Showing papers in "Journal of Cataract and Refractive Surgery in 2011"
TL;DR: The cornea lacks the neurobiological sophistication of the retina and the dynamic movement of the lens; yet, without its clarity, the eye would not be able to perform its necessary functions.
Abstract: The importance of the cornea to the ocular structure and visual system is often overlooked because of the cornea's unassuming transparent nature. The cornea lacks the neurobiological sophistication of the retina and the dynamic movement of the lens; yet, without its clarity, the eye would not be able to perform its necessary functions. The complexity of structure and function necessary to maintain such elegant simplicity is the wonder that draws us to one of the most important components of our visual system.
617 citations
TL;DR: All‐in‐one femtosecond refractive correction using a small incision technique was safe, predictable, and effective in treating myopia and myopic astigmatism.
Abstract: Purpose To report the clinical results of small incision lenticule extraction to correct refractive errors using a femtosecond laser to refine the femtosecond lenticule extraction technique. Setting Private laser center, Vadodara, India. Design Prospective clinical study. Methods The VisuMax femtosecond laser system was used to perform small incision lenticule extraction to treat refractive errors. The laser was used to cut a refractive lenticule intrastromally to correct myopia and myopic astigmatism. The lenticule was then extracted from the stroma through a 3.0 to 5.0 mm incision. Outcome measures were corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), and manifest refraction during 6 months of follow-up. Corneal topography and ocular wavefront aberrations were also measured. Results The study enrolled 51 eyes of 41 patients. The mean spherical equivalent was −4.87 diopters (D) ± 2.16 (SD) preoperatively and +0.03 ± 0.30 D 6 months postoperatively. Refractive stability was achieved within 1 month ( P Conclusion All-in-one femtosecond refractive correction using a small incision technique was safe, predictable, and effective in treating myopia and myopic astigmatism. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.
500 citations
TL;DR: Collagen crosslinking was effective in improving UDVA, CDVA, the maximum K value, and the average K value and Keratoconus patients had more improvement in topographic measurements than patients with ectasia.
Abstract: PURPOSE:Toevaluate 1-yearoutcomes of cornealcollagencrosslinking(CXL) fortreatment of keratoconus and corneal ectasia. SETTING: Cornea and refractive surgery subspecialty practice. DESIGN: Prospective randomized controlled clinical trial. METHODS:Collagen crosslinking was performed in eyes withkeratoconus orectasia. Thetreatment group received standard CXL and the sham control group received riboflavin alone. Principal outcomes included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, astigmatism, and topography-derived outcomes of maximum and average keratometry (K) value. RESULTS: The UDVA improved significantly from 0.84 logMAR G 0.34 (SD) (20/137) to 0.77 G 0.37 logMAR (20/117) (P Z .04) and the CDVA, from 0.35 G 0.24 logMAR (20/45) to 0.23 G 0.21 logMAR (20/34) (P<.001). Fifteen patients (21.1%) gained and 1 patient lost (1.4%) 2 or more Snellen lines of CDVA. The maximum K value decreased from baseline by 1.7 G 3.9 diopters (D) (P<.001), 2.0 G 4.4 D (P Z .002), and 1.0 G 2.5 D (P Z .08) in the entire cohort, keratoconus subgroup, and ectasia subgroup, respectively. The maximum K value decreased by 2.0 D or more in 22 patients (31.0%) and increased by 2.0 D or more in 3 patients (4.2%). CONCLUSIONS: Collagen crosslinking was effective in improving UDVA, CDVA, the maximum K value, and the average K value. Keratoconus patients had more improvement in topographic measurements than patients with ectasia. Both CDVA and maximum K value worsened between baseline and 1 month, followed by improvement between 1, 3, and 6 months and stabilization thereafter.
409 citations
TL;DR: The cause of dissatisfaction after implantation of a multifocal IOL can be identified and effective treatment measures taken in most cases, according to a retrospective chart review.
Abstract: Purpose To analyze the symptoms, etiology, and treatment of patient dissatisfaction after multifocal intraocular lens (IOL) implantation. Setting Department of Ophthalmology, Maastricht University Medical Center, The Netherlands. Design Case series. Methods In this retrospective chart review, the main outcome measures were type of complaints, uncorrected and corrected distance visual acuities, uncorrected and distance-corrected near visual acuities, refractive state, pupil diameter and wavefront aberrometry measurements, and type of treatment. Results Seventy-six eyes of 49 patients were included. Blurred vision (with or without photic phenomenon) was reported in 72 eyes (94.7%) and photic phenomena (with or without blurred vision) in 29 eyes (38.2%). Both symptoms were present in 25 eyes (32.9%). Residual ametropia and astigmatism, posterior capsule opacification, and a large pupil were the 3 most significant etiologies. Sixty-four eyes (84.2%) were amenable to therapy, with refractive surgery, spectacles, and laser capsulotomy the most frequent treatment modalities. Intraocular lens exchange was performed in 3 cases (4.0%). Conclusion The cause of dissatisfaction after implantation of a multifocal IOL can be identified and effective treatment measures taken in most cases. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
345 citations
TL;DR: The femtosecond laser produced capsulotomies that were more precise, accurate, reproducible, and stronger than those created with the conventional manual technique.
