Novel Application of Conjunctival Anterior Segment Optical Coherence Tomography Angiography to Assess Ocular Redness.

PURPOSE: The aim of this study was to determine anterior segment optical coherence tomography angiography (AS-OCTA) parameters to assess ocular redness severity. METHODS: AS-OCTA analyses of 60 eyes of 40 patients were grouped according to ocular redness stages using the 5-category validated bulbar redness scale in a cross-sectional retrospective study (groups 1-5). A subset of patients with slit-lamp photographs, total 35 eyes of 23 patients, were assessed with 10-category validated bulbar redness scale for comparison. AS-OCTA images of nasal and temporal bulbar conjunctiva were analyzed. Vessel density (VD) represented the blood flow pixels by the total pixels of image (%); vessel diameter index represented the VD by the skeletonized density; fractal dimension, measured with the box-count method, represented the vessel branching complexity. Averaged nasal and temporal parameters for each eye were correlated to validated bulbar redness scales. RESULTS: There was no statistical difference between groups for age ( P = 0.118), sex ( P = 0.501), eye laterality (OD/OS; P = 0.111), or location (nasal/temporal; P = 0.932). In the 5-category scale, VD significantly increased from group 1 to 2 (31.5 ± 1.9% and 33.4 ± 2.2%, P = 0.023), 2 to 3 (36.0 ± 3.5%, P < 0.001), and 4 to 5 (40.2 ± 2.9 and 46.5 ± 2.8, P < 0.001). The correlations were 0.805 ( P < 0.001) and 0.893 ( P < 0.001) for the 5-category and 10-category scales, respectively. Vessel diameter index showed a significant increase from 1 to 2 (2.90 ± 0.17 and 3.00 ± 0.15; P = 0.004) and 4 to 5 (2.92 ± 0.31 and 3.33 ± 0.08; P = 0.001). The correlations were 0.550 ( P < 0.001) and 0.625 ( P < 0.001) for the respective scales. The fractal dimension showed no significant differences between subsequent groups. The correlations were 0.445 ( P < 0.001) and 0.583 ( P < 0.001), respectively. CONCLUSIONS: Conjunctival AS-OCTA VD was the most reliable parameter to assess ocular redness.

Anterior segment optical coherence tomography angiography in the assessment of ocular surface lesions.

PURPOSE: Describe the utility of anterior segment optical coherence tomography angiography (AS-OCTA) to assess ocular surface lesions. METHODS: Retrospective, case-control study of 10 eyes of 9 patients with malignant lesions and 23 eyes of 22 patients with benign lesions. Lesions included 13 epithelial, 10 pigmented and 10 lymphoid lesions. Graders performed an average of 3 depth and diameter measurements of peri-lesional vessels entering each lesion on AS-OCTA. Statistical models to assess differences between groups accounted for bilateral eye inclusion and lesion thickness (on AS-OCT). Receiver operating characteristic (ROC) curve and area under the curve (AUC) were performed for each parameter. RESULTS: In the benign and malignant groups, age was 49.5 ± 22.4 and 64.3 ± 10.6 years (p = 0.145) with 45% males and 55% males (p = 0.458), in their respective groups. AS-OCTA showed greater peri-lesional vessel depth and diameter in malignant lesions (315.2 ± 73.0 µm, p < 0.001 and 76.4 ± 18.2 µm, p < 0.001; respectively) compared to benign lesions (199.4 ± 34.1 µm and 44.0 ± 9.4 µm, respectively). Malignant lesions showed deep and dilated peri-lesional vessels, which may represent feeder vessels. Vessel depth showed AUC = 0.980, 90.9% sensitivity and 100.0% specificity with a 236.5 µm cutoff. Vessel diameter showed AUC = 0.960, 100.0% sensitivity and 88.9% specificity with a 53.9 µm cutoff. CONCLUSION: AS-OCTA shows greater peri-lesional vessel depth and diameter of malignant lesions compared to benign lesions. This imaging modality provides novel and non-invasive functional vascular parameters that can potentially aid the assessment of ocular surface lesions.

The utility of anterior segment optical coherence tomography angiography for the assessment of limbal stem cell deficiency.

