Safety and efficacy of amniotic cytokine extract in the treatment of dry eye disease.

Purpose: Evaluate the safety and efficacy of cryopreserved amniotic cytokine extract (ACE) in the treatment of subjects with dry eye disease (DED). Patients and methods: This was a retrospective, multicenter, chart review of adult patients with DED that instilled cryopreserved ACE drops twice-daily for 4 or 12 weeks. Patients had corneal fluorescein staining (0-20 range) and/or a lissamine green conjunctival staining score (0-18 range) of ≥3 and ≤9 in at least 1 eye and a score ≥40 (0-100 range) of eye dryness/irritation on a visual analog scale (VAS). Following completion of a treatment course, medical records were reviewed from the initiation of therapy (baseline), and at post-treatment visits (4 weeks, 8 weeks, and 12 weeks). Patient records for visual acuity, adverse events, corneal fluorescein staining, conjunctival lissamine green staining, and symptom scores of ocular dryness/irritation were reviewed for each visit, as available. Safety and tolerability were assessed through the evaluation of patient-reported adverse events recorded in the medical records. Results: A total of 54 eligible patients were identified at 7 clinical sites; 16 patients administered ACE drops for 4-weeks, and 38 patients instilled ACE drops for 12 weeks. Significant improvements in the mean changes from baseline were observed for corneal fluorescein staining, lissamine green staining, visual acuity (LogMar) and VAS ocular symptom scores at the 4-week post-treatment visit (p<0.01). Additional improvements continued out to the 12-week follow-up assessment visits. Two patients discontinued therapy due to reports of ocular burning or foreign body sensation. Conclusion: The cryopreserved ACE formulation was well-tolerated and effective in reducing the clinical signs and symptoms of DED. Conduct of a vehicle-controlled prospective study is warranted.

Toric outcomes: Computer-assisted registration versus intraoperative aberrometry.

PURPOSE: To compare refractive outcomes of intraoperative computer-assisted registration and intraoperative aberrometry for the reduction of cylinder during toric intraocular lens (IOL) placement. SETTING: Bowie Vision Institute, Bowie, Maryland, USA. DESIGN: Prospective randomized case series. METHOD: The patients were divided into 2 groups that had toric IOL implantation after phacoemulsification. The intraoperative computer-assisted registration group (Group 1) had preoperative toric calculations. The aberrometry group (Group 2) was guided by a vergence formula and intraoperative pseudophakic cylindrical measurements to determine the final IOL power and intended orientation. The primary outcome measure was the mean postoperative remaining refractive astigmatism, and it was compared with the predicted amount of cylindrical correction with the IOL. RESULTS: Fifty-two patients (104 eyes) had sequential cataract surgery. The mean amount of cylinder correction was 1.60 diopters (D) ± 0.70 (SD) (range 0.75 to 3.08 D) in Group 1 and 1.74 ± 0.79 D (range 0.72 to 3.08 D) in Group 2. The mean remaining refractive astigmatism was -0.29 ± 0.22 D in Group 1 and -0.46 ± 0.25 D in Group 2 (P = .0003). A difference vector of 0.1 @ 87 degrees (0.31 D arithmetic mean) was calculated in Group 1 and 0.0 @ 82 degrees (0.44 D arithmetic mean) in Group 2. The correction index was 1.03 in Group 1 and 0.95 in Group 2. CONCLUSION: Intraoperative markerless computer-assisted registration and biometric guidance summarily yielded less remaining refractive cylinder than toric IOL placement guided by intraoperative aberrometry.

Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment.

Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition.

Continuous Curvilinear Capsulorhexis Performed With the VERUS Ophthalmic Caliper.

PURPOSE: To compare size, circularity, and centration outcomes of continuous curvilinear capsulorhexis (CCC) performed with or without assistance from the VERUS ophthalmic caliper (Mile High Ophthalmics, Denver, CO). METHODS: This was a multicenter retrospective consecutive case controlled series review. RESULTS: Data from 40 consecutive cases using the VERUS device for CCC were compared to 40 consecutive cases with standard manual CCC. VERUS-assisted CCC size, circularity, and centration were closer to target compared to that of manual only procedures (P < .05). The average time from initiation to completion of the capsulotomy was shorter with manual (40 ± 11 seconds) compared to VERUS-assisted (71 ± 13 seconds) cases (P < .0001). CONCLUSIONS: The VERUS ophthalmic caliper is effective at improving size, circularity, and centration of the CCC in a time-efficient manner when compared to manual procedures performed without VERUS guidance. [J Refract Surg. 2016;32(10):654-658.].

Posterior capsule opacity as initial manifestation of metastatic cutaneous melanoma.

BACKGROUND: Cutaneous metastatic melanoma usually is locoregional, and represents less than 5% of malignancies known to metastasize to the eye and orbit. When there is intraocular involvement, it most commonly occurs in the choroid, vitreous, and retina. METHODS: We report a case of a 71-year-old woman with metastatic melanoma presenting as a pigmented posterior capsular opacity in a pseudophakic eye 14 months after excisional biopsy of an ulcerative cutaneous melanoma of the upper arm. RESULTS: Histopathology confirmed the presence of melanocytic cells on the surface of the anterior lens optic and the posterior capsular surface, as well as melanophagic invasion of the trabecular meshwork. At 7 months following enucleation, there was no evidence of recurrence by either computed tomography or sequential positron emission tomography. CONCLUSIONS: To our knowledge this is the first report of posterior capsular opacification serving as the initial manifestation of cutaneous metastatic melanoma. With the incidence of cutaneous melanoma on the rise, and an increasing number of cataract procedures performed annually, clinicians should be are of the different ways cutaneous metastatic melanoma may involve the intraocular structures of the eye.

Outcomes of corneal spherical aberration-guided cataract surgery measured by the OPD-scan.

PURPOSE: To determine based on preoperative corneal spherical aberration, the practicality of targeting zero total ocular postoperative spherical aberration when selecting an aspheric intraocular lens (IOL). METHODS: Consecutive cataract patients were selected to receive an aspheric IOL based on corneal spherical aberration. A target of zero postoperative total spherical aberration Z(4,0) was calculated. One of three IOLs was chosen, based on the corneal spherical aberration Z(4,0) measurement at the 6-mm optical zone. The IOL was selected based on the summation of the corneal spherical aberration and the aspheric value of the prolate optic. The intention was an absolute value of zero total spherical aberration. Statistical analysis of the postoperative total ocular wavefront profile was performed to assess the accuracy of aspheric IOL selection. RESULTS: Forty eyes of 40 patients were available for postoperative assessment. The Tecnis Z9003 (Abbott Medical Optics) was implanted in 25 eyes with a preoperative corneal spherical aberration of +0.311±0.054 µm, the AcrySof IQ (Alcon Laboratories Inc) in 13 eyes (+0.188±0.034 µm), and the SofPort-Advanced Optic with Violet Shield (Bausch & Lomb) was implanted in 2 eyes (+0.0915 µm). Total postoperative ocular spherical aberration for the entire group measured +0.019±0.051 µm (Tecnis: +0.024±0.058 µm; AcrySof IQ: +0.010±0.035 µm; and SofPort AOV: +0.037 µm). Mean absolute predictive error, for the entire group, measured +0.025±0.020 µm. CONCLUSIONS: Skiascopy-derived total wavefront measurement of spherical aberration is a reproducible method of aspheric IOL selection and permits more precise control of total ocular spherical aberration.