Abstract: RESULTS: Laser-created capsulotomies were significantly more precise in size and shape than manually created capsulorhexes. In the patient eyes, the deviation from the intended diameter of the resected capsule disk was 29 mm G 26 (SD) for the laser technique and 337 G 258 mm for the manual technique. The mean deviation from circularity was 6% and 20%, respectively. The center of the laser capsulotomies was within 77 G 47 mm of the intended position. All capsulotomies were complete, with no radial nicks or tears. The strength of laser capsulotomies (porcine subgroup) decreased with increasing pulse energy: 152 G 21 mN for 3 mJ, 121 G 16 mN for 6 mJ, and 113 G 23 mN for 10 mJ. The strength of the manual capsulorhexes was 65 G 21 mN. CONCLUSION: The femtosecond laser produced capsulotomies that were more precise, accurate, reproducible, and stronger than those created with the conventional manual technique. Financial Disclosure: The authors have equity interest in OptiMedica Corp., which manufactures the femtosecond laser cataract system.
325 citations
TL;DR: To assess how intraocular lens (IOL) formula choice affects refractive outcomes after cataract surgery using IOLMaster biometry, optimized Hoffer Q, Holladay 1, and SRK/T formulas were used across a range of 0.5 mm or 1.0 mm axial length subgroups.
Abstract: Purpose To assess how intraocular lens (IOL) formula choice affects refractive outcomes after cataract surgery using IOLMaster biometry. Setting Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom. Design Database study. Methods Hypothetical prediction errors were retrospectively calculated on prospectively collected data from electronic medical records using optimized Hoffer Q, Holladay 1, and SRK/T formulas (Sofport AO and Akreos Fit IOLs) across a range of 0.5 mm or 1.0 mm axial length (AL) subgroups. Results In short eyes, the Hoffer Q had the lowest mean absolute error (MAE) for ALs from 20.00 to 20.99 mm. The Hoffer Q and Holladay 1 had a lower MAE than the SRK/T for ALs from 21.00 to 21.49 mm. There were no statistically significant differences in MAE for ALs from 21.50 to 21.99 mm. In medium eyes, there were no statistically significant differences in MAE for any IOL formula for ALs from 22.00 to 23.49 mm. For ALs from 23.50 to 25.99 mm, there was a trend toward lower MAEs for the Holladay 1, with statistically significant differences in 2 subgroups. In long eyes, the SRK/T had the lowest MAE, with statistically significant differences for ALs of 27.00 mm or longer. Conclusions The Hoffer Q performed best for ALs from 20.00 to 20.99 mm, the Hoffer Q and Holladay 1 for ALs from 21.00 to 21.49 mm, and the SRK/T for ALs of 27.00 mm or longer. Using optimized constants, refractive outcomes of 40%, 75%, and 95% within ±0.25 diopter (D), ±0.50 D, and ±1.00 D, respectively, were achievable. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.
278 citations
TL;DR: This review summarizes data collected by the Swedish National Cataract Register, which now contains data pertaining to more than a million cataract surgery procedures, representing 95.6% of the surgeries performed in Sweden during 1992-2009, and shows that preoperative visual acuity has risen steadily and endophthalmitis has decreased.
Abstract: This review summarizes data collected by the Swedish National Cataract Register, which now contains data pertaining to more than a million cataract surgery procedures, representing 95.6% of the sur ...
246 citations
TL;DR: Ultraviolet‐A light associated with riboflavin CXL is an efficient procedure to stabilize and improve progressive keratoconus and the results reinforce previous studies highlighting the efficacy and safety of the procedure.
Abstract: Purpose To report refractive, topographic, and biomechanical outcomes, efficiency, and safety of corneal collagen crosslinking (CXL) 1, 3, 6, and 12 months after treatment. Setting National Reference Centre for Keratoconus, Bordeaux and Toulouse, France. Design Case series. Methods This retrospective uncontrolled double-center study comprised eyes with progressive keratoconus. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), corneal pachymetry, endothelial cell count, and corneal hysteresis and corneal resistance factor were evaluated at baseline and at 1, 3, 6, and 12 months. Results One hundred forty-two eyes were enrolled in the study. At 6 months, the CDVA had stabilized in 53 eyes (48.1%), improved in 36 eyes (32.7%), and decreased in 18 eyes (16.3%). At 12 months, the CDVA had stabilized in 31 eyes (47.6%), improved in 26 eyes (40.0%), and decreased in 8 eyes (12%). At 6 months, keratoconus progression had stopped in 51 eyes (49.03%) and the maximum keratometry (K) value had decreased by more than 1.0 diopter (D) in 37 eyes (35.5%); it continued to progress in 16 eyes (15.3%). At 12 months, keratoconus progression had stopped in 42 eyes (68.8%) and the maximum K value had decreased by more than 2.0 D in 13 eyes (21.3%). The complication rate with loss of vision was 3.5%. Conclusions Ultraviolet-A light associated with riboflavin CXL is an efficient procedure to stabilize and improve progressive keratoconus. The results reinforce previous studies highlighting the efficacy and safety of the procedure. A large prospective randomized clinical trial is needed. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
199 citations
TL;DR: After CXL, the cornea thins and then recovers toward baseline thickness, and the recovery of corneal thickness was more rapid in ectasia than in keratoconus.
