Aspectos a considerar para el diagnóstico del queratocono infantil / Aspects to consider for the diagnosis of infant keratoconus

Introducción: Globalmente, existe un aumento de la prevalencia del queratocono y su diagnóstico en edades tempranas. Se notifican un gran número de casos subclínicos y otros con una rápida progresión, condicionada por el inicio precoz de la enfermedad y la asociación a factores de riesgo. Objetivo: Describir los aspectos epidemiológicos, clínicos y el resultado de los medios de diagnóstico implicados en la detección precoz del queratocono infantil. Desarrollo: En niños con ametropía hay elementos que alertan la presencia de un queratocono como causa del defecto refractivo. Desde el punto de vista epidemiológico se encuentran: distribución geográfica, rol de la herencia y factores ambientales. Clínicamente se señalan los antecedentes de enfermedades, tales como las alergias, la presencia de miopía o astigmatismo miópico con inestabilidad refractiva y los signos clínicos relacionados con la progresión del cono. En los pacientes de riesgo es preciso realizar exámenes mediante diferentes medios de diagnóstico según su disponibilidad, siendo primordial el análisis refractivo, queratométrico y topográfico. Conclusiones: En la evaluación de los niños con ametropía se deben tener en cuenta elementos epidemiológicos y clínicos que permiten sospechar y diagnosticar precozmente el queratocono. En la interpretación de los resultados de los medios de diagnóstico involucrados en su detección, se deben considerar los hallazgos más frecuentes en la población infantil según el grado de progresión de la ectasia.

Introduction: Globally, there is an increase of the keratoconus prevalence and its diagnosis in early ages. A great number of subclinical cases and others with a quick progression are notified, conditioned by the early onset of the disease and the association with risk factors. Objective: To describe the epidemiological, clinical aspects and the result of diagnostic means involved in the early detection of infant keratoconus. Development: There are elements that alert the presence of a keratoconus as a cause of the refractive defect in children with ametropia. From the epidemiologic point of view they are: geographical distribution, heredity role and environmental factors. History of previous diseases are clinically pointed out, such as allergies, myopia or myopic astigmatism with refractive instability and the clinical signs related to cone progression. In risk patients it is necessary to carry out exams by means of different diagnostic means according to their availability, being essential the refractive, keratometric and topographic analysis. Conclusions: In the evaluation of children with ametropia, epidemiological and clinical elements should be taken into account that allow to suspect and early diagnose the keratoconus. In the interpretation of results of the diagnostic means involved in their detection the most frequent findings in the infant population, should be considered according to the ectasia degree of progression.

Vector analysis outcomes after Femtosecond Laser In-Situ Keratomileusis (FS-LASIK) versus Small Incision Lenticule Extraction (SMILE) for moderate myopic astigmatism

Objectives@#To compare the vector analysis, visual, and refractive outcomes of femtosecond-assisted laser insitu keratomileusis (LASIK) and small incision lenticule extraction (SMILE) among myopic patients with moderate myopic astigmatism.@*Methods@#This was a single-center, retrospective, cohort study that compared eyes that underwent femtosecond LASIK or SMILE for the correction of myopia and astigmatism of 0.75 to 3.0 diopters. Vector analysis and standard graphs for reporting visual and refractive outcomes were utilized for analysis.@*Results@#There were 82 femtosecond LASIK-treated eyes and 80 SMILE-treated eyes with similar preoperative characteristics except for slightly higher mean preoperative sphere refraction in the SMILE group (-4.2±2.4 D vs -4.9±1.6 D, p=0.03). At 3 months, femtosecond LASIK group had better mean uncorrected distance visual acuity (UDVA) (LogMAR 0.006±0.06 vs 0.06±0.09, p=0.00) and had more eyes achieving postoperative UDVA of 20/20 or better (88% versus 56%). Although there were similar postoperative spherical equivalents, residual astigmatism was higher in the SMILE group (0.11±0.22 D vs 0.32±0.30 D, p=0.00). Vector analyses showed significantly better outcomes for femtosecond LASIK than for SMILE in terms of difference vector (DV), index of success (IOS), torque, and flattening index (FI). A trend for undercorrection for higher astigmatism was seen in both groups that was greater in the SMILE group. Both groups showed high safety with the majority of eyes showing postoperative corrected distance VA (CDVA) within 1 line of preoperative CDVA (98.8% versus 91.2%). @*Conclusion@#Although femtosecond LASIK and SMILE have similar predictability at 3 months, femtosecond LASIK has relatively better efficacy and superior astigmatic outcomes than SMILE for the correction of moderate myopic astigmatism.

Progress in the application of swept-source optical coherence tomography in corneal imaging / 国际眼科杂志(Guoji Yanke Zazhi)

Advances in imaging technology have revolutionized the field of ophthalmology, changing the understanding, diagnosis, and treatment of ophthalmic diseases. Swept-source optical coherence tomography(SS-OCT)is a non-contact high-resolution imaging technology. It further improves imaging depth and scanning speed, adds new algorithms and features. The application of SS-OCT enables the three-dimensional evaluation of corneal structures, offering curvature and height maps for both the anterior and posterior surfaces of the cornea, as well as precise corneal thickness mapping. These invaluable tools aid ophthalmologists in effectively screening and diagnosing various corneal lesions such as keratoconus, corneal dystrophy, and degeneration. Moreover, the enhanced speed, accuracy, and sensitivity provided by SS-OCT measurements facilitate improved surgical planning and postoperative monitoring for patients undergoing refractive surgery or keratoplasty. This article reviews the development of SS-OCT technology and its potential clinical utility in corneal diseases and surgical application, in order to support more possible future research and clinical treatment.

