Patient comfort and visual outcomes of mini-scleral contact lenses.

OBJECTIVE: To evaluate short-term visual outcome, patient acceptance, and tolerance of mini-scleral contact lenses (SCLs) in the management of various corneal pathologies. DESIGN: Retrospective case series. PARTICIPANTS: Thirty-two patients (40 eyes) who received mini-SCLs. METHODS: Single-centre retrospective case series, between February 2010 and January 2013, of 32 patients (40 eyes) with various corneal pathologies who were offered either Maxim 5R, Maxim 7, or Maxim 7 × 11 mini-SCLs for nonsurgical optimization of visual correction. Patients were followed up at 1 and 3 months for assessment of best-corrected visual acuity, comfort, length of daily wear, and complications. RESULTS: Thirty-two patients (40 eyes), with a mean age of 41 ± 16 years, opted to receive mini-SCLs. Eighteen patients had previously undergone surgery such as penetrating keratoplasty, deep anterior lamellar keratoplasty, and intraocular lens implantation. The median best-corrected visual acuity improved from 0.3 logMAR (range 0-1.3) before mini-SCLs, to 0.05 logMAR (range 0-1) with mini-SCLs (p < 0.0001). At 1-month follow-up, the median length of wear was 10 hours/day (range 1.5-15). At 3-month follow-up, the median length of wear was 12 hours/day (range 2-15). All eyes were comfortable at initial use of mini-SCLs and 91% were comfortable at 3-month follow-up. CONCLUSION: Mini-SCLs may be a comfortable management option for patients with keratoconus and other corneal pathologies who are unable to achieve adequate visual outcome with traditional spectacles or rigid gas-permeable contact lenses.

Long-Term Results of Phototherapeutic Keratectomy Versus Mechanical Epithelial Removal Followed by Corneal Collagen Cross-Linking for Keratoconus.

PURPOSE: To compare the long-term visual outcomes of patients with keratoconus treated with either phototherapeutic keratectomy (PTK) or mechanical epithelial removal before corneal collagen cross-linking (CXL) at 1, 3, 6, and 12 months postoperatively. METHODS: CXL was performed by 1 of 3 surgeons (K.B., W.B.J., or G.M.). Seventeen eyes underwent mechanical epithelial removal before CXL and were consecutively selected after being matched with the 17 eyes in the PTK group for the variables of procedure date, average keratometry, and pachymetry. All cones were central. Manifest refraction spherical equivalent, sphere, cylinder, corrected distance visual acuity (CDVA), and pachymetry were measured and compared preoperatively and in follow-up. RESULTS: The mean CDVA change in the PTK group at 12 months postoperatively was statistically different from the mean CDVA change in the mechanical group at 12 months postoperatively (P = 0.031). The PTK group had significantly better outcomes in visual acuity 12 months postoperatively than did the mechanical group (P > 0.05). The mean number of lines of improvement in the PTK and mechanical groups were 2.30 ± 0.96 and 0.00 ± 0.33 lines, respectively (P = 0.0036). The mean change between the preoperative and 12 months postoperative manifest refraction spherical equivalent for the PTK and mechanical groups were 0.78 ± 0.65 and 0.17 ± 0.65, respectively (P > 0.05). CONCLUSIONS: PTK CXL resulted in better visual outcomes in comparison with mechanical epithelial removal CXL 1 year after treatment.

Phototherapeutic keratectomy versus mechanical epithelial removal followed by corneal collagen crosslinking for keratoconus.

OBJECTIVE: To compare the visual outcomes of patients with keratoconus treated with either phototherapeutic keratectomy (PTK) or mechanical epithelial removal prior to corneal collagen crosslinking (CXL). DESIGN: Comparative study. PARTICIPANTS: The records of 34 patients (34 eyes) who had PTK (17 eyes) or mechanical (17 eyes) epithelial removal prior to CXL for keratoconus were reviewed retrospectively. METHODS: CXL was performed by 1 of 3 surgeons (G.M., W.B.J., or K.B.). Of the eyes, 17 had undergone mechanical epithelial removal prior to CXL and were consecutively selected, after matching with the 17 eyes in the PTK group, for the variables of procedure date, average keratometry, and pachymetry. All eyes had central cones. Manifest refraction spherical equivalent, sphere, cylinder, best-corrected distance visual acuity, and pachymetry were measured and compared preoperatively and in follow-up. RESULTS: The mean change between the pre- and postoperative manifest refraction spherical equivalent for the PTK and mechanical groups was 1.68 ± 0.80 and 0.26 ± 0.90, respectively (p < 0.05). The mean change between pre- and postoperative cylinder for the PTK and mechanical groups was 0.53 ± 0.28 and 0 ± 0.18, respectively (p < 0.05). The mean number of lines of improvement in the PTK and mechanical groups were 0.33 ± 0.82 and -0.58 ± 0.45 lines, respectively (p > 0.05). CONCLUSIONS: Early results suggest that CXL with laser epithelial removal is superior to CXL with mechanical epithelial removal because it reduces refractive error in qualified patients. Although not statistically significant, there was also a trend for PTK CXL patients to have better visual outcomes.

Comparison of visual and refractive outcomes following Intacs implantation in keratoconus eyes with central and eccentric cones.

