Refractive results of photorefractive keratectomy comparing trans-PRK and PTK-PRK for correction of myopia and myopic astigmatism.

PURPOSE: To compare refractive outcomes after transepithelial photorefractive keratectomy (tPRK) and combined phototherapeutic keratectomy (PTK-PRK) procedure using two different excimer laser platforms for correction of myopia and myopic astigmatism. METHODS: In this retrospective multicenter study, we compared the results of two different PRK methods. The first group received a tPRK treatment with the Amaris750 excimer laser (Schwind eye-tech solutions). The second group received a combined PTK-PRK treatment with the MEL90 excimer laser (Carl Zeiss). Only healthy eyes with no previous surgery and a spherical equivalent (SE) of -1 to -8 diopters (D) were included. Preoperative spherical equivalent (SE), age, and sex were matched among the two groups. All treatments were performed by the same surgeon in different clinics. This study was approved by the local Ethics Committee (No. 2022-1980). RESULTS: We included 154 eyes of 86 patients in our study. There was no difference in predictability of SE between the two groups. Efficacy and safety indices were equally high in both groups. Similarly, no significant differences were seen in change of higher order aberrations (HOA) between the two groups (p > 0.05). No complications occurred. CONCLUSION: Both investigated methods provide safe and effective refractive results. The combination of PTK with PRK may be a suitable option to the already used one-step tPRK for the correction of myopia.

Surgical outcomes of laser in situ keratomileusis (LASIK) in patients with stable systemic disease.

PURPOSE: To evaluate the surgical outcome in terms of safety, efficacy, predictability, and retreatment rate of LASIK surgery in patients with controlled systemic diseases in comparison with healthy individuals. METHODS: The retrospective study included data from 1936 eyes of 976 patients with stable systemic diseases who underwent LASIK surgery between January 2016 and June 2019. The safety, efficacy, predictability of the surgery, and retreatment rate were evaluated in comparison with a control group comprising 1951 patients. The study was approved by the local ethics committee and adhered to the principles of the Declaration of Helsinki. Statistical analysis was performed using R team and the level of statistical significance was set at p < 0.05. RESULTS: All treatment groups demonstrated high safety and efficacy indices after LASIK surgery. Furthermore, the study arms demonstrated comparable predictability and retreatment rates to the control group in nearly all cases. Retreatment rates were significantly higher in the rheumatoid arthritis group (p = 0.03), while safety indices were significantly lower in the hay fever group compared to the control group (p = 0.004). No intra- or postoperative sight-threatening complications were documented. CONCLUSION: Our findings suggest that selected patients with stable systemic conditions can safely undergo LASIK surgery and achieve comparable outcomes to healthy individuals. Further research is needed to better understand the treatment outcomes in this challenging patient population.

Influence of the patient's age on the safety, efficacy, and prediction accuracy of the microkeratome in laser-assisted in situ keratomileusis.

The purpose of this retrospective pseudonymised data analysis was to determine whether the patient's age has an influence on the safety, efficacy, and prediction accuracy of laser in situ keratomileusis (LASIK) treatment of myopic and hyperopic eyes. This study was performed at CARE Vision GmbH (Düsseldorf, Germany) and included two patient cohorts: an older group with patients > 55 years old and a younger group with patients 30-40 years old. Each patient had a single LASIK treatment. The safety, efficacy, and prediction accuracy of the refractive results were analysed. In total, 682 patients were analysed, with 341 patients in each patient group (one eye per patient). There were 570 myopic eyes and 112 hyperopic eyes. In myopic eyes, the efficacy was significantly influenced by the patient's age but only in myopic eyes (myopic: p ≤ 0.05; hyperopic: p = 0.085), while safety was not significantly influenced by the patient's age in hyperopic or myopic eyes (p = 0.204). We found that LASIK treatment at an older age (> 55 years) resulted in almost the same safety outcomes as a LASIK treatment at a younger age (30-40 years) but with a lower efficacy; the efficacy correlated with the patient's age. If the patient was hyperopic, their age did not influence safety or efficacy.

