Visual Performance of Eyes with Residual Refractive Errors after Implantation of an Extended Vision Intraocular Lens.

Background: To analyze the tolerance on distance vision of different combined residual astigmatic situations in patients implanted with a novel wavefront shaping extended depth of focus (EDoF) intraocular lens (IOL). Methods: The study included patients implanted with the Acrysof® IQ Vivity® IOL. Uncorrected (UDVA) and corrected distance visual acuity (CDVA) were measured three months after surgery, considering CDVA as the reference situation of the study. Distance VA was also measured in different refractive situations: (A) with 0.50 diopters (D) of positive (myopization) and negative (hyperopization) defocus and (B) with a residual mixed astigmatic refraction induced by adding a combination of -0.25 D spherical and 0.50 D cylindrical lenses placed in vertical (against the rule-ATR), oblique, and horizontal (with the rule-WTR) positions. Results: The study included 30 eyes of 30 patients. UDVA and CDVA were -0.04 ± 0.05 and -0.05 ± 0.05 logMAR, respectively. VA values with +0.50 D and -0.50 D of defocus were 0.01 ± 0.06 and 0.00 ± 0.04 logMAR, respectively. VA was better with distance correction (p < 0.001) and no differences were found between the myopic and the hyperopic situations (p=0.09). Distance VA for the ATR, oblique, and WTR astigmatic situations was 0.01 ± 0.05, 0.01 ± 0.06, and 0.01 ± 0.04 logMAR, respectively. VA was better for the reference situation (p < 0.001) and no differences were found among the three astigmatic situations (p=0.21). Conclusions: Low residual defocus and mixed astigmatic errors, regardless of its orientation, seem to be tolerated by patients implanted with the studied EDoF IOL. This trial is registered with NCT05392998. Registered 26 May 2022-Retrospectively registered.

Botulinum toxin for treatment of restrictive strabismus / Botox y estrabismo restrictivo

Purpose: To study the types of acquired restrictive strabismus treated in a tertiary hospital and the outcome of treatment with botulinum toxin. Methods: We performed a 10-year retrospective study of patients with restrictive strabismus aged ≥18 years who were treated with botulinum toxin. Treatment was considered successful if the final vertical deviation was ≤5 PD, horizontal deviation ≤10 PD, with no head turn or diplopia. Results: We included 27 cases (mean age, 61.9 years). Horizontal strabismus was diagnosed in 11.1%, vertical in 51.9%, and mixed in 37%. Strabismus was secondary to cataract surgery in 6 cases, high myopia in 6, orbital fractures in 5, retinal surgery in 5, Graves ophthalmopathy in 4, and repair of conjunctival injury in 1 case. Diplopia was diagnosed in all patients, head turn in 33.3%. The initial deviation was 14 PD (range, 2-40), the mean number of injections per patient was 1.6 (range, 1-3), and the mean dose was 9.5 IU (range, 2.5-22.5). At the end of follow-up, diplopia was recorded in 59.3%, head turn in 18.5%, surgical treatment in 51.9%, and need for prism glasses in 14.8%. Outcome was successful in 37% of patients (4 high myopia, 3 orbital fractures, 2 post-surgical retinal detachment, and 1 post-cataract surgery). Mean follow-up was 3 ± 1.8 years. Conclusion: Vertical deviation was observed in half of the sample. The most frequent deviation was secondary to cataract surgery and high myopia. Treatment with botulinum toxin was successful in one-third of the patients at the end of follow-up (AU)

Objetivo: Estudiar los tipos de estrabismo restrictivo adquirido tratados en un hospital terciario, y los resultados del tratamiento utilizando toxina botulínica. Métodos: Realizamos un estudio retrospectivo de diez años en pacientes con estrabismo restrictivo y edades ≥18 años, a quienes se trató con toxina botulínica. El tratamiento se consideró exitoso cuando la desviación vertical final fue ≤5 PD, la desviación horizontal ≤10 PD, y no se produjo torsión ni diplopía. Resultados: Incluimos 27 casos (edad media, 61,9 años). Se diagnosticó estrabismo horizontal en el 11,1% de los casos, vertical en el 51,9%, y mixto en el 37%. El estrabismo fue secundario a: cirugía de cataratas en 6 casos, miopía magna en 6, fracturas orbitales 5, cirugía de la retina en 5, oftalmopatía de Graves en 4, y reparación de lesiones conjuntivales en 1 caso. Se diagnosticó diplopía en todos los pacientes, y tortícolis en el 33,3%. La desviación inicial fue de 14 PD (rango, 2-40), el número medio de inyecciones por paciente fue de 1,6 (rango, 1-3), y la dosis media de 9,5 IU (rango, 2,5-22,5). Al final del seguimiento, se registró diplopía en el 59,3% de los casos, tortícolis en el 18,5%, tratamiento quirúrgico en el 51,9%, y necesidad de gafas prismadas en el 14,8%. El resultado fue exitoso en el 37% de los pacientes (4 miopes magnos, 3 fracturas orbitaria, 2 post-cirugía de desprendimiento de retina, y 1 post-cirugía de cataratas). El seguimiento medio fue de 3 ± 1,8 años. Conclusión: Se observó desviación vertical en la mitad de la muestra. La desviación más frecuente fue secundaria a la cirugía de cataratas y a miopía magna. El tratamiento con toxina botulínica fue exitoso en una tercera parte de los pacientes al finalizar el seguimiento (AU)

Botulinum toxin for treatment of restrictive strabismus.

PURPOSE: To study the types of acquired restrictive strabismus treated in a tertiary hospital and the outcome of treatment with botulinum toxin. METHODS: We performed a 10-year retrospective study of patients with restrictive strabismus aged ≥18 years who were treated with botulinum toxin. Treatment was considered successful if the final vertical deviation was ≤5 PD, horizontal deviation ≤10 PD, with no head turn or diplopia. RESULTS: We included 27 cases (mean age, 61.9 years). Horizontal strabismus was diagnosed in 11.1%, vertical in 51.9%, and mixed in 37%. Strabismus was secondary to cataract surgery in 6 cases, high myopia in 6, orbital fractures in 5, retinal surgery in 5, Graves ophthalmopathy in 4, and repair of conjunctival injury in 1 case. Diplopia was diagnosed in all patients, head turn in 33.3%. The initial deviation was 14 PD (range, 2-40), the mean number of injections per patient was 1.6 (range, 1-3), and the mean dose was 9.5 IU (range, 2.5-22.5). At the end of follow-up, diplopia was recorded in 59.3%, head turn in 18.5%, surgical treatment in 51.9%, and need for prism glasses in 14.8%. Outcome was successful in 37% of patients (4 high myopia, 3 orbital fractures, 2 post-surgical retinal detachment, and 1 post-cataract surgery). Mean follow-up was 3±1.8 years. CONCLUSION: Vertical deviation was observed in half of the sample. The most frequent deviation was secondary to cataract surgery and high myopia. Treatment with botulinum toxin was successful in one-third of the patients at the end of follow-up.