Retinal detachment after phacoemulsification in refractive surgery clinics: a large series analysis with variable follow-up during 16 years.

PURPOSE: To determine the long-term incidence of pseudophakic retinal detachment (PRD) after phacoemulsification and the weight of the main risk factors in the appearance of such complication in a large sample. To implement a customized formula and a software calculation program able to quantify the risk of suffering PRD applicable to all lens extraction patients. METHODS: Retrospective cumulative risk analysis conducted on 178,515 eyes operated under similar conditions in a group of refractive surgery clinics (Clínica Baviera SL) located in a relatively limited geographical area (Spain). A survival analysis was performed and the data were modelled using the Weibull regression to determine the risk over a period of 16 years and to estimate the association of different risk factors: sex, age, axial length (AXL) of the eye, intraoperative posterior capsule rents (PCR), and YAG laser capsulotomies. The resulting estimates were translated into a predictive equation for hazard rates and survival probabilities. Later, an application was developed to make prediction available for the clinical community in order to estimate the potential risk of any hypothetical case before lens surgery. RESULTS: Globally, 1521 (0.85%) cases of PRD were diagnosed during the period. The risk for PRD was significantly greater in males (5.48 [2.94-10.2]; p < 0.001), in long eyes (1.24 [1.21-1.26]; p < 0.001), and also after posterior capsule rents (13.97 [11.61-16.82]; p < 0.001). Posterior capsule rupture increased the risk of PRD up to fourteen times. CONCLUSIONS: From weaker to stronger impact, age, axial length, sex, and intraoperative posterior capsule rent were significant risk factors for the appearance of PRD after lens extraction.

Efficacy, safety and visual outcomes of cataract surgeries performed during blindness prevention programs in different locations in Kenya.

PURPOSE: To determine the visual outcomes achieved in terms of efficacy and safety during high-volume cataract surgery programs in different locations in Kenya. METHODS: Eight hundred eighty-one eyes of 849 patients underwent extracapsular cataract extraction with intraocular lens implantation in a retrospective, observational, consecutive cohort study on patients who underwent cataract surgery in five programs that a Spanish non-governmental organization conducted between 2013 and 2019 for the prevention of blindness in different geographical areas of Kenya: Thika, Athi River, Kissi, Bagavathi, and Nakuru. The programs were carried out by Spanish and Kenyan surgeons working together. RESULTS: Mean age was 66.81 ± 14.47 years. Fifty-one percent of the operated eyes (447 eyes) were women. 94% of patients belonged to six ethnic groups. The mean uncorrected distance visual acuity (UDVA) before surgery was 1.98 ± 0.98 logMAR (20/2000), which changed to 0.82 ± 0.68 logMAR (20/150) 3 months after surgeries. The corrected distance visual acuity (CDVA) was 0.4 ± 0.53 logMAR (20/50) 3 months after surgery, 77.5% of the patients had good visual outcomes, and 6.3% had poor outcomes. Preoperative UDVAs were significantly different with respect to the different geographical areas (Kruskal-Wallis; p < 0.001). The most common intraoperative complication was posterior capsule rupture (incidence, 4.2%, 37 of 881), and the most serious complication was expulsive hemorrhage (incidence, 0.1%, 1 of 881). CONCLUSIONS: Cataract programs performed in a middle-income country with the proper technique and standardized protocols of action improved the visual outcome of the patients. Dissimilar baseline status was found in different areas regarding preoperative visual acuities. Training programs of local surgeons should be reinforced.

Diffractive trifocal pseudophakic intraocular lenses in high myopic eyes: 2-year assessment after implantation.

