Monovision Versus Multifocality for Presbyopia: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: Refractive surgery in presbyopia tends to achieve spectacle independence with minimal optical disturbances. We compared monovision to multifocality procedures regarding these outcomes. METHODS: We conducted a systematic review of published (till November 21, 2016) randomized controlled trials (RCTs) comparing any monovision to any multifocality method or comparing different monovision/multifocality methods to each other that enabled direct or indirect comparisons between particular monovision and particular multifocality procedures in presbyopic patients undergoing cataract-related or unrelated surgery in respect to spectacle independence, unaided binocular visual acuity (VA), contrast sensitivity (CS), and adverse events. RESULTS: Three trials comparing monovision (monofocal lenses, LASIK) to multifocal intraocular lenses (MFIOLs; Isert refractive or Tecnis diffractive) and 6 comparing other MFIOLs to Tecnis were included (1-12 months duration). Spectacle independence. All reporting trials were of sufficient quality. Directly, pseudophakic monovision was inferior to Isert (1 trial, N = 75, RR = 0.49, 95% CI 0.28-0.80) and Tecnis (1 trial, N = 211, RR = 0.36, 95% CI 0.25-0.52) in cataract patients, and LASIK was comparable to Tecnis (1 trial, N = 100, RR = 0.93, 0.78-1.10) in refractive surgery. In network meta-regression (6 trials, 14 arms) pseudophakic monovision in cataract patients was inferior to Tecnis. Indirect data suggest also that it is inferior (ReZoom refractive, TwinSet diffractive) or tends to be inferior (Array refractive) to other MFIOLs. LASIK was comparable to Tecnis in refractive surgery. Indirect data suggest also that it tends to superiority vs. ReZoom or Array refractive MFIOLs. Adverse events. No pooling was possible (heterogeneity of assessment and reporting). One quality direct RCT indicated less glare/dazzle with pseudophakic monovision vs. Tecnis in cataract patients. Unaided VA and CS data were burdened with heterogeneity (assessment, reporting) and insufficient quality. CONCLUSIONS: Randomized comparisons of monovision to multifocality are scarce. Existing estimates regarding spectacle independence (imprecision, indirectness) and particularly regarding unaided VA and CS (assessment/reporting heterogeneity, bias, imprecision, indirectness) are burdened with uncertainty. Dysphotopsia is less common with monovision, but estimate uncertainty is high (bias, imprecision).

Enhanced S-cone syndrome with preserved macular structure and severely depressed retinal function.

We present ophthalmic features and genetic analysis findings of a 44-year-old croatian patient with enhanced S-cone syndrome (ESCS). Complete ophthalmic examination, Ishihara colour vision test, dark adaptometry, spectral-domain optical coherence tomography (SD-OCT), fundus autofluorescence imaging, Goldmann visual field and automated perimetry, full-field electroretinography (ERG), multifocal ERG, S-cone ERG and ON-OFF ERG were performed. Mutation screening of the NR2E3 gene, which encodes a photoreceptor-specific orphan nuclear receptor, was performed with polymerase chain reaction amplification and direct sequencing. The patient has good visual acuity and normal colour vision. Fundus examination showed normal posterior pole and nummular pigment depositions at the level of the retinal pigment epithelium in the mid-periphery of the retina. The SD-OCT images showed normal macular structure and thickness. The ERG showed characteristic findings: photopic and scotopic responses to the same stimulus had a similar waveform and were dominated by short-wavelength-sensitive mechanisms. Mutation analysis revealed the known NR2E3 mutation c.481delA (p.Thr161HisFsX18) and the novel NR2E3 variant c.1120C > T (p.Leu374Phe). To the best of our knowledge, this is the only ESCS patient older than 40 years who phenotypically has preserved macular structure, good central visual acuity and severely depressed full-field ERG as well as the first reported patient with NR2E3 mutation from Croatia.

Comparison of optical low-coherence reflectometry and applanation ultrasound biometry on intraocular lens power calculation.

