Presbyopic LASIK using the Supracor algorithm and micromonovision in presbyopic myopic patients: 12-month visual and refractive outcomes.

PURPOSE: To evaluate the visual and refractive outcomes for presbyopia and myopia treatment using the Teneo 317 M2 platform and the myopic Supracor algorithm. SETTING: Percy Military Hospital and Private Laser Victor Hugo Center, Paris, France. DESIGN: Observational retrospective nonrandomized study. METHODS: 50 eyes (25 patients) treated with bilateral myopic Supracor and micromonovision using the Teneo 317 M2 platform and followed up for 12 months. Study outcomes included binocular and monocular visual acuities (without correction for distance and near vision), the spherical equivalent, predictability, stability, safety, optical aberrations, and complications. RESULTS: The mean age was 50.6 ± 2.7 years, and the mean preoperative spherical equivalent was -2.6 ± 1.4 diopters. At 12 months postoperatively, the mean binocular uncorrected distance visual acuity was 0.02 ± 0.03 logMAR, and 24 patients (96%) achieved an acuity of 20/25 or better. The binocular uncorrected near visual acuity was equal to Jaeger 1 in 18 patients (72%) and Jaeger 2 or better in 23 patients (92%). 12 eyes (24%) had lost 1 Snellen line, and 1 eye (2%) had lost 2 Snellen lines of monocular corrected distance visual acuity. No cases required retreatment; however, 1 eye (2%) underwent revision surgery because of diffuse lamellar keratitis. CONCLUSIONS: This study suggests that Supracor using the Teneo 317 M2 platform is a safe and effective technique for myopia and presbyopia treatment. Supracor is therefore a viable alternative to monovision for presbyopia and myopia. However, a careful patient selection is essential to satisfy realistic expectations.

Tear trough rejuvenation: A safety evaluation of the treatment by a semi-cross-linked hyaluronic acid filler.

The aim of this study is to describe the experience of 33 physicians, dermatologists and surgeons, with the use of a semi-cross-linked hyaluronic acid (HA) gel as a tear trough deformity filler within one month following injection, and to assess patient satisfaction with the procedure. This study is a case series conducted between February 2012 and December 2012 with the use of semi-cross-linked HA to correct tear trough deformity. The filler was administered in the preperiosteal tissues. The study involved case note review and a patient satisfaction survey. A total of 302 eyes of 151 patients were treated by 33 physicians, with a mean follow-up of 3 weeks. Patients were mainly female (86%), and middle-aged (mean age 48 years old). The gel was placed preperiosteally, deep to the orbicularis, anterior to the inferior orbital rim, with a mean volume of 0.48 ml per eye to achieve correction. The injection procedure was performed without local anesthetic for 79% of the patients. No serious adverse event was recorded. Side effects reported by investigators immediately after injection included bruising (11%), swelling (12%), and redness (inflammation 12%). Very few transitional blue discolorations (2.6%) were observed. No patient required dissolution with hyaluronidase. According to our satisfaction survey, all patients had cosmetic improvement. Most patients (97%) described marked or moderate satisfaction with the treatment. At one month, 18% requested additional hyaluronic acid gel for a touch-up injection. This case series confirms the effective use of a semi-cross-linked HA gel in tear trough rejuvenation. It has excellent patient tolerability, minimal complications, and excellent patient satisfaction.

Central PresbyLASIK for Hyperopia and Presbyopia Using Micro-monovision With the Technolas 217P Platform and SUPRACOR Algorithm.

PURPOSE: To analyze the refractive outcomes and satisfaction of presbyopic hyperopes treated with central presbyopicLASIK (presbyLASIK) with induced micro-monovision. METHODS: This retrospective study included 74 eyes of 37 patients treated with central presbyLASIK with micro-monovision using the Technolas 217P excimer laser (Technolas Perfect Vision GmbH, Munich, Germany) between June 2011 and March 2014. Study parameters included uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA), aberrometry, the central steep zone, and patient satisfaction. RESULTS: Median age was 54.3±4 years (range: 46 to 63 years). Mean postoperative spherical equivalent refraction was 0.00±0.58 diopters (D) for dominant eyes and -0.51±0.54 D for non-dominant eyes. Mean binocular UDVA was 0.01±0.10 logMAR (Snellen 20/20) at 6 months and -0.01±0.05 logMAR (Snellen 20/19) at 1 year postoperatively. Mean binocular UNVA was 0.18±0.14 logMAR (Parinaud 2) (Jaeger 1) at 6 months and 0.18±0.12 logMAR (Parinaud 2) (Jaeger 1) at 1 year postoperatively. At 6 months, 79.31% of patients achieved 20/25 and could read Parinaud 2 (Jaeger 1) binocularly. At 1 year, 84.21% of patients achieved 20/25 and could read Parinaud 2 (Jaeger 1) binocularly. The mean central steep zone was 2.35±1.00 D. There were significantly more negative spherical aberration and vertical coma in the central 5 mm postoperatively (P<.05). The re-treatment rate was 6.75%. Eighty-three percent of these patients did not need any glasses for distance and near vision. CONCLUSIONS: This procedure may improve functional near, intermediate, and distance vision in presbyopic patients with low and moderate hyperopia.

Demarcation line evaluation of iontophoresis-assisted transepithelial corneal collagen cross-linking for keratoconus.