Effect of residual corneal astigmatism on visual acuity of patients undergoing regional refractive intraocular lens implantation / 眼科新进展

Objective To investigate the effect of residual corneal astigmatism on visual acuity after regional refrac-tive intraocular lens(IOL)implantation.Methods A retrospective cohort study was conducted.The medical records and follow-up data of 73 eyes of 57 cataract patients who underwent ultrasound emulsification cataract extraction combined with LENTIS Comfort LS-313 MF15 IOL implantation in the Ophthalmology Department of the Hebei General Hospital from June 2020 to March 2022 were collected.These patients were grouped according to postoperative residual corneal astigmatism:32 patients(40 eyes)with a residual corneal astigmatism of 0.75(exclusive)-1.50 D were taken as the experimental group,and 25 patients(33 eyes)with a residual corneal astigmatism ≤0.75 D were taken as the control group.The uncor-rected distance visual acuity(5 m),uncorrected intermediate visual acuity(80 cm),uncorrected near visual acuity(40 cm),out-of-focus curve,objective visual quality,subjective visual quality,satisfaction degree and lens removal rate of pa-tients in the two groups were recorded 6 months postoperatively.Results The postoperative uncorrected distance visual acuity(logMAR)was 0.10(0.00,0.22),the uncorrected intermediate visual acuity(logMAR)was 0.00(0.00,0.10),and the uncorrected near visual acuity(logMAR)was 0.20(0.10,0.30)and 0.20(0.10,0.20)in the experimental and control groups,with no statistically significant differences(all P＞0.05).The postoperative out-of-focus curves showed that the distance visual acuity of patients with additional spherical equivalent refraction ranged from+2.00 D to-4.00 D in the two groups had no statistically significant difference(all P＞0.05).There were statistically significant differences in to-tal aberration,coma aberration,modulation transfer function and Strehl ratio in the objective visual quality of patients after surgery(all P＜0.05),and there was no statistically significant difference in the total higher-order aberration,spherical ab-erration and cloverleaf aberration(all P＞0.05).There was no statistically significant difference in the subjective visual quality,satisfaction degree and lens removal rate in the two groups(all P＞0.05).Conclusion Residual corneal astig-matism of 0.75 D to 1.50 D after LENTIS Comfort LS-313 MF15 IOL implantation has no effect on higher-order aberration,spherical aberration,and cloverleaf aberration in subjective and objective visual quality,and has an impact on total aberra-tion,coma aberration,modulation transfer function and Strehl ratio in objective visual quality.

Evaluation of the efficacy and safety of phacoemulsification under the IOL protection: a randomized controlled clinical study / 中华实验眼科杂志

Objective:To observe the therapeutic effect of intraocular lens (IOL) protected phacoemulsification (PHACO) in patients with hard nucleus cataract.Methods:A randomized controlled clinical study was conducted.A total of consecutive 120 patients (120 eyes) with hard nucleus cataract of Emery grade Ⅳ or Ⅴ were enrolled from January 2019 to May 2022.The patients were randomly divided into PHACO group receiving routine PHACO, IOL protected PHACO group receiving PHACO under IOL protection, and extracapsular cataract extraction (ECCE) group receiving ECCE, with 40 cases (40 eyes) in each group.Finally, 99 patients completed the follow-up, including 30 cases (30 eyes) in PHACO group, 35 cases (35 eyes) in IOL protected PHACO group, and 34 cases (34 eyes) in ECCE group.The total operation time, intraoperative PHACO time and cumulative energy release of each patient were recorded.The corneal endothelial cell density (ECD), coefficient of variation in endothelial cell area (CV), hexagonal endothelial cell ratio (6A), corneal astigmatism and the number of eyes with different grades of uncorrected visual acuity were measured and compared after 3-month follow-up.The intraoperative and postoperative complications were recorded.This study adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Yanbian University Hospital (NO.2023002).Patients were informed of study content and purpose and signed a consent form before treatment.Results:There was no significant difference in ultrasonic energy and time between PHACO group and IOL protected PHACO group ( P=0.691, 0.982).The total operation time was (38.81±2.73) and (36.45±3.45) minutes in PHACO group and IOL protected PHACO group, significantly shorter than (69.60±4.35) minutes in ECCE group (both at P<0.001).There was no significant difference in age, sex, lens nucleus hardness and other baseline data among the three groups before operation (all at P>0.05).Three months after operation, the number of patients with higher uncorrected visual acuity in PHACO group and IOL protected PHACO group was larger than that in ECCE group ( P=0.006, 0.007).The ECD and 6A in IOL protected PHACO group were (2 155.57±177.88)/mm 2 and (41.31±5.18)%, respectively, which were significantly higher than (1 912.64±224.11)/mm 2 and (36.18±3.27)% in PHACO group, and the CV in IOL protected PHACO group was (50.34±5.90)%, which was lower than (55.67±3.30)% in PHACO group, showing statistically significant differences ( P=0.007, 0.003, 0.005).At 1 week and 3 months after the operation, the corneal astigmatism was significantly lower in IOL-protected PHACO group than in ECCE group, but higher than in PHACO group, and the difference were statistically significant (all at P<0.05). Conclusions:Compared with conventional PHACO, IOL-protected PHACO can effectively reduce the damage of corneal endothelium caused by ultrasonic energy, shorten the operation time and reduce postoperative inflammatory reaction compared with ECCE, and does not significantly increase postoperative corneal astigmatism.IOL-protected PHACO is an effective improved surgical method for patients with hard nucleus cataract.