PURPOSE: To determine the utility of anterior segment optical coherence tomography angiography (AS-OCTA) in assessing limbal stem cell deficiency (LSCD). METHODS: Twenty-six eyes of 24 LSCD patients, classified clinically into stage I, II and III, and 12 eyes of 12 healthy subjects were included. AS-OCTA images were analyzed by two masked observers, measuring the maximum corneal vascular extension (CoVE) from the limbus to the furthest vessel over the cornea, and corneal vascular thickness (CoVT) from the most superficial to the deepest corneal vessel. RESULTS: CoVE was 0.27 ± 0.10, 0.79 ± 0.21, 1.68 ± 0.89 and 2.53 ± 0.82 mm in controls, stage I, II and III LSCD, respectively (p < 0.001). The CoVT was 51.0 ± 19.4, 113.7 ± 36.6, 129.7 ± 39.3 and 336.0 ± 85.0 µm, respectively (p < 0.001). There was a significant difference in CoVE and CoVT between all stages compared to controls, and between stage I and III LSCD (p < 0.001). Further, CoVE showed a significant difference between stage I and II, whereas CoVT showed a significant difference between stage II and III LSCD (p < 0.001). BCVA showed strong correlation with CoVT (r = 0.765, p < 0.001) and moderate correlation with CoVE (r = 0.547, p = 0.001). AS-OCTA parameters showed excellent intra- and inter-class correlation coefficients (>0.900). CONCLUSION: LSCD demonstrates significant changes in CoVE and CoVT as early as stage I LSCD in comparison to controls. CoVE and CoVT strongly correlate to both disease severity and BCVA. AS-OCTA may provide novel quantitative and non-invasive parameters to assess LSCD.

Novel Parameters to Assess the Severity of Corneal Neovascularization Using Anterior Segment Optical Coherence Tomography Angiography.

PURPOSE: Assessment of anterior segment-optical coherence tomography angiography (AS-OCTA) to determine severity of corneal neovascularization (CoNV). DESIGN: Retrospective, cross-sectional, single-center study. METHODS: Patients of various CoNV etiologies were selected and classified into mild, moderate, and severe. Their AS-OCTA images were measured for CoNV anterior limit, CoNV posterior limit, CoNV thickness, CoNV depth%, CoNV vessel density, CoNV area, and CoNV volume. Further, AS-OCTA parameters were correlated to clinical parameters, such as classification, a numerical severity scale, vascular clock hours, and best-corrected visual acuity (BCVA). RESULTS: A total of 19 mild, 10 moderate, and 6 severe CoNV eyes were included with no significant age-gender differences. CoNV depth% and volume increased from mild to moderate (9.3 ± 1.1% to 17.7 ± 3.3%, P = .030, and 0.2 ± 0.1 mm3 to 1.0 ± 0.3 mm3, P = .025, respectively) and from moderate to severe CoNV (44.6 ± 5.3%, P < .001, and 2.0 ± 0.3 mm3, P = .014, respectively). CoNV area and posterior limit increased from mild to moderate (1.7 ± 0.3 mm2 to 4.6 ± 0.7 mm2, P = .001, and 217.7 ± 16.8 µm to 349.1 ± 54.9 µm, P = .048, respectively), not from moderate to severe (P = .999 and P = .403, respectively). CoNV thickness increased from moderate to severe (218.2 ± 46.6 µm to 340.2 ± 8.7 µm, P = .020), but not from mild to moderate. CoNV area and volume showed good correlations to CoNV staging (r = 0.703 and r = 0.771, respectively; P < .001) and severity scale (r = 0.794 and r = 0.712, respectively; P < .001). CoNV area showed good correlation to clock hours (r = 0.749, P < .001). CoNV depth and volume showed good correlation to BCVA (r = 0.744 and r = 0.722, respectively; P < .001). CoNV anterior limit and vessel density showed no significant correlations (P ≥ .05). CONCLUSIONS: Severe CoNV shows greater CoNV posterior limit, thickness, depth%, area, and volume on AS-OCTA compared to mild. CoNV volume and depth strongly correlate to BCVA. AS-OCTA provides novel, quantitative, and noninvasive parameters for assessing CoNV severity.