PURPOSE: To assess the visual outcomes and ocular safety when implanting diffractive trifocal intraocular lenses in a population of high myopic eyes. METHODS: This is a retrospective cumulative clinical study. Two hundred five myopic eyes consecutively operated in the hospitals of Clínica Baviera, Spain, were included. All eyes presented an axial length equal or greater than 26 mm and were treated and examined following the same methodology for at least 2 years. Refractive and visual outcomes and also intraoperative or postoperative complications were tabulated for later analysis. Furthermore, a subjective questionnaire was completed by all patients at the end of the follow-up period. RESULTS: The percentage of eyes that lost two or more lines of corrected distance visual acuity (CDVA) was 5.9%, 11.5% and 10.7% 3, 12 and 48 months after surgeries respectively. However, 33% of eyes gained two or more lines of CDVA 2 years after implantation. Excimer laser correction of residual refractive error was performed after implants in 29.75% of eyes. Uncorrected distance visual acuities (UDVAs) were significantly better 1 year (0.10 ± 0.3 logMAR) and 2 years after the surgeries (0.10 ± 0.14 logMAR) compared with those estimated 3 months postoperatively (0.14 ± 0.15 logMAR; Kruskal-Wallis; p < 0.001). Mean near and intermediate uncorrected visual acuities remained stable from the first to the last postoperative visit (Kruskal-Wallis; p > 0.05 for all comparisons). Of the eyes, 27.31% were diagnosed and treated with yttrium aluminum garnet (YAG) laser after being diagnosed as having posterior capsular opacification. Retinal detachment (RD) was diagnosed in six eyes (2.92%). CONCLUSIONS: Diffractive trifocal IOLs have good efficacy and predictability in high myopic eyes. Retinal concerns should lead the surgeons to explore other alternatives for refractive surgery in young patients without cataracts.

Safety and Efficacy of the Transition from Extracapsular Cataract Extraction to Manual Small Incision Cataract Surgery in Prevention of Blindness Campaigns.

PURPOSE: To compare the safety and the visual outcomes of two experienced cataract surgeons who converted from extracapsular cataract extraction (ECCE) to manual small incision cataract surgery (MSICS) during a campaign for the prevention of blindness. METHODS: Two surgeons used the ECCE technique (ECCE group) during a campaign in Burkina Faso on 93 consecutive cataract patients with a corrected distance visual acuity (CDVA) <20/80 in the best eye. Both surgeons used MSICS for the first time on 98 consecutive cases in another campaign in Kenya after theoretical instructional courses. RESULTS: There were no significant differences in CDVA at 3 months postoperatively. There were 69% of eyes with uncorrected distance visual acuity ≥20/60 in the MSICS group and 49% eyes in the ECCE group. Spherical equivalents ranged between -1D and +1D in 55% of the MSICS group versus 43% in the ECCE group. There were significant differences in the changes in the vertical component of astigmatism (J45) but not the horizontal (J0) component. There were no significant differences in the intraoperative complications. The most common postoperative complication was corneal edema on the first day in 40.86% and 19.38% of the ECCE and MSICS groups, respectively. CONCLUSION: Transitioning from ECCE to MSICS for experienced cataract surgeons in surgical campaigns is safe. The rate of complications is similar for both techniques. Slightly better visual and refractive outcomes can be achieved due to the decreased induction of corneal astigmatism.

Implantable Collamer Lens for Myopia: Assessment 12 Years After Implantation.

PURPOSE: To evaluate the long-term refractive and visual stability and the risks related to the implantation of Implantable Collamer Lens (ICL; STAAR Surgical, Monrovia, CA) phakic intraocular lens (PIOL) for myopia. METHODS: This retrospective, consecutive, cumulative clinical study was performed in a group of 144 eyes implanted with ICL PIOL for myopia. Only the cases with clinical data available 12 years after the implantation were included in the series. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity, spherical equivalent, refractive astigmatism, endothelial cell density, ICL vaulting, and postoperative complications were analyzed. RESULTS: Mean spherical equivalent refraction was -16.90±4.26 diopters (D) preoperatively and -1.77±1.93 D 12 years postoperatively. Mean CDVA at the first and last visit were 0.31±0.19 logMAR and 0.22±0.22 logMAR, respectively (Mann-Whitney U test, P<.001). Twelve years postoperatively, 8.9% of eyes had lost more than two lines of CDVA. The incidence of clinically relevant cataracts (13.88%) was significantly linked to the use of the V3 model ICL (chi-square test, P=.007). During the follow-up period, a significant reduction in PIOL vaulting was observed (Kruskal-Wallis test, P<.05), and the mean endothelial cell density decreased by 19.75%. CONCLUSIONS: The ICL PIOL provided good refractive outcomes and stability in the long term. The incidence of cataracts is low when the latest models of this PIOL are used.

Visual outcomes of a trifocal aspheric diffractive intraocular lens with microincision cataract surgery.