Advances in the inclusiveness of extended depth of focus intraocular lens for astigmatism / 国际眼科杂志(Guoji Yanke Zazhi)

Since the first intraocular lens(IOL)was implanted by Harold Ridley in 1949 and the widespread use of depth-of-focus extended intraocular lens(EDOF IOL)clinically, the IOL has been constantly updated and developed, aiming to provide patients with good postoperative visual quality. The residual astigmatism is one of the important factors affecting the postoperative visual quality of cataract patients, 35%-40% of cataract patients have astigmatism of 1.00 D, and 19%-22% have astigmatism of 1.50 D. Therefore, it is important to understand the inclusiveness of EDOF IOL for astigmatism, so that the right IOL can be selected for the patient. This article summarizes the inclusiveness of different types of EDOF IOL for astigmatism and their advantages and disadvantages, with the expectation that it will provide a reference in selecting EDOF IOL for patients with different residual astigmatism.

Distribution characteristics of astigmatism in preschool children from Tongzhou District of Beijing and its effect on visual acuity / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the characteristics of astigmatism distribution among preschool children from Tongzhou District, Beijing, discuss its categorizations, severity, and the effect on preschoolers' vision, and clarify the influence of cycloplegic refraction on the detection of astigmatism.METHODS:In this cross-sectional study conducted from December 2021 to January 2022, a cluster random sampling method was utilized to assess 1 498 preschool children(2 996 eyes)from Tongzhou District, Beijing. The sample comprised 791 males and 707 females, with 222 children aged 3 to &#x0026;#x003C;4 years, 521 children aged 4 to &#x0026;#x003C;5 years, 647 children aged 5 to &#x0026;#x003C;6 years, and 108 children aged 6 to &#x0026;#x003C;7 years. Evaluations included visual acuity, anterior segment, computerized optometry, and cycloplegic refraction.RESULTS:Prior to cycloplegic refraction, the prevalence of astigmatism was found to be 61.88%(927/1498). For post-cycloplegic refraction, this percentage slightly increased to 64.02%(959/1498, P=0.095). Following cycloplegic refraction, the distribution of astigmatism severity was as follows: 51.87%(777/1498)had mild astigmatism, 9.41%(141/1498)had moderate astigmatism, and 2.74%(41/1498)had severe astigmatism. Astigmatism was predominantly with-the-rule across all age groups, with compound hyperopic astigmatism being the most frequent type. In cases of subnormal vision caused by astigmatism: low degree accounted for 9.38%, moderate degree accounted for 25.4%,and high degree accounted for 52.6%.CONCLUSION:The findings reveal a high incidence of astigmatism in preschool children, predominantly in a mild nature. Cycloplegic refraction was observed to have a negligible effect on the rate of astigmatism detection. Moreover, its impact on vision becomes more significant as the degree of astigmatism increases.

Clinical effect of cross positioning method for correcting low and moderate astigmatism during small incision lenticule extraction / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical outcomes of using the cross-positioning method for correcting low and moderate astigmatism during small incision lenticule extraction(SMILE)surgery with Alpins vector analysis.METHODS: A total of 50 patients(81 eyes)with low and moderate astigmatism with the rule ≤1.50 D who underwent SMILE surgery at the laser myopia treatment center of Xi'an No.1 Hospital from May 2022 to November 2022 were included in the prospective randomized controlled study, and they were divided into two groups according to the random table, with 25 case(41 eyes)in cross-positioning group and 25 cases(40 eyes)in control group. In the cross-positioning group, the patients' head position was adjusted based on the cross intersection lines before the standard SMILE procedure, aligning the lateral canthi with the horizontal line and the midpoint of the eyebrows and the nose bridge with the vertical line. Postoperative visual acuity and refractive results at 3 mo were observed in both groups, and astigmatic changes were analyzed and evaluated using the Alpins vector analysis method.RESULTS: During the follow-up period, 6 cases(11 eyes)in the cross-positioning group were lost to follow-up, while in the control group, 8 cases(14 eyes)were lost to follow-up, with 19 cases(30 eyes)and 17 cases(26 eyes)finally included in the cross-positioning group and the control group, respectively. At 3 mo postoperatively, the uncorrected visual acuity(UCVA)of both groups' operated eyes was ≥1.0, and no serious complications occurred, with no significant differences in UCVA, best corrected visual acuity(BCVA), spherical power, and spherical equivalent between the cross-positioning group and the control group(all P&#x0026;#x003E;0.05). The cylindrical power in the cross-positioning group was 0.00(0.00, 0.00)D, which was lower than -0.13(-0.50, 0.00)D in the control group(P=0.01). The vector analysis results showed that the difference vector(DV)in the cross-positioning group was lower than that in the control group [0.00(0.00, 0.00)vs 0.13(0.00, 0.50), P=0.01], and the index of success(IOS)was better than that of the control group [0.00(0.00, 0.00)vs 0.18(0.00, 0.77), P&#x0026;#x003C;0.01]. At 3 mo postoperatively, 26(87%)and 15(58%)eyes in the cross-positioning group and control groups achieved an angle of error(AE)within ±5°, respectively.CONCLUSION: The cross positioning method was used to calibrate the patients' head position during SMILE surgery, which reduced the axial position error and improved the accuracy of SMILE in correcting low and moderate astigmatism.