Abstract: PURPOSE: To determine the changes in corneal thickness over time after corneal collagen crosslinking (CXL) for keratoconus and corneal ectasia. SETTING: Cornea and refractive surgery subspecialty practice. DESIGN: Prospective randomized controlled clinical trial. METHODS: Corneal thickness at the apex, thinnest point, and pupil center were measured using Scheimpflug imaging (Pentacam) at baseline and 1, 3, 6, and 12 months after CXL. The treatment group was compared with both a sham-procedure control group and a fellow-eye control group. Associations with clinical outcomes (uncorrected and corrected distance visual acuities and maximum keratometry) were analyzed. RESULTS: The study comprised 82 eyes, 54 with keratoconus and 28 with ectasia after laser in situ keratomileusis. The mean preoperative thinnest pachymetry was 440.7mmG 52.9 (SD). After CXL, the cornea thinned at 1 month (mean change � 23.8 G 28.7 mm; P<.001) and from 1 to 3 months (mean change � 7.2G 20.1 mm,PZ.002), followed by a recovery of the corneal thickness between 3 months and 6 months (mean C20.5 G 20.4 mm; P<.001). At 1 year, apex and pupil-center thicknesses returned to baseline (PZ.11 and PZ.06, respectively); however, the thinnest pachymetry remained slightly decreased from baseline to 12 months (mean change � 6.6 G 22.4 mm; PZ.01). The recovery of corneal thickness was more rapid in ectasia than in keratoconus. There was no association between the degree of corneal thinning at 3 months and clinical outcomes after CXL. CONCLUSIONS:AfterCXL,thecorneathins and thenrecovers toward baselinethickness.The cause and implications of corneal thickness changes after CXL remain to be elucidated.
195 citations
TL;DR: The combination of 2 diffractive profiles to achieve far, intermediate, and near correction is validated and the IOL theoretically allows improved intermediate vision without impairing near and far vision and favors distance vision in mesopic conditions without increasing halos or glare perception under dim light or large pupil conditions.
Abstract: PURPOSE: To theoretically and experimentally assess a new aspheric diffractive trifocal intraocular lens (IOL). SETTING: Centre Spatial de LiLiBelgium. DESIGN: Evaluation of diagnostic test or technology. METHODS: The theoretical profile of the IOL was designed using software simulation and validated by optical calculation software tools that enabled complete theoretical characterization. These data resulted in a new aspheric diffractive trifocal IOL. The IOL theoretically allows improved intermedi- ate vision without impairing near and far vision and favors distance vision in mesopic conditions without increasing halos or glare perception under dim light or large pupil conditions. The theoret- ical findings were compared with those of in vitro testing on the optical bench. RESULTS: There was good agreement between the theoretical profile and achieved IOL profile. The simulated and achieved light distribution and focus distribution showed good concordance. The FineVision aspheric trifocal IOL provided intermediate addition at 1.75 diopters. CONCLUSION: The combination of 2 diffractive profiles to achieve far, intermediate, and near correction is validated. Further clinical investigations are required to validate these principles. Financial Disclosure: Dr. Houbrechts has no financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes. J Cataract Refract Surg 2011; 37:2060-2067 Q 2011 ASCRS and ESCRS
185 citations
TL;DR: Uncorrected astigmatism, even as low as 1.00 D, caused significantly decreased vision and if left uncorrected could significantly affect patients’ independence, quality of life, and well‐being.
Abstract: PURPOSE: To examine the effect of uncorrected astigmatism in older adults. SETTING: University Vision Clinic METHOD: Twenty-one healthy presbyopes, aged 58.9±2.8 years, had astigmatism of 0.0 to -4.0 x 90?DC and -3.0DC of cylinder at 90?, 180? and 45? induced with spectacle lenses, with the mean spherical equivalent compensated to plano, in random order. Visual acuity was assessed binocularly using a computerised test chart at 95%, 50% and 10% contrast. Near acuity and reading speed were measured using standardised reading texts. Light scatter was quantified with the cQuant and driving reaction times with a computer simulator. Finally visual clarity of a mobile phone and computer screen was subjectively rated. RESULTS: Distance visual acuity decreased with increasing uncorrected astigmatic power (F=174.50, p 0.05), but the reliability and variability of measurements decreased with increasing uncorrected astigmatic power (p 0.05), but subjective rating of clarity decreased with increasing uncorrected astigmatic power (p<0.001). Uncorrected astigmatism at 45? or 180? orientation resulted in a worse distance and near visual acuity, and subjective rated clarity than 90? orientation (p<0.05). CONCLUSION: Uncorrected astigmatism, even as low as 1.0DC, causes a significant burden on a patient’s vision. If left uncorrected, this could impact significantly on their independence, quality of life and wellbeing.
TL;DR: The proposed method of optimizing AL significantly reduced the percentage of long eyes with a hyperopic outcome and updated optimizing AL formulas by combining all eyes from the 2 study centers are proposed.
Abstract: Purpose To evaluate the accuracy of refractive prediction of 4 intraocular lens (IOL) power calculation formulas in eyes with axial length (AL) greater than 25.0 mm and to propose a method of optimizing AL to improve the accuracy. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA, and Department of Ophthalmology, Goethe University, Frankfurt am Main, Germany. Design Case series. Methods Refractive prediction errors with the Holladay 1, Haigis, SRK/T, and Hoffer Q formulas were evaluated in consecutive cases. Eyes were randomized to a group used to develop the method of optimizing AL by back-calculation or a group used for validation. Further validation was performed in 2 additional data sets. Results The optimized AL values were highly correlated with the IOLMaster AL (R2 from 0.960 to 0.976). In the validating group, the method of optimizing AL significantly reduced the mean numerical errors for IOLs greater than 5.00 diopters (D) from +0.27 to +0.68 D to −0.10 to −0.02 D and for IOLs of 5.00 D or less from +1.13 to +1.87 D to −0.21 to +0.01 D, respectively (all P Conclusions The proposed method of optimizing AL significantly reduced the percentage of long eyes with a hyperopic outcome. Updated optimizing AL formulas by combining all eyes from the 2 study centers are proposed. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: Combined analysis of anterior and posterior corneal power, elevation, and thickness data provided by the Scheimpflug device effectively discriminated between ectatic corneas and normal cornea.