PURPOSE: To evaluate the visual outcomes of patients with a new diffractive trifocal intraocular lens (IOL). METHODS: A trifocal diffractive Fine Vision IOL (Physiol, Liege, Belgium) was implanted after microincision cataract surgery (MICS) in 40 eyes of 20 patients with bilateral cataract. The monocular and binocular visual performance and the refractive status were assessed, as well as the defocus curve and contrast sensitivity at 1 and 6 months postoperatively. RESULTS: The monocular visual outcomes (logMAR) at 6 months postoperatively were uncorrected distance visual acuity 0.18 ± 0.13, uncorrected near visual acuity 0.26 ± 0.15, and uncorrected intermediate visual acuity 0.20 ± 0.11. With the best distance correction, the visual outcomes were 0.05 ± 0.06 for corrected distance visual acuity, 0.16 ± 0.13 for distance corrected near visual acuity, and 0.17 ± 0.09 for distance corrected intermediate visual acuity. Binocular defocus curve at 6 months shows a wide range of useful vision with 0.19 ± 0.08 (logMAR) at -1.50 diopter defocus. The monocular contrast sensitivity under scotopic conditions (3 cd/m(2)) was within normal range for a population older than 60 years. CONCLUSION: The trifocal Fine Vision IOL can restore vision at different distances after cataract surgery, specifically intermediate and near vision.

Correlation of anterior and posterior corneal shape in keratoconus.

PURPOSE: To evaluate the correlation of the mean curvature and shape factors of both corneal surfaces for different corneal diameters measured with the Scheimpflug photography-based system in keratoconus eyes. METHODS: A total of 61 keratoconus eyes of 61 subjects, aged 14 to 64 years, were included in this study. All eyes received a comprehensive ophthalmologic examination including anterior segment and corneal analysis with the Sirius system (CSO): anterior and posterior mean corneal radius for 3, 5, and 7 mm (aKM, pKM), anterior and posterior mean shape factor for 4.5 and 8 mm (ap, pp), central and minimal corneal thickness, and anterior chamber depth. RESULTS: Mean aKM/pKM ratio around 1.20 (range, 0.95-1.48) was found for all corneal diameters (P = 0.24). Weak but significant correlations of this ratio with pachymetric parameters were found (r between -0.28 and -0.34, P < 0.04). The correlation coefficient between aKM and pKM was ≥ 0.92 for all corneal diameters. A strong and significant correlation was also found between ap and pp (r ≥ 0.86, P < 0.01). The multiple regression analysis revealed that central pKM was significantly correlated with aKM, central corneal thickness, anterior chamber depth, and spherical equivalent (R ≥ 0.88, P < 0.01) and that 8 mm pp was significantly correlated with 8 mm ap and age (R = 0.89, P < 0.01). CONCLUSIONS: Central posterior corneal curvature and shape factor in the keratoconus eye can be consistently predicted from the anterior corneal curvature and shape factor, respectively, in combination with other anatomical and ocular parameters.

Correlation of the corneal toricity between anterior and posterior corneal surfaces in the normal human eye.

PURPOSE: To evaluate the correlation of the magnitude of corneal toricity and power vector components of both corneal surfaces measured with a Scheimpflug photography-based system. METHODS: A total of 117 healthy normal eyes of 117 subjects selected randomly with ages ranging from 7 to 80 years were included. All eyes received an anterior segment and corneal analysis with the Sirius system (CSO) evaluating the anterior and posterior mean toricity for 3 and 7 mm (aAST and pAST). The vector components J0 and J45 as well as the overall strength blur (B) were calculated for each keratometric measurement using the procedure defined by Thibos and Horner. RESULTS: The coefficient of correlation between aAST and pAST was 0.52 and 0.62 and the mean anteroposterior ratio for toricity was 0.46 ± 0.39 and 0.57 ± 0.75 for 3 and 7 mm, respectively. These ratios correlated significantly with aAST, anterior corneal J0, and manifest refraction J0 (r ≥ 0.39, P < 0.01). The coefficient of correlation was 0.69 and 0.81 between anterior and posterior J0 for 3 and 7 mm, respectively. For J45, the coefficients were 0.62 and 0.71, respectively. The linear regression analysis revealed that the pAST and power vectors could be predicted from the anterior corneal data (R2 ≥ 0.40, P < 0.01). CONCLUSIONS: The toricity and astigmatic power vector components of the posterior corneal surface in the human healthy eye are related to those of the anterior and therefore can be predicted consistently from the anterior toricity and astigmatic power vectors.

