Central macular thickness change after uneventful small-incision cataract surgery - An observational study

Purpose: The purpose of this study was to diagnose CME with the help of optical coherence tomography (OCT) after uneventful cataract surgery to prevent visual deterioration. Methods: This study was conducted on 120 patients, who underwent manual small-incision cataract surgery with posterior chamber intra-ocular lens implantation. Follow-up was performed after the first week, sixth week, and 12th week post-operatively. Detailed examination was performed at each visit along with measurements of central macular thickness using OCT. Statistical analysis was performed using SPSS 22.0. Result: The mean age of the patients was 61.85 � 11.41 years having female preponderance. The pre-operative mean best corrected visual acuity (BCVA) was found to be 0.05 � 0.04, whereas the mean post-operative BCVA was found to be 0.65 � 0.17 at the first week, 0.66 � 0.17 at the sixth week, and 0.67 � 0.17 at the 12th week follow?up. The post-operative mean macular thicknesses at the first week, sixth week, and 12th week post?operatively were documented to be 221.66 � 8.49 ?m, 224.60 � 8.75 ?m, and 219.17 � 8.22 ?m, respectively. Conclusion: A sub-clinical increase in macular thickness occurs even after uncomplicated cataract surgery. The maximum increase was observed after 6 weeks of surgery, which returns to near normal values within 3 months. Comparison of central macular thicknesses pre-operatively and post-operatively at the first week, sixth week, and 12th week suggests a significant correlation

A prospective study of a new presbyopia pseudophakic intraocular lens: Safety, efficacy and satisfaction

Purpose: To evaluate the safety, visual performance, and patient satisfaction of a new presbyopic pseudophakic intraocular lens (IOL). Methods: A prospective non?randomized case?series study was performed in Buenos Aires, Argentina. Patients included in the study underwent a programmed Femtosecond laser assisted cataract surgery (FLACS), performed between October and December 2020, with a 6?month follow?up period. The Intensity (Hanita Lenses) IOL was bilaterally implanted. Spherical equivalent (SE) refraction, uncorrected distance and near visual acuity (UDVA/UNVA), defocus curve, endothelial cell density (ECD), central corneal thickness (CCT), and a satisfaction questionnaire were evaluated. Results: A total of 56 patients (112 eyes), aged 65 ± 6.12 years were included. The mean ± SD of preoperative SE was 1.85 ± 2.24 D (range; ?4.50 to 4.75), which had decreased 6 months after surgery to ?0.08 ±0.32 D (range; ?0.75 to 0.63). No eyes experienced a loss of lines of vision, and 94% obtained SE values between ± 0.50 D. Defocus curve for different additions was 0.03 LogMAR (logarithm of the minimum angle of resolution) for ?3.0 D, ?0.005 LogMAR for ?1.5 D, and ?0.07 LogMAR for 0 D. The ECD, CCT remained stable (P: 0.09 and 0.58, respectively) and all patients achieved their preoperative expectations, with a 6?month follow?up period. Conclusion: Patients who underwent a safe bilateral implantation with Intensity IOL achieved a high degree of spectacle independence and satisfaction, 6 months after surgery.

Correlations between Quality of Vision, Higher Order Aberrations and Non-Invasive Keratographic Tear Film Break-Up Time in Pseudophakic Eyes after Uncomplicated Phacoemulsification

