Visual and refractive outcomes following implantation of a new trifocal intraocular lens.

BACKGROUND: Independence from all optical aids, and freedom from unwanted symptoms, following cataract and lens surgery remains the ultimate goal of both patient and surgeon. The development of trifocal IOL technology provides an ever-increasing range of options. The purpose of our study is to understand the predictability, safety and efficacy of a new trifocal intraocular lens (IOL) following cataract or refractive lens exchange (RLE) surgery. METHODS: This was a retrospective consecutive case series of patients undergoing cataract extraction or RLE followed by implantation of the Alcon IQ Panoptix IOL. Pre and postoperative refractive and visual parameters were recorded and evaluated. As the cohort followed a normal distribution, standard parametric tests were used. Paired t-test was used to compare the difference between target and postoperative refractive errors. The incidence of intraoperative and postoperative complications was also reported. RESULTS: The IOL was implanted in 66 eyes of 33 patients. Mean postoperative spherical equivalent (SE) refraction was -0.08 ± 0.25 dioptres (D). This was not significantly different from the target refraction (p = 0.841). Sixty-five percent of patients were within ± 0.25 D of the target SE refraction with 100% within ± 0.50 D of intended correction. Mean postoperative uncorrected distance visual acuity (UDVA) was 0.01 ± 0.10 LogMAR. All patients achieved an unaided distance acuity of 20/40 or better postoperatively. Binocularly, 100% saw 0.20 LogMAR or better at near without correction and 88.9% achieved this level for uncorrected intermediate visual acuity. No intraoperative complications were noted. Five patients complained of moderate haloes in the early postoperative period. CONCLUSION: The AcrySof IQ Panoptix IOL provides functional uncorrected visual acuity at distance, intermediate and near positions. Our results remain equivalent with existing trifocal IOL outcomes and provide surgeons with a further IOL alternative for the patient motivated to obtain true spectacle independence. Surgeons should consider individual reading and working requirements when counselling patients preoperatively to optimise postoperative patient satisfaction.

Oral antivirals for preventing recurrent herpes simplex keratitis in people with corneal grafts.

BACKGROUND: Ocular herpes is a viral infection of the eye caused by the herpes simplex virus (HSV), a double-stranded DNA virus. Corneal scarring caused by herpes simplex keratitis (HSK) is the leading infectious cause of penetrating corneal graft in high-income countries. Acyclovir is an antiviral drug known to have a protective effect against recurrences in herpetic eye disease. While there are some studies which have evaluated the effects of intervention with oral antiviral in preventing such recurrences in people with corneal grafts, a systematic review of all comparative clinical trials has not been previously undertaken. OBJECTIVES: To assess the efficacy of oral antivirals such as acyclovir in any dosage when taken for six months or more, in preventing recurrence of herpetic keratitis in people having corneal graft surgery for herpetic keratitis. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 1 June 2016. We handsearched conference proceedings and contacted authors of the included studies and researchers active in the field. SELECTION CRITERIA: We included randomised controlled trials (RCTs). People enrolled in these trials had corneal grafts for HSK. The intervention was oral antivirals for six months or more following the corneal graft surgery, and this was compared to no treatment or placebo. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. We contacted trial investigators for any clarification or missing information. We graded the certainty of the evidence using GRADE. MAIN RESULTS: We included three trials, involving 126 participants, comparing the use of oral acyclovir to no treatment or placebo. Two studies were conducted in single centres in Turkey and the USA, and one was multi-centred in the Netherlands. In general, the studies were poorly reported and it was difficult to judge the extent to which bias had been avoided.Oral acyclovir may reduce the risk of recurrence of herpetic keratitis (risk ratio (RR) 0.29, 95% confidence interval (CI) 0.13 to 0.64, 126 people, low-certainty evidence). Based on data from the included trials, this corresponds to approximately 23 fewer cases of HSK recurrence (95% CI 29 fewer cases to 12 fewer cases) per 100 corneal graft operations if oral acyclovir is used.Oral acyclovir may reduce the risk of graft failure (RR 0.40, 95% CI 0.16 to 0.97, 126 people, low-certainty evidence). Based on data from the included trials, this corresponds to approximately 13 fewer cases of graft failure (95% CI 18 fewer cases to 1 fewer cases) per 100 corneal graft operations if oral acyclovir is used.None of the studies reported any serious side effects of the antivirals necessitating stoppage or change. None of the trials reported outcomes over the long term (more than two years) or any data on quality of life. AUTHORS' CONCLUSIONS: Compared to placebo or to no treatment, oral antiviral (acyclovir) may reduce the risk of recurrence of herpetic keratitis in the first 12 months in eyes that have undergone corneal graft surgery.

