Changes in anterior chamber biometry and intraocular pressure after uneventful phacoemulsification in non-glaucomatous eyes.

Background: In non-glaucomatous eyes, many factors impact intraocular pressure (IOP) reduction following phacoemulsification. This study aimed to determine the relationship between changes in IOP and alterations in anterior chamber biometric measurements using the Pentacam Scheimpflug anterior segment imaging system before and after uneventful phacoemulsification in non-glaucomatous eyes. Methods: This prospective interventional study included patients with ages of 20 - 80 years, no known systemic diseases, and visually significant cataracts necessitating phacoemulsification with posterior chamber intraocular lens implantation. The preoperative and two-month postoperative IOPs were measured using a Goldmann applanation tonometer, and the iridocorneal angle (ICA) in four quadrants (superior, inferior, nasal, and temporal), anterior chamber depth (ACD), and anterior chamber volume (ACV) were measured using the Pentacam. Results: Forty-two eyes of 42 patients with a mean (standard deviation [SD]) age of 56.8 (10.7) years were included; 22 (52%) were men and 20 (48%) were women. The eyes demonstrated statistically significant changes in postoperative IOP, ACD, ACV, and in widening of the ICA (all P < 0.05), with a mean (SD) IOP reduction of 4.5 (2.7) mmHg, ACD deepening of 0.7 (0.6) mm, ACV increase of 33.2 (21.1) mm3, and ICA widening of 7.5o (6.4o), 12.4o (7.7o), 9.1o (7.1o), and 11.5o (6.1o) in the superior, inferior, temporal, and nasal quadrants, respectively. A significant positive correlation was detected between pre- and postoperative IOP (r = + 0.58; P < 0.001) and between pre- and postoperative ACD (r = + 0.50; P < 0.001). Significant negative correlations were detected between preoperative ACV and changes in ACV (r = - 0.42; P < 0.001) and between preoperative ICA and changes in ICA (r = - 0.02; P = 0.001). However, no significant correlations were observed between the changes in IOP and patient age (r = + 0.001; P = 0.957) and axial length of the eye (r = + 0.13; P = 0.221), or changes in ICA (r = - 0.01; P = 0.945), ACD (r = + 0.01; P = 0.945), and ACV (r = - 0.12; P = 0.599). Conclusions: We observed a significant reduction in IOP, widening of the ICA, and increases in ACD and ACV after phacoemulsification; however, there was no significant correlation between changes in IOP and other biometric variables. Further studies are required to determine the exact mechanisms underlying these effects.

Surrogates of the Left Ventricular Thrombus Resolution: A Retrospective Data Review.

OBJECTIVE: The left ventricular thrombus is one of the serious complications of ischemic cardiomyopathy. In this study, we aimed to search for the independent factors to predict the resolution of left ventricular thrombus. METHODS: This retrospective study included all patients with coronary artery disease, aged above 18 years old, and with the thrombus at the apical location of the left ventricle. Demographic, clinical, and echocardiographic characteristics of the patients were recorded. Major adverse cardiovascular events developed within the follow-up period were recorded. The time in the therapeutic range of each patient was calculated. The presence of left ventricular thrombus beyond 180 days despite warfarin usage was classified as persistent left ventricular thrombus. RESULTS: The study included 174 subjects (169 males and 5 females). The mean age of the study population was 54.5 ± 11.0 years. The number of patients in whom the left ventricular thrombus resolved with treatment in less than 180 days was 56 (32.2%). Median anticoagulation time in the study population was 252 [150-480] days and the meantime in the therapeutic range of the patients was 54 ± 19%. The time in therapeutic range value of the groups was similar (P=.593). It was found that concomitant clopidogrel use (P=.003) and left ventricular thrombus area (P < .001) were the independent predictors of left ventricular thrombus resolution within less than 180 days in the logistic regression analysis. CONCLUSION: Concomitant use of clopidogrel was found to be associated with left ventricular thrombus resolution but left ventricular thrombus size was related to left ventricular thrombus persistency. Although standard 3-6 months of anticoagulation is advised for left ventricular thrombus, considering the presence of these predictors in such patients may guide the physicians to individualize the treatment.

Temporal and Spatial Flap Variability in Laser In-Situ Keratomileusis by Optical Coherence Tomography.

PURPOSE: To study changes in flap thickness made with two different microkeratome heads across different corneal locations using anterior segment optical coherence tomography (OCT). METHODS: In this prospective, non-randomized, consecutive case series, subjects who had their laser in-situ keratomileusis (LASIK) flaps made using 90 µm (MSU90) or 130 µm (MSU130) disposable M2 microkeratome heads were examined using OCT. The measurements were performed at three locations (central and 2.5 mm to either side) at 1 day, 1 week, and 1 month postoperatively. RESULTS: The central flap thickness was 123 ± 15, 130 ± 14, and 127 ± 13 µm, respectively, at 1 day, 1 week, and 1 month postoperatively in the MSU90 group (41 eyes) and 142 ± 20, 147 ± 19, and 143 ± 15 µm, respectively, in the MSU130 group (47 eyes). At 1 month, peripheral flap thickness was 161 ± 17 and 159 ± 13 µm, respectively, at 2.5 mm to the right and left of corneal center in the MSU90 group. The corresponding figures were 170 ± 14 and 167 ± 13 µm, respectively, in the MSU130 group. There was a statistically significant difference between the two groups at all locations (P < 0.001). No statistically significant change in flap thickness was detected in either group at any assessment time. There was a partial positive correlation (after controlling for preoperative manifest refractive spherical equivalent) between central flap thickness and preoperative ultrasound central pachymetry (r = 0.739, P = 0.036) in the MSU90 group but not in the MSU130 group. CONCLUSION: Using OCT, changes in flap thickness were minimal in the first month after LASIK. Flap thickness correlated strongly with central corneal thickness if a 90 µm head was used.

Femtosecond laser flap parameters and visual outcomes in laser in situ keratomileusis.

PURPOSE: To evaluate the flap-producing characteristics of the VisuMax femtosecond laser system and their relationship to visual and refractive outcomes after laser in situ keratomileusis (LASIK). SETTING: Dr. Sulaiman Al Habib Medical Center, Dubai Healthcare City, Dubai, United Arab Emirates. DESIGN: Case series. METHODS: A review of LASIK cases from December 2008 to December 2009 was performed. Parameters recorded included the achieved flap thickness measured with intraoperative ultrasonic pachymetry, laser energy, side-cut angle, visual outcomes including uncorrected (UDVA) and corrected (CDVA) distance visual acuities and manifest refraction, higher-order aberrations using Hartman-Shack wavefront analysis, and complications. RESULTS: The study comprised 98 patients (195 eyes). The femtosecond laser energy for flap preparation was 160 to 200 nJ. The mean achieved flap thickness was 91.35 µm ± 12.26 (SD) (attempted 80 µm), 98.5 ± 14.39 µm (attempted 90 µm), 109.94 ± 13.43 µm (attempted 100 µm), 112.7 ± 7.45 µm (attempted 110 µm), and 123.82 ± 9.64 µm (attempted 120 µm). Postoperatively, 87% of eyes were within ± 0.25 diopter of the intended spherical equivalent, 75% had a UDVA of 20/16 (-0.1 logMAR) or better, and 42% gained 1 or more lines of visual acuity; no eye lost CDVA. No statistically significant relationships were found between energy, side-cut angle, achieved flap thickness, and refractive and visual outcomes. Complications were mild and did not affect final visual outcomes. CONCLUSION: The femtosecond laser yielded precise flap dimensions with a narrow standard deviation and a high level of safety. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.