Abstract: Purpose To determine the efficacy of different Scheimpflug-imaging parameters in discriminating between subclinical keratoconus, keratoconus eyes, and normal eyes. Setting Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey. Design Comparative case series. Methods Pentacam Scheimpflug measurements were taken in eyes with mild to moderate keratoconus, subclinical keratoconus, or with myopic astigmatism (normal eyes). Several parameters provided by the software or derived from the elevation maps were evaluated and compared between the groups. The Mann-Whitney test, receiver-operating-characteristic (ROC) curves, and logistic regression analysis were used to compare the mean measurements and to evaluate the sensitivity and specificity of the parameters or constructed models. Results The corneal power and elevation measurements were statistically significantly higher and the cornea was significantly thinner in eyes with subclinical or clinical keratoconus than in normal eyes (P Conclusion Combined analysis of anterior and posterior corneal power, elevation, and thickness data provided by the Scheimpflug device effectively discriminated between ectatic corneas and normal corneas. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: There were improvements in 4 of 7 topography indices 1 year after CXL, suggesting an overall improvement in corneal shape, however, no significant correlation was found between the changes in individual topographic indices and changes in visual acuity after C XL.
Abstract: PURPOSE: To evaluate changes in corneal topography indices after corneal collagen crosslinking (CXL) in patients with keratoconus and corneal ectasia and analyze associations of these changes with visual acuity. SETTING: Cornea and refractive surgery subspecialty practice. DESIGN: Prospective randomized controlled clinical trial. METHODS:Cornealcollagencrosslinkingwasperformed ineyes withkeratoconusorectasia.Quantitative descriptors of corneal topography were measured with the Pentacam topographer and included 7 indices: index of surface variance, index of vertical asymmetry, keratoconus index, central keratoconus index, minimum radius of curvature, index of height asymmetry, and index of height decentration. Follow-up was 1 year. RESULTS: The study comprised 71 eyes, 49 with keratoconus and 22 with post-LASIK ectasia. In theentire patient cohort,there were significant improvements inthe index ofsurfacevariance, index of vertical asymmetry, keratoconus index, and minimum radius of curvature at 1 year compared with baseline (all P<.001). There were no significant differences between the keratoconus and ectasia subgroups. Improvements in postoperative indices were not correlated with changes in corrected or uncorrected distance visual acuity. CONCLUSIONS:Therewereimprovementsin4of7topographyindices 1yearafter CXL,suggesting an overall improvement in corneal shape. However, no significant correlation was found between the changes in individual topography indices and changes in visual acuity after CXL.
TL;DR: Intraocular pressure and medication use results in all eyes were significantly decreased from baseline at every time point and canaloplasty led to a significant and sustained IOP reduction in adult patients with open‐angle glaucoma and had an excellent short‐ and long‐term postoperative safety profile.
Abstract: Purpose To report 3-year results of the safety and efficacy of canaloplasty, a procedure involving circumferential viscodilation and tensioning of the inner wall of Schlemm canal to treat open-angle glaucoma. Setting Multicenter surgical sites. Design Nonrandomized multicenter clinical trial. Methods This study comprised adult open-angle glaucoma patients having canaloplasty or combined cataract–canaloplasty surgery. Qualifying preoperative intraocular pressures (IOPs) were at least 16 mm Hg with historical IOPs of at least 21 mm Hg. A flexible microcatheter was used to viscodilate the full circumference of the canal and to place a trabecular tensioning suture. Primary outcome measures included IOP, glaucoma medication use, and adverse events. Results Three years postoperatively, all study eyes (n = 157) had a mean IOP of 15.2 mm Hg ± 3.5 (SD) and mean glaucoma medication use of 0.8 ± 0.9 compared with a baseline IOP of 23.8 ± 5.0 mm Hg on 1.8 ± 0.9 medications. Eyes with combined cataract–canaloplasty surgery had a mean IOP of 13.6 ± 3.6 mm Hg on 0.3 ± 0.5 medications compared with a baseline IOP of 23.5 ± 5.2 mm Hg on 1.5 ± 1.0 medications. Intraocular pressure and medication use results in all eyes were significantly decreased from baseline at every time point ( P Conclusion Canaloplasty led to a significant and sustained IOP reduction in adult patients with open-angle glaucoma and had an excellent short- and long-term postoperative safety profile. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
TL;DR: Asdiscussed, precision of the capsulorhexis could improve the optical performance in cases of “premium” intraocular lenses (IOLs) and monofocal IOL implantation, but it remains to be demonstrated that the minimal difference in capsul orhexis size and shape would have a significant impact on the refractive outcome.
Abstract: Femtosecond laser capsulotomy I would like to commend Friedman et al. for reporting their interesting experience with an optical coherence tomography-guided femtosecond laser in cataract surgery.Asdiscussed, precision of the capsulorhexis could improve the optical performance in cases of “premium” intraocular lenses (IOLs). In cases of monofocal IOL implantation, it remains to be demonstrated that the minimal difference in capsulorhexis size and shape found in this studywould have a significant impact on the refractive outcome. To date, only 55% to 66% of eyes achieve a final refraction within 0.5 diopter of the target.More than the capsulorhexis, many other things can be the contributing factors. Although I agree that patient safety and the noninferiority of the femtosecond laser capsulotomy compared with the standard treatment have been verified, I have some concerns: Is this technology sustainable and affordable? Eyes with a “pupillary dilation of at least 7.0 mm, axial length between 22.0 mm and 26.0 mm, and anterior chamber depth greater than 2.5 mm” enrolled in this study represent the majority. Therefore, manual capsulorhexis would be required rarely, such as in cases of poor preoperative pupil dilation, if the femtosecond laser capsulorhexis were the standard. That might have a detrimental effect on surgical training. How and when would trainees gain experience in performing this delicate surgical step in cataract extraction? In recent years, we have joined other healthcare providers in demanding the most cost-effective, evidence-based treatment methods. In cataract surgery, the search for healthcare efficiency has led to exploration of the feasibility of simultaneous bilateral cataract surgery with a view to cost savings. I refer not only to the costs related to implementing lasers in our departments, but mainly to the costs that derive from “operating room floor time and staff time,” as recently investigated by Leivo et al.