Influence of perfluorohexyloctane (Evotears®) on higher order aberrations.

PURPOSE: To prospectively assess the effect of regular application of perfluorohexyloctane (F6H8; Evotears®) on the tear film lipid layer, higher order aberrations (HOA) and the repeatability of measurements in healthy eyes. METHODS: This prospective clinical study included 104 eyes treated with F6H8 four times daily for four weeks (group A) and 101 eyes that served as controls (group B). Measurements were performed with the WASCA aberrometer (Carl Zeiss Meditec GmbH, Jena, Germany). Main outcome measurement in addition to subjective refraction were the root mean square values of HOA measured before and after the intervention. RESULTS: Regular use of F6H8 over a period of four weeks significantly increases HOA in healthy eyes (p < 0.05). In addition, the repeatability of measurement increases after the application of F6H8. CONCLUSION: F6H8 may be a suitable treatment option to improve the accuracy of refractive assessment, although it increases HOA. Further studies are needed to confirm the effect on HOA and the repeatability of measurement.

Repeatability of pupil diameter measurements using three different topography devices.

PURPOSE: To evaluate the intra- and inter-device repeatability of pupil diameter measurements using three different devices in patients prior to corneal refractive surgery. METHODS: We examined preoperative measurements from a total of 204 eyes (102 patients) scheduled for corneal refractive surgery at two private centers between July and December 2021. Three consecutive scans were performed with three different devices (Sirius anterior segment analyzer, Pentacam HR, IOLMaster 500) in the same session by the same examiner under standardized conditions. To assess the intra- and inter-device repeatability, we calculated the Intraclass Correlation Coefficient (ICC) and demonstrated results using Bland-Altman plots. RESULTS: The measurement accuracy (intra-device repeatability) of Sirius and IOLMaster was comparable (ICC = 0.64 and 0.61, respectively), with almost no statistically significant differences. Sirius showed the highest measurement accuracy among the three devices. Pentacam measurements resulted in lower precision, with an ICC of 0.09. The agreement between the pairs of devices (inter-device repeatability) was low (wide LoA ranges, Table 5). CONCLUSION: In this study, the intra-device repeatability of Sirius and IOLMaster was higher than that of the Pentacam, although it did not achieve an optimal level across all three devices. The three devices examined cannot be used interchangeably.

Pre- and postoperative angle kappa in MIOL patients after touch-up LASIK.

PURPOSE: To study the influence of angle kappa (κ) on visual acuity after implantation of a multifocal intraocular lens (MIOL) and consecutive "touch-up" corneal refractive surgery with Laser-in-situ-Keratomileusis (LASIK). METHODS: This retrospective multicenter study included patients who underwent MIOL surgery and consecutive LASIK (= Bioptics) in the period from 2016 to 2020 at Care Vision Refractive Centers in Germany. Our study was approved by the local ethics committee at the University in Duesseldorf (approval date: 23.04.2021) and conducted according to the tenets of the Declaration of Helsinki and Good Clinical Practices Guidelines. The pre- and post-operative κ of 548 eyes were measured using a Scheimpflug-based imaging system. Corrected distance visual acuity (CDVA) and the safety index (SI) were analyzed in relation with κ. For a more detailed analysis, the cohort was divided into pre-operative hyperopic and myopic patients to show group-specific differences. RESULTS: There was a significant decrease (p<0.001) in the magnitude of κ after MIOL implantation and Bioptics. However, there was almost no significant correlation of κ on CDVA and SI, pre- and postoperatively. CONCLUSION: A large κ is not a significant risk factor for poor visual acuity. Therefore, it is not a suitable clinical predictor of postoperative outcomes after a Bioptic procedure.

Safety and Precision of Two Different Flap-morphologies Created During Low Energy Femtosecond Laser-assisted LASIK.