Astigmatism inclusivity of regional refractive intraocular lens / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect of residual astigmatism on visual quality after phacoemulsification combined with regional refractive intraocular lens(IOL)implantation in patients with age-related cataract, and to evaluate the astigmatism inclusivity of regional refractive IOL.METHODS: Retrospective cohort study. The clinical data of 62 cases(73 eyes)of age-related cataract patients who underwent phacoemulsification combined with regional refractive IOL(Lentis Comfort LS-313 MF15)implantation from July 2020 to March 2022 at the ophthalmology department of our hospital were collected. They were grouped according to residual astigmatism at 6 mo postoperatively, taking 35 cases(40 eyes)with residual astigmatism of 0.75 D to 1.50 D as the experimental group, and 27 cases(33 eyes)with residual astigmatism ≤0.75 D as the control group. Visual acuity, defocus curves, objective visual acuity [wavefront aberrations, Strehl ratio(SR), modulation transfer functions(MTF)], subjective visual acuity(national eye institute visual function questionnaire-25), patients' satisfaction, and spectacle independence were compared between the two groups at 6 mo postoperatively.RESULTS:There was a difference in the preoperative astigmatism and the number of postoperative 6 mo residual astigmatism between the two groups(P&#x003C;0.01). At 6 mo postoperatively, there was no difference in uncorrected distance, intermediate, and near visual acuity, objective visual quality, subjective visual quality, satisfaction, and spectacle independence between the two groups(P&#x003E;0.05). The defocus curves showed that there was no difference in visual acuity between the two groups at all points in the +2.00 to -4.00 D defocus range of the additional spherical equivalent(P&#x003E;0.05).CONCLUSION:Lentis Comfort LS-313 MF15 IOL was able to accommodate regular astigmatism of 1.50 D.

Accuracy of a smartphone-assisted novel labeling method for marking target axial position in cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the convenience and accuracy of a novel smartphone-assisted “any-point two-step method” for finding the target axial position in cataract phacoemulsification combined with intraocular lens(IOL)implantation.METHODS: Prospective observational study. A total of 62 cases(62 eyes)of patients with age-related cataracts who underwent cataract phacoemulsification combined with IOL implantation in our hospital from October 2021 to April 2022 were selected. They were randomly divided into two groups: 31 cases(31 eyes)in the control group were applied with the “traditional two-step method” using slit lamp to mark the target axial position of the IOL, and 31 cases(31 eyes)in the experimental group were applied with the smartphone-assisted “two-step method” to mark the target axial position of the IOL. The Callisto eye navigation system was used as a standard reference, and the deviation of the reference marking point(deviation-1), the deviation of the target axial marking point(deviation-total), and the deviation of the angle from the reference marking point to the target axial marking point(deviation-2)were calculated and recorded as the preoperative axial marking time.RESULTS:Both deviation-1 and deviation-total values were lower in the experimental group than those in the control group(1.06°±1.39° vs 2.48°±2.23°, 1.77°±1.54° vs 2.81°±1.58°, all P&#x003C;0.01), but there was no significant difference in the deviation-2 values between the two groups(1.35°±1.40° vs 1.48°±1.79°, P&#x003E;0.05). The preoperative axial marking took shorter time in the experimental group than in the control group(1.77±1.70 min vs 2.88±3.20 min, P&#x003C;0.01).CONCLUSION: The smartphone-assisted “any-point two-step method” for finding the target axial position in cataract phacoemulsification combined with IOL implantation is simple, time-saving, and accurate compared with the “traditional two-step method”.

Vector analysis of toric implantable collamer lens V4c implantation in correcting moderate to high myopia with high astigmatism / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical effect of toric implantable collamer lens(TICL)V4c for correcting moderate to high myopia with high astigmatism using vector analysis and quality of life impact of refractive correction(QIRC).METHODS: Retrospective case series. A total of 55 patients(90 eyes)with moderate to high myopia and high astigmatism who received TICL V4c implantation in the refraction surgery center of ophthalmology department in our hospital from January 2019 to December 2022 were collected. Followed-up for 1 a, the uncorrected distance visual acuity(UDVA), best corrected visual acuity(BCVA)and diopters were observed. Alpins vector analysis was used to evaluate the effect of astigmatism correction, and QIRC scale was used to evaluate patients' quality of life.RESULTS: At 1 a postoperatively, the UDVA of 98% eyes was the same or better than pre-operative BCVA, the safety index was 1.11±0.14, and the efficacy index was 1.11±0.15. The angle of error of 97% of the astigmatic eyes was within ±15°. The results of vector analysis showed that correction index was 0.83±0.13, angle of error was 1.00±4.49°, and index of success was 0.21±0.15. The total higher order aberrations under a pupil diameter of 6 mm was significantly increased compared with preoperatively(P&#x003C;0.05), the QIRC score was significantly better than that before surgery(P&#x003C;0.001), and the increase of total QIRC scores was positively correlated with preoperative spherical equivalent(rs=0.215, P&#x003C;0.05), indicating that the higher degree of myopia before surgery the patients, the better the quality of life after TICL implantation.CONCLUSION: TICL V4c implantation for the correction of moderate to high myopia with high astigmatism is safe and effective, and the patients' quality of life significantly improved after surgery.