BACKGROUND: The aim of the study was to determine whether the innovative non-contact optical low-coherence reflectometry method utilized by the Lenstar LS 900® agrees sufficiently with applanation ultrasound A-scan technique in routine biometric measurement and intraocular lens power calculation to replace it. METHODS: Twenty-two patients hospitalized at our eye clinic undergoing cataract surgery were assigned to have five consecutive measurements of axial length by two examiners in a single session using applanation ultrasound and the Lenstar. The applanation ultrasound intraocular lens power calculation was based on automated keratometry and applanation ultrasound axial length measurements. The Lenstar intraocular lens power calculation was based on its measurement of keratometry and axial length. Bland-Altman analysis was used to assess interobserver repeatability of applanation ultrasound and the Lenstar as well as agreement between the Lenstar and applanation ultrasound for axial length measurement and intraocular lens power calculation. RESULTS: Thirty-two eyes of 22 patients were analyzed. In 95% of the observations, predicted refractive error corresponded to -0.26 ± 0.62 D and 0.01 ± 0.20 D obtained with applanation ultrasound and the Lenstar, respectively. CONCLUSIONS: Based on excellent repeatability of the Lenstar and acceptable repeatability of applanation ultrasound, two techniques may be used interchangeably. The predicted refractive error of ± 0.20 D in 95% of the observations has never been achieved. Optical low-coherence reflectometry might become a new standard method for biometric measurement needed for intraocular lens-power calculation in patients with cataract.

Intraobserver and interobserver repeatability of ocular components measurement in cataract eyes using a new optical low coherence reflectometer.

BACKGROUND: The purpose of the study was to assess intraobserver and interobserver repeatability of eight ocular components measurement in cataract eyes using the optical low-coherence reflectometer Lenstar LS 900®. METHODS: Five consecutive measurements of ocular components were taken by two examiners using the Lenstar. Components analyzed were: central corneal thickness, lens thickness, anterior chamber depth, axial length, retinal thickness, keratometry, white-to-white distance, and pupillometry. Within-subject standard deviation and the coefficient of variation were calculated for evaluation of intraobserver repeatability. Bland-Altman analysis was used for assessment of interobserver repeatability. RESULTS: Thirty-two eyes of 22 patients were included. For both observers, the smallest intraobserver coefficient of variation was obtained for axial length, while the largest was found for corneal steepest meridian position. Interobserver repeatability demonstrated less repeatable results for white-to-white distance and corneal steepest meridian position. Considering axial length and anterior chamber depth values, predicted refractive error was 0 ± 0.05 D and 0.02 ± 0.19 D respectively in 95% of observations. CONCLUSION: The Lenstar LS 900® evidenced excellent repeatability and observers´ independent results of all components analyzed except white-to-white distance and corneal steepest meridian position measurements. To the best of our knowledge, this is the first study on interobserver repeatability of optical low-coherence reflectometry in cataract eyes.

Comparison of preoperative and postoperative astigmatism after superotemporal or superonasal clear corneal incision in phacoemulsification.

The aim of this work was comparison of preoperative and postoperative astigmatism after superotemporal or superonasal clear corneal incision. Twenty eight eyes of 28 patients treated with phacoemulsification through superotemporal or superonasal 3 mm clear corneal incision were examined by kerato-refractometer preoperatively and six months postoperatively. Adequate score was assigned to each preoperative and postoperative K-value with associated axis of astigmatism to enable comparison. Wilcoxon paired samples test was used for statistical analysis. Postoperative uncorrected Snellen visual acuity was 0.5 or better in 26 patients. In one patient visual acuity was 0.3 because of diabetic maculopathy. Postoperative astigmatism was less or equal than preoperative in 18 and greater in 10 patients. There was no statistical difference between the preoperative and postoperative astigmatism (Wilcoxon paired samples test, p = 0.966) and therefore the conclusion can be made that the superotemporal or superonasal clear corneal incision has minimal effect on corneal astigmatism.

[Correlation of photodynamic therapy outcome with choroidal neovascular membrane size]. / Procjena uspjesnosti fotodinamske terapije s obzirom na velicinu korioidalnih neovaskularizacija.