Comparative analysis of the relationship between anterior and posterior corneal shape analyzed by Scheimpflug photography in normal and keratoconus eyes.

BACKGROUND: To analyze and compare the relationship between anterior and posterior corneal shape evaluated by a tomographic system combining the Scheimpflug photography and Placido-disc in keratoconus and normal healthy eyes, as well as to evaluate its potential diagnostic value. METHODS: Comparative case series including a sample of 161 eyes of 161 subjects with ages ranging from 7 to 66 years and divided into two groups: normal group including 100 healthy eyes of 100 subjects, and keratoconus group including 61 keratoconus eyes of 61 patients. All eyes received a comprehensive ophthalmologic examination including an anterior segment analysis with the Sirius system (CSO). Antero-posterior ratios for corneal curvature (k ratio) and shape factor (p ratio) were calculated. Logistic regression analysis was used to evaluate if some antero-posterior ratios combined with other clinical parameters were predictors of the presence of keratoconus. RESULTS: No statistically significant differences between groups were found in the antero-posterior k ratios for 3-, 5- and 7-mm diameter corneal areas (p ≥ 0.09). The antero-posterior p ratio for 4.5- and 8-mm diameter corneal areas was significantly higher in the normal group than in the keratoconus group (p<0.01). The k ratio for 3, 5, and 7 mm was significantly higher in the keratoconus grade IV subgroup than in the normal group (p<0.01). Furthermore, significant differences were found in the p ratio between the normal group and the keratoconus grade II subgroup (p ≤ 0.01). Finally, the logistic regression analysis identified as significant independent predictors of the presence of keratoconus (p<0.01) the 8-mm anterior shape factor, the anterior chamber depth, and the minimal corneal thickness. CONCLUSIONS: The antero-posterior k and p ratios are parameters with poor prediction ability for keratoconus, in spite of the trend to the presence of more prolate posterior corneal surfaces compared to the anterior in keratoconus eyes.

Intrasubject repeatability in keratoconus-eye measurements obtained with a new Scheimpflug photography-based system.

PURPOSE: To evaluate in keratoconus eyes the intrasubject repeatability of anterior and posterior corneal curvature and of other anterior segment anatomic measurements obtained with a new topography system combining Scheimpflug-photography and Placido-disk technology. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Evaluation of technology. METHODS: All keratoconus eyes had a comprehensive ophthalmologic examination including analysis with the Sirius system. Three consecutive measurements were obtained to assess the intrasubject repeatability of the following parameters: anterior and posterior corneal curvature and shape factor, white-to-white (WTW) corneal diameter, central and minimum corneal thickness, and anterior chamber depth (ACD). The within-subject standard deviation (S(w)) and intraclass correlation coefficient (ICC) were calculated. RESULTS: This study comprised 61 eyes of 61 patients ranging in age from 14 to 64 years. For anterior and posterior corneal curvatures and power vector components, the S(w) was 0.29 mm or less in all cases. The ICC was above 0.990 in all cases except the flattest curvature of the posterior corneal surface at 3.0 mm, which was 0.840 (moderate agreement), and the posterior power vector J0, which was 0.665 (poor agreement), 0.752, and 0.758 (moderate agreement) for 3.0 mm, 5.0 mm, and 7.0 mm, respectively. In shape factor measurements, the S(w) was 0.12 or less in all cases and the ICC ranged between 0.989 and 0.999. Pachymetry, ACD, and WTW had ICC values very close to 1. CONCLUSION: The new topography system provided repeatable measurements of corneal shape and other anatomic parameters in eyes with keratoconus. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Scheimpflug photography-based clinical characterization of the correlation of the corneal shape between the anterior and posterior corneal surfaces in the normal human eye.

