Vector analysis of changes in corneal astigmatism following lateral tarsal strip procedure in patients with involutional ectropion or entropion.

PURPOSE: To perform vector analysis of changes in corneal astigmatism and evaluate changes in corneal topographic parameters following the lateral tarsal strip (LTS) procedure in patients with involutional ectropion or entropion. METHODS: Nineteen eyes of 15 patients (10 eyes with ectropion and 9 eyes with entropion) were included in this prospective nonrandomized interventional case series. Corneal topographic measurements (Tomey TMS 4a topographer, Tomey Corp, Nagoya, Japan) were performed at the baseline and 3 months after the LTS procedure. Relevant changes in the topographic astigmatism magnitude or axis (defined as a change more than 0.2 D or a shift in the axis greater than 10°, respectively) were analyzed following surgery. Polar astigmatic vector analysis was performed using the Astig PLOT software to calculate surgically induced astigmatism (SIA). RESULTS: There were no significant changes in average keratometry, steep and flat meridian keratometric values, absolute cylinder, surface regularity index and surface asymmetry index after the surgery (All P > 0.05). A relevant change in the magnitude of astigmatism and an axis change greater than 10° occurred in 14 (73.6%) and 10 (52.6%) of the operated eyes, respectively. Polar vector analysis revealed that SIA was 0.47 ± 1.34 D at 91 ± 23°, indicating induction of "with the rule" astigmatism following the surgery. CONCLUSION: The LTS procedure for the correction of involutional ectropion or entropion could induce relevant changes in corneal astigmatism, sufficient to affect visual function in short term. Longer-term follow-up is required to further characterize the effect of LTS procedure on the corneal topographic features.

Refractive lens exchange and piggyback intraocular lens implantation in nanophthalmos: Visual and structural outcomes.

PURPOSE: To evaluate the best piggyback intraocular lens (IOL) implantation method and the outcomes in nanophthalmos eyes and to define the postoperative structural changes. SETTING: Farabi Eye Hospital, Tehran, Iran. DESIGN: Prospective case series. METHODS: Candidates for refractive surgery who were nanophthalmic were recruited. Patients had refractive lens exchange followed by implantation of both IOLs in the bag or 1 IOL in the bag and 1 IOL in the sulcus. The baseline and follow-up visual acuity, refractive status, and structural Scheimpflug imaging were evaluated. Ultrasound biomicroscopy (UBM) was performed 6 months postoperatively. RESULTS: The study comprised 9 nanophthalmic patients (18 eyes) with a mean preoperative uncorrected distance visual acuity (UDVA) of 1.53 logarithm of the minimum angle of resolution (logMAR) ± 0.3 (SD), mean corrected distance visual acuity (CDVA) of 0.34 ± 0.2 logMAR, and mean spherical equivalent (SE) of +13.55 ± 4.0 diopters (D). The mean postoperative UDVA improved from baseline. There was no significant difference in the mean UDVA and CDVA between the 2 IOL groups. Postoperatively, both groups had a significant improvement in SE, a significant rise in anterior chamber depth and angle, and similar UBM measurements. CONCLUSIONS: Piggyback IOL implantation was an effective refractive procedure in nanophthalmic eyes. Both implantation methods resulted in similar outcomes; however, the small number of patients in each group made it less likely that possible differences would be found. The increase in angle values might help prevent the development of closed-angle glaucoma.

Tailored lamellar keratoplasty: a new technique.

We present a new method for treating complicated corneal gaps among patients who have previously undergone radial keratotomy (RK).After complete healing of a fungal keratitis in a patient who has undergone RK, we removed the oedematous corneal sector and put anterior tailored segment of a corneal button previously used for Descemet stripping endothelial keratoplasty. The patient's best-corrected visual acuity reached to 20/20 6 months later. This technique will compensate for oedematous parts without putting a significant effect on other parts such as purse string sutures.

Anterior Chamber Depth Change Following Cataract Surgery in Pseudoexfoliation Syndrome; a Preliminary Study.

PURPOSE: To assess the pseudophakic anterior chamber depth (PP-ACD) or effective lens position (ELP) change after cataract surgery in patients with pseudoexfoliation syndrome (PEX). METHODS: Consecutive eyes with PEX and cataract underwent standard phacoemulsification and were implanted with single-piece acrylic posterior chamber intraocular lenses (IOLs). Eyes with severe PEX and with axial length (AL) greater than 24 mm or less than 22 mm were not included. Eyes with capsular complication or unstable bags that needed capsular tension ring insertion were excluded. The SRK-II formula was applied to calculate IOL power for postoperative emmetropia. PP-ACD or ELP was measured using anterior segment optical coherence tomography. Data obtained at one and six months post operation were evaluated during analysis. RESULTS: Twenty-six eyes of 26 subjects (mean age: 72 years; range: 60-84 years) were studied. PP-ACD was deepened (mean change: 0.08 mm) and a concurrent hyperopic shift (0.3 D) was observed postoperatively between month 1 and month 6 (P values ≤0.002). PP-ACD and postoperative refraction changes were correlated with age and AL (P values < 0.025), respectively. Increased hyperopic shift and PP-ACD deepening in eyes with posterior capsule opacification (PCO) was noted postoperatively at six months, but the difference was not statistically significant (P values = 0.15 and 0.2, respectively). CONCLUSION: After cataract surgery in eyes with PEX syndrome, a significant backward movement of the IOL occurs postoperatively in the first six months, which is associated with a concurrent small hyperopic shift.