Efficacy of MyoRing implantation in the treatment of keratoconus / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the anterior and posterior corneal astigmatism and total refractive astigmatism before and after MyoRing implantation in keratoconus(KCN)patients.METHODS: In this historical cohort study, the preoperative and postoperative total refractive, anterior and posterior corneal astigmatism of KCN patients implanted with a 360-degree full-ring implant(MyoRing)were compared before and after four consecutive follow-up sessions at 3, 6, 9, and 12 mo after surgery.RESULTS: The study encompassed 79 KCN patients(85 eyes), comprising 43 males and 36 females. The mean age of the patients was 29±7.41 years, ranging from 17 to 48 years. Throughout the follow-up sessions, a gradual decrease was observed in the trend of changes for total refractive astigmatism, anterior corneal astigmatism, and posterior corneal astigmatism. Postoperatively, total refractive astigmatism measurements exhibited a significant decrease of 2.09 D at 12 mo after MyoRing implantation(4.27±3.15 vs 2.18±1.63 D, P&#x003C;0.001). Additionally, post-operative measurements revealed an enhancement of approximately 3.20 D and 0.59 D for anterior and posterior corneal astigmatism, respectively [6.40±1.90 vs 3.20±1.75 D for anterior corneal astigmatism(P&#x003C;0.001)and 1.30±0.55 vs 0.71±0.35 D for posterior corneal astigmatism(P&#x003C;0.001)].CONCLUSION: MyoRing implantation demonstrates significant improvements in astigmatism parameters, encompassing total refractive astigmatism as well as anterior and posterior corneal astigmatism.

Analysis of ocular biometric parameters in Tibetan patients with age-related cataract / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the differences of ocular biometric parameters of age-related cataract between Tibetan and Han ethnic groups, and to analyze the distribution characteristics of ocular biometric parameters in Tibetan cataract patients.METHODS:Retrospective cohort study. A total of 661 patients(1 030 eyes)with age-related cataract confirmed in the hospital between January 2019 and December 2020 were enrolled. The parameters of axial length, anterior chamber depth, keratometry, corneal astigmatism and astigmatic axis were measured by IOL Master 500 in 483 cases(739 eyes)of Tibetan age-related cataract patients and 178 cases(291 eyes)of Han patients.RESULTS:The axial length, anterior chamber depth and corneal astigmatism of the Tibetan patients with age-related cataract were 23.33(22.81, 23.86)mm, 3.04(2.79, 3.30)mm and 0.73(0.47, 1.07)D. The mean keratometry was 43.89±1.35 D. The results indicated that Tibetan cataract patients had shorter axial lengths and smaller keratometry compared to Han patients(all P&#x003C;0.05). Age in Tibetan patients was negatively correlated with axial length and anterior chamber depth, and positively correlated with keratometry(all P&#x003C;0.05). Tibetan male patients had longer axial lengths, deeper anterior chambers, and flatter corneas compared to female patients(all P&#x003C;0.05).CONCLUSION:There were differences in ocular biometric parameters between age-related cataract patients of Tibetan and Han ethnicities. The distribution of ocular biometric parameters in Tibetan cataract patients varied across different age groups and gender groups.

Astigmatisme induit après phaco-alternative: à propos de 100 yeux opérés au CHU Donka, Conakry / Induced astigmatism after phaco-alternative: An Analysis of100 eyes operated at Donka University Hospital, Conakry

ntroduction.Après une opération par phaco-alternative chez les patients souffrantde cataracte,on peut observerune acuité visuelle non souhaitée. Une réfraction met en évidence souvent un astigmatisme important appelé astigmatisme induit. La qualité du résultat fonctionnel dépend en partie de ce dernier qu'il faut réduire à son minimum.Le but de notre étude était d'étudier l'astigmatisme induit après phacoalternative à Conakry et suggérer des recommandations pour l'amélioration de la qualité de la chirurgie.Méthodologie. Il s'agissait d'une étude transversale, descriptive et analytique d'une cohorte de patients opérés de la cataracte par phaco alternative de Juillet 2016 à Janvier 2017 (six mois)au CHU de Donka. Résultats.Nous avons inclusdans notre étude 100 yeux opérés par phaco-alternative avec un âge moyen de 62±12,18ans pour un sex ratio de 1. La tranche d'âge la plus représentée était cellede 61 -70 ans(38%). La femme ménagère était la plus touchée (39%).L'hypertension artérielleétait l'antécédent le plus retrouvée dans 23% des cas.L'œil gauche était le plus opéré (59%). L'acuité visuelle était réduite à la perception lumineuse dans 58% des cas en préopératoire, 95% des astigmatismes préopératoiresétaient inférieurs à 2D et 57% selon la règle. La puissance moyenne de l'implant après biométrie était de 19±2,38 dioptries et 50% des patientsont reçu l'implant calculé.L'œdème cornéen était la complication précoce la plus fréquenteConclusion.la phacoalternativeavec incision supérieure linéaire induit un astigmatisme contre la règle de 3,15 dioptries en moyenne