Multicenter visual outcomes comparison of 2 trifocal presbyopia-correcting IOLs: 6-month postoperative results.

PURPOSE: To clinically evaluate visual performance of the AcrySof IQ PanOptix TFNT00 and AT LISA tri 839MP intraocular lenses (IOLs) in binocular visual acuity (VA) and to characterize low-contrast visual performance at 6 months postimplantation. SETTING: Multicenter, 15 sites. DESIGN: Prospective, parallel-group, randomized, double-masked, postmarketing clinical study. METHODS: Binocular uncorrected distance (UDVA, 4 m), intermediate (UIVA, 60 cm), and near (UNVA, 40 cm) visual acuities and binocular defocus curves were evaluated under photopic lighting conditions. Photopic and mesopic contrast sensitivities with and without glare were assessed. RESULTS: The study included 182 subjects (62% women; mean age, 66 ± 9.4 years) who were implanted bilaterally with the TFNT00 IOL (n = 93) or 839MP IOL (n = 89), and binocular VA was evaluated 4 to 6 months (120-180 days) postimplantation. The TFNT00 IOL group showed superior visual outcomes compared with the 839MP IOL group in binocular UIVA (P = .001) and UNVA (P = .003) and noninferior outcomes in UDVA (95% CI, -0.023 to 0.041; upper limit <0.1 logarithm of the minimum angle of resolution [logMAR] [margin of noninferiority]). Mean defocus curve from 0.00 to -3.00 diopter (D) ranged from 0.1 to 0.0 logMAR for both IOLs; better mean VA values (logMAR) were observed in the TFNT00 IOL group between -1.50 and -2.50 D compared with those of the 839MP IOL group. Contrast sensitivity values were similar between the 2 groups in all conditions. CONCLUSIONS: The results of this study showed improved visual performance at near and intermediate distances with the TFNT00 IOL compared with that of the 839MP IOL.

Persistence of granular corneal dystrophy type-1 deposits in the predescemetic layer after big-bubble deep anterior lamellar keratoplasty.

We report intraoperative finding of Granular Corneal Dystrophy Type-1 (GCD1) deposits after stromal pneumodissection in deep anterior lamellar keratoplasty (DALK) in a 61-year-old female. Pneumodissection was performed from the center to the periphery of the cornea, characterizing a big bubble type 1 technique which dissects the deep stroma from the predescemetic layer. After stromal removal, persistence of whitish deposits inside the predescemetic layer was noted. During post-operative evaluation, anterior biomicroscopy and anterior segment optical coherence tomography showed granular opacities between the patient's Descemet's membrane and the donor cornea, suggesting possible involvement of the predescemetic layer in GCD1. This may require the surgeon's attention to choose between DALK keratoplasty or penetrating keratoplasty.

Persistence of granular corneal dystrophy type-1 deposits in the predescemetic layer after big-bubble deep anterior lamellar keratoplasty / Persistência de depósitos da distrofia corneal granular tipo-1 na camada pre-Descemet após transplante lamelar anterior profundo

ABSTRACT We report intraoperative finding of Granular Corneal Dystrophy Type-1 (GCD1) deposits after stromal pneumodissection in deep anterior lamellar keratoplasty (DALK) in a 61-year-old female. Pneumodissection was performed from the center to the periphery of the cornea, characterizing a big bubble type 1 technique which dissects the deep stroma from the predescemetic layer. After stromal removal, persistence of whitish deposits inside the predescemetic layer was noted. During post-operative evaluation, anterior biomicroscopy and anterior segment optical coherence tomography showed granular opacities between the patient's Descemet's membrane and the donor cornea, suggesting possible involvement of the predescemetic layer in GCD1. This may require the surgeon's attention to choose between DALK keratoplasty or penetrating keratoplasty.

