Combined phacoemulsification and viscocanalostomy with Ologen implant versus combined phacoemulsification and viscocanalostomy.

BACKGROUND: To study the efficacy of the biodegradable collagen implant Ologen® as an adjuvant in phaco-viscocanalostomy in patients with coexisting cataract and primary open angle glaucoma. METHODS: This prospective, interventional, randomized clinical study was done at Alpha Vision Center, Zagazig, Egypt. Patients with coexisting cataract and glaucoma were randomized to receive either phaco-viscocanalostomy (Phacovisco group) (39 eyes) or phaco-viscocanalostomy with Ologen® implant (OloPhacovisco group) (40 eyes). Follow-up period was 2 years. Nd:YAG laser goniopuncture was done in cases where the intraocular pressure (IOP) was elevated above 21 mmHg after discontinuation of corticosteroid eye drops at any follow-up visit. RESULTS: No significant operative or postoperative complications (other than failure) were encountered in either group. At 2 years follow-up, the mean IOP level was statistically significantly decreased in the OloPhacovisco group (p = 0.02) and complete success occurred in 23 eyes (59.0%) in the Phacovisco group and in 32 eyes (80.0%) in the OloPhacovisco group. There was a statistically significant higher success rate regarding complete success in patients that received Ologen® implant (p = 0.04). CONCLUSIONS: Ologen® implant improved the success rate of phaco-viscocanalostomy. Larger studies with longer follow-up periods may be required to confirm these findings. TRIAL REGISTRATION: This trial was retrospectively registered on 20/12/2018 under the number ( NCT03782051 ).

Conjunctival Autograft Combined With Either Preoperative Mitomycin C Injection or Intraoperative Local Mitomycin C Over the Medial Rectus Muscle Tendon in Primary Pterygium Surgery.

PURPOSE: To evaluate and compare the recurrence rate and complications of conjunctival autograft (CAG) combined with preoperative mitomycin C (MMC) injection versus CAG with intraoperative local MMC over the medial rectus muscle tendon in primary pterygium. STUDY DESIGN: Randomized prospective study. METHODS: This study included 108 eyes of 108 patients with primary fleshy or growing pterygium. All patients were from rural areas and less than 50 years old. Fifty-three patients were treated with injection of 0.1 mL of 0.15 mg/mL MMC into the body of pterygium followed 1 day later by pterygium excision and CAG (group I), and 55 patients were treated with pterygium excision and local application of 0.2 mg/mL MMC for 2 min over the medial rectus tendon followed by CAG (group II). The minimum follow-up period was 18 months. RESULTS: Two patients from group I and one patient from group II did not complete the follow-up period and were excluded. There were no statistically significant differences between the two groups regarding age, sex, laterality, or follow-up period. Recurrence occurred in 2 eyes in group I (3.92%) and 1 eye in group II (1.85%); (P=0.52). All recurrences occurred in male patients of less than 30 years of age. No significant complications were encountered in both groups. CONCLUSIONS: Both preoperative MMC injection followed 1 day later by pterygium excision with CAG, and pterygium excision and intraoperative local application of MMC on the medial rectus tendon are successful in treating primary pterygium with low recurrence rate and few complications.

EFFICACY AND FREQUENCY OF INTRAVITREAL AFLIBERCEPT VERSUS BEVACIZUMAB FOR MACULAR EDEMA SECONDARY TO CENTRAL RETINAL VEIN OCCLUSION.

PURPOSE: To compare the safety, efficacy, and frequency of intravitreal injection of aflibercept and bevacizumab for treatment of macular edema secondary to central retinal vein occlusion. DESIGN: Prospective, comparative, randomized, interventional study. PATIENTS AND METHODS: Eyes with macular edema secondary to central retinal vein occlusion were randomized between two groups according to the intravitreal injection used. Group A included eyes treated with intravitreal aflibercept, and Group B included eyes treated with intravitreal bevacizumab injections. The inclusion criteria were macular edema secondary to central retinal vein occlusion and follow-up duration of at least 12 months after the first injection. Exclusion criteria were macular ischemia, associated diabetes, hypertensive or renal retinopathy, other retinal disease, and previous anti-vascular endothelial growth factor injection. The main outcome measures are central foveal thickness, best-corrected visual acuity, time intervals between injections, improved retinal nonperfusion, and any reported complication. RESULTS: Group A included 39 patients with a mean age of 57.4 ± 8.2 years. Group B included 40 eyes with a mean age of 56.5 ± 9.1 years. Twelve months after the first injection, central foveal thickness significantly improved from 475.45 ± 71.05 m to 259.11 ± 20.67 m in Group A and from 460.22 ± 89.38 m to 264.29 ± 32.05 m in Group B; best-corrected visual acuity significantly improved from 0.81 ± 0.16 logarithm of the minimum angle of resolution (20/125) to 0.34 ± 0.14 logarithm of the minimum angle of resolution (20/40) in Group A and from 0.73 ± 0.15 logarithm of the minimum angle of resolution (20/100) to 0.33 ± 0.17 logarithm of the minimum angle of resolution (20/40) in Group B; the mean number of injections was 3.72 ± 2.93 in Group A and was 5.44 ± 2.85 in Group B (P < 0.05); and the mean interval between injections was 54.23 ± 8.47 days in Group A and was 35.12 ± 7.76 days in Group B (P < 0.05). Retinal nonperfusion improved in 9/12 eyes in Group A and in 3/8 eyes in Group B (P < 0.05). CONCLUSION: Both aflibercept and bevacizumab are comparably effective for treatment of macular edema secondary to central retinal vein occlusion without significant complications. However, the burden of frequent intravitreal injections could be significantly reduced when using aflibercept.