Introduction.After a phaco-alternative operation in patients suffering from cataracts, unwanted visual acuity may be observed. Refraction often reveals significant astigmatism called induced astigmatism. The quality of the functional result partly depends on the amount of induced astigmatism, which needs to be minimized. The aim of our study was to investigate induced astigmatism after phaco-alternative in Conakry and suggest recommendations for improving the quality of surgery. Methodology.This was a cross-sectional, descriptive, and analytical study of a cohort of cataract patients operated by phaco-alternative from July 2016 to January 2017 (six months) at Donka University Hospital. Results.We included 100 eyes operated by phaco-alternative with an average age of 62±12.18 years and a sex ratio of 1. The most represented age group was 61-70 years (38%). Homemakers were the most affected group (39%). Hypertension was the most commonly found history in 23% of cases. The left eye was the most operated on (59%). Visual acuity was reduced to light perception in 58% of cases preoperatively, 95% of preoperative astigmatism was less than 2D, and 57% were with-the-rule. The average power of the implant after biometry was 19±2.38 diopters, and 50% of patients received a calculated implant. Corneal edema was the most common early complication. Conclusion.Phaco-alternative with a linear superior incision nduces an astigmatism against-the-rule of 3.15 diopters on average.

Evaluation of corneal tomography in children and adolescents without ocular or systemic allergy / Avaliação da tomografia de córnea em crianças e adolescentes sem alergia ocular ou sistêmica

ABSTRACT Purpose: To determine normal corneal tomographic parameters in children and adolescents without corneal disease or atopy diagnosis. Methods: This descriptive cross-sectional study evaluated patients aged 8-16 years who underwent a complete slit-lamp biomicroscopic examination and tomographic corneal evaluation by a dual Scheimpflug analyzer, excluding those with ocular disease (including allergic conjunctivitis) or a positive prick test for systemic atopies. Results: A total of 170 patients were evaluated, and 34 patients (68 eyes) were analyzed once the exclusion criteria were applied. The sample's mean age was 10.76 ± 2.31 years; with 19 (55.9%) men and 15 (44.1%) women. The mean keratometry in the flat meridian (Kflat), steep meridian (Ksteep), and maximum (Kmax) were 42.37 ± 1.63D, 43.53 ± 1.65D, and 43.90 ± 1.73D, respectively. The mean values for corneal asphericity (ε2) and thinnest point were 0.28 ± 0.11 and 550.20 ± 37.90 μm, respectively. The inferior-superior asymmetry ratio (I-S) and coma were 0.74 ±0.59D and 0.28 ± 0.12D, respectively. Conclusion: The knowledge of normal corneal tomographic parameters and their variation in children and adolescents without corneal disease or atopy may be useful for diagnosing keratoconus and initiating early disease treatment.

RESUMO Objetivo: Identificar parâmetros tomográficos de normalidade em córneas de crianças e adolescentes sem a presença de atopias sistêmicas e alergias oculares. Métodos: Este estudo descritivo transversal avaliou pacientes com idade entre 8 e 16 anos que foram submetidos a exame biomicroscópico completo por lâmpada de fenda e avaliação tomográfica da córnea por tomógrafo dual Scheimpflug, excluindo pacientes com doença ocular (incluindo conjuntivite alérgica) ou prick test positivo para atopias sistêmicas. Resultados: Cento e setenta pacientes foram avaliados e após cumpridos os critérios de exclusão, 34 (68 olhos) foram analisados. A média etária da amostra foi 10,76 ± 2,31 anos; 19 (55,9%) eram meninos e 15 (44,1%) meninas. A média da ceratometria em dioptrias (D) no meridiano mais plano (Kflat), mais curvo (Ksteep) e máxima (Kmax) foram 42,37 ± 1,63D, 43,53 ± 1,65D e 43,90 ± 1,73D, respectivamente. Os valores médios da asfericidade corneana (ε2) e do ponto mais fino da córnea foram 0,28 ± 0,11 e 550,20 ± 37,90 micras (μm). A assimetria corneana inferior-superior (I-S) e coma foi em média 0,74 ± 0,59D e 0,28 ± 0,12D, respectivamente. Conclusão: O conhecimento dos valores médios e sua variação de parâmetros tomográficos da córnea em crianças e adolescentes sem atopias sistêmicas ou alergias oculares pode ser útil para o diagnóstico precoce do ceratocone e o seu tratamento em estágio inicial.

Post-Bader procedure: a long-term follow-up case study / Procedimento pós-Bader: estudo de caso com acompanhamento de longo prazo

ABSTRACT Keratoconus is a progressive disorder that manifests as a cone-like steepening of the central or paracentral inferior cornea and irregular stromal thinning. There is a gradual decrease in visual acuity due to corneal asymmetry, irregular astigmatism, and increased optical aberrations, consequently impacting the quality of life. Several procedures have been developed in an attempt to slow or reverse the progression. The Bader procedure, which includes a pattern of incisions around the circumference of the cornea and at the base of the protruding cone, is one such surgery. These incisions penetrate 70-90% of the cornea's depth. Its goal is to flatten the topography and reduce corneal asymmetry and irregular astigmatism. Though prior research found these to be highly promising, we report a patient who was given contact lenses to restore and maintain his vision while his corneal ectasia and thinning progressed over the following decade.