RESUMO Relatamos o achado intraoperatório de persistência dos depósitos de Distrofia Granular Tipo 1 (GCD1) após pneumodissecção estromal no transplante de córnea lamelar anterior profundo (DALK) em uma mulher de 61 anos. A pneumodissecção começou a partir do centro para a periferia da córnea, caracterizando uma big bubble tipo 1, que disseca o estroma profundo da camada pré-Descemet. Após a remoção do estroma, notamos a persistência de depósitos esbranquiçados no interior da camada pré-Descemet. Na avaliação pós-operatória, a biomicroscopia anterior e a tomografia de coerência óptica do segmento anterior evidenciaram opacidades granulares entre a membrana de Descemet e a córnea doadora, sugerindo o possível envolvimento da camada pré-Descemet na GCD1, o que pode chamar atenção do cirurgião para decidir entre manter o DALK ou converter para transplante penetrante.

Phacoemulsification with intraocular lens implantation after previous descemetorhexis without endothelial keratoplasty.

A 58-year-old woman with bilateral Fuchs endothelial corneal dystrophy presented with predominantly central guttata in the left eye causing visually significant stromal edema. A 4.0 mm descemetorhexis without endothelial keratoplasty was performed. At the 6-week follow-up, the central cornea had cleared completely and the central endothelial cell density (ECD) was 541 cells/mm2. The central corneal clearing remained stable for 2 years after the procedure; however, vision declined because of a visually significant cataract in the left eye. Uneventful phacoemulsification with intraocular lens implantation was performed with a target refraction of -0.50 diopters. At 1.5 months postoperatively, the uncorrected distance visual acuity was 20/20 with a manifest refraction of -0.25 -0.25 × 60 and the central ECD was 2373 cells/mm2 (increased from 1471 cells/mm2 prior to phacoemulsification). Cataract surgery by phacoemulsification years after descemetorhexis without endothelial keratoplasty appears to be well-tolerated, with good clinical and predictive refractive outcomes.

Optical coherence tomography analysis of hydrofluoric acid decontamination of human cornea by mannitol solution.

PURPOSE: To evaluate the efficacy of mannitol solution as a decontamination agent on the chemical burn of the human corneas. METHODS: Eight donor corneas from an eye bank were exposed to 25µl of 2.5% hydrofluoric acid (HF) solution on a filter paper for 20s. Three eyes were rinsed with 1000ml of mannitol 20% for 15min immediately after removal of the filter paper, 3 other were rinsed with sodium chloride (NaCl) 0.9% (1000ml for 15min) and two eyes were not rinsed. Microstructural changes were monitored in the time domain by optical coherence tomography (OCT) imaging for 75min. RESULTS: NaCl reduced the penetration depth to approximately half the thickness of the cornea at 15min; scattering within the anterior cornea was higher than that for the unrinsed eye. With mannitol, no increased scattering was observed in the posterior part of the corneal stroma within a time period of 1h after rinsing. OCT images revealed low-scattering intensity within the anterior stroma at the end of the rinsing period. CONCLUSION: In eye bank human corneas, mannitol proved to be an efficient agent to decontaminate HF burn.

Descemet Membrane Detachment in Femtosecond Laser-Assisted Cataract Surgery.

PURPOSE: To report a case series of 4 patients with Descemet membrane detachment (DMD) after undergoing femtosecond laser-assisted cataract surgery incisions. METHODS: Case report. RESULTS: DMD was noted at the secondary incision (n = 2) or at the main incision (n = 2). All the secondary incision and 1 main incision DMD were resolved with intraoperative maneuvers. Delay in recognizing DMD intraoperatively at the principal incision in 1 case led to inadvertent aspiration of a part of it and persistent postoperative corneal edema. This complication was handled with Descemet membrane endothelial keratoplasty 1 month after initial surgery. CONCLUSIONS: DMD can occur after femtosecond laser-assisted cataract surgery, although it is a rare complication as it is in traditional phacoemulsification. The surgeon must be prepared to recognize it, manage it intraoperatively, and treat it postoperatively to reduce the risk of permanent damage to the eye.

Refractive and Visual Outcomes of Different Intraocular Lenses with Femtosecond Laser Cataract Surgery: The Expectation of Independence from Spectacles.