Aims: In this study, we aimed to investigate the intercorrelations between tear film break up time, measured non-invasively using non-invasive keratographic break-up time (NIKBUT), higher order aberrations (HOA) and quality of vision (QoV) in pseudophakic patients.Study Design: Cross-sectional.Methods: Thirty-five pseudophakic aged patients aged 50 years or older, and 35 control phakic patients aged 17 to 23 years with corrected visual acuity of 20/20 were included in this study. All subjects underwent similar examination including QoV questionnaire, aberrometry to measure HOA, and NIKBUT. HOA was measured with the OPD-Scan/ ARK 10000 corneal analyzer (Nidek CO. Ltd), expressed as Root Mean Square (RMS) HOA and NIKBUT was assessed using non-invasive TF-Scan module Keratograph 5M (K5M), equipped with modified tear film scanning function (Oculus, Wetzlar, Germany). Statistical analysis was performed to find the correlation between NIKBUT, HOA and QoV.Results: Patients in the pseudophakic group were significantly older (median age 66 vs. 20 years; P<0.01), had shorter NIKBUT (10.5 vs. 17.2; P<0.01), lower QoV score (1.63 vs. 0.68; P=0.04), and higher RMS HOA (0.5 vs. 0.26; P<0.01) compared to control group. NIKBUT was inversely correlated with RMS HOA (r = -0.19; p = 0.03) and RMS HOA was significantly correlated with QoV, even after adjustment for age and gender (r = -0.21; P0.04). NIKBUT <9.93s was correlated with lower QoV. The area under the curve was 0.81 (95% CI = 0.67 � 0.95, p = 0.012), and had 100% sensitivity and 61% specificity.Conclusion: Shorter NIKBUT was correlated with greater HOA and greater HOA was correlated with lower QoV. NIKBUT value of shorter than 9.93s could potentially predict pseudophakic patients who will likely experience visual symptoms leading to decreased QoV; thus, the use of artificial tears might be beneficial.

Utilization rate of corneal tissue obtained from donors over 75 years of age in Western India for keratoplasty

Purpose: To examine the utilization patterns of cornea procured from diseased individuals ?75 years of age at an eye bank in western India. Methods: In this retrospective study, data from 1,217 eyes of 653 donors with age ?75 years were reviewed from October 2008 to December 2019. Donor age, lens status, endothelial cell count (ECD), utilization of the tissue for transplantation or non?clinical purposes (e.g., research, training/discarded), and causes of non?utilization were noted. Results: The mean age of the donors was 80.9 ± 4.6 years and the tissue utilization rate was 36.5% (445 out of 1,217 eyes). The eyes used for keratoplasty procedures had a lower donor age (79.6 ± 5.7 vs. 81.5 ± 5.1; P < 0.001), a higher endothelial cell count (2493 ± 531 vs. 2034 ± 581; P < 0.001), and were more often phakic (61% vs. 36.6%) compared to the unused group. A multivariable logistic regression analysis showed that the likelihood of tissue utilization for keratoplasty was 13% higher with every 100?cell increment in donor ECD (odds ratio [OR] = 1.13, 95% CI = 1.10–1.16, P < 0.001) and 33% lower with having a pseudophakic status in the donor eye (OR = 0.67, 95% CI = 0.52–0.87, P = 0.03). Age was not a significant determinant of tissue utilization when used in the same multivariable model. Conclusion: More than one?third of the eyes (36.5%) can be utilized even when the donors are above 75 years of age. Eyes that were more likely to be utilized for keratoplasty were phakic and had a significantly higher ECD; age was not a determinant in tissue utilization

Vitrectomía pars plana asociada a banda de silicona comparada con vitrectomía pars plana para desprendimiento de retina pseudofáquico y afáquico / Pars plana vitrectomy plus scleral buckle versus pars plana vitrec-tomy in pseudophakic retinal detachment

INTRODUCCIÓN: La cirugía de cataratas es un factor de riesgo para el desprendimiento de retina regmatógeno. Dentro de las técnicas utilizadas para su reparación, se encuentran la vitrectomía pars plana y la banda de silicona. La combinación de ambas técnicas ha sido propuesta en pacientes con desprendimiento de retina previamente operados de cataratas (pseudofáquicos o afáquicos), pero su efectividad no está clara. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron ocho estudios primarios, de los cuales, uno corresponde a un ensayo aleatorizado. A partir de éste, concluimos que la combinación de vitrectomía pars plana y banda de silicona podría resultar en poca o nula diferencia en la reaplicación retinal primaria, en la reaplicación retinal final y en la agudeza visual, pero la certeza de la evidencia es baja. Respecto a las complicaciones, no es posible establecer con claridad si la combinación de ambas técnicas aumenta la frecuencia de vitreorretinopatía proliferativa o si disminuye el desarrollo de glaucoma, debido a que la certeza de la evidencia fue evaluada como muy baja.