Purpose: Currently, two major principles exist to create LASIK flaps: firstly, a strictly horizontal (2D) cut similar to the microkeratome-cut and secondly an angled cut with a "step-like" edge (3D). The strictly horizontal (2D) cut method can be performed using apparatus such as the low-energy FEMTO LDV Z8 laser and its predecessors which are specific to this type. Alternatively, the low-energy FEMTO LDV Z8 laser's 3D flap design creates an interlocking flap-interface surface which potentially contributes toward flap stability. In addition, the FEMTO LDV Z8 offers flap-position adjustments after docking (before flap-creation). The current study analyzed precision, safety, efficacy, as well as patient self-reported pain and comfort levels after applying two different types of LASIK flap morphologies which were created with a low-energy, high-frequency femtosecond (fs) laser device. Methods: A prospective, interventional, randomized, contralateral eye, single-center comparison study was conducted from November 2019 to March 2020 at the Hamburg vision clinic/ zentrumsehstärke, Hamburg, Germany. Eleven patients and 22 eyes received low-energy fs LASIK treatment for myopia or myopic astigmatism in both eyes. Before the treatment, the eyes were randomized (one eye was treated with the 2D, the other eye with the 3D method). Results: The mean central flap thickness one month after surgery was 110.7 ± 1.6 µm (2D) and 111.2 ± 1.7 µm (3D); P = 0.365 (2D vs 3D). Flap thickness measured at 13 different points resulted in no statistically significant differences between any of the measurement points within/between both groups; demonstrating good planarity of the flap was achieved using both methods. Despite not being statistically significant, the surgeons recognized an increase in the presence of an opaque bubble layer in the 3D flap eyes during surgery and some patients reported higher, yet not statistically significant, pain scores in the 3D flap eyes during the first hours after the treatment. Overall, safety- and efficacy indices were 1.03 and 1.03, respectively. Conclusion: In this prospective, randomized, contralateral eye study, the low-energy fs laser yielded predictable lamellar flap thicknesses and geometry at one-month follow-up. Based on these results, efficacy and safety of the corresponding laser application, that is, 2D vs 3D, are equivalent.

The influence of a mineral oil cationic nanoemulsion or perfluorohexyloctane on the tear film lipid layer and higher order aberrations.

PURPOSE: To prospectively assess the effect of a single and regular application of either a cationic nanoemulsion of mineral oil (CN) or perfluorohexyloctane (F6H8) on the lipid layer of the tear film and higher order aberrations (HOA) in patients with Dry Eye Disease (DED). METHODS: Fifty-seven patients with a lipid layer thickness (LLT) ≤ 75 interferometric colour units (ICU) were included in the study. In group A (20 patients) the effect of a single drop of F6H8 or CN on HOA and LLT was assessed immediately after application and up to two hours later. For long term effects (Group B) 37 patients applied CN or F6H8 five times a day for 12 weeks. Measurement of LLT, HOA, non-invasive-tear-break-up-time (NIBUT) and meibography were assessed prior to as well as at 4 weeks and 12 weeks after initiation of treatment. Our study is registered in the "German Clinical Trials Register" under the trial number: DRKS00028696. RESULTS: CN led to an increase of the LLT from 46.8 ± 16.9 ICU to 76.3 ± 23.5 ICU (p = 0.021) and to an increase of HOA from 0.43 ± 0.06 µm to 0.48 ± 0.08 µm immediately after application (p = 0.027). There was no correlation between the increase of LLT and HOA (r = -0.04; p = 0.90). In group B an increase of LLT was observed in the F6H8 group from 45.8 ± 8.8 ICU at baseline to 66.7 ± 19.5 ICU at 12 weeks (p = 0.002). No changes of HOA were measured throughout the observation period in group B. After 12 weeks CN increased NIBUT from 9.9 ± 5.3 seconds to 15.5 ± 5.6 seconds (p = 0.04). F6H8 increased NIBUT from 12.4 ± 5.9 seconds to 16.9 ± 4.7 seconds (p = 0.02) after 12 weeks. CONCLUSION: CN leads to a short-term increase in LLT and HOA, but only immediately after application. In contrast F6H8 does lead to an increase of LLT after regular long-term use but has no effect on HOA. The regular application of lipid-based products does not seem to decrease the quality of vision as measured in HOA. Instead, CN and F6H8, both are able to stabilize the tear film after regular application.

