Efficacy and Safety After Toric Posterior Chamber Implantable Collamer Lens and Toric Iris-Fixated Foldable Phakic Intraocular Lens for Myopic Astigmatism.

PURPOSE: To compare visual, refractive, and safety outcomes of toric posterior chamber Implantable Collamer Lens (T-ICL) (STAAR Surgical) and toric iris-fixated foldable phakic intraocular lens (IOL) (T-Artiflex; Ophtec BV) implantation for the correction of myopic astigmatism. METHODS: This retrospective cohort study included 312 eyes of 312 patients who had phakic IOL implantation for myopic astigmatism. Two groups were defined: 205 eyes that underwent T-ICL implantation and 107 eyes that underwent T-Artiflex implantation. Safety, efficacy, and predictability outcomes were evaluated preoperatively and at 12 months postoperatively. Refractive and corneal astigmatic vector analysis were performed using the Alpins method. RESULTS: One year postoperatively, uncorrected distance visual acuity was 0.05 ± 0.18 (T-ICL) and 0.10 ± 0.16 (T-Artiflex) logMAR, with efficacy indexes of 1.16 ± 0.27 and 1.05 ± 0.31, respectively (P < .001). Safety indexes were 1.28 ± 0.30 and 1.21 ± 0.31, respectively (P = .04). Spherical equivalent was within ±0.50 diopters (D) of emmetropia in 165 (80.5%) and 88 (82.2%) eyes, respectively. Refractive astigmatic analysis showed an index of success of 0.28 ± 0.33 (T-ICL) and 0.31 ± 0.26 (T-Artiflex) (P = .07). Surgically induced corneal astigmatism was 0.48 ± 0.74 and 0.81 ± 0.61 D, respectively (P < .001). Mean endothelial loss was 1.11% and 2.05%, respectively (P = .42). Six (2.9%) eyes in the T-ICL group and 1 (0.9%) eye in the T-Artiflex group had phakic IOL repositioning due to significant misalignment. No vision-threatening complications occurred. CONCLUSIONS: Both the T-ICL and T-Artiflex groups showed high visual and refractive efficacy with a good safety profile for the correction of myopic astigmatism. T-ICL implantation demonstrated significantly better efficacy and safety indexes after 12 months. Vector analysis showed similar refractive astigmatic correction in both groups, but T-Artiflex implantation revealed higher surgically induced corneal astigmatism. [J Refract Surg. 2022;38(6):339-347.].

Purtscher-like retinopathy: Ocular findings in a young woman with chronic kidney disease.

PURPOSE: To report a case of Purtscher-like retinopathy treated with systemic steroids in a young woman with chronic kidney disease. OBSERVATIONS: An 18-year-old female with a stage 3b chronic kidney disease presented with bilateral, sudden vision loss during an influenza-like syndrome. Best corrected visual acuity (BCVA) was 20/32 bilaterally and fundoscopic examination revealed cotton-wool spots, Purtscher flecken and intraretinal haemorrhages. Flourescein angiography showed areas of retinal ischemia with vascular leakage and optical coherence tomography showed cystoid macular oedema. The patient completed a short-course treatment with high-dose oral steroids. After 1 week, BCVA was 20/20 bilaterally. After 1 month, fundoscopy and imaging evaluation revealed complete resolution of the retinal injury. This favorable outcome remained stable throughout the 1-year follow-up. CONCLUSIONS: AND IMPORTANCE: Purtscher-like retinopathy is a rare, sight-threatening retinal disorder. We described a case of retinal injury presumably related to chronic kidney disease and possibly triggered by an influenza-like syndrome, with a favorable visual recovery.

Foveal and Extrafoveal Effects of Half-Dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy: A Cohort Study.

PURPOSE: To compare the efficacy and safety of foveal and extrafoveal half-dose photodynamic therapy (HD-PDT) for chronic Central Serous Chorioretinopathy (cCSC). METHODS: This retrospective, cohort study included cCSC eyes submitted to HD-PDT on foveal (F) or extrafoveal (E) areas. Patients were evaluated at baseline and 12 weeks after treatment for best corrected visual acuity (BCVA) and the following spectral-domain optical coherence tomography (SD-OCT) subfoveal parameters: central macular thickness (CMT), outer nuclear layer, external limiting membrane, ellipsoid zone, interdigitation zone, choroidal thickness and subretinal fluid (SRF). RESULTS: F group comprised 33 eyes (47.1%) and E group comprised 37 eyes (52.9%). Both groups showed an improvement of BCVA after HD-PDT with no significant differences in final BCVA (p = .41). CMT and SRF showed a significant improvement after HD-PDT in both groups, but the rate of disruption of the external retinal layers remained stable. During follow-up, SD-OCT parameters and the rate of anatomical success showed no significant differences regarding the treatment location. No major sequelae were noticed. CONCLUSION: Foveal and extrafoveal applications of HD-PDT for cCSC showed comparable efficacy and safety.

Posterior chamber collamer phakic intraocular lens implantation: Comparison of efficacy and safety for low and moderate-to-high myopia.