INTRODUCTION: Cataract surgery increases the risk for rhegmatogenous retinal detachment. Pars plana vitrectomy and scleral buckling are two surgical procedures used for its repair. The combination of both techniques had been proposed for rhegmatogenous retinal detachment in patients with previous cataract surgery (pseudophakic or aphakic), but its effectiveness remains unclear. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews with eight studies overall, one of them was a randomized trial. With this data, we conclud-ed that pars plana vitrectomy plus scleral buckle may make little or no difference in primary or final retinal reattachment rate nor in final visual acuity, but the certainty of the evidence is low. In terms of surgery complications, we are uncertain if vitrecto-my plus scleral buckle increases the risk of proliferative vitreoretinopathy or reduces the risk of glaucoma because the certainty of the evidence is very low.

Actualización terapéutica de la queratopatía bullosa pseudoafáquica / Therapeutic update on pseudophakic bullous keratopathy

RESUMEN La queratopatía bullosa pseudoafáquica o edema corneal crónico pseudoafáquico del paciente operado por cataratas con implante de lente intraocular es un proceso en el que la córnea se edematiza y pierde su función óptica, con síntomas dolorosos e irritativos de lagrimeo, ojo rojo, probabilidad de inflamación y ulceración corneal por infección secundaria. Se observan en esta afección multicausal dos grupos de pacientes. En uno de ellos el daño estructural corneal y ocular ha sido excesivo y no existe expectativa de mejora visual. El otro grupo aún conserva la potencialidad de recuperación de la agudeza visual. En el intento de solucionar esta afección se han empleado diversos tratamientos con fundamentos diferentes y resultados acordes con el desarrollo técnico y científico en que fueron aplicados. Es propósito de esta actualización describir y adecuar las posibilidades que los oftalmólogos puedan aplicar como terapéutica en sus respectivos niveles de actuación(AU)

ABSTRACT Pseudophakic bullous keratopathy or chronic pseudophakic corneal edema in patients undergoing cataract surgery with intraocular lens implantation is a process in which the cornea edematizes and loses optical function, with painful and irritating lacrimation symptoms, red eye, probable inflammation and corneal ulceration due to secondary infection. Sufferers of this multicausal condition are divided into two groups: In one of them structural corneal and ocular damage has been extreme and no visual improvement is expected, whereas in the other visual acuity recovery is still possible. In an attempt to heal this condition various treatments have been used with different rationales and results according to the scientific and technological development of the setting where they were applied. The present update is aimed at describing and adjusting the possible therapies that ophthalmologists may use in their respective fields of activity(AU)

A Prospective Interventional Study to Evaluate the Efficacy of Nepafenac 0.1% for Prevention of Macular Oedema Associated with Cataract Surgery in Patients with Diabetes

Pseudophakic cystoid macular oedema is a significant cause of suboptimal visual acuity post phacoemulsification.Diabetics are at greater risk of developing PCME following cataract surgery. Topical nepafenac ophthalmic suspension 0.1% is used to prevent inflammation postoperatively. We wanted to study the effect of Topical Nepafenac 0.1% eye suspension on macular thickness following phacoemulsification in patients of diabetes mellitus and correlate the final visual acuity and macular thickness.METHODSThis prospective interventional study was conducted between January 2018 and May 2019 in the Department of Ophthalmology, MMIMSR, Mullana, Ambala. 100 patients based on the inclusion and exclusion criteria were included in the study and phacoemulsification was done. They were divided in to two groups of 50 each. Group 1 received topical Nepafenac 0.1% ophthalmic suspension thrice daily along with the routine post-op medications whereas Group 2 received routine post-op medications. The groups were analysed preoperatively and at 2, 4, 6, 8 weeks postoperatively and their CMT was recorded using a SD-OCT. The change in BCVA was analysed with the help of ETDRS letter chart. The data was entered in Microsoft Excel and analysed using SPSS-PC-20 version. Quantitative data was expressed by mean and standard deviation while qualitative data was expressed as percentage. Difference between the proportions was tested with Chi Square Test or Fisher’s Exact test while difference between quantitative variable between the two groups was tested with students ’t’ test or Mann Whitney U test. For comparison of quantitative data between more than two groups, ANOVA or Kruskal Wallis ‘H’ test followed by post hoc test was used. A ‘p’ value of less than 0.05 was considered statistically significant.RESULTSA lower percentage of patients in Group 1 developed ME relative to Group 2 (2% vs. 8%; p-value= 0.36). The mean CMT was significantly lower in Group 1 at 2 (p-value<0.01), 4 (p-value<0.001), 6 (p-value<0.001) and 8 weeks (p-value<0.001). A greater percentage of patients in Group 1 (60%) experienced a gain of >15 letters as compared to the baseline (p-value<0.01)

