Spectral-Domain OCT Lens Meridian Position as a Metric to Estimate Postoperative Anatomical Lens Position.

PURPOSE: To evaluate the prediction of postoperative anatomical lens position (ALP) using intraoperative spectral-domain optical coherence tomography (SD-OCT) lens anatomy metrics in patients who underwent femtosecond laser-assisted cataract surgery. METHODS: Intraoperative SD-OCT (Catalys; Johnson & Johnson Vision) and postoperative optical biometry (IOLMaster 700; Carl Zeiss Meditec AG) were used to assess anterior segment landmarks, including lens thickness, lens volume, anterior chamber depth, lens meridian position (LMP), and measured ALP. LMP was defined as the distance from the corneal epithelium to the lens equator, and ALP was defined as the distance from the corneal epithelium to the IOL surface. Eyes were divided into groups according to axial length (> 22.5 mm, 22.5 to 24.5 mm, and > 24.5 mm) and IOL type (Tecnis ZCB00 [Johnson & Johnson Vision]; AcrySof SN-60WF [Alcon Laboratories, Inc], or enVista MX60E [Bausch & Lomb]) to further analyze the correlation between LMP and ALP. Theoretical effective lens position was back-calculated using a specific formula. Primary outcome was correlation between postoperative measured ALP and LMP. RESULTS: A total of 97 eyes were included in this study. Linear regression analysis displayed a statistically significant correlation between intraoperative LMP and postoperative ALP (R2 = 0.522; P < .01). No statistically significant correlation was observed between LMP and lens thickness (R2 = 0.039; P = .06) or between ALP and lens thickness (R2 = 0.02; P = .992). The greatest predictor for ALP was LMP (ß = 0.766, P < .001; R2 = 0.523). CONCLUSIONS: Intraoperative SD-OCT-measured LMP correlated better than anterior chamber depth and axial length to postoperative ALP. Further studies are necessary to analyze the impact of preoperative or intraoperative LMP measurements on postoperative refractive outcomes. [J Refract Surg. 2023;39(3):165-170.].

Refractive Accuracy of Barrett True-K vs Intraoperative Aberrometry for IOL Power Calculation in Post-Corneal Refractive Surgery Eyes.

PURPOSE: To compare the refractive predictability of intraoperative aberrometry (IA, ORA, Alcon) and Barrett True-K/Universal II formulas for intraocular lens (IOL) power calculations in post-corneal refractive surgery and normal eyes. METHODS: Retrospective study of normal and post-corneal refractive surgery eyes that underwent cataract surgery with IA at tertiary academic center. Preoperatively, IOL power calculations were performed using Barrett Universal II (normal eyes) or Barrett True-K (post-corneal refractive surgery eyes) formulas. Intraoperatively, aphakic IA measurements were used for IOL power calculations. Mean absolute refractive prediction error (MAE) and the percentage of eyes with prediction error within ±0.50, ±0.75 and ±1.00 D were calculated. Refractive predictability was also evaluated in short, normal, and long eyes. RESULTS: Two hundred and seventy-three eyes were included in the analysis. No statistically significant differences were observed between the MAE of preoperative formulas and IA for post-hyperopic laser vision correction (LVC), post-myopic LVC, post-radial keratotomy (RK) and normal eyes. For prediction error within ±0.5 D in post-corneal refractive surgery eyes, range of agreement between Barrett True-K and IA ranged from 28% (7/25) of the time in post-RK eyes to 49% (40/81) of the time in post-hyperopic LVC; the corresponding value for Barrett Universal II/IA was 62% (64/103) in normal eyes. When there was disagreement, IA outperformed Barrett True-K in post-hyperopic LVC eyes and Barrett formula outperformed IA in post-myopic LVC, post-RK, and normal eyes. CONCLUSION: IA appears to be comparable to Barrett formulas for IOL power calculations in post-corneal refractive surgery and normal eyes. In post-hyperopic LVC, IA yields better results compared to Barrett True-K formula; in real-life scenarios, IA reveals statistical advantage over the Barrett True-K no history formula for eyes post-hyperopic LVC.

Comparability of corneal thickness and opacity depth assessed by OCT and UBM.

