Relationship between refractive outcomes and quantitative retinal vascularization and severity of plus disease in eyes treated with intravitreal bevacizumab

Purpose: The study aimed to investigate the relationship between refractive outcomes with the extent of retinal vascularization and severity of the plus disease in infants treated with intravitreal bevacizumab (IVB). Methods: Pre?IVB fundus images (PFIs), final fundus images (FFIs), and refractive outcomes of the 93 infants who underwent IVB monotherapy for type 1 and aggressive retinopathy of prematurity (A?ROP) were retrospectively evaluated. Quantitative measurements were performed on PFIs and FFIs. Pre?IVB plus severity was scored on a five?leveled scale. Correlation between spherical equivalent (SE) with pre?treatment and final extent of the temporal retinal vascularization and pre?treatment severity of plus disease was analyzed. Results: There was a linear and low positive correlation between the extent of pre?IVB and final temporal retinal vascularization with final SE (p = 0.000, r = 0.267; P = 0.002, r = 0.274, respectively). There was a low negative correlation between the pre?IVB plus severity score with final SE (p = 0.012, r = ?0.192). Gestational age (GA), birth weight (BW), IVB dose, presence of additional IVB, or laser treatments were not correlated with refractive outcome. Out of 171 eyes, 38 eyes had >1 D myopia. In the univariate logistic analyses, pre?IVB retinal zone and pre?IVB and final extent of the temporal retinal vascularization were found to be related to the development of >1 D myopia (p = 0.002, odds ratio (OR) = 0.298; P = 0.000, OR = 0.281; P = 0.001, OR = 0.317; respectively). Conclusion: Our study indicates that the pre?treatment and final extent of retinal vascularization were the main parameters that were related to final refractive outcomes in IVB?treated eyes for type 1 and A?ROP.

Study Of Visual And Refractive Outcomes In Patients Undergoing Limbal Relaxing Incision During Clear Corneal Phacoemulsification Surgery With Foldable Intra Ocular Lens

Background:Phacoemulsification requires a smaller incision, few or no stitches are needed and the patient's recovery time is usually shorter when using a foldable IOL.Limbal Relaxing Incisions, or LRIs, are partial thickness corneal incisions strategically placed to reduce or eliminate pre-existing astigmatism duringcataractsurgeryorrefractivelensexchangesurgery. Present study was aimed to evaluate the visual and refractive outcome in patients undergoing limbal relaxing incision during clear corneal phacoemulsification surgery with foldable intra ocular lens.Material And Methods:Present study was single-center, prospective, observational study, conducted in patients of age more than 18-75 years, with clear cornea and regular astigmatism on keratometry, with preoperative astigmatism more than or equal to 0.5D on keratometry, fit for phacoemulsification cataract surgery with foldable IOL.Result:A total of 44 eyes of 44 patients who for cataract phacoemulsification surgery, mean age of the patient was 56.98 ± 05.98 years. Refractive acceptance preoperatively was 0.50 D to 2.0 D.Onslit lamp examination showed most common Cataract Nucleus grade is NS 3 with PSC preoperatively. We observed improved diopteric difference by automated keratometry on postoperative 90th day as compared to preoperative values. Majority of patients had Preop Keratometric Difference (K1-K2) of 1.5 D, all required LRI Incisions length of 4 clock hours (60°).The difference between the visual acuity preoperatively and post operatively was found to be statistically significant with a p<0.01 by employing the statistical test Analysis of Variance (ANOVA). Visual outcome a change after limb relaxing incisions statistically significant. Keratometry changes preop and postop is statistically significant with p value <0.001.Conclusion:Visual and refractive outcome changes as improved best corrected visual acuity (BCVA), decrease in Corneal Astigmatism was noted in patients undergoing limbal relaxing incision during clear corneal phacoemulsification surgery with foldable intra ocular lens

Refractive, sensory, and biometric outcome among retinopathy of prematurity children with a history of laser therapy: A retrospective review from a tertiary care center in South India

Purpose: Ocular morbidities like high refractive error, strabismus, and amblyopia are common among laser-treated retinopathy of prematurity children (ROP). Long-term optical status and refractive outcomes including the sensory outcomes were less investigated in these children from this region. The purpose of our study is to evaluate the long-term outcome (refractive, biometric profile, sensory) of treatment for ROP using laser. Methods: This study is a retrospective, cross-sectional, observational, and intervention research among 6–15-year-old children who underwent laser for ROP with a minimum of 6-year follow-up. Results: Eighty lasered eyes of 41 children were assessed. Mean age was 9.71 years (±3.39). Seventy-three eyes (91.2%) achieved visual acuity better than 20/40. The mean visual acuity in LogMAR was 0.18 (20/30). The mean spherical equivalence was ?5.29 D ± 4.9. Mean astigmatism measured was ?1.53 DC (range: +0.50 DC to ?4.5DC). Fifty-three eyes (66.25%) had significant astigmatism. The mean axial length was 23.5 ± 1.35 (21–26) mm. Mean lens thickness was 3.76 ± 0.30 (3.03–4.34) mm. Correlation analysis among the low and high spherical equivalent group signified that axial length (P value = 0.001), visual acuity (P value = 0.0002), and myopic shift (P value = 0.0006) were found to be statistically significant. Stereopsis better than 480 s of arc for near was observed in 41% children. Structural posterior pole sequelae developed in 3 eyes (3.75%). Conclusion: A significant number of children with high myopia, astigmatism, and strabismus had satisfactory visual outcome observed at long-term follow-up after treatment for ROP using laser. Our study revealed that myopia was influenced by an increase in axial length than the lens thickness.