PURPOSE: To evaluate the correlation of the mean curvature and shape factors between both corneal surfaces for different corneal diameters measured with a Scheimpflug photography-based system. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Case series. METHODS: Randomly selected healthy normal eyes had a comprehensive ophthalmologic examination including anterior segment analysis with the Sirius system as follows: anterior and posterior mean corneal radius for 3.0 mm, 5.0 mm, and 7.0 mm; anterior and posterior mean shape factor for 4.5 mm and 8.0 mm; central (CCT) and minimum corneal thickness; and anterior chamber depth (ACD). RESULTS: The study enrolled 117 eyes (117 subjects; aged 7 to 80 years). The mean anterior mean corneal radius:posterior mean corneal radius ratio was 1.19 (range 1.12 to 1.27) for all corneal diameters (P = .86). The correlation coefficient between the anterior and posterior mean corneal radius was 0.85 or more for all corneal diameters. The anterior mean shape factor:posterior mean shape factor ratio for the 2 corneal diameters analyzed was approximately 1 (range 0.45 to 4.03). The correlations between anterior and posterior mean shape factors were extremely poor and not significant. Multiple regression analysis showed that the central posterior mean corneal radius was significantly correlated with the anterior mean corneal radius, CCT, and spherical equivalent (R(2) = 0.77, P<.01). CONCLUSIONS: Central posterior corneal curvature could be predicted from the anterior corneal curvature, pachymetry, and the refractive status of the eye but not from the corneal shape factor. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Near visual outcomes with single-optic and dual-optic accommodating intraocular lenses.

PURPOSE: To compare the visual and ocular optical performance in eyes with a single-optic or a dual-optic accommodating intraocular lens (IOL) with particular attention to near-vision outcomes. SETTING: Vissum Instituto Oftalmológico de Alicante, Miguel Hérnandez University, Alicante, Spain. DESIGN: Prospective consecutive nonrandomized interventional comparative clinical study. METHODS: Eyes with cataract were divided into 2 groups. Group A had implantation of a single-optic accommodating IOL (Crystalens HD) and Group B, of a dual-optic accommodating IOL (Synchrony). Distance and near visual acuities, contrast sensitivity, ocular aberrations, reading performance, and the defocus curve were evaluated over a 6-month postoperative follow-up. RESULTS: Group A comprised 27 eyes and Group B, 26 eyes. The patient age ranged from 59 to 82 years. Uncorrected and corrected distance visual acuities were significantly better in Group B (P≤.04). There were no significant between-group differences in near or intermediate visual vision (P≥.13). In the defocus curve, Group B had significantly better visual acuities at several levels of defocus (P≤.04). The ocular Strehl ratio and contrast sensitivity were also significantly better in Group B (P≤.04). Group A had higher postoperative total and higher-order root-mean-square aberrations (P≤.01). The incidence of posterior capsule opacification was significantly higher in Group A (40.7%) than in Group B (11.5%). CONCLUSIONS: Both IOLs restored distance visual function after cataract surgery with limitations in near visual outcomes. Eyes with the dual-optic IOL had significantly better ocular optical quality.

Visual outcomes with a single-optic accommodating intraocular lens and a low-addition-power rotational asymmetric multifocal intraocular lens.

PURPOSE: To compare the visual outcomes and intraocular optical quality in patients with a low-addition (add) power multifocal refractive intraocular lens (IOL) with rotational asymmetry and a single-optic accommodating IOL. SETTING: Vissum Instituto Oftalmológico de Alicante, Miguel Hérnandez University, Alicante, Spain. DESIGN: Prospective comparative nonrandomized consecutive case series. METHODS: Consecutive cataract patients had implantation of a low-add-power refractive multifocal IOL with rotational asymmetry (Lentis-Mplus LS-312 MF15) (multifocal group) or a single-optic accommodating IOL (Crystalens HD) (accommodating group). Distance and near visual acuities were evaluated. Ocular optical quality, intraocular aberrations, defocus curve, and contrast sensitivity were evaluated postoperatively. RESULTS: Of the 66 eyes (40 patients; age 61 to 81 years), 31 were in the multifocal group and 35 were in the accommodating group. Postoperatively, both groups had a significant improvement in the uncorrected and corrected distance visual acuities and uncorrected (UNVA) and corrected near (CNVA) near visual acuities (P <.01). Distance-corrected near visual acuity was significantly better in the multifocal group postoperatively (P ≤.04). No significant differences in UNVA and CNVA were detected postoperatively (P ≥.09). In the defocus curve, the multifocal group had significantly better visual acuities at several defocus levels. The accommodating group had better contrast sensitivity under photopic conditions at all spatial frequencies (P ≤.04). The multifocal group had significantly higher postoperative intraocular tilt (P <.01). CONCLUSIONS: Both IOLs restored distance vision. The refractive multifocal IOL provided better near visual rehabilitation.