Trypan blue-assisted posterior capsulorhexis in pediatric cataract surgery.

PURPOSE: To evaluate the safety and efficacy of staining the posterior capsule with trypan blue during capsulorhexis in pediatric cataract surgery. PATIENTS AND METHODS: This was a prospective randomized comparative study carried out at Alpha Vision Center, Zagazig, Egypt. This study included 2 groups of children with pediatric cataract randomly allocated to undergo irrigation and aspiration. In the trypan group, which included 11 eyes, trypan blue was used to stain the posterior capsule during posterior capsulorhexis. In the control group, which included 10 eyes, no staining was performed. All surgeries were performed by the same surgeon. The 2 groups were compared for criteria such as completion of capsulorhexis, disruption of vitreous face and in-the-bag intraocular lens implantation. RESULTS: This study included 21 eyes of 16 patients (age range: 6 months-4 years). A statistically significant difference was observed for the following parameters between the 2 groups: capsulorhexis completion (P=0.04), vitreous face disruption (P=0.01) and in-the-bag intraocular lens implantation (P=0.022). CONCLUSION: This study suggests that staining of the posterior capsule during capsulorhexis in pediatric cataract operation gives better results than capsulorhexis without staining. The stain changes the capsule texture making capsulorhexis easier with fewer complications.

Four-point scleral fixation of posterior chamber intraocular lenses without scleral flaps.

PURPOSE: To report the visual results and complications of a new technique for scleral fixation of posterior chamber intraocular lenses (IOLs) without scleral flaps. METHODS: Half-thickness 3 mm scleral grooves 1 mm behind the limbus were constructed opposite to each other. The straight needle with a double-armed 10/0 prolene suture was introduced at one end of the scleral groove to exit through the corneal incision then passed through the two holes of the IOL. It re-entered the globe through the corneal incision and then passed behind the iris to exit the globe at the other end of the scleral groove. The same was repeated on the other side. The corneal section was enlarged, the IOL was implanted, and the two ends were tied to each other to form a loop that was rotated and buried in the scleral groove. RESULTS: The study included eight men and seven women. Their ages ranged from 7 to 69 years (mean 40+/-21.53 years). The preoperative best corrected visual acuity (BCVA) ranged from 3/60 to 6/9. The operation time ranged from 25 to 50 min (mean 34.55+/-7.66 min). Anterior vitrectomy was performed in nine (60%) cases. Ciliary bleeding during needle passage occurred in six (40%) cases and accidental suture cutting during section enlargement occurred in one (6.7%) case. There was no major IOL decentration. The final UCVA ranged from 6/24 to 6/18 and the final BCVA ranged from 6/24 to 6/9. Five cases (33.33%) showed postoperative glaucoma and three cases (20%) had mild to moderate vitreous haemorrhage. No cases of suture erosion, postoperative endophthalmitis, retinal detachment or IOL dislocation were detected. CONCLUSION: This technique of four-point scleral fixation of posterior chamber IOLs reduces the operation time, achieves good centration and stability of the IOL, and minimises postoperative suture-related complications.

Outcomes of ZB5M angle-supported anterior chamber phakic intraocular lenses at 12 years.

PURPOSE: To evaluate the visual and refractive stability and the potential long-term risks associated with ZB5M phakic intraocular lens (PIOL) implantation. METHODS: A retrospective, non-randomized, cumulative clinical study was performed over 12 years in a consecutive group of 225 eyes implanted with the ZB5M PIOL. The main analyzed variables were visual and refractive outcomes (best spectacle-corrected visual acuity [BSCVA], uncorrected visual acuity [UCVA], and spherical equivalent), endothelial cell density, and postoperative complications. RESULTS: Mean preoperative spherical equivalent refraction was -17.23 +/- 7.69 diopters (D) and 12 years postoperatively it was -1.80 +/- 0.80 D. Mean BSCVA at 1- and 12-year follow-up was 0.38 +/- 0.19 and 0.57 +/- 0.18, respectively (Wilcoxon test, P < .001). At 12 years postoperatively, 3.5% of eyes lost > or = 2 lines of BSCVA. An initial 10.6% reduction in endothelial cell density was noted in the first year, followed by a mean annual rate of decrease of 1.78%. The cumulative incidence of pupil ovalization was 34.7% (78 eyes), and there was no statistical correlation with endothelial cell impairment. Bilateral hypertensive uveitis was diagnosed in 3 (1.33%) eyes. CONCLUSIONS: The ZB5M PIOL offers good refractive outcomes and stability in the long-term; however, endothelial cell loss increases over 12 years, requiring annual endothelial cell counts.

