Implantation of a Small Aperture Intraocular Lens in Eyes with Irregular Corneas and Higher Order Aberrations.

Purpose: Corneal irregularities can lead to high order aberrations (HOAs) and may influence the outcomes in terms of intraocular lens (IOL) selection and visual acuity assessment. The aim of this study was to evaluate the visual acuity and satisfaction after IC-8 implants in patients characterized by corneal irregularities and HOAs who could not undergo refractive surgery due to the poor residual thickness of the cornea or other conditions such as astigmatism secondary to previous radial keratotomy. Methods: This descriptive, retrospective cohort study was conducted on nine eyes in six patients affected by corneal irregularities and HOAs who had undergone IC-8 IOL implantation. The primary endpoint was the best-corrected visual acuity (BCVA), the subjective visual function, and the visual field. Results: Nine eyes of six patients (three bilateral implantation) were enrolled. For each patient, BCVA, vision, and lifestyle quality were evaluated. In all patients, we noticed an improvement in all parameters without visual field defects. Conclusion: Our work encourages the use of the IC8 lens to improve visual acuity in patients with irregular corneas and HOAs who cannot be treated with customized refractive surgery. Patients experience a subjective improvement of their quality of vision and also more self-confidence in their daily life. IC-8 lenses do not interfere with the visualization of retinal fundus and there is no impairment of the visual field detected by patients.

A singular case of iatrogenic gas-filled double anterior chamber after DALK.

AIM: To present a case of double anterior chamber after DALK and its surgical management. CASE DESCRIPTION: A 67-year-old healthy woman underwent deep anterior lamellar keratoplasty (DALK) in her right eye for keratoconus with the big-bubble technique. About 7 days after surgery a partial detachment of the Descemet membrane from the posterior corneal stroma was revealed using AS-OCT (double anterior chamber appearance). In spite of two injections in the anterior chamber of air and gas on the 7th and 9th post-operative days respectively, the double anterior chamber still persisted. Furthermore, both air and gas passed through the little perforation of the host Descemet membrane-endothelium complex and enlarged the space between the stroma and Descemet membrane. About 10 weeks after DALK, a spontaneous resolution of the double anterior chamber was observed. CONCLUSION: This case suggests that an injection of air or gas into the anterior chamber, to deal with a Descemet membrane detachment following perforation during DALK procedure, can enlarge the double anterior chamber by increasing the space between stroma and Descemet membrane. These cases can be managed with a "wait and see" strategy for a spontaneous resolution to Descemet membrane detachment.

Efficacy and safety of Ab interno XEN gel implant after a failed filtering surgery.

Purpose: To evaluate the efficacy and safety of Ab interno XEN gel stent in patients with open angle glaucoma who underwent a previous failed filtering surgery. Methods: A retrospective, observational, multi-centered and descriptive cohort study was conducted from January 2019 to February 2020 on patients with primary open angle glaucoma (POAG) who underwent XEN gel stent implant after a failed filtering surgical procedure. Main parameters evaluated were: changes in IOP measured with Goldmann applanation tonometer, number of anti-glaucomatous eye drops, postoperative complications, and necessity of further surgical procedures. The quantification of quality of life was obtained from the VFQ-25 questionnaire. A descriptive analysis based on pre- post- and intra-operative data was carried out. Results: In all patients included in the study (6 patients for a total of 7 eyes), IOP dropped during the follow up time. We found a mean percentage reduction of -41.5% at 9 months compared to the preoperative data (baseline). IOP lowered from 21.71 ± 4.64 mmHg to 9 ± 3,21 mmHg 1 day after the operation, 11 ± 3.21 at 1 week, 11.42 ± 1.81 mmHg at 1 month, 12.42 ± 3.10 mmHg at 3 months, 13.57 ± 3.45 at 6 months, 12.71 ± 1.79 at 9 months. In 71.4%, the procedure turned out to be complication free and only one case required needling of the bleb in order to achieve optimal intraocular pressure control. A total of 71.4% patients reached a medication free regimen with a percentage of reduction in the mean number of drugs needed of -88.9%. Conclusion: In our experience, XEN gel stent implant performed in Caucasian patients with POAG and a history of failed filtrating surgery, showed to be an effective and safe procedure.