The Vision Correction Questionnaire: an electronic patient-reported outcome measure for refractive surgery.

PURPOSE: To develop a psychometrically robust electronic patient reported outcome measure (ePROM) for refractive surgery. SETTING: Moorfields Eye Hospital, London, United Kingdom. DESIGN: Questionnaire development study. METHODS: Items were derived in 6 domains (spectacle dependence, visual quality, eye comfort, functional freedom, emotional wellbeing, and satisfaction with treatment) from existing Rasch adjusted instruments, patient and surgeon feedback, and refinement in semistructured interviews before administration to a field test cohort (n = 360) of patients undergoing routine refractive surgery. Spectacle dependence and satisfaction with treatment items were used to provide descriptive statistical information only. Contemporary criteria for item reduction and Rasch modeling were applied to the remaining domains. The finalized questionnaire was then administered to a second patient cohort (n = 120) before and after surgery to assess sensitivity to change. RESULTS: A 5-item scale derived for emotional wellbeing was unidimensional and a good fit to the Rasch model with ordered category response profiles, adequate precision (person separation 2.22 logits, reliability coefficient 0.83), and no misfitting items. Mean logit scores were 0.91 higher after treatment (effect size 1.26) suggesting a positive impact on emotional wellbeing. Functional scales could not be derived for visual quality, eye comfort, or functional freedom. Single-item ratings for visual quality and eye comfort were retained in our final 11-item questionnaire. CONCLUSIONS: This short ePROM should integrate well with routine clinical care and clinical trials in refractive surgery. The Rasch adjusted emotional wellbeing scale may help quantify the way patients feel about refractive surgery, with the remaining items providing useful descriptive information.

Spectrum and resistance in bacterial infections of the ocular surface in a German tertiary referral center 2009-2019.

PURPOSE: Aim of this study was to evaluate the frequencies, trends, and antibiotic resistance of bacteria collected from ocular surface or contact lens material in a German tertiary referral center from 2009 to 2019. METHODS: Microbiological data from 2009 to 2019 was analyzed. Culture-dependent microbial identification and analysis of antibiotic sensitivity was completed by the Institute of Microbiology. Statistical analysis of age- and sex-specific differences as well as changes in the microbial spectrum and resistance over the study period was performed with GraphPad Prism 9.0 applying nonparametric tests (level of significance: p ≦ 0.05). RESULTS: A total of 6361 specimens were analyzed. Positivity rate was 18.6%. Sixty-three percent (n = 680) of the bacterial isolates were derived from ocular surface and 37% (n = 399) from contact lens material. The ratio of gram-negative bacteria was significantly higher in contact lens material. Multiresistant bacteria showed a significant increase with patient age (p < 0.0001). An overall increase in resistance to levofloxacin (p = 0.0239) was detected. Only 2.4% and 3.1% isolates were resistant to a combination of moxifloxacin and gentamicin, respectively, levofloxacin and gentamicin. CONCLUSIONS: The reported bacterial spectrum is similar to comparable centers. Our data show that it should not be assumed that the newest classes of antibiotics have the best efficacy or lowest resistance levels. In suspected bacterial conjunctivitis, we propose using gentamicin as first-line therapy. In therapy refractive cases and in involvement of the cornea, we recommend a combination of gentamicin and ofloxacin or moxifloxacin. Overall, the evaluated organisms showed good sensitivity to the regularly used antibiotics.

Effect of Postoperative Ocular Residual Astigmatism (ORA) on Treatment Outcome After Myopic Laser in situ Keratomileusis (LASIK).