TL;DR: Statistically significant flattening occurred during 1 year after CXL in more than 50% of cases when the preoperative maximum keratometry reading was more than 54.00 D and none of the other preoperative parameters evaluated had a statistically significant impact on corneal flattening after C XL.
Abstract: Purpose To identify preoperative parameters that may predict flattening of the keratoconic cornea after collagen crosslinking (CXL). Setting Institut fur Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland. Design Cohort study. Methods Patients with verified progressive primary keratectasia received standard corneal CXL. Factors such as corrected distance visual acuity (CDVA) and Scheimpflug tomography (Pentacam) were used to follow the evolution from preoperatively to 12 months after CXL. Statistical analysis included U tests and Spearman rank correlation tests to detect risk factors for flattening of the keratoconus. Results The study enrolled 151 eyes of 151 patients; more than 80% completed the 12-month follow-up. The flattening rate (flattening of the maximum curvature >1.00 diopter [D]) was 37.7%. A preoperative maximum keratometry (K) reading of more than 54.00 D was identified as the only significant risk factor for this effect (odds ratio, 1.88; 95% confidence interval, 1.01-3.51). A restriction to corneas with a maximum K value greater than 54.00 D would have resulted in a significant flattening in 51% of the cases. Conclusions Statistically significant flattening occurred during 1 year after CXL in more than 50% of cases when the preoperative maximum K reading was more than 54.00 D. None of the other preoperative parameters evaluated (eg, age, sex, diagnosis, CDVA, corneal shape factors) had a statistically significant impact on corneal flattening after CXL. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: The visual limitation in keratoconus could be explained by different alterations that occur in these corneas and allowed development of a new grading system for this condition.
Abstract: Purpose To evaluate the clinical features of keratoconus taking into consideration anterior corneal aberrations, internal astigmatism, and corneal biomechanical properties and to define a new grading system based on visual limitation. Setting Vissum Corporation, Alicante, Spain. Design Retrospective case series. Methods This multicenter study comprised consecutive keratoconic eyes with no previous ocular surgery or active ocular disease. Visual, refractive, corneal topography, and pachymetry outcomes were analyzed. Internal astigmatism was calculated by vectorial analysis. Corneal aberrations and corneal biomechanics characterized by the Ocular Response Analyzer were evaluated in some eyes. Correlations between clinical data and a linear multiple regression analysis for characterizing the relationship between visual limitation and objective clinical data were performed. Results This study comprised 776 eyes of 507 patients (age range 11 to 79 years) The mean keratometry (K) correlated significantly with logMAR corrected distance visual acuity (CDVA) ( r = 0.591, P r = 0.497, P r = −0.647, P r ≥0.603, P r ≥0.444, P r 2 = 0.69, P P Conclusion The visual limitation in keratoconus could be explained by different alterations that occur in these corneas and allowed development of a new grading system for this condition. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: The anterior segment measurements provided by the new Scheimpflug camera–Placido corneal topography system were highly repeatable and can be relied on in clinical routine and for research purposes.
Abstract: Purpose To assess the repeatability of anterior segment measurements performed by a Scheimpflug camera combined with Placido corneal topography (Sirius) in unoperated, post-refractive surgery, and keratoconus eyes. Setting Private clinical ophthalmology practice. Design Evaluation of diagnostic test or technology. Methods Three consecutive scans were acquired for each eye. The following parameters were evaluated: simulated keratometry, posterior corneal power, mean pupil power (ie, corneal power assessed by ray tracing through the anterior and posterior corneal surfaces), corneal asphericity, thinnest and apex corneal thickness, aqueous depth, anterior chamber volume, and corneal spherical aberration. Repeatability was assessed using test–retest variability, the coefficient of variation, and the intraclass correlation coefficient (ICC). Results Sixty-four unoperated eyes, 17 eyes that had myopic excimer laser surgery, and 13 eyes with keratoconus were analyzed. High repeatability was achieved for most parameters in the 3 groups, with an ICC higher than 0.99 for all measurements except posterior corneal power and mean pupil power in keratoconus (ICC, 0.868 and 0.976, respectively), anterior and posterior asphericity in normal eyes (ICC, 0.904 and 0.977, respectively), and spherical aberration in normal eyes (ICC, 0.806), post-refractive surgery eyes (ICC, 0.980), and keratoconus eyes (ICC, 0.981). Conclusion The anterior segment measurements provided by the new Scheimpflug camera–Placido corneal topography system were highly repeatable and can be relied on in clinical routine and for research purposes. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: Complications were common, and suture rupture is an important long‐term complication, particularly in young patients, and these issues affect IOL choice for the surgical treatment of aphakia and should be discussed with patients during the consent process.