Refractive outcomes of a single-step and a two-step approach for silicone oil removal and cataract surgery

Purpose: To compare the intermediate-term refractive outcomes of a single-step and a two-step approach for silicone oil removal (SOR) and cataract surgery. Methods: Case records of patients who had SOR and phacoemulsification (PE) from 2011 to 2013 at a tertiary center in South India were retrospectively analyzed. A total of 135 eyes that underwent ultrasound biometry (UB) were studied. Eighty-seven eyes had SOR and PE at a single surgery (Group A), where as UB was done in a silicone oil (SO) filled eye. Forty-eight eyes had SOR followed by PE later (Group B), where UB was done in a fluid-filled eye. The refractive error (RE) and best-corrected visual acuity (BCVA) at postoperative day 45 (D45) and postoperative month 3 (M3) were compared. Results: Baseline axial length, intraocular lens (IOL) power, and RE in both groups were comparable. A myopic shift (4.18 ± 5.47 diopters [D]) was noted in 92% eyes at M3. Forty-nine percent eyes had a RE of ?±1.5D at M3. RE at D45 and at M3 was significantly lesser in Group B (?1.73 ± 2.04 vs. ?0.64 ± 1.75; P, 0.002). BCVA was significantly lesser in Group A at baseline, at D45, and at M3 (P < 0.01 for all). There was no difference in other baseline characteristics of eyes that had RE ?±1.5D and those that had RE >±1.5D at M3. Conclusion: SO-filled eyes had a myopic shift in refraction after SOR and PE. When UB is used for IOL power calculation, better refractive outcomes are obtained when SOR and PE are performed in a two-step approach.

Refractive Error Induced by Combined Phacotrabeculectomy

PURPOSE: We evaluated the postoperative accuracy of intraocular lens power prediction for patients undergoing phacotrabeculectomy and identified preoperative factors associated with refractive outcome in those with primary open-angle glaucoma (POAG). METHODS: We retrospectively reviewed the medical records of 27 patients who underwent phacotrabeculectomy to treat POAG. We recorded all discrepancies between predicted and actual postoperative refractions. We compared the data to those of an age- and sex-matched control group that underwent uncomplicated cataract surgery during the same time period. Preoperative factors associated with the mean absolute error (MAE) were identified via multivariate regression analyses. RESULTS: The mean refractive error of the 27 eyes that underwent phacotrabeculectomy was comparable to that of the 27 eyes treated via phacoemulsification (+0.02 vs. −0.01 D, p = 0.802). The phacotrabeculectomy group exhibited a significantly higher MAE (0.65 vs. 0.35 D, p = 0.035) and more postoperative astigmatism (−1.07 vs. −0.66 D, p = 0.020) than the phacoemulsification group. The preoperative anterior chamber depth (ACD) and the changes in the postoperative intraocular pressure (IOP) were significantly associated with a greater MAE after phacotrabeculectomy. CONCLUSIONS: POAG treatment via combined phacoemulsification/trabeculectomy was associated with greater error in terms of final refraction prediction, and more postoperative astigmatism. As both a shallow preoperative ACD and a greater postoperative change in IOP appear to increase the predictive error, these two factors should be considered when planning phacotrabeculectomy.

Clinical Outcome of Ciliary Sulcus-Implanted Single-Piece Foldable Acrylic Intraocular Lens

PURPOSE: To evaluate complications and refractive outcomes of implantation of a single-piece acrylic intraocular lens (SPA-IOL) in the ciliary sulcus during phacoemulsification complicated with posterior capsule tear (PCT). METHODS: This retrospective study included patients who visited our hospital from 2014 January to 2015 June with implantation of a SPA-IOL (RAYNER 920H Superflex) in the ciliary sulcus during phacoemulsification complicated with PCT. Patients had their IOL power reduced by 1 diopter (D) from that calculated for in-the-bag implantation. At 3 months after operation, best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA) and a refraction test were performed. RESULTS: PCT requiring implantation of IOL in the ciliary sulcus occurred in 17 eyes. Postoperative complications included corneal edema (3 eyes), anterior segment inflammation (1 eye), intraocular pressure elevations (3 eyes). However, improvements resulting from proper management and no significant IOL decentration were observed. At 3 months after operation, the mean spherical equivalent was -0.79 ± 0.39 D (-0.25 to -1.5 D), the mean UCVA was 0.77 ± 0.22 (0.4 to 1.0), and the mean BCVA was 0.94 ± 0.08 (0.8 to 1.0). CONCLUSIONS: Sulcus implantation of a SPA-IOL (RAYNER 920H Superflex) has no clinically significant complication, and the mean spherical equivalent after 3 months with a power reduction of 1.0 D was -0.79 ± 0.39 D (-0.25 to -1.5 D).