PURPOSE: To evaluate the visualization and depth of the demarcation line with anterior segment optical coherence tomography (AS-OCT) after iontophoresis-assisted transepithelial corneal collagen cross-linking (CXL). METHODS: This prospective, consecutive, single center, non-randomized clinical study involved 15 eyes of 12 patients with keratoconus who underwent an AS-OCT scan (Spectralis; Heidelberg Engineering, Inc., Carlsbad, CA) to search for a demarcation line and its depth at 1 month after iontophoresis-assisted transepithelial CXL. AS-OCT scan measurements were performed by two independent examiners. RESULTS: No intraoperative or postoperative complications were observed. Kappa coefficient estimation for operator agreement in demarcation line visualization (whether it was visualized) was 70.6%. The corneal stromal demarcation line was identified in 9 eyes (60%) by both examiners. Mean depth of the corneal stromal demarcation line was 246.67 ± 50.72 µm (range: 183 to 339 µm) for the first examiner and 241.89 ± 62.52 µm (range: 163 to 358 µm) for the second examiner. There were no statistically significant differences for the measurements of the paired comparisons between the two examiners (P = .61). The Pearson correlation coefficient between the measurements was 0.910. CONCLUSIONS: Iontophoresis-assisted transepithelial CXL creates a demarcation line that can be visualized with AS-OCT, which seems less easily distinguishable and shallower than in conventional CXL. However, its depth and visualization seems to be more similar to conventional CXL than transepithelial CXL.

Total IgE and eotaxin (CCL11) contents in tears of patients suffering from seasonal allergic conjunctivitis.

BACKGROUND: To prospectively investigate patients with seasonal allergic conjunctivitis (SAC) during the pollen season and test associations between tears total IgE, eotaxin concentrations, and SAC severity. METHODS: Enrolled patients presented ocular symptoms and clinical signs of SAC at the time of presentation. Ocular itching, hyperaemia, chemosis, eyelid swelling, and tearing were scored, and the sum of these scores was defined as the clinical score. Conjunctival papillae were separately graded. We measured eotaxin concentration in tears by an enzyme-linked immunosorbent assay (ELISA) and total tear IgE by Lacrytest strip. RESULTS: Among thirty patients (30 eyes), 11 showed neither tear IgE nor tear eotaxin, while 15 out of 19 patients with positive IgE values presented a positive amount of eotaxin in their tears (Fisher's test: p < 0.001). The mean eotaxin concentration was 641 ± 154 (SEM) pg/ml. In patients with no amount of tear IgE, we observed a lower conjunctival papilla grade than in patients whose tears contained some amount of IgE (trend test: p = 0.032). In the 15 patients whose tear eotaxin concentration was null, tear IgE concentration was 5.3 ± 3.5 arbitrary units; in the other 15 patients whose eotaxin was positive, IgE reached 21 ± 4.3 arbitrary U (Mann-Whitney: p < 0.001). We measured 127 ± 47 pg/ml eotaxin in patients with no history of SAC but newly diagnosed as suffering from SAC, and 852 ± 218 pg/ml eotaxin in patients with a known SAC (p = 0.008). In contrast, tear IgE concentrations of both groups did not differ statistically significantly (p = 0.947). CONCLUSIONS: If IgE and eotaxin secreted in tears are major contributors in SAC pathogenesis, they however act at different steps of the process.

Anatomic and functional outcome after 23-gauge vitrectomy, peeling, and intravitreal triamcinolone for idiopathic macular epiretinal membrane.

PURPOSE: To report both the functional and anatomic outcome and safety profile of 23-gauge pars plana vitrectomy combined with membrane peeling and intravitreal injection of triamcinolone acetonide in eyes with idiopathic macular epiretinal membranes. METHODS: Retrospective study of 39 consecutive patients who underwent 23-gauge transconjunctival sutureless vitrectomy, membrane peeling, and intravitreal triamcinolone acetonide injection for an idiopathic macular epiretinal membrane between February 2007 and February 2008. Minimum follow-up was 6 months. RESULTS: Thirty-nine eyes of 39 patients were included in the study. The mean follow-up was 7 +/- 2.2 months (range, 6-15 months). Twenty-two eyes (56%) were pseudophakic and 17 (44%) were phakic at the time of surgery. Five of the phakic eyes (29.4%) had worsening of cataracts during the follow-up period. Mean preoperative intraocular pressure was 14 +/- 3.5 mmHg. At the final follow-up, mean intraocular pressure was 14.5 +/- 2.7 mmHg, which did not differ significantly from the intraocular pressure at baseline (P = 0.14, two-tailed t-test). Five (13%) patients needed topical antiglaucoma treatment. Mean preoperative best-corrected visual acuity (BCVA) was 0.28 decimal equivalent (20/71 Snellen equivalent; logarithm of the minimum angle of resolution 0.54 +/- 0.2, range: 1.0-0.2) and improved significantly (P < 0.0001, two-tailed t-test) to a mean of 0.6 decimal equivalent (20/33 Snellen equivalent; logarithm of the minimum angle of resolution 0.22 +/- 0.16, range: 0.6-0) at the final follow-up. The BCVA improved by a mean of 3.2 +/- 2.1 lines (range: 0-8). Twenty-nine patients (74%) demonstrated a gain of > or =3 lines. Mean central macular thickness was 456 +/- 77 microm (mean +/- SD) at baseline, which was significantly reduced at the final follow-up to 327 +/- 79 microm (mean +/- SD; P < 0.0001, two-tailed t-test). Average central macular thickness reduction was 131 +/- 77 microm (mean +/- SD; range: 36-380 microm). A subgroup analysis of 15 selected cases, which had central macular thickness and BCVA measurements after the first postoperative week, demonstrated that 84% of the total final reduction in central macular thickness and 84% of the total final improvement in BCVA occurred already during the first postoperative week. CONCLUSION: Twenty-three-gauge sutureless transconjunctival vitrectomy is a safe and effective technique for the treatment of idiopathic macular epiretinal membranes. The concomitant administration of intravitreal triamcinolone acetonide after pars plana vitrectomy may speed up and improve the anatomic and functional outcome.