OBJECTIVE: To compare the measurement of central thickness and depth of involvement of opacity-bearing corneas at different intensities (mild, moderate, and dense) using different instruments: Visante and Optovue OCTs, ultrasound biomicroscopy (UBM), and ultrasound pachymetry (central thickness). METHODS: Sample of 102 eyes: 70 eyes (68.63 %) with corneal opacity; 32 eyes (31.37%) with normal corneas. Corneal opacity grading included mild (28 eyes, 40.00 %), moderate (27 eyes, 37.57 %), and dense (15 eyes, 21.43 %). Opacity intensity was graded and documented. Central corneal thickness was determined using Optovue and Visante OCTs, ultrasound pachymetry, and UBM VuMax (50 MHz), and depth of corneal opacity, using Optovue and Visante OCTs and UBM. RESULTS: Total corneal thickness of the control group showed differences with a small correction factor using Optovue OCT (534.03 ± 39.88 µm), Visante OCT (523.72±38.70 µm), and ultrasound pachymetry (529.84 ± 39.76 µm), and were higher when compared to UBM (492.06 ± 37.93 µm). In mild opacity, depth measurements were the same with OCT Optovue and Visante and higher than those by UBM. In moderate opacities, there were no differences in measurements by different instruments. In dense opacities, OCT Optovue and Visante measurements were the same and higher than those by UBM. CONCLUSIONS: Central corneal thickness measurements were considered higher in corneas with opacity than in normal corneas. We observed that the greatest thicknesses were measured in corneas with dense opacities. There was a difference between the measurements taken by different instruments, both in central thickness and in opacity depth in cases of mild and dense opacity, and no difference in moderate opacity.

Use of virtual reality equipment to assess the manual dexterity of applicants for ophthalmology residency.

PURPOSE: To assess the microsurgery dexterity outcomes of two sequential training evaluations using virtual reality technology. METHODS: This was a multicenter cross-sectional study of all candidates who were accepted as first-year residents at one of six ophthalmology teaching institutions. Residents were subjected to two identical series of standardized, reproducible dexterity tests using virtual reality equipment (Eyesi®): "sequence 1" and "sequence 2." Each sequence consisted of five difficulty levels that were assessed using a proprietary scoring system. The data were tested for normality using the Shapiro-Wilk test. The differences between tests in sequences 1 and 2 were evaluated using the Wilcoxon signed-rank test. RESULTS: The data did not follow a normal distribution. There were improvements from sequence 1 in all the tests (all p values<0.05). The sum of all scores (total score) improved from sequence 1 (median= 152.50) to sequence 2 (median 256.00; p<0.001). There was no correlation between the delta sequence values and the average scores. CONCLUSION: Two sequential training evaluations using virtual reality technology showed relevant improvement in quantifications of microsurgery dexterity. This information should be considered if virtual reality approaches are used for testing purposes, as previous experience may lead to improved test results.

Corneal suture for acute corneal hydrops secondary to post-LASIK ectasia: a case report.

Corneal ectasia is one of the main complications of keratorefractive procedures. In this report, we describe a case of corneal ectasia after laser-assisted in situ keratomileusis), which progressed with acute hydrops and aqueous leakage and required a suture for correction.

Nasal Polyposis: More than a Chronic Inflammatory Disorder-A Disease of Mechanical Dysfunction-The São Paulo Position.

Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP.

Nasal polyposis: more than a chronic inflammatory disorder-a disease of mechanical dysfunction - the São paulo position

Introduction: The importance of our study lies in the fact that we have demonstrated the occurrence ofmechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective: To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data: Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion: The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP (AU)

Complete depigmentation of a small aperture corneal inlay implanted for compensation of presbyopia.

We describe a case of late-onset remarkable depigmentation of a small aperture corneal inlay implanted for presbyopia compensation. The patient was a participant in a clinical trial designed to evaluate the safety and efficacy of the AcuFocusTM ACU-10R160, which is a 10 µm-thick polyimide film tinted with an organic dye. Inlay implantation occurred under mechanical microkeratome Lasik flaps set for a depth of 120 µm. The patient returned to the clinic 11 years after surgery and reported loss of near-vision acuity. Clinical examination showed the complete absence of pigments in the device and the total loss of the initial effect on near vision, despite normal distance vision. Manifest refraction remained stable during the follow-up period. Scheimpflug images characterized the loss of the small aperture effect on incoming light. Confocal analysis revealed small hyper-reflective round images on the endothelium and no signs of inflammation.

Lens: Management of Cataract Surgery, Cataract Prevention, and Floppy Iris Syndrome.