PURPOSE: To evaluate the visual performance of different types of intraocular lens (IOL) in eyes submitted to femtosecond laser (FSL) cataract surgery and to analyze whether this technology could result in spectacles independence. DESIGN: Retrospective comparative case series. METHODS: Consecutive eyes that were scheduled for FSL cataract surgery were included in this study. After one month postoperative, patients were divided into two groups: cases that required prescription for eyeglasses and cases that did not require prescription. In addition, the patients were analyzed according to the type of IOL that was implanted (monofocal, monofocal toric, multifocal and multifocal toric). RESULTS: Thirty-five cataract surgeries were analyzed. Twenty-three eyes had a monofocal IOL implanted, and 12 had a multifocal IOL implanted. After 1 month, 12 cases required prescription (Group 1), and 23 did not require prescription (Group 2). The proportion of eyes that did not require corrective lenses was significantly greater (P = 0.02) in eyes that received multifocal IOL (91.67%) compared with those that received monofocal IOL (47.83%). Additionally, 100% of eyes that received multifocal toric IOL did not require eyeglasses at one month postoperatively. CONCLUSION: The FSL surgical precision associated with modern IOL technology may be an important factor related to vision satisfaction after cataract surgery.

Clinical experience with the first 40 cases with femtosecond laser cataract surgery technology: safety of the learning curve / Experiência clínica com os primeiros 40 casos de cirurgia de catarata com a tecnologia de laser de femtossegundo: segurança da curva de aprendizagem

Objective:To evaluate the introduction of the femtosecond laser (FSL) to perform the key steps of the traditional cataract surgery process and the operational difficulties and safety of this new technology during routine use in an operating room in Brazil.MethodsA retrospective study was conducted using the first cases operated on at a single center using the laser platform LenSx/Alcon with a soft contact lens patient interface.All patients underwent a detailed preoperative assessment.The anterior capsulotomy, nuclear fragmentation, and corneal incisions were created with the FSL; then, the surgery was completed following the standard phacoemulsification procedure. The main outcome measurements were difficulties and complications related to the learning curve and an analysis of postoperative uncorrected distance visual acuity (UDVA).Results:Of 31 patients (40 eyes), 9 patients had FSL cataract surgery in both eyes.The mean age was 64 ± 12 years (ranging from 42 to 82), the mean cataract nuclear sclerosis was grading 2 ± 0.6 (ranging from 1 to 4), and the preoperative mean UDVA in logMAR was 0.4 ± 0.2 (ranging from 0.1 to 1.3). Anterior capsulotomy was complete in all patients, and scissors were not needed to cut off any intact portion. The postoperative corneal incisions were not completely linear and showed some irregularities. Laser phaco-fragmentation was effective, with the division of the nucleus into smaller segments easily performed before phacoemulsification.After 1 month, the postoperative mean UDVA in logMAR was 0.1 ± 0.1 (ranging from 0.0 to 0.4) (P < 0.0001).Conclusion:With increasing surgical cases and experience, the phacoemulsification steps are performed precisely and effectively with FSL pretreatment, resulting in a safe learning curve.

Objetivo:Avaliar a introdução do laser de femtossegundo (FSL) para realizar etapas fundamentais da cirurgia de catarata tradicional e as dificuldades e segurança desta nova tecnologia na rotina de um centro cirúrgico no Brasil.Métodos:Um estudo retrospectivo foi realizado com os primeiros casos operados em um único centro usando a plataforma de laser LenSx/Alcon, sendo utilizado lentes de contato gelatinosa na interface do paciente. Todos os pacientes foram submetidos a uma avaliação pré-operatória detalhada. Capsulotomia anterior, fragmentação nuclear e incisões na córnea foram criados com a FSL, em seguida, a cirurgia foi concluída com procedimento de facoemulsificação padrão. As principais medidas de desfecho foram dificuldades e complicações relacionadas à curva de aprendizado e análise da acuidade visual pós-operatória não corrigida à distância (UDVA).Resultados:Dos 31 pacientes (40 olhos), 9 realizaram cirurgia de catarata em ambos os olhos com FSL. A média de idade foi de 64 ± 12 anos (variando de 42 a 82), a média de classificação da catarata através da esclerose nuclear foi 2 ± 0,6 (variando de 1 a 4) e UDVA pré-operatória em logMAR foi de 0,4 ± 0,2 (variando de 0,1 a 1,3). A capsulotomia anterior foi completa em todos os pacientes e não precisou usar da pinça para cortar qualquer porção intacta. Incisões corneanas pós-operatórias não foram lineares, mostrando ainda algumas irregularidades. A facofragmentação a laser foi eficaz, com a divisão do núcleo em segmentos menores facilmente realizados antes da facoemulsificação. Após 1 mês de pós-operatório, UDVA em logMAR foi de 0,1 ± 0,1 (variando de 0,0 a 0,4) (P < 0,0001).Conclusão:Com o aumento do volume dos casos cirúrgicos e ganho de experiência, passos precisos da facoemulsificação são realizados com o pré-tratamento com o FSL, resultando em uma segura curva de aprendizagem.