OBJECTIVE: To compare visual and refractive outcomes after Intacs implantation in keratoconus eyes with central and eccentric cones and to validate the current nomogram used to select Intacs size. DESIGN: Comparative study. PARTICIPANTS: The charts of 20 patients in a single practice, who had symmetric (15 eyes) or asymmetric (16 eyes) implants, were retrospectively reviewed. METHODS: Intacs were implanted by a single surgeon using a femtosecond laser. Based on Scheimpflug imaging, central and eccentric cone patterns received symmetric and asymmetric Intacs, respectively. Uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), and keratometry (K) values were measured pre- and postoperatively. RESULTS: The mean improvement in UDVA and CDVA in the symmetric group was 3.8 ± 0.9 and 0.6 ± 0.5 lines, and in the asymmetric group was 3.4 ± 0.7 and 1.8 ± 0.3 lines, respectively. The mean change in manifest refraction spherical equivalent (MRSE), refractive cylinder, and average K in the symmetric group was 2.40 ± 0.71 D, 0.02 ± 0.90 D, and -2.71 ± 0.50 D, and in the asymmetric group was 2.67 ± 1.21 D, 0.05 ± 0.47 D, and -2.35 ± 0.40 D, respectively. In CDVA, asymmetric Intacs showed statistically significant and better results than symmetric Intacs (p = 0.0016). There was no statistically significant difference between the means of symmetric and asymmetric implantation for UDVA, MRSE, average K, or corneal astigmatism (p > 0.05). CONCLUSIONS: The implantation of symmetric and asymmetric Intacs segments in keratoconus eyes with central and eccentric cones, respectively, was found to have comparable visual and refractive outcomes except for CDVA, which improved significantly more in the asymmetric group. This study also demonstrates the validity of the nomogram used.

Relationship between central corneal thickness and progression of visual field loss in patients with open-angle glaucoma.

OBJECTIVE: To determine whether a relationship exists between central corneal thickness (CCT) and visual field (VF) progression in treated patients with open-angle glaucoma and asymmetric corneal thickness. DESIGN: Retrospective chart review. PARTICIPANTS: We studied 100 charts of patients with open-angle glaucoma and also bilateral CCT and VF data. METHODS: Charts from 2 glaucoma subspecialty practices were reviewed. The CCT and the rate of progression and event analysis of visual field data were assessed in all subjects. Subanalysis was performed for subjects whose CCT asymmetry was ≥ 16 µm. RESULTS: The mean CCT was 544 ± 40 µm OD and 541 ± 40 µm OS. The mean CCT difference between fellow eyes was 15 ± 11 µm (range, 1 to 52 µm). There was no significant intrasubject difference in the mean deviation (MD) and the pattern standard deviation (PSD) (p =0.917 and p = 0.704, respectively; paired t test). The more advanced VF MDs and PSDs were found in the thin eyes of 47 and 50 subjects, respectively (p = 0.459 and p = 0.317, respectively; χ(2)). Of the 65 subjects whose visual field indexes were available, 34 had the more rapid visual field index rates of progression in the thin eye (p = 0.400; χ(2)). Of the 27 subjects for whom event analysis was available, 15 had the worse progression category in the thin eye (p = 0.453, χ2). Subgroup analysis of 48 subjects with ≥ 16 µm CCT asymmetry did not find any significant difference in analyses of field progression between fellow eyes. CONCLUSIONS: No relationship was found between CCT and VF loss in treated patients with primary open-angle glaucoma or normal-tension glaucoma with asymmetrical CCT. Specifically, the thin eye did not have the more advanced VF loss or more rapid VF progression.

The efficacy of 5-fluorouracil bleb needling performed 1 year or more posttrabeculectomy: a retrospective study.

PURPOSE: To determine the efficacy of a subconjunctival needling revision using 5-fluorouracil (5FU) when administered to patients who have nonfiltering, flat, or encapsulated blebs over 1 year after the original surgery. METHODS: The charts of 37 glaucoma patients, who had undergone both a trabeculectomy filtering procedure and a subconjunctival 5FU needling revision, with a minimum interval of 1 year between these procedures and with no intervening surgical procedures, were retrospectively reviewed. The needling was a clinic procedure using a 30-gauge needle and 0.1 mL of 50 mg/mL 5FU. RESULTS: Intraocular pressure (IOP) decreased by an average of 10.5 mm Hg (44.8%) immediately after the needling procedure. Eleven eyes (29.7%) achieved absolute success, defined as IOP control with no further needling revision, surgical intervention, or antiglaucoma medication in the 2-year follow-up period. Thirteen eyes (35.1%) achieved a qualified success, defined as IOP control with resumed medication use, undergoing a laser procedure, or a repeat needling within the follow-up period. Thirteen eyes (35.1%) failed the procedure by requiring a repeat surgical intervention. The mean IOP was 16.3+/-4.6 mm Hg in the success group, 15.5+/-6.5 mm Hg in the qualified success group, and 27.7+/-8.9 mm Hg in the failure group at the end of follow-up. CONCLUSIONS: Late 5FU needling is an effective method to control IOP and avoid further surgery in a high proportion of patients with medically uncontrolled nonfiltering blebs.