Macular Choroidal Thickening in Keratoconus Patients: Swept-Source Optical Coherence Tomography Study.

PURPOSE: To determine the choroidal thickness (CT) profile in keratoconus (KC) patients using swept-source optical coherence tomography (SS-OCT). METHODS: This was a prospective, cross-sectional study. One hundred two eyes of 52 KC patients were studied using Pentacam and SS-OCT. The macular CT profile was created by manually measuring the distance between the retinal pigment epithelium and the choroid-sclera junction on horizontal b-scans at nine different macular locations. The results were compared to 93 eyes of 93 healthy controls. RESULTS: Mean age of the KC group was 34.9 ± 13.5 years and mean axial length (AL) was 24.1 ± 1.3 mm. Mean topographic KC classification (TKC) was 2.0; 39 eyes were classified as early KC (TKC <1-2), 34 eyes as moderate (TKC 2, 2-3), and 29 as advanced (TKC 3+). Mean subfoveal CT was 383.2 µm in KC patients and 280.5 µm in control group (P < 0.001). CT in KC patients was statistically thicker in all measure locations (P < 0.001). CT in KC eyes decreased with age, approaching control group at >45 years old, losing statistical significance (P = 0.37). CONCLUSIONS: CT in KC patients is statistically thicker than in healthy population. After age 45, CT decreases approaching control group values. TRANSLATIONAL RELEVANCE: This study describes changes in the CT profile of KC patients, a disease that was considered purely corneal. These choroidal changes argue that KC is a disease that likely involves several ocular structures other than the cornea, and could open new research lines related to the pathophysiology of KC.

Analysis of inner and outer retinal layers using spectral domain optical coherence tomography automated segmentation software in ocular hypertensive and glaucoma patients.

OBJECTIVE: To analyse the morphological features and diagnostic ability of eight macular retinal layers using a new segmentation software Heidelberg's Spectralis Optical Coherence Tomography (SD-OCT) in healthy, ocular hypertensive and primary open angle glaucoma patients. METHODS: Single-center, cross-sectional, non-interventional study. 193 eyes from 193 consecutive patients (56 controls, 63 ocular hypertensives, 32 early primary open glaucoma patients and 42 moderate-advanced primary open glaucoma patients). Those patients presenting any retinal disease were excluded. Macular segmentation of the retinal layers was automatically performed using the new segmentation Heidelberg's Spectralis OCT software providing measurements for eight retinal layers. The software provides thickness maps divided into nine subfields. RESULTS: Statistically significant differences in inner layers' thickness was found between all 4 four groups. Superior and inferior sectors of macular retinal nerve fiber layer; nasal, temporal, superior and inferior sectors of ganglion cell layer and inner plexiform layer were significantly different when comparing ocular hypertensive patients and early glaucoma patients. Areas under the ROC curves for early glaucoma diagnosis were 0.781±0.052 for macular retinal nerve fiber layer outer inferior sector, 0.760±0.050 for ganglion cell layer outer temporal sector, 0.767±0.049 for the inner plexiform layer outer temporal sector and 0.807±0.048 for the combination of all three. No differences were found between groups when considering outer retinal layers. CONCLUSIONS: The automated segmentation software from Heidelberg's Spectralis OCT provides a new diagnostic tool for the diagnosis of ocular hypertensive and glaucoma patients.

Systemic Effects of Repeated Intraocular Dexamethasone Intravitreal Implant in Diabetic Patients: A Retrospective Study.

INTRODUCTION: The objective of this study is to evaluate the influence of repeated intraocular dexamethasone implant (Ozurdex) injections on metabolic control in type 2 diabetic patients. METHODS: Retrospective study of 165 type 2 diabetic patients starting Ozurdex treatment who received no less than three consecutive injections. Glycated hemoglobin (HbA1c), serum creatinine, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TGs) were evaluated during 15 months of follow-up after Ozurdex treatment onset. RESULTS: Fifty-seven patients met inclusion criteria. Mean baseline values for HbA1c, creatinine, total cholesterol, HDL cholesterol, and TGs before treatment (7.1%, 1.3, 176.7, 51.1, and 125.6 mg/dl, respectively) were similar to mean values after Ozurdex onset (Wilcoxon test p values were 0.68, 0.41, 0.06, 0.87, and 0.33, respectively) and remained stable during the follow-up period. Mean LDL cholesterol levels increased slightly after Ozurdex treatment onset (90.1 vs 88.2 mg/dl, p = 0.04) but after 15 months of follow-up they had returned to baseline values. Transient increase in LDL cholesterol was remarkable in the group of 24 bilaterally treated patients (96.8 vs 88.4 mg/dl, p = 0.03). A third of these patients increased their baseline LDL values by more than 20%. Even with continuous injections of Ozurdex, LDL cholesterol levels also declined back to baseline by month 15. CONCLUSION: Ozurdex injections had no influence on HbA1c or renal function. Lipid profile changes were mild and transient. However, a significant temporary increase has been found in LDL cholesterol levels in patients receiving simultaneous bilateral injections. Lipid levels should be monitored in patients starting with bilateral Ozurdex injections especially in those with recent history of acute myocardial infarction.

