The role of mitomycin C and porcine extracellular matrix in phacotrabeculectomy.

PURPOSE: To compare between mitomycin C alone, porcine extracellular matrix alone, and combined low dose mitomycin C with porcine extracellular matrix in term of efficacy and safety in phaco-trabeculectomy surgery. STUDY DESIGN: Prospective comparative. METHODS: Sixty eyes of 60 patients complaining of primary open angle glaucoma and cataract, undergoing phaco-trabeculectomy, were distributed into three groups: group I: surgery was augmented with mitomycin C, group II with porcine extracellular matrix, and group III with porcine extracellular matrix combined with low dose mitomycin C. Intraocular pressure was evaluated, postoperatively, at day 1, week 1, and 1, 3, 6, 9, and 12 months. Bleb vascularity, pre- and post-operative intraocular pressure lowering medications, success of IOP control and complications were also evaluated. RESULTS: After 12 months, the mean preoperative intraocular pressure (mm Hg) improved from 30.85 ± 4.7, 33.8 ± 4.2, and 31.05 ± 5.4 mm Hg, in groups I, II, and III respectively, to 13.8 ± 4.7 (55.2%), 15.2 ± 4.8 (55%), and 13 ± 4.9 (58.1%) (p > 0.05). Success of IOP control, postoperative IOP lowering medications and complications were comparable (p > 0.05). Bleb vascularity was significantly different (p < 0.05). CONCLUSION: Mitomycin C, porcine extracellular matrix and their combination are equally effective in phacotrabeculectomy.

Subjective Perception Of Trifocal IOL Performance, Including Toric Models.

PURPOSE: To study the patients' perception of trifocal IOL (Panoptix™) performance. PATIENTS AND METHODS: 60 eyes of 35 were implanted with trifocal IOL. Refractive (sphere - S, cylinder - Cyl and spherical equivalent - SE, all in D) and visual (distance uncorrected - VAsc, distance corrected - VAcc, intermediate - IntVA, near uncorrected - NVAsc and distance corrected near - NVAcc, all in LogMAR) results were recorded. Patients were asked about satisfaction (per eye), spectacle independence, near and intermediate activities, distance activities in quantity and quality, finally about personal facial care (per patient). Comparison was made between non-toric (48) and toric models, genders (18 males) and between bilateral (25 patients) and unilateral implantations. Results were correlated to age and IOL power. RESULTS: With a SE of mean -0.3 ± 0.5 D, cases achieved mean VAsc 0.09 ± 0.1 (~20/25), VAcc 0.05 ± 0.1 (~20/22), IntVA 0.05 ± 0.9 (~20/22), NVAsc 0.05 ± 0.09 (~~20/22) and NVAcc 0.04 ± 0.8 (~~20/22). Mean level of satisfaction was 85.7 ± 16.5, spectacle independence 96.0 ± 10.6, near activities 95.4 ± 9.8, intermediate activities 97.7 ± 6.4, quantity of distance activities 90.2 ± 10.1, quality of distance activities 88.0 ± 12.1 and facial care 92.6 ± 11.9. All comparisons (non-toric and toric, male and female and bilateral and unilateral implantation) were statistically insignificant (P>0.05). Correlation with age and IOL power was also statistically insignificant (P>0.05). CONCLUSION: As perceived by patients, trifocal IOL resulted in very high level of satisfaction. This satisfaction is reflected on diverse visual activities. This level is achieved regardless of gender, IOL model or even unilateral implantation. It is also achieved regardless the age of patients or preoperative eye status.

Effect of D-Panthenol on Corneal Epithelial Healing after Surface Laser Ablation.

PURPOSE: To study the effect of D-panthenol (provitamin B5) on corneal epithelial healing, in cases of surface laser ablation. Patients and Methods: 45 eyes, of 45 patients undergoing laser surface ablation, received D-panthenol 2% in one eye and artificial tear drops of similar composition not containing D-panthenol in the other eye, postoperatively, for 2 months. Patients were examined daily for 3 days after the procedure. They were then examined weekly for 1 month. An additional examination was made after 2 months. Visual acuity (Log MAR) was assessed at every visit. Rate of healing (% of covered area) and subjective sensation of discomfort (scale 0-5) were assessed in the 1st 3 visits. Residual manifest cylinder (D) (as a parameter of corneal irregularity) and corneal clarity (epithelial and stromal haze) were assessed from week 1 to month 2. RESULTS: During the first 3 days, both groups showed statistically nonsignificant (P > 0.05) results. From week 1 to month 2, eyes receiving D-panthenol showed better vision and less residual cylinder (P < 0.05) at week 1. For all other parameters, and at different examinations, both groups showed a statistically nonsignificant (P > 0.05) difference. Still, eyes receiving D-panthenol showed better values at the majority of the parameters tested. CONCLUSION: D-Panthenol effect on corneal epithelial regeneration is of minimal clinical relevance. A different dosage and a larger sample of patients might reveal a statistical relevance. This trial is registered with https://doi.org/10.1186/ISRCTN81441126.