Intrasubject repeatability of corneal morphology measurements obtained with a new Scheimpflug photography-based system.

PURPOSE: To evaluate in normal healthy eyes the intrasubject repeatability of anterior and posterior corneal curvature measurements and other anatomic anterior segment measurements obtained with a new topography system combining Scheimpflug photography and Placido-disk technology. SETTING: Vissum Corp., Alicante, Spain. DESIGN: Evaluation of technology. METHODS: All eyes received a comprehensive ophthalmologic examination including anterior segment analysis with the Sirius system. Three consecutive measurements were performed with the device to assess the intrasubject repeatability of the following parameters: anterior and posterior corneal curvature and shape factor, white-to-white (WTW) corneal diameter, central and minimum corneal thickness, and anterior chamber depth (ACD). The within-subject standard deviation (S(w)) and intraclass correlation coefficient (ICC) were calculated. RESULTS: This study included 117 eyes of 117 subjects (mean age 42 years; range 7 to 80 years). For anterior and posterior corneal curvatures, the S(w) was 0.04 mm or lower and the ICC was higher than 0.990. For shape-factor measurements, the S(w) was below 0.08 in all cases and ICC values ranged between 0.909 and 0.994. Significantly larger S(w) values were found for the anterior and posterior shape factor calculated for 8.0 mm compared with 4.5 mm (P<.01). An S(w) value below 3 µm was observed for the central and minimum thickness, with ICC values close to 1. The mean S(w) for ACD and WTW was below 0.1 mm. CONCLUSION: In healthy eyes, the new topography system provided repeatable measurements of several anterior segment parameters, including anterior and posterior curvature and pachymetry.

Clinical outcomes and postoperative intraocular optical quality with a microincision aberration-free aspheric intraocular lens.

PURPOSE: To evaluate the visual outcomes and optical quality with an aspheric intraocular lens (IOL) with no aberration in microincision cataract surgery. SETTING: Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain. METHODS: This prospective cohort study included eyes that had cataract surgery with implantation of an Akreos Adapt Advanced Optics MI60 IOL. Surgery was performed using the Millennium phacoemulsification platform. The IOL was implanted through a sub-1.8 mm incision using the 1.8 Viscoglide cartridge. Visual and refractive outcomes were analyzed during a 12-month follow-up. In addition, postoperative ocular optical quality was evaluated using the Optical Quality Analysis System. Postoperative intraocular optical aberrations were calculated by subtracting corneal aberrations from total aberrations. RESULTS: The cohort comprised 25 eyes of 25 patients ranging in age from 52 to 83 years. The mean spherical equivalent was -0.47 diopters +/- 0.62 (SD) 3 months postoperatively (P = .72). The mean corrected distance visual acuity improved from 0.54 +/- 0.23 logMAR preoperatively to 0.08 +/- 0.16 logMAR 3 months postoperatively (P<.01). Optical quality analysis showed a mean spatial frequency at 50% of the modulation transfer function (MTF) of 2.85 +/- 0.55 cycles per degree (cpd) and a mean cutoff MTF frequency of 21.50 +/- 7.02 cpd. Postoperatively, the mean intraocular spherical aberration was 0.16 +/- 0.11 microm and the mean primary coma root mean square, 0.23 +/- 0.15 microm. CONCLUSION: Implantation of the aberration-free aspheric IOL was safe and effective and provided excellent visual and refractive outcomes with good optical performance.

Corneal aberrations after microincision cataract surgery.