ANALYSIS OF AGE-RELATED CHOROIDAL LAYERS THINNING IN HEALTHY EYES USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To study the changes in the choroidal layers thickness with age in a healthy population using swept-source optical coherence tomography. METHODS: Retrospective data analysis of a subgroup of eyes from a previous single-center, prospective, cross-sectional, noninterventional study. One hundred and sixty-nine healthy eyes were evaluated using swept-source optical coherence tomography. Inclusion criteria were best-corrected visual acuity between 20/20 and 20/25, spherical equivalent between ±3 diopters, and no systemic or ocular diseases. Two independent investigators determined the macular horizontal choroidal thickness (CT) and the Haller's layer thickness across a 9 mm line centered at the fovea. Subjects were divided into five age groups. RESULTS: Mean subfoveal choroidal thickness was 305.76 ± 80.59 µm (95% confidence interval: 294.85-319.33). Mean subfoveal thickness for Haller's layer was 215.47 ± 67.70 µm (95% confidence interval: 207.30-227.86) and mean subfoveal thickness for choriocapillaris plus Sattler's layer was 87.31 ± 40.40 µm (95% confidence interval: 83.38-95.65). No significant differences were found due to gender. Choroidal thickness profile was similar between groups with choroidal thickness and Haller's layer thickness decreasing with age (P = 0.002). CONCLUSION: Choroidal and Haller's layer thickness profiles are similar between different age groups. Age-related choroidal thinning is mostly at the expense of Haller's layer.

Psoriasis and Psoriatic Arthritis-Related Uveitis: Different Ophthalmological Manifestations and Ocular Inflammation Features.

PURPOSE: To compare clinical features of uveitis in patients affected by psoriasis and psoriatic arthritis (PsA). METHODS: A retrospective case-control study. RESULTS: 117 patients were affected by uveitis and psoriasis or PsA (92 and 25 patients, respectively) from 2003 to 2013. Axial PsA was associated with unilateral uveitis onset compared to the peripheral pattern (p < 0.03). The prevalence of eyes with at least one complication involving anterior segment was significantly more represented in the PsA group than the psoriasis one (p = 0.024). Anterior segment complications were more frequently associated with posterior ones in PsA patients than in psoriasis patients (p = 0.005). Most common complications in total sample at baseline examination were cataract (29.7%), ocular hypertension (17%), macular edema (7%), and pupillary seclusion (4.4%). CONCLUSION: Uveitis in patients with psoriasis and PsA may have distinguishing clinical features. PsA patients have more ocular complications than those with psoriasis. Both groups need an ophthalmological examination to promptly detect ocular co-morbidity.

Detection of subclinical keratoconus through non-contact tonometry and the use of discriminant biomechanical functions.

The purpose of the present study was to develop a discriminant function departing from the biomechanical parameters provided by a non-contact tonometer (Corvis-ST, Oculus Optikgeräte, Wetzlar, Germany) to distinguish subclinical keratoconus from normal eyes. 212 eyes (120 patients) were divided in two groups: 184 healthy eyes of 92 patients aged 32.99 ± 7.85 (21-73 years) and 28 eyes of 28 patients aged 37.79 ± 14.21 (17-75 years) with subclinical keratoconus. The main outcome measures were age, sex, intraocular pressure (IOP), corneal central thickness (CCT) and other specific biomechanical parameters provided by the tonometer. Correlations between all biomechanical parameters and the rest of variables were evaluated. The biomechanical measures were corrected in IOP and CCT (since these variable are not directly related with the corneal structure and biomechanical behavior) to warrant an accurate comparison between both types of eyes. Two discriminant functions were created from the set of corrected variables. The best discriminant function created depended on three parameters: maximum Deformation Amplitude (corrected in IOP and CCT), First Applanation time (corrected in CCT) and CCT. Statistically significant differences were found between groups for this function (p=2·10(-10); Mann-Withney test). The area under the Receiving Operating Characteristic was 0.893 ± 0.028 (95% confidence interval 0.838-0.949). Sensitivity and specificity were 85.7% and 82.07% respectively. These results show that the use of biomechanical parameters provided by non-contact tonometry, previous normalization, combined with the theory of discriminant functions is a useful tool for the detection of subclinical keratoconus.