RESUMO O ceratocone é uma doença progressiva que se manifesta como uma elevação semelhante a um cone da cór­nea central ou paracentral inferior e é associada a uma re­dução irregular da espessura do estroma. Há uma diminuição gradual da acuidade visual devido à assimetria da córnea, ao astigmatismo irregular e a um aumento das aberrações ópticas, o que prejudica a qualidade de vida. Foram desenvolvidos vários procedimentos para tentar interromper ou mesmo reverter a evolução da doença. Um deles é o chamado procedimento de Bader, que inclui um padrão de incisões em volta da circunferência da córnea e na base do cone protuberante. Essas incisões penetram até 70%-90% da profundidade da córnea e têm o objetivo de achatar a topografia e diminuir a assimetria da córnea e o astigmatismo irregular. Embora essa técnica seja muito promissora, segundo um estudo anterior, aqui se apresenta o caso de um paciente no qual esses objetivos não foram atingidos. Esse paciente recebeu lentes de contato para restaurar e manter sua visão, enquanto sua ectasia corneana e a redução da espessura progrediram ao longo da década seguinte.

Asimetría interocular en el queratocono pediátrico / Interocular Asymmetry in Pediatric Keratoconus

El queratocono es una ectasia corneal bilateral asimétrica, en etapas iniciales no se evidencia la afectación binocular. El conocimiento del grado de asimetría en el queratocono pediátrico permite tomar decisiones oportunas en el manejo de los pacientes. Se realizó este trabajo con el objetivo de describir las características clínicas y el tratamiento de tres casos pediátricos con diferente grado de asimetría interocular del queratocono, atendidos en la consulta provincial de ectasias corneales pediátricas en Ciego de Ávila. Los pacientes mostraron diferencia entre ambos ojos de los signos clínicos, la refracción y las variables topográficas. Al paciente dos se le diagnosticó queratocono en un ojo, sin evidencias clínicas ni topográficas de la enfermedad en el ojo contralateral. Todos los pacientes mostraron astigmatismo miópico compuesto en ambos ojos y se les indicó corrección óptica. Al paciente uno se le corrigió con cristales, al dos con lentes de contacto rígidos de gas permeable y al tercero con piggyback en un ojo y lentes de contacto rígidos de gas permeable en el otro. Presentaron, además, una ambliopía asociada y se les orientó tratamiento oclusivo y tareas de visión cercana en los pacientes dos y tres. Es frecuente encontrar asimetría interocular en pacientes pediátricos con queratocono por la diferencia de progresión entre ambos ojos. El seguimiento periódico permite diagnosticar la enfermedad en el ojo contralateral en pacientes con diagnóstico de queratocono en un ojo, indicar una corrección óptica individualizada, sobre todo en presencia de anisometropía, y monitorizar la evolución de la ambliopía refractiva asociada con frecuencia(AU)

Keratoconus is an asymmetric bilateral corneal ectasia, in early stages binocular involvement is not evident. Knowledge of the degree of asymmetry in pediatric keratoconus allows timely decisions in patient management. This research was carried out with the objective of describing the clinical characteristics and the treatment of three pediatric cases with different degree of interocular asymmetry of keratoconus, treated in the provincial consultation of pediatric corneal ectasia in Ciego de Avila. Patients showed difference between both eyes in clinical signs, refraction and topographic variables. Patient two was diagnosed with keratoconus in one eye, with no clinical or topographic evidence of the disease in the contralateral eye. All patients showed compound myopic astigmatism in both eyes and optical correction was indicated. Patient one was corrected with glasses, patient two with rigid gas permeable contact lenses and patient three with piggyback in one eye and rigid gas permeable contact lenses in the other eye. They also presented an associated amblyopia and were directed occlusive treatment and near vision tasks in patients two and three. It is common to find interocular asymmetry in pediatric patients with keratoconus due to the difference in progression between the two eyes. Periodic follow-up makes it possible to diagnose the disease in the contralateral eye in patients diagnosed with keratoconus in one eye, to indicate individualized optical correction, especially in the presence of anisometropia, and to monitor the evolution of frequently associated refractive amblyopia(AU)

Piggyback corneal como alternativa en el tratamiento del queratocono / Corneal Piggyback as an Alternative in the Treatment of Keratoconus

El queratocono es una afección inflamatoria, es una ectasia corneal que se caracteriza por un aumento de la curvatura corneal. Se describe como una enfermedad progresiva y asimétrica asociada con cambios estructurales en la organización del colágeno corneal. Existen diferentes opciones terapéuticas con el objetivo de estabilizar la superficie corneal, mejorar la visión y evitar su progresión. El sistema piggyback consiste en adaptar un lente rígido de gas permeable con alta permeabilidad al oxígeno sobre un lente de contacto hidrofílico, es ideal para pacientes que requieren la óptica de un lente de contacto rígido, pero tienen dificultades con su material. Se indica cuando existe una intolerancia a los lentes rígidos de gas permeable, en córneas irregulares y con curvaturas avanzadas. Se presenta una paciente de 24 años de edad con diagnóstico de queratocono desde los 10 años de edad que se corregía con lente rígido de gas permeable. Acudió a consulta del servicio de córnea del Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el año 2010 porque comenzó a presentar intolerancia a los lentes. Debido a que la paciente no presentaba criterio quirúrgico y tenía una agudeza visual mejor corregida con lentes de 1,0 en ambos ojos, se decidió realizar el tratamiento con piggyback corneal. Pese al seguimiento, como parte de la progresión de la enfermedad, a los 10 años de mantenerse con el piggyback, presentó un hidrops corneal agudo, el cual fue tratado. En la actualidad la paciente mantiene seguimiento anual por consulta, sin progresión del queratocono y sin complicaciones con el tratamiento de piggyback corneal(AU)