Research progress of pseudophakic cystoid macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#Cataract is the most common blinding eye disease in our country. Cataract phacoemulsification combined with intraocular lens implantation is the first choice for cataract surgery, with advantages of a small incision, mild anterior chamber reaction, repaid recovery and small astigmatism of corneal. However, there are still some patients failed to achieve ideal visual quality after surgery due to various reasons even if the surgery is successful. Cystoid macular edema(CME)is one of the common complications in pseudophakic eyes affecting postoperative visual quality after cataract surgery. Recent studies on pseudophakic cystoid macular edema(PCME)are reviewed in this paper.

A randomized controlled trial on the effect of Lutein Supplementation on Macular Pigment Optical Density and Macular Function in Pseudophakic Patients

Objective@#To evaluate the efficacy of oral lutein supplementation on macular pigment optical density (MPOD) levels and macular function in pseudophakic eyes that underwent phacoemulsification. @*Methods@#This was a prospective, randomized, parallel-arm, single-masked study comparing oral lutein supplement 20 mg/tablet (Lutax 20) with non-supplementation in pseudophakic eyes. We assessed MPOD, low-luminance deficit (LLD), visual recovery time (VRT) using photostress test, and adverse events. One hundred twenty-eight (128) eyes were enrolled and randomized 1:1 to active treatment (lutein supplementation) or no treatment (no supplementation). The supplementation period was 12 weeks and patients were assessed every 4 weeks over a period of 16 weeks.@*Results@#Sixty-four (64) eyes in each group completed the study. A significant increase in MPOD (p<0.001) was observed in the lutein supplemented group, from 0.36 DU at baseline to 0.55 DU at week 12, with a mean increase of 6.32 ± 1.72% per 4 weeks of supplementation compared with a mean MPOD decrease rate of 0.63 ± 0.48% in the non-supplementation group. A significant reduction in LLD was observed in the lutein-treated group, from LogMAR 0.063 at baseline to LogMAR 0.023 at Week 12 (p=0.003). VRT was also significantly shorter in the treatment from a baseline of 83.06 to 68.80 seconds at Week 12 (p<0.001).@*Conclusion@#Lutein supplementation (20 mg/tablet; Lutax 20) demonstrated a significant degree of MPOD augmentation, and reductions in LLD and VRT among patients who underwent phacoemulsification with lens implantation.

Manual Preparation of Donor Lenticule Using Artificial Anterior Chamber for Descemet's Membrane Stripping Endothelial Keratoplasty

PURPOSE: To report a patient with a pseudophakic bullous keratopathy (PBK) who underwent Descemet's membrane stripping endothelial keratoplasty (DSEK) with manual preparation of the donor corneal graft.CASE SUMMARY: A 61-year-old female presented with visual disturbance in her right eye. Five months prior, she was treated with phacoemulsification and intraocular lens exchange surgery of the right eye, and a very severe corneal edema was revealed by slit-lamp examination. We diagnosed PBK and planned DSEK with manual preparation of a donor corneal graft because of the non-availability of a microkeratome or a femtosecond laser. After making the corneal graft using an artificial anterior chamber, crescent knife and cornea dissector, the keratoplasty proceeded using the graft. Three months after surgery, her graft was well-maintained on the right eye. The patient's visual acuity was 0.3, and the corneal endothelial cell count was 1,844/mm².CONCLUSIONS: Manual preparation of the donor corneal graft for DSEK is suitable as a second choice treatment method when the availability of surgical devices is limited.