Abstract: Purpose To report the long-term visual outcomes and complications after implantation of scleral-fixated posterior chamber intraocular lenses (PC IOLs). Setting Princess Alexandra Hospital, Mater Hospital, and Queensland Eye Institute, Brisbane, Australia. Design Case series. Methods This study reviewed the records of patients who had anterior vitrectomy and scleral-fixated PC IOL implantation between 1993 and 2008 and had a minimum follow-up of 6 months. Results The study comprised 82 eyes of 72 patients (47 men). The mean follow-up was 83.3 months (range 6.7 to 166.5 months) and the mean age at surgery, 62 years (range 15 to 97 years). The mean improvement in corrected distance visual acuity (CDVA) was 1.6 Snellen chart lines of vision, which was statistically significant; 59 eyes (72%) had an improved or unchanged CDVA, and 23 eyes (28%) had a reduced CDVA. The most common postoperative complication was ocular hypertension (25 eyes [30.5%]). Suture breakage occurred in 5 eyes (6%) after a mean of 4.9 years; 4 of these patients were younger than 40 years. Overall, 44 eyes (53.7%) had at least 1 complication, 36.4% within 1 week postoperatively and 63.6% after 1 week. Thirteen eyes (15.8%) required at least 1 further operation. Conclusions Scleral-fixated PC IOL insertion provided favorable visual outcomes in many cases. Complications were common, and suture rupture is an important long-term complication, particularly in young patients. These issues affect IOL choice for the surgical treatment of aphakia and should be discussed with patients during the consent process. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.
TL;DR: The new‐generation multifocal IOL restored distance, intermediate, and near visual function after cataract surgery and the optical quality with this type of IOL was particularly affected by IOL tilt and decentration.
Abstract: Purpose To compare visual acuity outcomes and ocular and intraocular optical quality in patients with a monofocal intraocular lens (IOL) or a multifocal IOL with rotational asymmetry. Setting Vissum Corporation, Alicante, Spain. Design Comparative case series. Methods Consecutive eyes of cataract patients were divided into 2 groups. One group received a Lentis Mplus LS-312 multifocal IOL and the other, an Acri.Smart 48S monofocal IOL. Distance and near visual acuities, contrast sensitivity, intraocular aberrations (global minus corneal aberrations), and defocus curves were evaluated preoperatively and postoperatively during a 3-month follow-up. Results The study evaluated 52 eyes of 29 patients (age range 36 to 87 years); 24 eyes were in multifocal IOL group and 28 eyes, in the monofocal IOL group. Both groups had a significant improvement in uncorrected and corrected distance visual acuities and in distance-corrected near visual acuity (DCNVA) postoperatively ( P ≤.04). The multifocal IOL group had significantly better uncorrected near acuity and DCNVA (Jaeger [J] 5 versus J2) (both P P P ≥.25). Conclusions The new-generation multifocal IOL restored distance, intermediate, and near visual function after cataract surgery. The optical quality with this type of IOL was particularly affected by IOL tilt and decentration. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.
TL;DR: The results can help hospitals analyze the demand for and cost of using toric IOLs in patients with corneal astigmatism and to establish thedemand for toric intraocular lenses in a hospital unit.
Abstract: Purpose To analyze and quantify the pattern of corneal astigmatism in patients awaiting cataract surgery and to establish the demand for toric intraocular lenses (IOLs) in a hospital unit. Setting Singleton Hospital Abertawe Bro Morgannwg University NHS Trust, Swansea, United Kingdom. Design Cross-sectional study. Methods Keratometric measurements of all patients attending the preassessment clinic over a 4-month period were prospectively collected and analyzed. Results The study comprised 1230 eyes of 746 patients with a mean age of 75.54 years ± 0.71 (SD). The corneal astigmatism was 0.50 diopter (D) or less in 301 eyes (24.47%), 1.50 D or less in 978 eyes (79.50%), more than 2.50 D in 57 eyes (4.61%), and 3.00 D or more in 24 eyes (1.93%). Conclusions Of patients attending for routine cataract surgery at a single center, 497 (40.41%) had more than 1.00 D of astigmatism. The results can help hospitals analyze the demand for and cost of using toric IOLs in patients with corneal astigmatism. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.
TL;DR: Implantation of the collagen copolymer pIOL for moderate to high myopia was safe and effective and provided long‐term predictable, stable refractive results.
Abstract: Purpose To evaluate the long-term safety and efficacy of posterior chamber collagen copolymer phakic intraocular lens (pIOL) implantation to correct myopia. Setting Fernandez-Vega Ophthalmological Institute, Oviedo, Spain. Design Cohort study. Methods Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, pIOL vault, endothelial cell loss, and adverse events were evaluated for 5 years after implantation of the Visian Implantable Collamer Lens pIOL for moderate to high myopia. Results The mean spherical equivalent (188 eyes) decreased from −11.17 diopters (D) ± 3.40 (SD) preoperatively to −0.88 ± 0.72 D 5 years postoperatively. The mean change in refraction from 1 month to 5 years was −0.65 ± 0.65 D. The mean UDVA and CDVA (Snellen decimal) were 0.69 ± 0.26 and 0.83 ± 0.15, respectively. The mean safety and efficacy indices were 1.27 ± 0.33 and 0.89 ± 0.35, respectively. No eye lost more than 2 lines of visual acuity; 70% achieved 0.80 or better CDVA. Three eyes (1.6%) developed late anterior subcapsular cataract that was clinically significant in 1 case, leading to pIOL removal and phacoemulsification. Of the 3 eyes (1.6%) with a mild transient increase in intraocular pressure (up to 27 mm Hg), none required a second surgical procedure or prolonged topical medication. The total endothelial cell loss (considered cumulatively at consecutive intervals through 5 years) was 7.7%. There was a tendency toward decreased pIOL vault decrease over time. No vision-threatening complications occurred. Conclusion Implantation of the collagen copolymer pIOL for moderate to high myopia was safe and effective and provided long-term predictable, stable refractive results. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: Residents who trained using the simulator had shorter phaco times, lower percentage powers, fewer intraoperative complications, and a shorter learning curve.