Design and validity of a miniaturized open-field aberrometer.

PURPOSE: To design and validate a new miniaturized open-field wavefront device that can be attached to an ophthalmic surgical microscope or slitlamp. SETTING: Solihull Hospital and Aston University, Birmingham, United Kingdom. DESIGN: Comparative noninterventional study. METHODS: The dynamic range of the Aston aberrometer was assessed using a calibrated model eye. The validity was compared with that of a conventional desk-mounted Hartmann-Shack aberrometer (Topcon KR1W) in dilated eyes. The instruments were used in random order, with measurements repeated 5 times to assess intrasession repeatability. RESULTS: The open-field aberrometer had a large dynamic range of at least +21.0 diopters (D) to -25.0 D. It gave similar measurements to the conventional aberrometer for mean spherical equivalent (SE) (mean difference 0.02 D ± 0.49 [95% confidence interval]; correlation r = 0.995; P<.001), astigmatic components (J0: 0.02 ± 0.15 D; r = 0.977, P<.001; J45: 0.03 ± 0.28, r = 0.666, P<.001), and higher-order aberration (HOA) root mean square (RMS) (0.02 ± 0.20 D, r = 0.620, P<.001). Intraclass correlation coefficient assessments of intrasession repeatability were excellent (SE = 1.000, P<.001; J0 = 0.998, P<.001; J45 = 0.980, P<.01; HOA RMS = 0.961, P<.001). CONCLUSIONS: The new aberrometer gave valid, repeatable measurements of refractive error and HOAs over a large range. It can measure continuously, thus providing direct feedback on the optical status of the visual system to surgeons during intraocular lens implantation and corneal surgery.

Outcomes of deep anterior lamellar keratoplasty following successful and failed 'big bubble'.

AIM: The most popular technique for deep anterior lamellar keratoplasty (DALK) is the 'big bubble' (BB) technique wherein air is injected in the cornea to create a bubble that separates Descemet's membrane (DM) from the stroma. An attempt to create a BB often results in the cornea being filled with numerous small bubbles without the formation of a BB. Manual dissection is then required to complete the procedure. The aim of the study is to compare these two groups, successful BB versus failed bubble (FB) dissection to determine whether the clinical outcomes were different. METHODS: In this retrospective comparative study, 46 patients out of 52 who underwent DALK for various corneal stromal diseases such as keratoconus, stromal dystrophy or corneal scarring (caused by different conditions) were included in the analysis. BB was achieved in 25 patients and in the remaining 21 patients a BB separation of the DM was not possible necessitating manual lamellar dissection of stroma to get as close to the DM as possible. RESULTS: The authors compared best-corrected visual acuity, contrast sensitivity, astigmatism, interface densitometry and Scheimpflug pachymetry in the two groups. Postoperative corneal thickness was higher in the 'small bubbles' group (mean 628.9 vs 564.1 µm; p<0.0005), but there was no significant difference in best-corrected visual acuity, astigmatism, contrast sensitivity and densitometry between the groups. CONCLUSIONS: In DALK, manual lamellar dissection is a reasonable alternative when BB separation of the DM is not achieved.

Removal of lens epithelial cells and the effect on capsulorhexis size.

PURPOSE: To assess the long-term effects of lens epithelial cell (LEC) removal on capsulorhexis opening size. SETTING: Dorset County Hospital, Dorchester, United Kingdom. METHODS: This prospective randomized control study included 39 eyes of 38 patients. Twenty eyes were selected randomly for removal of LECs from the anterior capsule as part of routine cataract operation comprising phacoemulsification with intraocular lens (IOL) implantation. The other 19 eyes were used as controls in which the LECs were not removed. All surgeries were performed by 1 surgeon (A.T.). All patients had silicone IOL (Allergan SI-40) implantation. The capsulorhexis opening size was determined immediately after surgery and 2 weeks and 6 months after surgery. Data on treatment outcome of the cataract surgery were analyzed statistically. RESULTS: Six months postoperatively, the size of the capsulorhexis had statistically significant increased in the study group that had LECs removed (mean increase 1.07 +/- 1.70 mm(2); paired Student t test P=.01), whereas the capsulorhexis size had statistically significant decreased in the control group (mean decrease -3.38 +/- 2.37 mm(2); paired Student t test, P<.0001). The difference in changes in the capsulorhexis areas between the 2 groups was also highly statistically significant (independent-sample Student t test, P<.0001). CONCLUSION: Removal of anterior subcapsular LECs by aspiration helped maintain the size of the capsulorhexis opening and thus can help prevent capsule contraction syndrome.