Refractive Eerror According to the Anterior Chamber Depth and Corneal Refractive Power in Short Eyes

PURPOSE: To evaluate the accuracy of the chosen formula in short eyes and the effect of the anterior chamber depth (ACD) and corneal refractive power on the accuracy. METHODS: A total of 251 eyes out of 185 patients (axial length below 22.0 mm) who underwent cataract surgery in our hospital were retrospectively studied. Introcular lens (IOL) power was calculated with the Hoffer Q, SRK II, SRK-T and Holladay 1 formulas and refractive outcome was measured. Patients were divided into 2 groups based on ACD. The accuracy of the 4 formulas was compared and the errors according to the ACD were also evaluated. RESULTS: In eyes with short axial lengths, all formulas showed a tendency for hyperopic shifts. The Hoffer Q formula showed significantly high predictive accuracy. This tendency for hyperopic shifts was similar in the eyes with extremely short axial length, but a large refractive error deviation was observed. The 2 groups based on ACD showed no significant difference in the refractive error, but the group with deep ACD had a tendency for hyperopic shifts. The difference of the calculated IOL power between the 4 formulas was more pronounced in eyes with lower corneal refractive power. CONCLUSIONS: In eyes with short axial lengths, preoperative ACD and corneal refractive power had an influence on the accuracies of predicted IOL power. Therefore, these factors should be considered in IOL power determination.

The Preoperative Prognostic Factors for Outcome After LASEK Using the MEL60

PURPOSE: To investigate the preoperative clinical factors affecting the refractive outcome after laser-assisted subepithelial keratomileusis (LASEK). METHODS: This retrospective study was conducted on 58 patients (116 eyes) who underwent bilateral LASEK using the MEL60. The outcome efficacy and predictability of LASEK was examined by analyzing data including age, gender, preoperative uncorrected visual acuity, preoperative refraction (spherical equivalent and cylindrical diopter), central corneal thickness, tear breakup time, and Schirmer test through multiple logistic regression analysis. RESULTS: The preoperative factor associated with postoperative uncorrected visual acuity was the amount of preoperative spherical equivalent. Greater preoperative spherical equivalent was associated with decreased efficacy. Predictability was also associated with the amount of preoperative spherical equivalent. Greater preoperative spherical equivalent was associated with decreased predictability. The other preoperative factors including sex, age, preoperative uncorrected visual acuity, amount of preoperative cylinder diopter, intraocular pressure, tear breakup time, Schirmer test and central corneal thickness did not show any association with efficacy or predictability. CONCLUSIONS: The preoperative spherical equivalent was determined as the most important prognosis factor in LASEK, as it is in PRK or LASIK.

Multiple Logistic Regression Analysis of Factors in Refractive Outcome of Photorefractive Keratectomy(PRK)

PURPOSE: The purpose of our study was to evaluate the preoperative factors associated with refractive outcome of photorefractive keratectomy. METHODS: 113 eyes of 84 patients were observed for 1 year after PRK. We examined the outcome of PRK with efficacy, predictability, and stability and analyzed data through multiple logistic regression analysis to evaluate the independent association of multiple preoperative factors with each of three principle results. RESULTS: Lesser intended correction and lesser intraocular pressure were associated with an increased likelihood of achieving 20/25 or better uncorrected visual acuity. Greater intraocular pressure and lesser corneal opacity were associated with increased predictability. Lesser intended correction was associated with an increased likelihood of stability. Preoperative factors associated with postoperative uncorrected visual acuity are amount of intended correction and intraocular pressure. Predictability is associated with intraocular pressure and degree of corneal opacity. Stability is associated with greater amount of intended correction. CONCLUSIONS: If we consider these factors, we can expect more exact outcome in patient selection, determining timing of fellow eye surgery.

Factor Analysis of Refractive Outcome in LASIK

We intended to identify preoperative factors associated with refractive outcome of LASIK.We have performed LASIK for correction of 3.25 to 19.00 diopter of myopia using Aesculap-Meditec, Mel 60.Three principal outcomes of LASIK on 75 patients (104 eyes)were examined : (1)Efficacy (2)Predictability (3)Stability.Multiple logistic regression was used to test for independent associations of multiple preoperative factors with each of three outcomes. Lesser astigmatism was associated with increased efficacy (odds ratio=0.580).Greater optical zone was associated with increased efficacy (0.289) and with lesser likelihood of instability of refraction (0.272).Greater attempted correction was associated with decreased predictability, specifically with undercorrection (4.545 :8.25-14.75D / 21.430 :> or=15.00D).Greater average SimK was associated with decreased likelihood of instability of refraction (0.602). In conclusion.preoperative factors associated with postoperative uncorrected visual acuity are amount of astigmatism and optical zone size.Predictability is associated with attempted correction.Stability is associated with average SimK and optical zone size.Such information may help guide patient selection, determine timing of fellow eye treatment, and suggest changes in the laser treatment algorithm for individual patients.