PURPOSE: To compare visual, refractive and safety outcomes of central-hole posterior chamber collamer phakic intraocular lens implantation for low and moderate-to-high myopia. SUBJECTS/METHODS: This retrospective cohort study included 338 eyes submitted to posterior chamber collamer phakic intraocular lens implantation that completed a 12-month postoperative follow-up. Two groups were defined depending on preoperative spherical equivalent: group 1 comprised 106 eyes with manifest spherical equivalent of -6.00 D or less; group 2 comprised 232 eyes with manifest spherical equivalent higher than -6.00 D. Effectiveness, predictability, stability and safety outcomes were compared preoperatively and at 1, 6 and 12 months postoperatively. RESULTS: At 1-year postoperative, uncorrected and corrected visual acuities were 0.02 ± 0.17 and -0.01 ± 0.12 logMAR (group 1) and 0.04 ± 0.20 and 0.01 ± 0.16 logMAR (group 2), with an efficacy index of 1.05 ± 0.17 and 1.17 ± 0.28. Respectively, 92 (86.8%) and 199 (85.8%) eyes were within ±0.50 D of targeted refraction, and postoperative manifest refraction changes were -0.07 ± 0.25 D and -0.07 ± 0.35 D. Intraocular pressure did not change significantly. The mean rate of endothelial cell loss was 1.12% and 1.10%, respectively. One case of anterior subcapsular cataract (group 2) was observed. ICL exchange occurred in one case (group 1) and three cases (group 2). No vision-threatening complications were reported. CONCLUSION: The posterior chamber collamer phakic intraocular lens implantation demonstrated high visual and refractive efficacy with an excellent safety profile for the correction of both low and moderate-to-high myopia, revealing equivalent 1-year outcomes regardless of the degree of preoperative myopia.

Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy - Success Rates and Related Factors During 3 Years of Follow-Up.

Purpose: To evaluate the success rates of transcanalicular diode laser-assisted dacryocystorhinostomy (TCL-DCR) during 3 years of follow-up and to find clinical factors that influence surgical outcomes.Methods: Major outcomes were the anatomical success defined as a patent neo-ostium tested by irrigation and the functional success defined as a patent osteotomy with the absence of epiphora, accessed at 6-month, 1, 2, and 3-year follow-up visits. To determine which factors influence success rates, patients were divided according to gender, age, previous lacrimal surgeries, nasosinusal anatomy, energy employed, treatment with topical prostaglandin analogs, and timing of extubation.Results: A total of 134 eyes were included. 55.2% of patients underwent peribulbar block. The surgical mean duration was 30.6 min. We obtained anatomical and functional success rates of 80.0% and 70.8% at 6 months; 69.3% and 61.4% at 1 year; 64.2% and 58.0% at 2 years; 56.4% and 46.2% at 3 years, respectively. Functional success was significantly higher in younger patients (p = .008). Bicanalicular intubation for 2 months improved anatomical and functional success rates (p = .028 and p = .001, respectively). No other factors showed a significant impact. 85.8% of patients didn´t experience any complications. Palpebral swelling was the most frequent complication.Conclusion: TCL-DCR is a minimally invasive, repeatable, and safe alternative to treat nasolacrimal duct obstructions. We found success rates comparable to literature and stated that younger patients and those intubated for 2 months show better results.

Long-term efficacy and safety results after iris-fixated foldable phakic intraocular lens for myopia and astigmatism: 6-year follow-up.

PURPOSE: To evaluate the long-term efficacy and safety of iris-fixated foldable phakic intraocular lenses (pIOLs) for the management of myopia and astigmatism after 6-year follow-up. SETTING: Ophthalmology Department, Hospital Braga, Portugal. DESIGN: Retrospective cohort study. METHODS: Patients included underwent iris-fixated foldable Artiflex pIOL implantation between January 2010 and December 2013. Follow-up evaluations were performed 6 months postoperatively and every 12 months until 72 months. Preoperative and follow-up data on uncorrected and corrected distance visual acuity (CDVA), manifest refraction, endothelial cell density (ECD), and anterior chamber depth (ACD) were analyzed. RESULTS: A total of 177 eyes of 98 patients with a mean age of 32.33 ± 7.13 years were analyzed. There was a statistically significant improvement in CDVA from 0.09 ± 0.02 logMAR preoperatively to 0.04 ± 0.02 logMAR (P < .0001) at 6 years postoperatively. The spherical equivalent demonstrated a statistically significant improvement from -9.50 ± 2.93 diopters (D) to -0.41 ± 0.45 D at 6 years. At 72 months, the efficacy and safety indexes were 0.94 and 1.15, respectively. A mean loss of 31.77 cells/mm2 (1.19%) was observed each year until the sixth year. The overall mean ECD loss after correction for the physiological loss was 3.02% after 6 years. No correlations were observed between the mean ECD loss and the preoperative ACD. CONCLUSIONS: The Artiflex pIOL was a safe, effective, and a stable option to correct myopia. A mean ECD loss of 3.02% was observed over 6 years. No pIOL was explanted due to corneal decompensation.