Keratoconus is an inflammatory condition, a corneal ectasia characterized by increased corneal curvature. It is described as a progressive and asymmetric disease associated with structural changes in the organization of corneal collagen. There are different therapeutic options to stabilize the corneal surface, improve vision and prevent progression. The piggyback system consists of fitting a rigid gas permeable lens with high oxygen permeability over a hydrophilic contact lens, it is ideal for patients who require the optics of a rigid contact lens, but have difficulties with its material. It is indicated when there is intolerance to rigid gas permeable lenses, in irregular corneas and with advanced curvatures. We present a 24-year-old female patient with a diagnosis of keratoconus since she was 10 years old, which was corrected with a rigid gas permeable lens. She went to the cornea service of the Cuban Institute of Ophthalmology Ramón Pando Ferrer, in 2010 because she began to present intolerance to lenses. Since the patient did not present surgical criteria and had a visual acuity better corrected with 1.0 lenses in both eyes, it was decided to perform corneal piggyback treatment. Despite the follow-up, as part of the progression of the disease, after 10 years of piggyback, she presented an acute corneal hydrops, which was treated. At present, the patient maintains annual follow-up via consultation, without progression of keratoconus and without complications with the corneal piggyback treatment(AU)

Comparison of keratoplasty outcomes at the scar versus edema stages of keratoconus

ABSTRACT Purpose: To assess the outcomes of deep anterior lamellar keratoplasty or penetrating keratoplasty at the scar and the edema stages. Methods: Forty-five patients (45 eyes) with keratoconus scar stage (scar group, n=26; penetrating keratoplasty a subgroup, n=7; deep anterior lamellar keratoplasty b subgroup, n=19) and keratoconus edema stage (edema group, n=19; penetrating keratoplasty c subgroup, n=12; deep anterior lamellar keratoplasty d group, n=7) who received penetrating keratoplasty or deep anterior lamellar keratoplasty from 2000 to 2022 were retrospectively studied. At 1, 6, and 12 months after surgery, the best-corrected visual acuity, astigmatism, spherical equivalent, corneal endothelial cell density, and complications were analyzed. Results: The best-corrected visual acuity and average corneal endothelial cell loss rate were not significantly different between the scar and edema groups (p>0.05). At 6 and 12 months after surgery, the astigmatism and spherical equivalent in the scar group were significantly lower than those in the edema group (p<0.05). The spherical equivalent of the deep anterior lamellar keratoplasty b subgroup was lower than that of the penetrating keratoplasty a subgroup in the scar group 6 months after surgery (p<0.05). In the edema group, there was no significant difference in spherical equivalent between subgroups (p>0.05). There were no significant differences in best-corrected visual acuity and astigmatism between subgroups within the two groups (p>0.05). In comparison to the scar group, the edema group experienced more complications. According to a survival analysis, there was no statistically significant difference between the scar group and the edema group regarding the progression of vision. Conclusions: In terms of the outcomes and prognosis for vision after keratoplasty with edema stage and scar stage, deep anterior lamellar keratoplasty may be as effective as penetrating keratoplasty.

Bidirectional associations between hyperopia, myopia, astigmatism, and strabismus, and attention-deficit/hyperactivity disorder in children: a national population-based cohort study

Objectives: The present study analyzed the reciprocal relationships between four common pediatric ophthalmic diseases (i.e., hyperopia, myopia, astigmatism, and strabismus) and attention‐deficit/hyperactivity disorder (ADHD) in children. Methods: This study enrolled 86,028 children with ADHD and 1,798,673 children without ADHD in the Taiwan Maternal and Child Health Database who were born at any time from 2004 to 2017. Cox proportional hazards regression models were used to estimate the bidirectional relationships of the four ophthalmic diseases with ADHD in children after adjusting for age, sex, and gestational age at birth. Survival curves for time-to-event variables were estimated using the Kaplan-Meier method, and the log-rank test was used to compare the curves. Results: The results indicated that ADHD significantly predicted the occurrence of hyperopia, myopia, astigmatism, and strabismus. Furthermore, hyperopia, myopia, astigmatism, and strabismus significantly predicted the occurrence of ADHD. The time between enrollment and ADHD diagnosis was shorter for patients with ophthalmic diseases than for the control group, and the time between enrollment and ophthalmic disease diagnosis was also shorter for ADHD patients than for the control group. Sex differences were found in the associations between ADHD and ophthalmic diseases. Conclusion: Clinicians should monitor children with ADHD for hyperopia, myopia, astigmatism, and strabismus to ensure appropriate treatment, and vice versa.