Fifteen years follow-up of photorefractive keratectomy up to 10 D of myopia: outcomes and analysis of the refractive regression.

PURPOSE: To evaluate outcomes of photorefractive keratectomy up to -10.00 D of myopia and -4.50 of astigmatism and to develop a predictive model for the refractive changes in the long term. SETTING: Vissum Corporation and Miguel Hernandez University (Alicante, Spain). DESIGN: Retrospective-prospective observational series of cases. METHODS: This study included 33 eyes of 33 patients aged 46.79±7.04 years (range 40-57) operated with the VISX 20/20 excimer laser with optical zones of 6 mm. No mitomycin C was used in any of these cases. The minimum follow-up was 15 years. The main outcome measures were: uncorrected and corrected distance visual acuity, manifest refraction and corneal topography. Linear regression models were developed from the observed refractive changes over time. RESULTS: Safety and efficacy indexes at 15 years were 1.18 and 0.83, respectively. No statistically significant differences were detected for any keratometric variable during the follow-up (p≥0.103). 15 years after the surgery 54.55% of the eyes were within ±1.00 D of spherical equivalent and 84.85% within ±2.00 D. The uncorrected distance visual acuity at 15 years was 20/25 or better in 60.6% of the eyes and 20/40 or better in 72.73% of the eyes. The correlation between the attempted and the achieved refractions was r=0.948 (p<0.001) at 1 year, and r=0.821 (p<0.001) at 15 years. No corneal ectasia was detected in any case during the follow-up. CONCLUSIONS: Photorefractive keratectomy is a safe refractive procedure in the long term within the range of myopia currently considered suitable for its use, although its efficacy decreases with time, especially, in high myopia. The model developed predicts a myopic regression of 2.00 D at 15 years for an ablation depth of 130 µm.

ASYMMETRY IN MACULAR CHOROIDAL THICKNESS PROFILE BETWEEN BOTH EYES IN A HEALTHY POPULATION MEASURED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To determine the difference in macular choroidal thickness (CT) profile between eyes in healthy individuals using swept-source optical coherence tomography. DESIGN: Cross-sectional noninterventional study. PARTICIPANTS: One hundred and forty eyes from 70 healthy patients with spherical equivalent between ± 3 D and with difference ≤ 0.25 D between eyes were scanned using a swept-source optical coherence tomography (Topcon Corporation). METHODS: Cross-sectional noninterventional study. One hundred and forty eyes from 70 healthy patients with spherical equivalent between ± 3 D and with difference #0.25 D between eyes were scanned using a swept-source optical coherence tomography (Topcon Corporation). A horizontal CT profile of the macula was created in both eyes by manually measuring the subfoveal CT from the posterior edge of retinal pigment epithelium (RPE) to the choroid/sclera junction. Three determinations were performed at successive points 1,000 mm nasal to the fovea and 5 more temporal to the fovea. The differences in CT between both eyes were analyzed. RESULTS: Mean age was 25.4 ± 19.9 years (from 4 to 75). The mean spherical equivalent was 0.18 ± 1.37 D (from -3 to +3). Mean macular nasal CT was thicker in the right eye (RE) than in the left eye (LE) (228.11 ± 69.23 µm vs. 212.27 ± 62.71 µm; P = 0.0002; Student's t-test paired data). Mean subfoveal CT and mean temporal CT was not statistically significantly different between the eyes. No statistically significant differences were observed comparing spherical equivalent in the RE compared with the LE. Both men and women showed a thicker mean nasal choroid in the RE versus the left (men, 226.97 ± 61.56 µm vs. 209.87 ± 60.31 µm; women, 229.63 ± 79.39 µm vs. 215.47 ± 66.68 µm, P = 0.003 and P = 0.03, respectively; Student's t-test paired data). At each nasal determination, CT in the RE was statistically significantly thicker than the LE (N1: 283.72 ± 81.10 µm vs. 269.76 ± 75.81 µm [P = 0.001]; in N2: 230.45 ± 73.47 µm vs. 211.33 ± 66.92 µm [P = 0.0002]; and in N3: 170.16 ± 61.00 µm vs. 155.72 ± 53.87 µm [P = 0.008], respectively). CONCLUSION: To the best of our knowledge, this is the first report suggesting thicker macular nasal choroid in the RE compared with the LE. In contrast, subfoveal CT and temporal CT were not found to be different between eyes.