Análise quantitativa e qualitativa do filme lacrimal nos pacientes submetidos a PRK e LASIK com femtossegundo / Analysis quantitative and qualitative of the tear film in patients undergoing PRK and LASIK with femtosecond

Objetivo: Analisar a secreção lacrimal, coloração da superfície ocular e estabilidade do filme lacrimal em indivíduos submetidos à cirurgia de PRK e LASIK com laser de femtossegundo (femto LASIK). Métodos: Vinte olhos de 10 pacientes submetidos à técnica de Femto LASIK e 11 olhos de 6 pacientes submetidos à técnica de PRK foram estudados de forma prospectiva, longitudinal e intervencionista. Tempo de rotura do filme lacrimal (TRFL), teste de Schirmer basal e coloração da superfície ocular com lissamina verde foram analisados no pré-operatório (pré), no 15º e no 30º dia pós-operatório (15º pós e 30º pós, respectivamente). Resultados: Agrupando todos os olhos, observou-se que o TRFL reduziu-se de forma estatisticamente significante no 15º pós em relação ao valor pré-operatório (p=0,025), mantendo-se reduzido no 30º pós (p= 0,001); não houve diferença estatisticamente significativa entre o 15º pós e o 30º pós (p=0,219). No teste da lissamina verde, houve aumento significativo desse escore, no 15º pós em relação ao período pré-operatório (p=0,021), havendo, posteriormente, redução no 30º pós (p=0,010). No teste de Schirmer basal, não foi detectada mudança estatisticamente significante ao longo dos três momentos (p=0,107). Comparando-se os testes TRFL, lissamina verde ou Schirmer basal, nos dois grupos estudados (PRK e LASIK), não houve diferença estatisticamente significante em nenhum dos três momentos (pré, 15º pós e 30º pós). Conclusão: Evidenciou-se alteração do filme lacrimal nos pacientes submetidos à cirurgia refrativa, quando foram utilizados os testes de TRFL e lissamina verde. Nas duas técnicas empregadas, não houve diferença estatisticamente significante de alteração do filme lacrimal, quando comparadas entre si (PRK e LASIK). .

Purpose: To evaluate tear film stability, ocular surface staining and tear secretion in patients undergoing PRK and femtosecond laser LASIK. Methods: Twenty eyes of 10 patients submitted to femtosecond laser LASIK and 11 eyes of the 6 patients submitted do PRK underwent tear film break-up time (TBUT), Schirmer’s basal and lissamine green staining measurements pre and postoperatively on days 15 (PO 15) and 30 (PO 30). Results: When grouping all eyes TBUT was reduced on PO 15 (p=0.025) and on PO 30 (p=0.001) compared to preoperative values. No difference was found between PO 15 and PO 30 (p=0.219). Compared to preoperative measurements, lissamine green test demonstrated a significant increase in score on PO 15 (p=0.021) and a significant reduction on PO 30 (p=0.010), when both groups were analyzed together (all 42 eyes). No changes in Schirmer’s basal test were detected in all 3 time periods (p=0.107). TBUT, lissamine green and Schirmer’s basal measurements were no different in all 3 time periods when both groups (PRK and femtosecond laser LASIK) were compared. Conclusion: TBUT and lissamine green measurements were altered after refractive surgery regardless the technique (PRK or femtosecond laser LASIK). When comparing one technique to the other, no difference was found in all measurements. .

Sight-dependent quality of life and ophthalmic findings in a group of Brazilian patients with multiple sclerosis.