PURPOSE: To study the effect of microincision cataract surgery (MICS) on the optical quality of the cornea, characterized in terms of Seidel aberrations. SETTING: Instituto Oftalmológico de Alicante, Vissum, Alicante, Spain. METHODS: This study comprised 25 eyes of 25 patients with nuclear or corticonuclear cataract of grade 2+ to 4+ (Lens Opacities Classification System III). Microincision cataract surgery was performed using low ultrasound power through a 1.6 to 1.8 mm clear corneal incision placed on the axis of the positive corneal meridian. An Acri. Smart 48S intraocular lens (Acri.Tec) was implanted in all eyes. Seidel aberration root-mean-square (RMS) values were obtained with a 6.0 mm aperture using the CSO topographer (Costruzione Strumenti Oftalmici) preoperatively and 1 and 3 months postoperatively. RESULTS: The total RMS after MICS decreased slightly from a mean of 2.15 microm +/- 2.51 (SD) preoperatively to 1.96 +/- 2.01 microm postoperatively; the decrease was not statistically significant (P = 1.00). The difference between the corneal astigmatism from preoperatively (-0.80 +/- 0.76 diopter [D]) to postoperatively (-0.63 +/- 0.62 D) was not statistically significant (P = 1.00) nor were the differences in Seidel aberrations, coma, or higher-order aberrations. CONCLUSION: Microincision cataract surgery did not degrade the optical quality of the cornea or induce a modification in corneal astigmatism, including the axis.

Corneal wavefront-guided LASIK retreatments for correction of highly aberrated corneas following refractive surgery.

PURPOSE: To investigate the safety and efficacy of customized corneal wavefront-guided retreatment in symptomatic patients with highly aberrated corneas following LASIK. METHODS: This prospective study included 75 eyes of 59 patients with significant visual symptoms who underwent LASIK for the correction of residual refractive error. Ablation profiles were calculated using CSO corneal topography and ESIRIS/Schwind laser platform. Eyes were divided into two groups: those with significant night vision symptoms (37 eyes; night symptoms group) and those with decentration, irregular ablation profile, and flap complications (38 eyes; corneal complications group). Corneal topography and aberrations, visual acuity, point spread function (PSF), refractive outcome, and subjective symptoms were evaluated preoperatively, and 1, 3, and 6 months postoperatively. RESULTS: Mean uncorrected visual acuity was 20/32 preoperatively and 20/25 at 6 months postoperatively in the night symptoms group and 20/40 preoperatively and 20/30 at 6 months postoperatively in the corneal complications group. Mean best spectacle-corrected visual acuity was 20/25 both preoperatively and 6 months postoperatively in both groups (t test, P = .219 and P = .149 for the night symptoms and corneal complications groups, respectively). Safety index was 1.1 in both groups, and efficacy index was 0.93 and 0.92, respectively. Statistically significant improvement of total corneal higher order aberrations, tilt, and improvement of spherical aberrations and coma were observed, with corresponding improvement of PSF. CONCLUSIONS: Corneal wavefront-guided LASIK retreatment with CSO topography, ORK-W software, and ESIRIS/Schwind laser platform is safe and effective for treating symptomatic patients affected by corneal higher order aberrations or corneal irregularities following LASIK surgery.

Molecular alterations of parotid saliva in infantile chronic recurrent parotitis.

Infantile chronic recurrent parotitis (ICRP) is an insidious disease whose etiopathogenesis remains an enigma. Alterations in the physical appearance of parotid saliva from ICRP patients have been frequently reported. However, sialochemical studies in regard to ICRP are very rare. The aim of this study was to determine whether saliva of ICRP patients presents major physicochemical and biochemical alterations compared with saliva from paired healthy controls. Parotid, whole, and submandibular/sublingual saliva was collected at an asymptomatic stage from 33 ICRP patients (5-16 y old, both sexes) and from 33 sex- and age-matched healthy controls. Saliva was analyzed for protein concentration, mode of protein diffusion on cellulose membranes, unidimensional sodium dodecylsulfate (SDS)-polyacrylamide gel electrophoresis protein profiles and zymographic profiles of metalloproteinase 2 (MMP-2) and metalloproteinase 9 (MMP-9). Parotid saliva of ICRP patients showed an increased protein concentration, altered mode of protein diffusion, a higher frequency of polypeptide bands of 43, 37, 33, 29, 26, 16, and 10 kD, higher asymmetry in the polypeptide profiles of both contralateral parotid saliva, and an increase in the frequency of MMP-2 and MMP-9. Parotid saliva of patients with ICRP is molecularly altered with respect to normal saliva. Some of the molecular differences could be related to the etiopathogenesis of the disease.