Laser in situ keratomileusis for -6.00 to -18.00 diopters of myopia and up to -5.00 diopters of astigmatism: 15-year follow-up.

PURPOSE: To evaluate the long-term outcomes of laser in situ keratomileusis (LASIK) for high myopia with or without astigmatism. SETTING: Vissum Instituto Oftalmologico de Alicante and Miguel Hernandez University, Alicante, Spain. DESIGN: Retrospective-prospective case series. METHODS: Laser in situ keratomileusis was performed using the Visx 20/20 excimer laser. The minimum follow-up was 15 years. The main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, and corneal topography. RESULTS: This study included 40 patients (40 eyes) with a mean age of 51.08 years ± 6.67 (SD) (range 41 to 60 years) with high myopia (-6.00 to -18.00 diopters [D]). At 15 years, the safety index was 1.23 and the efficacy index, 0.95. During the follow-up, a significant increase in the dioptric power of all keratometric variables was detected (P≤.028, Friedman test), the most notable increase occurring between 3 months and 1 year (P≤.005). At 15 years, 46.15% of the eyes were within ±1.00 D of the attempted spherical equivalent and 64.10% were within ±2.00 D. The UDVA at 15 years was 20/25 or better in 43.59% of eyes and 20/40 or better in 64.10% of eyes. The postoperative CDVA was significantly better than preoperatively (P<.001). The postoperative complications were minor except in 1 eye in which ectasia occurred. CONCLUSIONS: Laser in situ keratomileusis for high myopia was safe over the long term. However, significant myopic regression with time was detected. Low preoperative pachymetry and low residual stromal bed were predictors of keratometric regression. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Phakic intraocular lens explantation: causes in 240 cases.

PURPOSE: To describe the main causes of explantation of phakic intraocular lenses (PIOLs) according to the anatomical site of implantation (angle supported, iris fixated, or posterior chamber). METHODS: This multicentric, retrospective, and consecutive study sponsored by the Spanish Ministry of Health comprised a total of 240 eyes (226 patients) explanted due to PIOL complications. Clinical data of 144 angle-supported lenses, 24 iris-fixated lenses, and 72 posterior chamber lenses explanted were recorded preoperatively and postoperatively. RESULTS: Mean age of the patients at explantation was 46.30 ± 11.84 years (range: 25 to 80 years). The mean time between implantation and explantation was 381.14 ± 293.55 weeks (range: 0.00 to 1,551.17 weeks). It was 422.33 ± 287.81 weeks for the angle-supported group, 488.03 ± 351.95 weeks for the iris-fixated group, and 234.11 ± 4,221.60 weeks for the posterior chamber group. It was 8.10 ± 5.52 years for the angle-supported group, 9.36 ± 6.75 years for the iris-fixated group, and 4.49 ± 4.25 years for the posterior chamber group. This period of time was significantly shorter in the posterior chamber group (P < .001). Overall, the main causes of explantation were cataract formation (132 eyes, 55%), endothelial cell loss (26 eyes, 10.83%), corneal decompensation (22 eyes, 9.17%), PIOL dislocation/decentration (16 eyes, 6.67%), inadequate PIOL size or power (12 eyes, 5%), and pupil ovalization (10 cases, 4.17%). Cataract development was the cause of explantation in 51.39% of angle-supported cases, 45.83% of iris-fixated cases, and 65.28% of posterior chamber cases. Endothelial cell loss was the cause of explantation in 15.97% of angle-supported PIOLs, 8.33% of iris-fixated PIOLs, and 1.39% of posterior chamber PIOLs. CONCLUSIONS: Cataract is the main cause of PIOL explantation, especially in posterior chamber PIOLs. In the angle-supported group, endothelial cell loss was the second cause of explantation.

Internal, corneal, and refractive astigmatism as prognostic factors for intrastromal corneal ring segment implantation in mild to moderate keratoconus.