OBJECTIVE: To assess the visual quality of life in patients with multiple sclerosis (MS), and to observe whether this parameter could be correlated to the findings of the ophthalmologic examination. METHOD: The translated and validated 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was used to assess the visual quality of life. Clinical data on MS, visual acuity, visual fields, optic coherence tomography (OCT) and disc cupping were used for assessing correlation with VFQ-25. RESULTS: The mean VFQ-25 value was 78.6 ± 18.2% in 27 patients. VFQ-25 did not correlate with patients' ages, with disability (EDSS), disease duration or medication use. Visual acuity showed a relatively poor (<60%) correlation to VFQ-25, while no correlation could be established between visual fields, OCT and disc cupping with VFQ-25. CONCLUSION: MS patients present several alterations in their eyes and sight that cannot be assessed by isolated measures. Ophthalmological examination of these patients must include many parameters not usually used in standard ophthalmologic consultations.

Sight-dependent quality of life and ophthalmic findings in a group of Brazilian patients with multiple sclerosis / Qualidade de vida visual e achados oftálmicos em um grupo de pacientes brasileiros com esclerose múltipla

OBJECTIVE: To assess the visual quality of life in patients with multiple sclerosis (MS), and to observe whether this parameter could be correlated to the findings of the ophthalmologic examination. METHOD: The translated and validated 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was used to assess the visual quality of life. Clinical data on MS, visual acuity, visual fields, optic coherence tomography (OCT) and disc cupping were used for assessing correlation with VFQ-25. RESULTS: The mean VFQ-25 value was 78.6±18.2 percent in 27 patients. VFQ-25 did not correlate with patients' ages, with disability (EDSS), disease duration or medication use. Visual acuity showed a relatively poor (<60 percent) correlation to VFQ-25, while no correlation could be established between visual fields, OCT and disc cupping with VFQ-25. CONCLUSION: MS patients present several alterations in their eyes and sight that cannot be assessed by isolated measures. Ophthalmological examination of these patients must include many parameters not usually used in standard ophthalmologic consultations.

OBJETIVO: Avaliar a qualidade de vida visual de pacientes com esclerose múltipla (EM) e observar se este parâmetro pode ser relacionado aos achados do exame oftalmológico. MÉTODO: O questionário traduzido e validado 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) foi utilizado para avaliar a qualidade de vida visual. Dados clínicos da EM, acuidade visual, campo visual, tomografia de coerência óptica (OCT) e escavação do disco foram utilizados para correlação com VFQ-25. RESULTADOS: A média do VFQ-25 foi 78,6±18,2 por cento em 27 pacientes. VFQ-25 não se correlacionou com a idade dos pacientes, com a incapacidade (EDSS), duração da doença ou medicação em uso. A acuidade visual mostrou uma correlação relativamente pobre (<60 por cento) com VFQ-25, enquanto não foi observada nenhuma correlação entre campo visual, OCT e escavação de disco com VFQ-25. CONCLUSÃO: Pacientes com EM apresentam diversas alterações oculares e na visão que não podem ser avaliadas por medidas isoladas. O exame oftalmológico destes pacientes deve incluir parâmetros que não são habitualmente utilizados em consultas oftalmológicas padronizadas.

Toric intraocular lens misalignment inducing astigmatism after refractive surgery.

PURPOSE: To report the unexpected induction of astigmatism after phacoemulsification and toric intraocular lens (IOL) implantation in an eye with previous corneal refractive surgery. METHODS: Case report of a 46-year-old man with bilateral nuclear cataract and previous photorefractive keratectomy. Because corneal topography identified regular corneal astigmatism at the central optical zone, phacoemulsification and implantation of a one-piece hydrophobic acrylic toric IOL were performed. RESULTS: Unexpected induction of astigmatism occurred in the first operated eye despite proper alignment of the IOL according to the preoperative calculations using simulated K values to determine toric IOL power and alignment. A retrospective qualitative analysis of corneal topography showed mismatching of the steepest meridian, leading to an off-axis IOL. Secondary IOL rotation improved both uncorrected and corrected distance visual acuity. CONCLUSIONS: Qualitative analysis of the corneal topography is mandatory during the assessment of toric IOL alignment in eyes with previous corneal refractive surgery to identify the actual location of the steepest meridian.