Purpose: To analyze the impact of postoperative ocular residual astigmatism (ORA) on refraction, visual acuity and subjective satisfaction after myopic laser-in-situ-keratomileusis (LASIK) by a comprehensive analysis, which includes clinically relevant data and patient-reported outcomes. Material and Methods: To evaluate the influence of ORA, comparison groups were built following Archer et al. Myopic patients were subdivided by the fraction ORA/MRC (matched and not matched for MRC) (MRC = manifest refractive cylinder), ORA magnitude and CA magnitude in high ORA eyes (CA = corneal astigmatism). Refractive and visual data were analyzed via retrospective cross-sectional analysis for multiple parameters. The subjective satisfaction was analyzed retrospectively 3-4 years after having LASIK via patient reported outcome analysis. Results: Refractive outcome: Only when grouped by ORA magnitude only, high ORA eyes resulted in approximately twice as cylinder magnitude compared to eyes with preoperative lower ORA. Furthermore, there appeared to be no statistically significant differences in any case. Visual outcome: There appeared to be no statistically significant differences for visual acuity parameters (safety index, efficacy index). Patient reported outcome: When grouped by the rate of ORA/MRC not matching for MRC, there were statistically significant differences in the subjective satisfaction (p = 0.006) and the postoperative side effects (p = 0.001, p = 0.01, p = 0.006), those differences appeared less strong when matched for MRC treated and result better for a higher ratio of ORA/MRC. Conclusion: Patients with postoperatively high ORA report on higher satisfaction with treatment results than patients with postoperatively low ORA. This did not correlate with differences in the refractive nor visual outcome. As a matter of fact, there is a discrepancy between the objective analysis results and the subjective satisfaction of patients.

Prediction model of free flaps in microkeratome-assisted LASIK.

PURPOSE: To identify mechanical factors, as well as patients' biometric and surgeons' experience factors that correlate with the FF incidence in microkeratome (MK)-assisted LASIK and to construct a predictive model based on these parameters. METHODS: 55,700 consecutive LASIK treatments of 28,506 patients between January 2017 and April 2020 done by 50 surgeons in 10 centers, all with Sub Bowman Keratome (SBK) and 90µ head (OUP) were analyzed retrospectively for the incidence of FF and their correlation to mean keratometry, central corneal thickness, MK ring height and stop, as well as surgeons' experience. A prediction model was built and tested for sensitivity and specificity. RESULTS: The incidence of FF using the SBK MK was 0.276%. Risk factors were low central corneal thickness, very flat (-1) or very thick (+2) ring height, and higher stop values (p<0.001). Mean keratometry and low surgeon experience were not correlated to FF incidence. A prediction model with a cut-off FF risk of 0.274%, a 76% specificity, and a 73% sensitivity was applied. CONCLUSIONS: Free flaps are rarely seen in modern MK LASIK. However, the incidence of this complication using the SBK MK increases using higher stop values, very thick and very thin MK rings, and in eyes with thin corneas.

Comparison of Syringes With Intravitreal Anti-VEGF Drugs: Particle Burden and Protein Aggregates in Brolucizumab, Aflibercept and Bevacizumab.