Modified low-dose triamcinolone acetonide intravitreal injection for macular cystoid edema after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the efficacy of intravitreal injection of modified low-dose of triamcinolone acetonide(TA)in the treatment of pseudophakic cystoid macular edema(PCME).<p>METHODS: Retrospective study. Totally 12 eyes of 12 patients with PCME in our hospital were received intravitreal injection with modified low doses of TA from 2015-01 to 2018-12. The TA suspension was firstly resuspended by intraocular irrigating solution through 0.22um pore filter, then the new TA suspension(2mg/0.05mL)was injected intravitreally. The best-corrected visual acuity(BCVA), central macular thickness(CMT), intraocular pressure(IOP), and other side effects were recorded at 2wk, 1mo, 3mo and 6mo after injection, then compared the data with pre-injection(baseline)information.<p>RESULTS: After intravitreal injection of modified low dose TA, all patients got improved BCVA and alleviated CMT, as compare to the baseline data, and the difference was statistically significant(<i>P</i><0.05), but the difference of IOP was not significant(<i>P</i>>0.05). All patients had no recorded ocular or systemic complication.<p>CONCLUSION: Intravitreal injection of modified low-dose TA is effective and safe for PCME, without significant increase in IOP. It's an affordable substitution to anti-vascular endothelial growth factor(anti-VEGF)agents. This still needs to be confirmed by the long-term follow-up study with large samples.

Intravitreal Dexamethasone Implantation in Intravitreal Bevacizumab Treatment-resistant Pseudophakic Cystoid Macular Edema

PURPOSE: To evaluate the changes in visual acuity (VA) and central macular thickness (CMT) after intravitreal dexamethasone (IVD) implantation in intravitreal bevacizumab (IVB) treatment-resistant cases with pseudophakic cystoid macular edema (PCME). METHODS: This study included 10 PCME cases who underwent uneventful phacoemulsification and intraocular lens implantation with similar methods and six PCME cases referred to our hospital for treatment of low VA after cataract surgery. Due to the persistence of PCME, both topical steroid and anti-inflammatory medication were administered first, followed by IVB injection. IVD implantation was performed for all IVB treatment-resistant cases. VA and CMT values were compared before and at three months after the first IVD implantation. RESULTS: The mean VA values before and at 3 months after the first IVD implantation were 0.69 ± 0.19 logarithm of the minimum angle of resolution (logMAR) (1.50 to 0.10 logMAR) and 0.26 ± 0.07 logMAR (1.00 to 0.00 logMAR), respectively (p < 0.001). The mean CMT was 476.13 ± 135.13 mm (314 to 750 mm) and 294.06 ± 15.26 mm (222 to 480 mm), respectively (p < 0.001). The mean number of implanted IVD was 1.44 ± 0.89 (1 to 4) and the mean follow-up time was 7.4 ± 4.6 months (6 to 24 months). After IVD implantation therapy, the mean VA and CMT values were 0.19 ± 0.05 logMAR (0.70 to 0.00 logMAR) and 268.38 ± 31.35 mm (217 to 351 mm), respectively. CONCLUSIONS: To the best of our knowledge, this is the first report to show the efficacy of IVD implantation even after repeated IVB injections in treatment-resistant PCME. IVD implantation is both a safe and effective method for decreasing PCME after both uneventful and complicated cataract surgery.