PURPOSE: To improve the predictability of the visual and refractive outcomes of intrastromal corneal ring segment (ICRS) implantation in keratoconus patients and highlight the importance of internal astigmatism and its relationship to corneal and refractive astigmatism as prognostic factors. SETTING: Vissum Corporación, Alicante, and Centro de Oftalmología Barrquer, Barcelona, Spain. DESIGN: Retrospective case series. METHODS: Visual, refractive, topographic, and aberrometric variables were evaluated in eyes having ICRS implantation. The eyes were divided into 2 groups according to the relative position of the keratometric axis and refractive axis; that is, coincident axis (0 degree ± 15 [SD]) or uncoincident axis. Internal astigmatism was calculated by vectorial analysis. The relationship between topographic astigmatism and refractive astigmatism was evaluated. The follow-up was 6 months. RESULTS: Of the 127 eyes evaluated, 79 had grade II keratoconus and 48 had grade I keratoconus. Statistically significant differences were found in the relative position of the refractive axis and keratometric axis (P=.017). Internal astigmatism had a significant correlation with the gain in visual acuity in patients with grade II keratoconus (r = -0.455, P=.0001). This relationship was less significant in patients with grade I keratoconus (r = -0.391, P=.021). CONCLUSION: The predictability of visual and refractive outcomes can be significantly increased in grade II keratoconus patients when the relative position of the keratometric and refractive axes; the internal, corneal, and refractive astigmatism; and their combinations are used as prognostic factors. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Comparative outcomes of bimanual MICS and 2.2-mm coaxial phacoemulsification assisted by femtosecond technology.

PURPOSE: To compare the efficacy and safety outcomes of bimanual microincision cataract surgery (MICS) versus 2.2-mm coaxial phacoemulsification assisted by Femtosecond LenSx (Alcon-LenSx Inc., Aliso Viejo, CA). METHODS: This prospective, randomized, observational, comparative case series comprised 50 cataractous eyes of 50 patients receiving femtosecond laser refractive lens surgery followed by a bimanual MICS technique with two 1-mm incisions (25 patients) (FemtoMICS group) and a coaxial phacoemulsification technique with a 1-mm paracentesis and a 2.2-mm principal incision (25 patients) (FemtoCoaxial group). The main outcomes measures were: ultrasound power, effective phacoemulsification time, postoperative spherical equivalent, higher-order aberrations (corneal and internal), corneal thickness, endothelial cell count, macular thickness, and complications during and after surgery. Both groups were absolutely comparable for all variables preoperatively. RESULTS: Mean ultrasound power was 1.8% ± 0.9% for MICS and 14.7% ± 4.9% for 2.2-mm incisions (P < .001). Effective phacoemulsification time values for MICS and 2.2-mm incisions were 1.5 ± 0.9 and 4.5 ± 2.9 sec, respectively (P = .002). Mean postoperative spherical equivalent was −0.26 for FemtoMICS and −0.33 for FemtoCoaxial (P > .05). The efficacy index at 1 month postoperatively was 160.2% for FemtoMICS and 149% for FemtoCoaxial. No significant differences were found in corneal thickness, endothelial cell count, and macular thickness. Complications included posterior capsule rupture (4%) and anterior capsule rupture with no posterior capsule tear (4%) for FemtoMICS and bridges due to incomplete capsulorhexis (4%) for FemtoCoaxial. CONCLUSIONS: MICS and coaxial phacoemulsification techniques assisted by the Femtosecond LenSx achieved excellent safety and efficient outcomes. The FemtoMICS technique was surgically and statistically more efficient than the FemtoCoaxial technique.

Macular choroidal thickness profile in a healthy population measured by swept-source optical coherence tomography.