AIM: To show the results of photodynamic therapy according to the size of choroidal neovascular membrane size. PATIENTS AND METHODS: A retrospective analysis included 94 patients undergoing photodynamic therapy at University Department of Ophthalmology, Sestre MilosrdniceUniversity Hospital from 2001 till 2005. There were 61 patients with age related macular degeneration (AMD) and 33 patients with high myopia. All patients had a predominantly classic choroidal neovascular membrane. Patients were divided into two subgroups according to the lesion size. The first subgroup included patients with a lesion equal to or less than one disc diameter, and the second subgroup had a lesion greater than one disc diameter. All patients were followed up for a minimum of 3 months. RESULTS: In the group of patients with AMD statistical analysis showed no significant difference in total closure and decrease in the size of choroid neovascularization (CNV) between the two subgroups. In the group of patients with high myopia a statistically significant difference was found in total closure and decrease in the size of CNV between patients with lesions smaller or equal to one disc diameter and those with lesions greater than one disc diameter. The former group also had better visual outcome. CONCLUSION: The size of CNV was not a prognostic factor in patients with AMD. In patients with high myopia, better outcome was recorded in the subgroup with CNV smaller or equal to one disc diameter.

Limbal graft and/or amniotic membrane transplantation in the treatment of ocular burns.

Limbal stem cell transplantation (LSCT) and amniotic membrane transplantation may improve corneal recovery after a chemical burn. Amniotic membrane was applied as a patch in 5 eyes; LSCT from healthy contralateral eye was performed in 6 eyes, and a combination of these techniques was performed in 4 eyes. There were no complications during surgical procedure. Epithelization was completed after 2 weeks in patients with LSCT, and after 3 weeks in the amniotic membrane transplantation group. Visual acuity improved in all patients. No complication was observed on either the donor or the recipient eye during a follow-up period of >13 months in all groups. Amniotic membrane is effective in promoting re-epithelization and reducing inflammation when applied alone in patients with 3- to 6-hour limbal involvement, as well as combined with LSCT in patients with >6-hour limbal ischemia. LSCT is an effective procedure for rehabilitation after severe chemical trauma of the eye with more than 50% limbal involvement.

[Evaluation of the efficacy and safety of lodoxamide in patients with allergic eye diseases]. / Procjena ucinkovitosti i sigurnosti lodoksamida u bolesnika s alergijskim bolestima ociju.

PURPOSE: To evaluate the effectiveness of lodoxamide in the therapy and prophylaxis of the ocular allergies. PATIENTS AND METHODS: This prospective study included 64 patients divided in 2 groups. In the first group there were 47 symptomatic patients suffering from seasonal allergic conjunctivitis (n = 27), perennial allergic conjunctivitis (n = 16) and giant papillary conjunctivitis (n = 4). The symptomatic patients were examined upon arrival and every 2 weeks until the symptoms were reduced. During the period, lodoxamide drops were administered 4 times a day. In the second group there were 17 patients who had a history of seasonal ocular allergies during previous years but were still not symptomatic upon arrival. In the group of 17 patients who were very likely to develop ocular allergy but up to inclusion into the study had no ocular symptoms, 12 (70%) presented with allergic rhinitis while 5 (30%) had asthma. The symptoms intensity (itching, discomfort, foreign body sensation, pain, tearing) was graded on a 0-3 scale. The clinical signs (follicles, papillae, hyperemia, conjunctival edema, Trantas dots, stromal infiltrates) were detected on a slit lamp examination and graded on a 0-3 scale. RESULTS: In the group of 47 symptomatic patients 2-4 weeks after lodoxamide administration, 70-80% of symptomatic patients examined clinically had less or no follicles, 60-70% had reduced or no edema, the secretion was stopped or greatly reduced in 50-70% of patients. All of the patients reported reduced or no itching, 60% of patients reported less discomfort, photophobia and reduced tearing. In the asymptomatic group two weeks after the initiation of the prophylaxis 88% of patients were still with no ocular signs of allergy while 12% of patients had a conjunctival hyperemia and follicles. After 4 weeks of the prophylaxis 76% of patients patients were still asympthomatic while only 4 developed a mild form of allergic conjunctivitis (conjunctival hyperemia and papillae), but less severe than during previous episodes. CONCLUSION: Lodoxamide was effective in reduction of symptoms and clinical signs of the ocular allergies. The best results were obtained if the drug was administered as a prophylaxis or very early in the course of the disease.