New progress of diagnosis and treatment in pseudophakic cystoid macular edema / 中华实验眼科杂志

Pseudophakic cystoid macular edema (PCME) is one of the most common complications of cataract surgery.It is the main cause of postoperative visual loss.PCME pathogenesis is unclear yet,inflammation is supposed to be an important cause.Systemic or local diseases,and complicated surgical operations may increase the risk of PCME.Diabetes is the most common independent risk factor,and the risk of PCME is closely related to severity of preoperative diabetes.Typical clinical symptoms of PCME include acute vision loss after surgery.In PCME eyes,fundus fluorescein angiography (FFA) can show the petal-like spots characteristically,and visual disc dot staining can be seen later.Cystoid macular edema (CME) first appears in the inner nuclear layer (INL) and gradually develops in the outer plexiform layer (OPL).Finally,fluid accumulates in the subretinal space.Besides,optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) have new advances in differential diagnosis between PCME and diabetic macular edema (DME).In practice,topical non-steroid anti-inflammatory drugs (NSAIDs) or glucocorticoids are generally used as first-line treatment medicines.Anti-vascular endothelial growth factor (anti-VEGF) also attracts attention as a new treatment.Individualized prevention and treatment is required for specific types of PCME.It still lacks a common recognized treatment of PCME,and long-term efficacy of the current treatment remains to be observed more rigorous and comprehensive experimental programs are required.

Clinical Study of Changes in Eye Dominance after Pseudophakic Conventional Monovision

PURPOSE: The purpose of this study was to evaluate whether eye dominance changes after conventional pseudophakic monovision, and to identify factors that affect changes in eye dominance. METHODS: This retrospective study included 70 patients who underwent bilateral conventional monovision cataract surgery. Patients were divided into two groups based on whether they experienced a change in the dominant eye. We compared patients' uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best-corrected visual acuity (BCVA), spherical equivalent, stereopsis, and time interval between cataract surgeries. RESULTS: The mean age was 71.26 ± 10.84 (range, 25–90) years, mean interval between surgery in each eye was 118.46 ± 183.50 (range, 17–1,018) days, and mean postoperative diopter difference was 1.16 ± 0.53 (range, 0.00–2.75) diopters. After bilateral cataract surgery, 22 patients (31.43%) experienced a change in eye dominance, whereas 48 patients (68.57%) experienced no change. There were no differences in the time interval between cataract surgeries, preoperative UCDVA and UCNVA, pre- and postoperative BCVA, or stereopsis in either group. Patients who experienced a change in eye dominance showed smaller differences between preoperative and postoperative spherical equivalent, compared with patients who experienced no change in eye dominance (t-test, p < 0.05). CONCLUSIONS: Twenty-two (31.43%) patients whose nondominant eyes were targeted for near vision showed altered eye dominance after conventional monovision cataract surgery. Eye dominance shows greater plasticity in patients with smaller differences between preoperative and postoperative spherical equivalent.

Effectiveness and safety of endothelial keratoplasty for pseudophakic and aphakic bullous keratopathy: a systematic review of randomized controlled trials and cohort studies / Eficácia da ceratoplastia endotelial no tratamento da ceratopatia bolhosa pseudofácica e afácica: revisão sistemática de ensaios clínicos randomizados e estudos coortes

ABSTRACT Objective: For nearly a century, penetrating keratoplasty has been the surgical technique of choice in the management of corneal changes. However, in recent years, several lamellar keratoplasty techniques have been developed, modified or improved, especially techniques for replacing the posterior portion, for the correction of bullous keratopathy. The aim of this study was to evaluate the effectiveness and safety of endothelial keratoplasty versus penetrating keratoplasty for pseudophakic and aphakic bullous keratopathy. Methods: A systematic review of the literature was carried out, and the main electronic databases were searched. The date of the most recent search was from the inception of the electronic databases to December 11, 2015. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data. Results: The electronic search yielded a total of 893 published papers from the electronic databases. Forty-four full-text articles were retrieved for further consideration. Of these 44 full-text articles, 33 were excluded because they were all case series studies; therefore, ten studies (with one further publication) met the inclusion criteria: one randomized clinical trial with two publications; three controlled studies; and six cohort studies. The clinical and methodological diversity found in the included studies meant that it was not possible to combine studies in a metaanalysis. Conclusions: There is no robust evidence that endothelial keratoplasty is more effective and safe than penetrating keratoplasty for improving visual acuity and decreasing corneal rejection for pseudophakic and aphakic bullous keratopathy. There is a need for further randomized controlled trials.