Purpose: In a benchwork particle counting analytical evaluation, the number and type of particles in intravitreal injection formulations of three different agents against vascular endothelial growth factor were investigated. Methods: Commercially available ready-to-use aflibercept and brolucizumab glass syringes, vials containing bevacizumab (off-label use in ophthalmology), and repackaged ready-to-use plastic syringes containing bevacizumab were tested without filtration. Total visible, subvisible, and nanoparticles numbers and size distributions were quantified using light obscuration, flow imaging, resonant mass measurement (RMM), tunable resistive pulse sensing, and dynamic light scattering. Results: Repackaged bevacizumab showed overall low particle numbers, aflibercept showed high numbers of micrometer sized particles but low nanoparticle numbers, brolucizumab showed low to moderate numbers of micrometer sized particles but high nanoparticle numbers. RMM measurements identified particles in the nanometer range as either proteinaceous or silicon oil; the nature of the other particles was not further evaluated. Conclusions: Repackaged bevacizumab shows no inferior particle quality compared to ready-to-use products. It is relevant to study nanoparticle load of the products as the micrometer-sized particle numbers do not in all cases correlate to nanoparticle counts. Particularly for the high concentration product Beovu (brolucizumab), high nanoparticle numbers were found despite low numbers of micrometer sized particles. Silicone oil droplets did not account for high particle numbers as the measured numbers were low. Translational Relevance: Different side effects are registered in different frequencies with different intravitreal anti-VEGF-drugs and syringes, which are applied by injection by small 30G needles through the sclera directly to the intravitreal cavity. The study of nanoparticles and silicone oil droplets may be able to contribute to narrowing down the causes.

Intraoperative OCT - Real-World User Evaluation in Routine Surgery. / Das intraoperative OCT ­ eine Real-World-basierte Nutzerevaluation im operativen Alltag.

BACKGROUND: In recent years, great progress has been made in intraoperative imaging using optical coherence tomography (iOCT). There are now several commercially available iOCT systems that allow high-resolution imaging of all structures of the eye without interrupting surgery. This real-time visualisation can provide additional information to conventional surgical microscopy, but is relatively expensive. The aim of our study was to find out how often OCT integrated into the surgical microscope is used by trained surgeons, or to what extent they consider that iOCT is relevant for intraoperative procedures. PATIENTS AND METHODS: A prospective monocentric analysis was conducted of the field of application and user-friendliness of the EnFocus Ultra-Deep OCT (Leica Microsystems), a mobile device combination of surgical microscope and OCT. The use and benefit were investigated of iOCT, which was not mandatory. Standardised documentation and evaluation using a questionnaire was performed by the respective surgeon (n = 5) immediately after surgery. RESULTS: Over a period of 25 working days, 118 procedures were performed in the operating theatre equipped with the microscope-OCT combination. The iOCT was used in 24.6% of the 118 procedures performed. iOCT was regarded as crucial to the intraoperative procedure in 3 of the 29 patients. In one patient, it was possible to check graft orientation during a DMEK operation in a very opaque cornea and, in the second patient, to visualise the correct positioning of an iris diaphragm in the capsular bag. In the third patient, the risk of developing a pseudoforamen was assessed, and this led to the decision not to perform a full gliosis peel. CONCLUSION: Experienced surgeons in a university eye hospital with a full surgical spectrum considered that intraoperative OCT was decisive for the course of surgery in only a few selected surgical situations, e.g. in case of limited corneal transparency. The impact of the use of iOCT on post-operative outcome quality still needs to be evaluated by larger prospective studies. On the basis of this survey, the cost-benefit ratio is still unclear.

Hidradenitis Suppurativa is Associated with Symptoms of Keratoconjunctivitis Sicca.

AIM OF THE STUDY: Hidradenitis suppurativa (HS) and psoriasis vulgaris (PSO) are chronic inflammatory dermatoses in which proinflammatory cytokines, such as IL-17, play a central role. The prevalence of keratoconjunctivitis sicca (KCS) is commonly higher in PSO than in healthy individuals. This study was thus set up to investigate the prevalence of KCS among patients with HS. MATERIALS AND METHODS: In a cross-sectional study standardized tear film parameters and symptom-oriented questionnaires (OSDI, SPEED) were analyzed in a total of 71 subjects (HS n = 20, PSO n = 20, healthy controls n = 31). Additionally, IL-17 and MMP-9 in the tear film were analyzed. These parameters were correlated to the clinical severity of the skin disease. PSO patients served as inflammatory control group. RESULTS: There were statistically significant differences in OSDI (p = .003) and SPEED (p ≤ 0.001) between HS and the control group, but not between PSO and controls. For HS, there was a statistically significant correlation between symptoms (OSDI) and the severity of HS according to Hurley stage (p = .023). Tear film concentrations showed significantly increased levels of IL-17 (p = .018), but not MMP-9, in PSO alone compared to the control group. CONCLUSION: Data show that subjective complaints of KCS may be associated with HS and correlate with the severity of the respective Hurley stage, but do not involve alterations of tear film MMP-9 and IL-17. Clinicians should remain mindful that ocular complications in HS are often more vague than in psoriatic patients, but dry eye symptoms might be detrimental for the patients' quality of life.