Abstract: Purpose To determine whether the use of an eye-surgery simulator during ophthalmology residency training improves cataract surgery performance. Setting Department of Ophthalmology, Medical Faculty Associates, George Washington University, Washington, DC, USA. Design Comparative case series. Methods Residents were divided into a simulator group and a nonsimulator group based on the inclusion or absence of the eye-surgery simulator in residency training. Consecutive resident cataract surgeries with the same attending surgeon were retrospectively reviewed. The phaco time and percentage power and intraoperative complications in each case were recorded. The adjusted phaco time in each case was calculated. Results The study reviewed 592 surgeries. The mean values for phaco time, percentage phaco power, adjusted phaco time, complication rates, and complication grade were 1.88 minutes (range 0.11 to 7.20 minutes), 25.32% (range 2.2% to 50.0%), 47.58 minutes (range 0.24 to 280.80 minutes), 0.04, and 2.33, respectively, in the simulator group (n = 17) and 2.41 minutes (range 0.04 to 8.33 minutes), 28.19% (range 8.0% to 70.0%), 71.85 minutes (range 0.32 to 583.10 minutes), 0.06, and 2.47, respectively, in the nonsimulator group (n = 25). The Student t tests showed a statistically significant between-group difference in mean phaco time ( P P P P Conclusions Residents who trained using the simulator had shorter phaco times, lower percentage powers, fewer intraoperative complications, and a shorter learning curve. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: Intracorneal inlay implantation was an effective, safe, and reversible procedure for the long‐term surgical treatment of presbyopia and there were no severe corneal complications that affected final vision.
Abstract: Purpose To evaluate the long-term visual results of Acufocus ACI-7000 (now Kamra) intracorneal inlay implantation in presbyopic phakic patients. Setting Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. Design Clinical trial. Methods This study comprised patients with emmetropic or post-laser in situ keratomileusis (LASIK) presbyopia. Patients had an uncorrected near visual acuity (UNVA) of 20/40 or worse, correctable to 20/25 or better at distance. The inlay was implanted on the stromal bed after the LASIK flap was relifted or a flap created. The inlay was centered on the presurgical position of the first Purkinje reflex. The main outcome measures were distance and near vision and the complication rate. Results The study enrolled 39 patients aged 45 to 60 years. At the 4-year follow-up, all patients (N = 22) had 2 or more lines of improvement in UNVA with no significant loss in distance vision. The mean final UNVA was 20/20 (Jaeger [J1]); 96% of patients could read J3 or better. The uncorrected distance acuity was 20/40 or better in all eyes. Five patients had cataract progression, and 2 had a change in refractive status. No eye with an intracorneal inlay had intraoperative complications during cataract extraction. Four inlays were explanted during the study. There were no severe corneal complications that affected final vision. Conclusion Intracorneal inlay implantation was an effective, safe, and reversible procedure for the long-term surgical treatment of presbyopia. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.
TL;DR: Intracameral injection of high doses of cefuroxime induced anterior and posterior inflammation and the final visual outcome was satisfactory in all cases, however, long‐term retinal function must be assessed through repeated ERG recordings.
Abstract: Purpose To report cases of intraocular inflammation after intracameral injection of a very high dose of cefuroxime at the end of uneventful cataract surgery. Setting Department of Ophthalmology, Bordeaux University Hospital, Bordeaux, France. Design Case series. Methods Patients were followed on an outpatient basis and were examined postoperatively at 1 and 5 days and 6 weeks. Central macular thickness, angiography, central corneal thickness (CCT), endothelial cell density (ECD), and electroretinography (ERG) were analyzed to evaluate ocular toxicity. Results One day postoperatively, the mean corrected distance visual acuity (CDVA) was 0.95 logMAR ± 0.40 (SD). All the cases had moderate anterior inflammation. Retinal optical coherence tomography scans systematically showed extensive macular edema (mean 843.2 ± 212.7 μm) associated with a large serous retinal detachment. Fluorescein angiograms showed diffuse leakage without abnormal retinal perfusion. At 5 days, the mean CDVA improved significantly to 0.52 ± 0.29 logMAR ( P P =.005). At 6 weeks, the mean CDVA reached 0.09 ± 0.06 logMAR. Modifications in CCT and ECD were similar to those observed after uneventful phacoemulsification. The macular thickness (mean 288.4 ± 22.6 μm) and profile returned to normal in all patients, although ERG recordings showed reduced rod photoreceptor cell function ( P Conclusions Intracameral injection of high doses of cefuroxime induced anterior and posterior inflammation. Without surgical intervention, the final visual outcome was satisfactory in all cases. Long-term retinal function, however, must be assessed through repeated ERG recordings. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: Iris‐claw IOL implantation for aphakia gave a good visual outcome and can be used for a wide range of indications and postoperative complication rates were comparable to, if not better than, those with conventional anterior chamber IOLs.
Abstract: Purpose To evaluate the indications, postoperative visual efficacy, and complication rate after intraocular implantation of an iris-claw aphakic intraocular lens (IOL). Setting Oxford Eye Hospital, Oxford, United Kingdom. Design Case series. Methods This chart review comprised eyes with no capsule support that had anterior iris-fixation IOL implantation for aphakia between 2001 and 2009. Results The study comprised 116 eyes (104 patients). Iris-claw IOLs were inserted during primary lens surgery in 18 eyes (15.5%), during an IOL exchange procedure for dislocated posterior chamber IOLs in 19 eyes (16.4%), and as a secondary procedure in 79 eyes (68.1%). The mean follow-up was 22.4 months (range 3 to 79 months). The final corrected distance visual acuity (CDVA) was 6/12 or better in 68.9% of all eyes and in 47 of 53 eyes (88.7%) with no preoperative comorbidity. Complications included wound leak requiring resuturing in 2.6% of eyes, postoperative intraocular pressure rise in 9.5% of eyes (glaucoma escalation 0.8%), and cystoid macular edema in 7.7% of eyes (0.8% chronic). Iris-claw IOL subluxation occurred in 6.0% of eyes from 5 days to 60 months postoperatively; all the IOLs were repositioned. Corneal decompensation occurred in 1.7% of eyes; 0.8% had retinal detachments. Conclusions Iris-claw IOL implantation for aphakia gave a good visual outcome and can be used for a wide range of indications. Postoperative complication rates were comparable to, if not better than, those with conventional anterior chamber IOLs. Correct implantation technique is critical in avoiding postoperative IOL subluxation. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
TL;DR: In DMEK, the hyperopic shift may result from a reversal of a preceding myopic shift induced by stromal swelling in endothelial disease, and if so, normal intraocular power nomograms apply for cataract surgery before or during DMEk.