RESUMO Objetivo: Durante quase um século, a ceratoplastia penetrante tem sido a técnica cirúrgica de escolha no tratamento de doenças corneais. No entanto, nos últimos anos, têm sido desenvolvidas várias técnicas de transplante lamelar, especialmente modificadas ou aperfeiçoadas para substituir a porção posterior para a correção da ceratopatia bolhosa. O objetivo deste estudo foi avaliar a eficácia e segurança da ceratoplastia endotelial quando comparada a ceratoplastia penetrante para a ceratopatia bolhosa afácica ou pseudofácica. Métodos: Uma revisão sistemática da literatura foi realizada, e as principais bases de dados eletrônicas foram pesquisadas. A data das bases de dados da última pesquisa foi 11 de dezembro de 2015. Dois autores selecionaram independentemente os estudos relevantes, avaliaram sua qualidade metodológica e extraíram os dados. Resultados: A busca eletrônica resultou em um total de 893 artigos publicados a partir das bases de dados eletrônicas. Quarenta e quatro artigos de texto completos foram recuperados para uma análise mais aprofundada. Destes 44 artigos de texto completos, 33 foram excluídos por serem estudos de séries de casos, portanto, dez estudos (com uma publicação adicional) preencheram os critérios de inclusão: um ensaio clínico randomizado, três estudos controlados e seis estudos de corte. A diversidade clínica e metodológica encontrada nos estudos incluídos tornou impossível combinar os resultados em uma metaanálise. Conclusões: Não há evidencias robustas de que a ceratoplastia endotelial é mais eficaz e segura do que o transplante penetrante de córnea para melhorar a acuidade visual e diminuir a rejeição da córnea na ceratopatia bolhosa afácica ou pseudofácica. Há necessidade de mais estudos controlados, randomizados.

Clinical Outcomes of Combined Descemet-stripping Endothelial Keratoplasty and Intraocular Lens Exchange

PURPOSE: To evaluate clinical outcomes after combined descemet-stripping endothelial keratoplasty (DSEK) and intraocular lens (IOL) exchange in a Korean population. METHODS: The medical records of 15 patients (15 eyes) with pseudophakic bullous keratopathy who underwent combined DSEK and IOL exchange from January 2011 to January 2015 and who were followed up for more than 12 months were reviewed retrospectively. RESULTS: In 14 eyes with successful results after surgery, the best corrective visual acuity (BCVA) was significantly improved from 2.01 ± 0.96 (log MAR, mean) to 0.68 ± 0.26 at 3 months (p = 0.001) except for one eye that received reoperation on the endothelial disc detachment. The BCVA at postoperative 6 and 12 months gradually increased (0.51 ± 0.26 and 0.40 ± 0.22 log MAR, mean). Central corneal thickness was significantly improved from 777 ± 139 µm to 605 ± 28 µm at 6 months (p = 0.003) and was maintained at 12 months. The mean endothelial cell count was 2,973 ± 281/mm2 in the donor lenticules and 1,790 ± 265/mm2 at 12 months. Endothelial cell loss was 40%. The target refraction was -0.81 ± 0.16 D and the 12 months postoperative spherical equivalent was -0.28 ± 0.36 D. Complications included intraocular pressure elevation in one eye and pupillary capture in one eye. CONCLUSIONS: Combined DSEK and IOL exchange may be a very efficient and safe option for surgically managing pseudophakic bullous keratopathy.

