDVA and age, sex, and laterality. The regression analysis showed a significant relationship between the increase in CDVA and TAH, trauma type and location, and surgical timing and techniques. The worst CDVA prognosis was found for patients with a zone 3 injury; patients with a zone 1 injury had the best prognosis. The prognosis is better for a closed globe injury than an open globe injury (p = 0.019). Early TAH was related to a better prognosis than later admissions. No difference was observed between simultaneous and secondary surgeries (p = 0.413) and surgical techniques (p = 0.12). Postoperative CDVA is better in traumatic cataract patients with a better preoperative VA. Early hospital admission after trauma, closed globe, and zone 1 injuries are better prognostic factors than late hospital admission time, open globe, and zone 3 injuries.

Short and long term outcomes after small-incision lenticule extraction: A tertiary referral centre experience

The objective of this study is to evaluate the preoperative and short- and long-term postoperative results in terms of visual acuity, refractive error, and corneal wavefront aberrations in patients with myopia and myopic astigmatism undergoing small incision lenticule extraction (SMILE). Seventy-nine eyes of 52 myopes with or without astigmatism (41 right and 38 left) were enrolled in this retrospective study. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and wavefront aberrations. All the measurements before and after SMILE surgery were systematically recorded. Mean preoperative UDVA was 1.19±0.24 logMAR and improved to 0.06±0.17 logMAR at the 3-year postoperative follow-up. At the conclusion of the 3-year follow-up, UDVA was better than or equal to 20/20 and 20/25 in 73% and 84% of eyes, respectively. At 1 month postoperatively, CDVA was 0.05±0.23 logMAR and significantly lower than the preoperative CDVA, 0.02±0.04 log MAR (P>0.05). However, at 1 year and 3 years after surgery, CDVA showed a significant increase compared to preoperative CDVA. At the conclusion of the 3-year follow-up, SE was -0.47 D, and 69.6% and 83.5% of the eyes were within±0.50 D and±1.00 D, respectively, of the intended correction. HOA's, coma, and spherical aberration increased significantly. No significant change in trefoil was detected. This study showed that SMILE produces a stable, safe outcome for surgical treatment of myopia and myopic astigmatism.

8-0 Polypropylene Suture Looping and Overhand Knot: Transconjunctival Approach to Four-Point Scleral Fixation of an Akreos Adapt Intraocular Lens.

To evaluate a novel surgical technique for transscleral fixation of the intraocular lens (IOL) with four hollow haptics using 8-0 polypropylene suture looping and overhand knot. An 8-0 polypropylene suture was tied to a 10-0 polypropylene suture with an overhand knot. One set of 8-0 polypropylene suture was then passed through the IOL four haptics. The suture knot was buried by rotating into the sclera tunnel. Best-corrected visual acuity, intraocular pressure, and complications were determined. The IOLs were fixed with using an 8-0 polypropylene suture in 13 eyes of 11 patients with aphakia and dislocated crystalline lens. The mean preoperative corrected distance visual acuity was 0.71 ± 0.58 logarithm of the minimum angle of resolution (Snellen 20/103), and it improved to 0.24 ± 0.25 logarithm of the minimum angle of resolution (Snellen 20/35) at the final follow-up ( P < 0.05). No vitreous hemorrhage, hypotony, suture exposed, and pupillary capture of the IOL were observed in any of the patients. The authors have developed a new technique for transscleral IOL fixation with one set of an 8-0 polypropylene suture tied to a 10-0 polypropylene suture with an overhand knot. The overhand knot offers the opportunity to use an 8-0 polypropylene suture for the long-term safety and may not require the surgeon to learn any new technique.