PURPOSE: To determine choroidal thickness (CT) profile in a healthy population using swept-source optical coherence tomography (SS-OCT). METHODS: This was a cross-sectional, noninterventional study. A total of 276 eyes (spherical equivalent ± 3 diopters [D]) were scanned with SS-OCT. Horizontal CT profile of the macula was created measuring subfoveal choroidal thickness (SFCT) from the posterior edge of retinal pigment epithelium (RPE) to the choroid-sclera junction. Three determinations were performed at successive points 1000 µm nasal and five more temporal to the fovea. Subjects were divided into five age groups. RESULTS: The mean SFCT was 301.89 ± 80.53 µm (95% confidence interval: 292.34-311.43). The mean horizontal macular choroidal thickness (MCT) was 258.69 ± 64.59 µm (95% confidence interval: 251.04-266.35). No difference in CT was found between men and women. Mean SFCT of the different study groups was 325.6 ± 51.1 (0-10 years), 316.7 ± 90.1 (11-20 years), 313.9 ± 80.3 (21-40 years), 264.6 ± 79.3 (41-60 years), and 276.3 ± 88.8 µm in subjects older than 60 years (P < 0.001; ANOVA test). Mean horizontal MCT was 286.0 ± 43.5, 277.7 ± 68.2, 264.0 ± 61.9, 223.4 ± 62.2, and 229.7 ± 66.1 µm, respectively (P < 0.001; ANOVA test). The CT profile was different for each age group. CONCLUSIONS: To our knowledge, this is the first population study of CT of healthy eyes across a broad range of age groups using SS-OCT. As has been determined using spectral-domain OCT, CT decreases with advancing age, especially after age 40. There were no differences due to sex. The greatest CT variation takes place in temporal sectors.

Comparison of iris-claw and posterior chamber collagen copolymer phakic intraocular lenses in keratoconus.

PURPOSE: To evaluate the visual and refractive outcomes, predictability, and stability of phakic intraocular lens (pIOL) implantation in keratoconic eyes and compare the results of 2 pIOL models. SETTING: Vissum Instituto Oftalmologico, Alicante, Spain. DESIGN: Retrospective case series. METHODS: An iris-claw (Artiflex) or collagen copolymer posterior chamber pIOL (PC pIOL) (Implantable Collamer Lens) was implanted in eyes with stable keratoconus. The main outcome measures were postoperative changes from the preoperative manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography, and endothelial cell count. Alpins vectorial analysis was performed. RESULTS: Twenty eyes received an iris-claw pIOL and 28 eyes, a PC pIOL. The mean spherical equivalent was -9.31 diopters (D) ± 4.20 (SD) (range -20.75 to -2.75) preoperatively and -0.46 ± 0.88 D (range -3.25 to 1.00 D) postoperatively (P<.001). No patient lost lines of CDVA. The mean decimal UDVA was 0.08 ± 0.09 preoperatively and 0.71 ± 0.26 postoperatively and the mean decimal CDVA, 0.77 ± 0.24 and 0.87 ± 0.98, respectively (P<.001). The mean efficacy index was 0.90 ± 0.26 and the mean safety index, 1.19 ± 0.29. The mean efficacy index was not statistically different between the PC pIOL (0.88 ± 0.28) and the iris-claw pIOL (0.96 ± 0.22) (P=.058). Refraction was stable during the follow-up. CONCLUSIONS: Phakic IOL implantation is a suitable refractive surgical option for stable keratoconus. It may be especially indicated for the management of high ametropia and showed good efficacy and safety. Refractive and keratometric stability was confirmed.

MICS with toric intraocular lenses in keratoconus: outcomes and predictability analysis of postoperative refraction.

AIMS: To investigate the visual and refractive outcomes, safety, efficacy and stability of cataract surgery in eyes with stable keratoconus. METHODS: 17 eyes (10 patients) diagnosed as stable keratoconus, aged from 34 to 73 years (56.63 ± 12.47), underwent micro-incision cataract surgery (MICS) followed by implantation of toric intraocular lens (IOL). Seven of them were operated bilaterally and three unilaterally. A complete ophthalmological examination was performed preoperatively and postoperatively. The main outcome measures were: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry and manifest refraction. RESULTS: Sphere changed from -1.77 ± 6.57D (-11.00 to 7.00) preoperatively to 0.08 ± 0.79D (-1.25 to 1.75) postoperatively (p=0.211), and cylinder changed from -2.95 ± 1.71D (-7.00 to -0.75) to -1.40 ± 1.13D (-3.25 to 0.00) (p=0.016). UDVA (logMAR) changed from 1.33 ± 0.95 (0.40 to 2.77) to 0.32 ± 0.38 (0.00 to 1.30) (p=0.008) and CDVA (logMAR) changed from 0.32 ± 0.45 (0.01 to 1.77) to 0.20 ± 0.36 (-0.03 to 1.30) (p=0.013). Efficacy and safety indexes were 1.38 ± 0.58 and 1.17 ± 0.66, respectively. Refraction and corneal topography were stable during the follow-up (9.10 ± 5.54 months, 3-15) CONCLUSIONS: MICS surgery using corneal topography data and standard formulas for the calculation of the IOL power is a safe and effective procedure regarding keratometric stability, visual and refractive results.