Clinical Results of Pseudophakic Monovision 1 Year after Cataract Surgery

PURPOSE: In this study, the visual performance and patient satisfaction one year after monovision cataract surgery and the results after 2 months. METHODS: Thirty patients who had bilateral cataract surgery between February 2010 and January 2014 treated with monovision therapy and received postoperative examinations for at least one year after surgery were enrolled in the present study. The eye with the more severe cataract had the surgery first and was corrected for distance vision targeted at emmetropia. The fellow eye was operated for near vision targeted to -1.50~-2.50 diopter (D) range considering the patient's need for near task and preoperative refractive errors 2-4 weeks after the first operation. Binocular uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), spherical equivalent, anisometropia, stereopsis, patient satisfaction for far and near distance, and spectacle dependence were evaluated preoperatively and two months and one year postoperatively. RESULTS: The mean age of patients was 71.9 years. Two months and one year after the surgery, the binocular UCDVA (log MAR) were 0.03 ± 0.10 and 0.08 ± 0.14, UCNVA were 0.21 ± 0.15 and 0.25 ± 0.14, anisometropia were 1.28 ± 0.68 and 1.29 ± 0.76 D, and stereopsis were 301.67 ± 251.28 and 251.67 ± 269.28 arcsec, respectively. One year after the surgery, the number of patients answering ‘Better’ or ‘Much better’ for distant vision was 27 (90%) and for near vision 22 (73.3%); 11 patients (36.7%) answered ‘Not dependent on spectacles at all’. CONCLUSIONS: Monovision is an effective method to correct presbyopia after bilateral cataract surgery. Visual performances and patient satisfaction at one year after cataract surgery were not different compared with those at two months.

A Result of Pneumatic Retinopexy for Pseudophakic Retinal Detachment

PURPOSE: To evaluate the clinical effectiveness of pneumatic retinopexy as a treatment method for pseudophakic retinal detachment. METHODS: A retrospective chart review was conducted of medical records of 38 patients who underwent pneumatic retinopexy using SF6 gas from January 2003 to December 2011 and who were observed during a follow-up period longer than 6 months. Primary and final success rates and final visual acuity were analyzed. Primary success was defined as retinal attachment at the last visit without additional surgery. Final success was defined as retinal reattachment at the last visit regardless of additional surgery. RESULTS: The mean patient age was 58.47 ± 17.00 years. All retinal tears were located in the upper retina (from 8 to 4 o'clock). Preoperative mean visual acuity was 1.17 ± 1.00 log MAR, and postoperative mean visual acuity was 0.42 ± 0.48 log MAR. The primary success rate was 61%, and patients with re-detached retina underwent repeat pneumatic retinopexy or other surgery such as scleral buckling or pars plana vitrectomy. At the final visit, all of the patients demonstrated successful results. CONCLUSIONS: Pneumatic retinopexy does not result in strabismus or refractive error, and the final success rate was 66% in our study. Therefore, pneumatic retinopexy can be considered as an effective management technique for some pseudophakic retinal detachment patients.

Long-term follow-up of zonulo-hyaloido-vitrectomy for pseudophakic malignant glaucoma.

Purpose: To report long-term follow-up of zonulo-hyaloido-vitrectomy (ZHV) via anterior approach for pseudophakic malignant glaucoma refractory to medical treatment. Design: Noncomparative case-series. Materials and Methods: Medical records of 9 patients who sought treatment for aqueous humor misdirection refractory to medical treatment were reviewed. All patients underwent anterior vitrectomy, hyaloido-zonulectomy, and peripheral iridectomy (PI) via an anterior approach. Main outcome measures were preoperative and postoperative visual acuity, intraocular pressure, medications, slit-lamp examination, and fundus findings. Results: 10 eyes of 9 patients (7 female, 2 male) who underwent ZHV for refractory pseudophakic malignant glaucoma between 2003 and 2010 were included in this case-series. The mean age of patients was 77.4 ± 9.0 years, mean follow-up duration 50.2 ± 27.2 months. Recurrence of malignant glaucoma was noted in 40% (four cases) after a successful ZHV on long-term follow-up. Conclusions: An anterior segment surgeon can treat malignant glaucoma refractory to medical treatment successfully by vitrectomy, hyaloido-zonulectomy, and PI. This can be done via an anterior approach and patients require long follow-up to rule out a relapse despite a successful outcome in the short term.