Quality of life in stable and progressive 'early-stage' keratoconus patients.

PURPOSE: To analyse the vision-related quality of life (vr-QoL) in stable and progressive keratoconus (KC) patients with a still good visual acuity. METHODS: Combined prospective/cross-sectional study design. The Refractive Status and Vision Profile (RSVP) and the National Eye Institute Visual Functioning - 25 (NEI-25) questionnaire were used in 16 emmetropic, 32 myopic and 56 KC patients, whereby KC patients with a stable (n = 26) and patients with a progressive stage (n = 30) and some of them before and after corneal cross-linking (CXL; n = 10) were included. All patients had a DCVA in at least one eye of ≥0.7 (decimal chart). RESULTS: The analyses revealed a minor decline of the vr-QoL from emmetropes to myopes to early KC patients with a stable disease. Nonetheless, sociological subscales (i.e. 'social functioning', 'role difficulties' and 'dependency') did not display statistically significant differences comparing these groups. In progressive KC, we could demonstrate a statistically significant decline also of these sociological subscales, which did not improve after CXL. CONCLUSION: Due to a still high and almost unaffected vr-QoL in early KC patients and the distinct decline after progression without rehabilitation after CXL, a reconsideration of current strategies to perform CXL only after a progression is diagnosed should be re-evaluated.

Gender-Specific Differences in Signs and Symptoms of Dry Eye Disease.

INTRODUCTION: Dry eye disease (DED) is a multifactorial disease of the ocular surface characterized by loss of homeostasis of the tear film. Epidemiological studies suggest it occurs more frequently in women than men. The aim of this retrospective analysis was to determine whether patients with DED show gender-specific differences in symptoms and signs. MATERIAL AND METHODS: A retrospective analysis of 107 patients was conducted at the Department of Ophthalmology of the University of Düsseldorf - Germany. After completing the OSDI questionnaire, the patients underwent objective refraction and were asked about the following symptoms: burning, itching, foreign body sensation, epiphora, sticky eyes, pain, red eyes and swollen eyelids. Furthermore, they underwent an evaluation of the following signs: lipid layer thickness, non-invasive break-up-time (NI-BUT), conjunctival hyperemia, lid parallel conjunctival folds, meibography, Schirmer test and tear meniscus height, ocular surface staining, expressibility of meibomian glands. RESULTS: Of the 107 patients (56.2 ± 17.3 years) 75 were women and 32 men. Women reported significantly more often eyelid swelling (p = .03) and showed a tendency to complain more about red eyes (p = .051), while men tended to complain more often about epiphora (p = .053). In an age-matched sample taken from the cohort, significant differences were found for OSDI-scores (p = .025) showing women reporting more symptoms compared to men, while men showed more conjunctival hyperaemia (p = .004) than women. Women showed a significant thicker lipid layer (p = .0009) in the full cohort, but not in the age-matched sample (p = .43). CONCLUSION: Although the majority of the investigated parameters did not show gender-specific differences, women reported higher OSDI scores. These findings could be explained by an increased frequency of neuropathic symptoms or ocular surface sensitivity in women or higher resilience of men to consult an ophthalmologist. Sex may have an effect on the clinical characteristics of DED, but further studies are needed to confirm these findings.

Pyramidal Aberrometry in Wavefront-Guided Myopic LASIK.