Confocal microscopy comparison of intralase femtosecond laser and Moria M2 microkeratome in LASIK.

PURPOSE: To analyze the quality of LASIK flaps created using a femtosecond laser or a mechanical microkeratome. METHODS: A prospective study of consecutive bilateral LASIK flaps (100 patients) created with a 15 kHz femtosecond laser (IntraLase) or with a mechanical microkeratome (Moria M2) was performed. Outcome measures included visual and refractive outcomes, flap dimensions, and intraoperative complications. The first consecutive ten patients (20 eyes) were examined using confocal microscopy 1 and 3 months following surgery. RESULTS: No significant differences were noted in the visual outcomes between groups (t test, P > .05 for all comparisons). Analysis of superficial measurements revealed more round flaps and greater predictability in surface dimensions for the femtosecond laser group (t test, P = .016). Mean deviation of flap thickness from target was the same for both instruments, 10 microm, with greater variability for the mechanical microkeratome. The incidence of diffuse lamellar keratitis was significantly greater in the femtosecond laser group (17%) than in the mechanical group (0%) (chi-square test, P < .001). Confocal microscopy revealed a higher wound healing opacity index in the femtosecond laser group. CONCLUSIONS: Although the clinical results are similar, the femtosecond laser produces LASIK flaps with more accurate dimensions compared to the mechanical microkeratome.

Optical analysis of visual improvement after correction of anisometropic amblyopia with a phakic intraocular lens in adult patients.

PURPOSE: To analyze possible reasons for an increase in visual acuity observed in myopic patients with anisometropic amblyopia after implantation of a phakic intraocular lens (PIOL) using a theoretical eye model. DESIGN: Retrospective case series. PARTICIPANTS: Fifty-nine eyes of 48 patients with anisometropic amblyopia implanted with an angle-supported PIOL. METHODS: Inclusion criteria were anisometropia of at least 3 diopters (D) and a best spectacle-corrected visual acuity (BSCVA) of 0.7 or less in the best eye. Follow-up was performed at 1, 3, 6, and 12 months and then annually for up to 10 years. The theoretical analysis of mechanisms to explain the visual improvement was performed using a theoretical eye, based on the Kooijman model, in which the measured values of radii and thickness of the different surfaces were substituted. The magnification and spot size were calculated by a ray tracing process. MAIN OUTCOME MEASURES: Uncorrected visual acuity, improvement in best spectacle-corrected visual acuity, and spherical equivalent. RESULTS: Mean gain in visual acuity was 3 lines (range, 0-7 lines). Fifty-four eyes (91.5%) gained at least 1 line of visual acuity, whereas no eyes lost lines of vision. The change in BSCVA did not correlate with preoperative BSCVA (Pearson coefficient, r = 0.19) or with the degree of anisometropia (Pearson coefficient, r = 0.23). The calculations using a Kooijman eye model corrected with spectacles and with a PIOL accounted for the full increase in visual acuity in terms of the magnification (increased by a factor of 1.2) and the spot size (reduced by a factor of 2). CONCLUSIONS: After implantation of a PIOL, the visual acuity of myopic patients with anisometropic amblyopia showed a significant increase. This increase was explained using a theoretical eye model not only in terms of magnification but also including changes in aberrations. An evident role of neuroprocessing in this visual improvement was not identified.

Angle-supported anterior chamber phakic intraocular lens explantation causes and outcome.

PURPOSE: To investigate the reasons for explantation of angle-supported phakic intraocular lenses (IOLs) as well as the outcome and safety of the explantation procedure. DESIGN: Consecutive retrospective series. PARTICIPANTS: One hundred eyes of 66 patients who underwent phakic angle-supported IOL explantation. INTERVENTION: Surgical explantation of anterior chamber angle-supported phakic IOLs. MAIN OUTCOME MEASURES: Visual acuity, refraction, and endothelial cell density. RESULTS: The main causes of explantation were cataract development (64 cases [64%]), progressive endothelial cell loss (24 cases [24%]), and pupil ovalization (10 cases [10%]). According to the reason for phakic IOL explantation and the condition of the eye at time of explantation, 92 cases underwent bilensectomy (phakic IOL explantation followed by phacoemulsification of the crystalline lens), 2 cases underwent phakic IOL exchange, 4 cases underwent concomitant phakic IOL explantation and penetrating keratoplasty, and 2 cases underwent simple explantation of a phakic IOL. The mean time between phakic anterior chamber IOL implantation and explantation due to cataract was 10.04+/-3.66 years (range, 2-14). The mean time between implantation and secondary intervention due to progressive endothelial cell loss was 8.97+/-2.21 years (range, 2-14), and most of these cases were related to a specific model of angle-supported phakic IOL. CONCLUSION: Nuclear cataract was the most frequent reason for angle-supported phakic IOL explantation. Bilensectomy was effective and maintained the refractive benefits obtained with phakic IOL implantation. Few cases developed severe endothelial cell loss, most of them related to certain types of phakic IOLs.