According to the World Health Organization, cataract is the major cause of reversible visual impairment in the world. It is present as the cause of decreased visual acuity in 33% of the visual impaired citizens. With the increase of life expectancy in the last decades, the number of patients with cataract is expected to grow for the next 20 years. Nowadays, the only effective treatment for cataracts is surgery and its surgical outcomes have been increasingly satisfactory with the technological advancement.Pharmaceutical development has been also responsible for surgical outcomes enhancement. This includes the development of new ophthalmic viscoelastic devices (OVDs), intraocular dyes, mydriatics, miotics, anesthetics, irrigating solutions, and antibiotics. However, the increased costs and demand for cataract surgery may be hard to meet in the future unless clinical preventive and curative options are evaluated.In this chapter, we review the studies that addressed pharmacological applications in cataract.

Complete depigmentation of a small aperture corneal inlay implanted for compensation of presbyopia / Despigmentação completa de um implante corneano de pequena abertura para correção da presbiopia

ABSTRACT We describe a case of late-onset remarkable depigmentation of a small aperture corneal inlay implanted for presbyopia compensation. The patient was a participant in a clinical trial designed to evaluate the safety and efficacy of the AcuFocusTM ACU-10R160, which is a 10 µm-thick polyimide film tinted with an organic dye. Inlay implantation occurred under mechanical microkeratome Lasik flaps set for a depth of 120 µm. The patient returned to the clinic 11 years after surgery and reported loss of near-vision acuity. Clinical examination showed the complete absence of pigments in the device and the total loss of the initial effect on near vision, despite normal distance vision. Manifest refraction remained stable during the follow-up period. Scheimpflug images characterized the loss of the small aperture effect on incoming light. Confocal analysis revealed small hyper-reflective round images on the endothelium and no signs of inflammation.

RESUMO Descrevemos um caso de importante despigmentação de início tardio de implante corneano de pequena abertura implantada para compensação de presbiopia. O paciente foi um dos participantes de ensaio clínico destinado a avaliar a segurança e eficácia do AcuFocusTM ACU-10R160, uma película de poliimida de 10 microns de espessura, tingida com um corante orgânico. A implantação ocorreu sob um flap de Lasik criado por microcerátomo mecânico ajustado para profundidade de 120 µm. O caso aqui descrito foi avaliado 11 anos após a cirurgia, relatando diminuição de acuidade de visão para perto. O exame clínico mostrou ausência total de pigmentos no dispositivo e perda total do efeito inicial na visão de perto, apesar da visão normal para distância. A refração manifesta permaneceu estável durante o período de seguimento. As imagens de Scheimpflug caracterizaram a perda do efeito da abertura pequena na luz entrante. A análise de microscopia confocal revelou pequenas imagens hiper-reflexivas redondas sobre o endotélio, sem sinais de inflamação.

Cyclotorsional and non-cyclotorsional components of eye rotation observed from sitting to supine position.

PURPOSE: Evaluate average cyclotorsional and non-cyclotorsional components (NCY) of eye rotation from sitting to supine, and associate average cyclotorsion to different variables. METHODS: Medical records of patients who underwent bilateral sequential laser refractive surgery were retrospectively evaluated. Recorded variables included the patient's age, refraction, automated keratometry, pupil displacement and eye rotation from sitting to supine position. Measured iris rotation (total rotation, TR) was decomposed into two components: NCY, defined as the common rotation component of each eye of the same patient, and cyclotorsional component (CY), defined as the assumed independent eye rotation for each eye in relation to the face, so that TR=NCY+CY. Cyclotorsion ratio (CR) was calculated as CR=|CY|/|TR|, and used to correlate CY with TR for each eye. RESULTS: Data from 310 eyes of 155 patients were evaluated. TR was +1.43° ±3.41° (-8.30° to +9.20°). Average CYs and NCYs per patient were +1.43°±2.04° (-3.15± to +7.40°) and -0.28°±2.72° (-6.85° to +7.15°), respectively. TR demonstrated that 40.6% and 8.4% of patients presented bilateral excyclotorsion and incyclotorsion, respectively. When excluding NCYs, average CYs demonstrated that 74.2% of patients presented excyclotorsion and 23.9% presented incyclotorsion. CR demonstrated that TR represented from 75% to 125% of average CY in 19.68% of the eyes. TR overestimated and underestimated average CYs above these limits in 52.26% and 28.06% of the eyes, respectively. There was no statistical association between average CYs and the different variables. DISCUSSION: This study demonstrates that most of the rotations previously attributed to torsional components were probably due to NCYs, such as postural misalignments. Apparently, the amplitude of cyclotorsional movements is smaller than observed in previous reports, and could not be associated with any studied variable.