Characterization and Prediction of the Clinical Outcome of Intense Pulsed Light-Based Treatment in Dry Eye Associated to Meibomian Gland Dysfunction.

This non-comparative prospective case series was conducted to characterize the clinical impact of intense pulsed light (IPL)-based treatment in dry eyes associated to Meibomian gland dysfunction (MGD), defining the predicting factors for a successful outcome with this therapy in a large case series. A total of 390 eyes (195 patients, range: 23-93 years) received four sessions of Optima IPL system (Lumenis, Yokneam, Israel). Significant changes were observed in tear film osmolarity in both eyes (p < 0.001) and in meibum quality (p < 0.001), with more eyes showing clear or yellow secretions after therapy. Mean change in the ocular surface disease index (OSDI) was -8.61, ranging from -27.00 to 11.00. This change was significantly correlated with the baseline value of OSDI (r = -0.489, p < 0.001). The change in osmolarity correlated significantly with the baseline osmolarity in both eyes (right r = -0.636, left r = -0.620, p < 0.001). A linear predicting model of the change in OSDI with therapy was obtained: change OSDI = 10.99 - 0.35 × OSDI - 1.03 × NIBUTRE-LE (mean non-invasive break up time of right and left eye) - 2.03 × Meibum quality grade (p = 0.001; R2: 0.325). In conclusion, the improvement in symptomatology achieved with an IPL-based therapy can be predicted at baseline using a linear model considering the level of MGD and the magnitude of OSDI and NIBUT (non-invasive break-up time).

Keratitis Due to Achromobacter xylosoxidans in a Contact Lens User.

OBJECTIVES: Ocular infections due to Achromobacter xylosoxidans are extremely uncommon; their diagnosis is a challenge and the optimal treatment remains controversial. We present a case of A. xylosoxidans in a contact lens user and a review of the literature to facilitate diagnostic suspicion and empirical therapeutic management. METHODS: Review of the literature in PubMed and MEDLINE. We also document a case diagnosed in our department in January 2016. SETTING: Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. RESULTS: According to the literature, clinical manifestations and antibiotic sensitivity of A. xylosoxidans varied greatly. Our patient with no history of keratopathy presented three risk factors that made the diagnosis suspicious. The infection was resolved with topical moxifloxacin and fluorometholone. CONCLUSIONS: A. xylosoxidans is an uncommon cause of infection, but must be suspected in atypical keratitis, reported contact with warm or still waters, use of contact lenses, or previous corneal damage. In these cases, microbiological studies and antibiotic sensitivity testing are particularly important.

Biomechanical property analysis after corneal collagen cross-linking in relation to ultraviolet A irradiation time.

PURPOSE: To study the biomechanical effect of riboflavin-ultraviolet A irradiation (UVA)-induced collagen cross-linking (CXL) in porcine corneas using two different exposure times of 30 and 60 min. METHODS: Seventeen enucleated porcine eyes were divided into three groups: group A, six eyes without any treatment, group B, six eyes treated by UVA CXL for 30 min, and group C, five eyes treated by UVA CXL for 60 min. Riboflavin (vitamin B2) was used as a photosensitizer in both groups of treatment. Then, the stress-strain behavior of all the specimens was measured to compare the corneal biomechanical properties among the three groups. The Young's modulus E of the mean curve of each group shows the stiffness of treated and untreated tissue. The stress data necessary for stretches of 6, 8, and 12% were used to perform the statistical analysis of the values. RESULTS: Group B (riboflavin-UVA-CXL, 30 min, E = 46 MPa) showed a stiffer behavior than group A (control, E = 29 MPa) . Group C (60 min CXL, E = 28 MPa) showed lower stiffness than group B and a similar mechanical behavior than group A. The statistical analysis of the stress-strain curves showed significant differences in the corneal response between group B and the control at the three values of stretch considered, 6, 8, and 12% (p = 0.025, p = 0.025 and p = 0.037, respectively) and between group B and group C (p = 0.028, p = 0.028, and p = 0.028). No statistically significant difference was found between group C and control (p = 0.855, p = 0.715, and p = 0.584). CONCLUSIONS: The application of 30-min UVA CXL treatment with riboflavin increased stiffness of the porcine corneal tissue. A 60-min UVA-radiated tissue presents lower stiffness than the 30-min treated tissue, showing a similar biomechanical behavior than the untreated corneas. A prolongation of the UVA irradiation time may cause structural weakening of the porcine corneas.

Multifocal intraocular lenses for unilateral cataract in children.

PURPOSE: To evaluate the implantation of apodized diffractive multifocal intraocular lenses (IOLs) in children with unilateral cataract. SETTING: Ophthalmology Service, Hospital Clínico Lozano Blesa, Zaragoza, Spain. DESIGN: Prospective clinical study. METHODS: Five children between 4 and 6 years of age with unilateral cataract had cataract extraction and implantation of an apodized diffractive multifocal IOL (AcrySof Restor SN60D3). Phacoaspiration was accompanied by posterior capsulorhexis followed by an anterior vitrectomy. Uncorrected distance (UDVA), corrected distance (CDVA), and corrected near (CNVA) visual acuities; binocular function using the Worth 4-dot test and the TNO stereotest; and subjective symptoms such as glare and halos were evaluated over 21 months of follow-up. RESULTS: At the final follow-up visit, the mean UDVA was 0.45 ± 0.149 logMAR and the mean CDVA was 0.30 ± 0.06 logMAR with 20/32 in 3 eyes, 20/50 in 1 eye, and 20/63 in 1 eye. The mean CNVA was 0.10 ± 0.05 logMAR (about 20/25) with J1 in 2 eyes, J2 in 1 eye, J3 in 1 eye, and J4 in 1 eye. The stereoacuity was 120 seconds of arc (arcsec) in 2 patients, 240 arcsec in 1 patient, 1980 arcsec in 1 patient, and nonexistent in 1 patient. The Worth 4-dot test showed that 4 patients had fusion. None of the 5 patients complained about halos or glare. No IOL decentration was observed in any patient. CONCLUSION: Implantation of an apodized multifocal IOL seems to be a satisfactory alternative to monofocal pseudophakia in children with unilateral cataract.