Quality of Vision after Deep Anterior Lamellar Keratoplasty (Fluid Dissection) Compared to Penetrating Keratoplasty for the Treatment of Keratoconus.

PURPOSE: To compare the visual quality of patients with keratoconus who underwent penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK) with fluid dissection. DESIGN: Cross-sectional, observational study. METHODS: Twelve eyes that underwent PKP (PKP group) were compared to 24 eyes that underwent DALK (DALK group) after complete removal of sutures and stability of refraction. Visual, refractive, corneal topographic, corneal aberrometry, and ocular aberrometry parameters were compared for both groups. The χ2 and Mann-Whitney U tests were used for comparisons as appropriate. P < 0.05 was considered statistically significant. RESULTS: Uncorrected and best spectacle-corrected visual acuity (UCVA and BSCVA, resp.), mean refractive spherical equivalent and mean refractive cylinder (MRSE and MRC, resp.), root mean square of the 3 mm and 5 mm OPD Scan (NIDEK Co. Ltd., Gamagori, Japan), steep and flat meridians (SimK1 and SimK2, resp.), and the difference (corneal cylinder) were not statistically significantly different between groups (P > 0.05, all comparisons). All aberrations, point spread functions (PSF), and the modulation transfer function (MTF) were not statistically different between groups (P > 0.05). CONCLUSION: For our small study, the postoperative PKP and DALK with fluid dissection patient groups had vision/optical quality parameters that were not statistically different. This may indicate that DALK with fluid dissection can replace PKP for keratoconus without compromising vision quality.

Optical and topographic changes in keratoconus after implantation of Ferrara intracorneal ring segments.

PURPOSE: To assess the morphological, optical, and visual properties of the cornea before and after implantation of Ferrara intracorneal ring segments (ICRS) and compare them to normal values. METHODS: Thirty-seven keratoconic eyes were implanted with Ferrara ICRS and compared pre- and postoperatively with 38 non-keratoconic (normal) eyes. Examinations were performed using the NIDEK Optical Path Difference (OPD)-Scan II and analyzed using OPD-Station software. Keratometric data were assessed, in addition to OPD, Zernike coefficients, point spread function (PSF), and modulation transfer function (MTF). RESULTS: Considering correlations, the central 3 mm cornea was found responsible for the low quality vision in keratoconus (P<.01). After implantation of Ferrara ICRS, all keratometric parameters improved significantly. Optical path difference also improved. Except for tilt and other lower order Zernike coefficients, higher order aberrations, PSF, and MTF did not change. The effect of flattening is greater at the central 3 mm, but the para-central changes are responsible for the residual defects (ie, incomplete improvements of high optical and visual functions). CONCLUSIONS: Ferrara ICRS improve topographic and visual results in keratoconic eyes.

Visual and optical performance before and after rotation of a misaligned STAAR Toric Implantable Collamer Lens.

PURPOSE: To document the use of the NIDEK OPD-Scan II/Station as a monitoring tool and clinical aid in the evaluation and re-rotation of a misaligned STAAR Toric Implantable Collamer Lens (TICL). METHODS: A 22-year-old man underwent bilateral TICL implantation. Emmetropia was achieved in the left eye after TICL implantation; however, the right eye showed residual compound myopic astigmatism. Both eyes were evaluated using the OPD-Scan II/Station, and re-rotation of the TICL in the right eye was planned using the internal wavefront and corneal topography maps. The remaining residual error after re-rotation was treated using photorefractive keratectomy (PRK). RESULTS: The left eye showed excellent axis alignment and optical quality. The right eye showed a difference of 8 degrees to 10 degrees in axis of orientation and an under-calculation of the lens power, which resulted in poor optical quality. After rotation of the lens and PRK, emmetropia was achieved and the patient reported resolution of symptoms. Higher order aberrations were reduced by 0.535 microm and the modulation transfer function increased 42% compared to initial TICL implantation. CONCLUSIONS: Internal and corneal surface aberrometry allowed proper evaluation and precise realignment of a TICL. The objective assessment of the internal astigmatism, optical quality, and visual performance aids in planning complicated surgical cases that require combination surgery to restore visual quality.