Abstract: Purpose To determine the refractive change and stability of the transplanted cornea after Descemet membrane endothelial keratoplasty (DMEK) through a 3.0 mm clear corneal incision. Setting Tertiary referral center. Design Cohort study. Methods Subjective and objective refractive data from pseudophakic eyes were obtained before and 3 and 6 months after DMEK. Results The study comprised 50 eyes, 7 were phakic and 43 pseudophakic. Six months postoperatively, the corrected distance visual acuity was 20/25 (0.8) or better in 38 eyes (74%). The mean increase in spherical equivalent at 6 months (N = 50) was +0.32 diopter (D) ± 1.01 D (SD) ( P =.0304) and in refractive cylinder, −0.48 ± 1.02 D ( P =.001). Although Scheimpflug imaging showed a stable anterior corneal curvature, the posterior curvature increased from 5.50 ± 0.5 D preoperatively to 6.40 ± 0.4 D at 6 months and pachymetry decreased from 672 ± 82 μm to 540 ± 59 μm, respectively (both N = 32) (both P =.000). Conclusions After DMEK, a slight preoperative to postoperative refractive change and stabilization at 3 months occurred that may induce a hyperopic shift that was not the result of the negative lenticule effect of DSEK/DSAEK. Thus, in DMEK, the hyperopic shift may result from a reversal of a preceding myopic shift induced by stromal swelling in endothelial disease. If so, normal intraocular power nomograms apply for cataract surgery before or during DMEK. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
TL;DR: The risk for postoperative endophthalmitis in ISBCS appears to be at least as low as and possibly lower than published rates for unilateral surgery, particularly when recommended precautions are taken.
Abstract: Purpose To determine a best estimate of the incidence of endophthalmitis after immediately sequential bilateral cataract surgery (ISBCS) and assess the benefit of prophylactic intracameral antibiotics. Setting Eye Foundation of Canada, Toronto, Ontario, Canada. Design Cohort study. Methods A detailed literature search was performed to obtain recently reported frequencies of postoperative endophthalmitis with or without the use of prophylactic intracameral antibiotics. Members of the International Society of Bilateral Cataract Surgeons were surveyed. The data were collected to determine the results of unilateral and bilateral cataract surgeries performed by experienced bilateral cataract surgeons. The data were statistically analyzed. Results In recently published European prophylactic intracameral cephalosporin studies, the incidence of postoperative endophthalmitis after unilateral cataract surgery weight-averaged to 1 in 331 (0.3%) without prophylactic intracameral antibiotics and to 1 in 1977 (0.05%) with prophylactic intracameral antibiotics, whereas studies in the United States using only topical antibiotics reported infection rates as low as 0.028%. Four cases of bilateral simultaneous endophthalmitis after ISBCS have been reported in the past 60 years, all with breaches of aseptic protocol. No bilateral simultaneous endophthalmitis occurred in the 95 606 ISBCS cases collected. The overall rate of postoperative endophthalmitis after ISBCS was 1 in 5759. Infection rates were significantly reduced with intracameral antibiotics to 1 in 14 352 cases. Conclusions The risk for postoperative endophthalmitis in ISBCS appears to be at least as low as and possibly lower than published rates for unilateral surgery, particularly when recommended precautions are taken. Intracameral antibiotics significantly reduced the risk for postoperative endophthalmitis. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.
TL;DR: Tansepithelial PRK for mild to moderate myopia with or without astigmatism was safe and easier to perform than conventional PRK, and patients had less pain, less postoperative haze, and a faster healing time.
Abstract: Purpose To assess the effectiveness, safety, and comfort of transepithelial photorefractive keratectomy (PRK) using the Amaris laser platform. Setting Ophthalmic Consultants of Beirut, Jal-El-Dib, Metn, Lebanon. Design Comparative case series. Methods Myopic eyes with or without astigmatism were treated by transepithelial PRK (study group) and compared with variable-adjusted eyes treated by conventional PRK (control group) during which the epithelium was removed with alcohol. Postoperative pain, epithelial healing time, uncorrected distance visual acuity (UDVA), manifest refraction, and haze were analyzed. Results The mean subjective postoperative pain score (out of 10, indicating worst pain) at 48 hours was 2.0 in the study group (50 eyes) and 4.5 in the control group (50 eyes) (P=.02). The mean time to complete epithelial healing was 2.5 days ± 0.6 (SD) and 3.7 ± 0.8 days, respectively (P=.01). At 1 week, the UDVA was statistically significantly better in the control group; however, at 3 months, there was no statistically significant difference in UDVA, corrected distance visual acuity, or manifest refraction between the groups. Haze was significantly less in the study group (P Conclusions Transepithelial PRK for mild to moderate myopia with or without astigmatism was safe and easier to perform than conventional PRK, and patients had less pain, less postoperative haze, and a faster healing time. The visual outcomes with the 2 techniques were comparable. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.