Ultraviolet damage to the eye revisited: eye-sun protection factor (E-SPF®), a new ultraviolet protection label for eyewear.

Ultraviolet (UV) radiation potentially damages the skin, the immune system, and structures of the eye. A useful UV sun protection for the skin has been established. Since a remarkable body of evidence shows an association between UV radiation and damage to structures of the eye, eye protection is important, but a reliable and practical tool to assess and compare the UV-protective properties of lenses has been lacking. Among the general lay public, misconceptions on eye-sun protection have been identified. For example, sun protection is mainly ascribed to sunglasses, but less so to clear lenses. Skin malignancies in the periorbital region are frequent, but usual topical skin protection does not include the lids. Recent research utilized exact dosimetry and demonstrated relevant differences in UV burden to the eye and skin at a given ambient irradiation. Chronic UV effects on the cornea and lens are cumulative, so effective UV protection of the eyes is important for all age groups and should be used systematically. Protection of children's eyes is especially important, because UV transmittance is higher at a very young age, allowing higher levels of UV radiation to reach the crystalline lens and even the retina. Sunglasses as well as clear lenses (plano and prescription) effectively reduce transmittance of UV radiation. However, an important share of the UV burden to the eye is explained by back reflection of radiation from lenses to the eye. UV radiation incident from an angle of 135°-150° behind a lens wearer is reflected from the back side of lenses. The usual antireflective coatings considerably increase reflection of UV radiation. To provide reliable labeling of the protective potential of lenses, an eye-sun protection factor (E-SPF®) has been developed. It integrates UV transmission as well as UV reflectance of lenses. The E-SPF® compares well with established skin-sun protection factors and provides clear messages to eye health care providers and to lay consumers.

Towards standardization of UV eye protection: what can be learned from photodermatology?

While knowledge about standardization of skin protection against ultraviolet radiation (UVR) has progressed over the past few decades, there is no uniform and generally accepted standardized measurement for UV eye protection. The literature provides solid evidence that UV can induce considerable damage to structures of the eye. As well as damaging the eyelids and periorbital skin, chronic UV exposure may also affect the conjunctiva and lens. Clinically, this damage can manifest as skin cancer and premature skin ageing as well as the development of pterygia and premature cortical cataracts. Modern eye protection, used daily, offers the opportunity to prevent these adverse sequelae of lifelong UV exposure. A standardized, reliable and comprehensive label for consumers and professionals is currently lacking. In this review we (i) summarize the existing literature about UV radiation-induced damage to the eye and surrounding skin; (ii) review the recent technological advances in UV protection by means of lenses; (iii) review the definition of the Eye-Sun Protection Factor (E-SPF®), which describes the intrinsic UV protection properties of lenses and lens coating materials based on their capacity to absorb or reflect UV radiation; and (iv) propose a strategy for establishing the biological relevance of the E-SPF.

Outcomes of a new diffractive trifocal intraocular lens.

PURPOSE: To evaluate refractive and visual parameters related to distance, intermediate, and near vision after cataract surgery and the optical quality of a new diffractive trifocal intraocular lens (IOL). SETTING: Vissum Instituto Oftalmologico de Alicante, Alicante, Spain. DESIGN: Case series. METHODS: Patients had bilateral refractive lens exchange and multifocal diffractive IOL (AT Lisa tri 839 MP) implantation. A complete ophthalmology examination was performed preoperatively and postoperatively. The follow-up was 6 months. The main outcome measures were uncorrected distance (UDVA) and corrected distance (CDVA), intermediate, and near visual acuities; keratometry; manifest refraction; and aberrations (total, corneal, internal). RESULTS: The study comprised 60 eyes of 30 patients (mean age 57.9 years ± 7.8 [SD]; range 42 to 76 years). There was significant improvement in UDVA, uncorrected intermediate visual acuity, uncorrected near visual acuity, CDVA, and distance-corrected intermediate and near visual acuity. The postoperative refractive status was within the range of +1.00 to -1.00 diopter. Total internal aberrations decreased significantly (P<.001). CONCLUSIONS: The trifocal IOL improved near, intermediate, and distance vision in presbyopic patients. The use of 3 foci provided significant intermediate visual results without sacrificing near or distance vision.

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.