PURPOSE: To evaluate measurement repeatability and clinical results for pyramidal aberrometry in routine myopic wavefront-guided laser in situ keratomileusis (LASIK). METHODS: Results from 265 consecutive eyes treated with myopic wavefront-guided LASIK using the Amaris 1050RS Excimer Laser and Peramis pyramidal aberrometer (SCHWIND eye-tech-solutions GmbH) were reviewed. Limits of repeatability were calculated for the aberrometric refraction spherical equivalent and higher order aberrations for the Peramis aberrometer using results from three consecutive scans acquired preoperatively and postoperatively for the first 100 eyes treated. RESULTS: The 95% limits of repeatability for pyramidal aberrometric measurement were: 0.3 diopters (D) for sphere, 0.2 D for cylinder, and 0.1 D (dioptric equivalent) for 3rd and 4th order aberration indices. A total of 95% of eyes were within ±0.50 D of the manifest refraction spherical equivalent target postoperatively. Uncorrected distance visual acuity was 20/20 or better in 96% of 232 eyes with a plano refraction target outcome. A total of 97% of eyes had a refraction cylinder of 0.50 D or less. No eyes lost one or more line of corrected distance visual acuity. CONCLUSIONS: These data demonstrate good measurement repeatability, safety, and efficacy for pyramidal aberrometry in routine myopic LASIK. [J Refract Surg. 2020;36(7):442-448.].

Issues with Intravitreal Administration of Anti-VEGF Drugs.

PURPOSE: To provide an update of summary of risk factors and side effects of long-term use and contamination of intravitreal anti-VEGF injections. METHODS: We reviewed relevant publications of the topic of contamination of anti-VEGF injections and long-term side effects due to this reason. RESULTS: Due to the long-term use of anti-VEGF drugs and the higher number of injections worldwide, various studies have shown side effects in recent years, ranging from increased intraocular pressure to visual disturbing silicone oil vesicles in the vitreous cavity. Several studies have demonstrated that both the drug and the processing, storage, environmental factors and the material and design of the syringes have a decisive influence on these side effects. CONCLUSION: The risks of deposits from syringes in the eye can be significantly reduced by various optimizations in transport, storage and syringe and cannula selection.

Diffractive trifocal lens implantation with or without excimer laser enhancement: is a touch-up procedure a negative predictor for refractive and subjective outcome?

PURPOSE: To investigate the refractive results of a LASIK enhancement and its impact on treatment safety, efficacy, predictability and patient reported outcome in eyes after clear lens extraction and diffractive trifocal lens implantation. METHODS: A retrospective cohort multicentre study of Care Vision Refractive Centres in Germany compared two groups of patients. Group 1 consisted of eyes that had non-toric MIOL surgery only, whereas group 2 had a consecutive laser enhancement after 3 months follow-up. Refractive and subjective results of the two groups were compared. Patient reported outcome measurements were assessed by using a 30-item questionnaire with four subscales. (Spectacle Dependence, Eye Comfort, Freedom and Looking/Feeling Well). Refractive results were reported following standard reporting in refractive surgery. RESULTS: 139 eyes of 79 patients were included in which either MIOL surgery or MIOL surgery plus LASIK enhancement had been performed between January and December 2017. UDVA reached 0.1logMAR (0.8; 20/25) in 94% in group 2 and 85% in group 1. Compared to preoperative CDVA no change in Snellen lines of CDVA was shown in 89% in group 1 and in 93% in group 2. Spectacle dependence (P = 0.41), eye comfort (P = 0.15), freedom (P = 0.48) and looking/feeling well (P = 0.45) showed no statistically significant difference between both the groups. CONCLUSIONS: In patients with residual ametropia after MIOL implantation, LASIK provides a reliable, safe and efficient way to achieve the desired refractive outcome and patient satisfaction. We recommend performing Laser enhancement at 3 months after MIOL implantation (Bioptics) in trifocal MIOL patients that benefit from improvement of residual ametropia.