Pars plana vitrectomy combined with phacoemulsification versus pars plana vitrectomy only for treatment of phakic rhegmatogenous retinal detachment: a systematic review and meta-analysis.

PURPOSE: To compare the visual, refractive, and anatomical outcomes and incidence of complications between combined pars plana vitrectomy and phacoemulsification (phacovitrectomy) versus pars plana vitrectomy (PPV-only) in phakic eyes with rhegmatogenous retinal detachment (RRD). METHODS: Two independent reviewers searched MEDLINE, Cochrane Central, and Web of Science to identify relevant articles. Prospective or retrospective studies comparing PPV-only and phacovitrectomy for RRD were included. Recruited studies provided information about at least anatomical success or refractive outcomes. Meta-analysis was performed for single surgery success rate, final best-corrected visual acuity (BCVA), postoperative complications, mean predicted refractive error, and mean absolute predicted refractive error. RESULTS: Seven studies (788 eyes) were selected, including two clinical trials and five retrospective comparative case series. The single surgery success rate was similar in PPV-only and phacovitrectomy groups (risk ratio [RR] = 1.02; 95% confidence interval [CI] 0.95-1.10; P = 0.57). Mean final BCVA was significantly better in the PPV-only group than the phacovitrectomy group (MD = 0.06; 95% CI 0.00-0.12; P = 0.04). The risk of epiretinal membrane formation was significantly higher in eyes that underwent phacovitrectomy than PPV-only (RR = 2.85; 0.95% CI 1.5-5.41; P = 0.001). Phacovitrectomy group showed a more myopic final mean predicted refractive error than PPV-only group (MD = -0.31; 95% CI -0.55--0.07; P = 0.01). CONCLUSION: There was no significant difference between the two groups regarding the anatomical outcome. Slightly better visual and refractive results were observed in the PPV-only group. However, the results should be interpreted with caution as the majority of included studies were low-quality retrospective studies.

Changes in in vivo confocal microscopic findings of ocular surface squamous neoplasia during treatment with topical interferon alfa-2b.

PURPOSE: To evaluate in vivo confocal microscopy (IVCM) findings of ocular surface squamous neoplasia (OSSN) during treatment with topical interferon alfa-2b (IFN alfa-2b). METHODS: In this prospective interventional case series, 20 eyes from 20 patients with OSSN were treated with topical IFN alfa-2b 3 million IU/mL four times a day. Treatment was continued for 2 or 3 months after clinical resolution. IVCM was done at baseline, on a monthly basis, and at the end of treatment. Confocal images were evaluated in conjunction with clinical findings during treatment. Limbal dendritic cell (DC) density within the involved areas was calculated manually in confocal images. RESULTS: Topical therapy resulted in clinical resolution of neoplasia in 80% of eyes. Main features of OSSN on IVCM were hyper-reflectivity of epithelium, demarcation line between neoplastic and normal epithelium, and pleomorphic cells. These findings became less prominent in response to IFN alfa-2b therapy. However, some degree of residual epithelial hyper-reflectivity could be detected in 9 (56.2%) subjects who responded to therapy at time of treatment cessation. Limbal DCs density within involved areas was significantly increased at month 1 follow-up compared to baseline only in responders (P < .0001). There was a trend toward higher limbal DCs density in responders to topical IFN alfa-2b than non-responders (208.6 ± 53.5 vs. 153.1 ± 48.2 cell/mm2, respectively; P = .08) at month 1 follow-up. CONCLUSIONS: IVCM is proposed as an adjunctive tool for monitoring OSSN during topical treatment. IVCM documents epithelial cell response as well as limbal DC density increase during topical IFN therapy.

Obesity and Density of the Crystalline Lens: Revisiting a Growing Dilemma.

BACKGROUND/AIMS: Obesity is believed to accelerate age-related cataractogenesis through various biomechanisms. On the contrary, there are also studies advocating the protective role of obesity against the cataract formation process. We investigate the correlation of body mass index (BMI) as a measure for obesity with crystalline optical lens density and opacity in a healthy adult population. METHODS: In a cross-sectional setting, 93 consecutive disease-free adult individuals who were working staff of a university-based hospital were assessed for the association between crystalline lens density and opalescence [measured by the objective Pentacam HR lens densitometry and subjective Lens Opacity Classification System III (LOCS III), respectively] with the degree of obesity as defined by BMI. RESULTS: LOCS III and crystalline lens density readings were positively correlated [Spearman rho CC (p value) = 0.224 (0.034)]. However, we found neither LOCS III nor crystalline lens density to be correlated with BMI [Spearman rho CC = -0.008 (p = 0.943) and -0.062 (p = 0.560), respectively]. CONCLUSIONS: Results from the present study indicate a lack of association between obesity and densitometry of the crystalline in the adult population group. Further studies are required to confirm the order of causality and pathogenesis of this finding.

Erratum.

[This corrects the article DOI: 10.1159/000454979.].

Visual, Keratometric and Corneal Biomechanical Changes after Intacs SK Implantation for Moderate to Severe Keratoconus.

PURPOSE: To report visual outcomes and corneal biomechanical changes after femtosecond-assisted Intacs SK implantation in keratoconic eyes. METHODS: This prospective interventional case series is comprised of 32 keratoconic eyes of 25 patients with mean age of 23.8 ± 5.4 years. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, manifest refraction spherical equivalent (MRSE), keratometry, central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF) were measured preoperatively, and 1, 3 and 6 months postoperatively. RESULTS: Mean UDVA improved from 0.81 ± 0.3 LogMAR preoperatively to 0.53 ± 0.2 LogMAR six months postoperatively (P < 0.001). At 6 months, MRSE was significantly reduced only in eyes with moderate KCN (mean change, +2.61 ± 0.54 diopter [D]; P< 0.001). A significant improvement in sphere (mean change, +1.92 ± 0.37 D; P< 0.001) and mean keratometry (mean change, -3.34 ± 0.47D; P< 0.001) were observed. CCT increased from 446.1 ± 38 µm preoperatively to 462.2 ± 50 µm at six months (P < .001). CRF decreased from 6.5 ± 1.6 mmHg to 5.9 ± 1.1 mmHg six months after surgery (P = 0.02). CDVA, refractive cylinder and CH did not change significantly (P = 0.48, 0.203 and 0.55, respectively). Linear regression analysis disclosed that a decrease in CCT and moderate KCN are associated with higher CRF (standardized B,-0.513 and 0.314;P= 0.004 and 0.024, respectively; Adjusted R square = 0.353). CONCLUSION: Visual, refractive and keratometric indices remarkably improved in a parallel fashion. CRF was inversely associated with CCT. Changes in CRF represent the trend of changes in corneal biomechanics and thickness during the early postoperative months.

Outcomes of Cataract Surgery at a Referral Center.

PURPOSE: To report the outcomes of cataract surgery at a large referral eye hospital and to identify factors associated with less than excellent visual outcomes. METHODS: Hospital records of patients, who had undergone age-related cataract extraction (1,285 procedures) within a two-year period were sampled randomly for 353 patients (405 eyes) and baseline characteristics were recorded. Up to three causes of visual loss (contributory reasons) were considered and the principal cause of "less than excellent outcome," i.e., best spectacle corrected visual acuity (BSCVA) <20/25 was defined as the primary reason. RESULTS: Mean age of the participants was 68.6 years, and 50.7% of enrolled subjects were female. Phacoemulsification had been performed in 92.1% of cases. Out of 405 eyes, 54%, 78%, and 97% achieved BSCVA of ≥20/25, ≥20/40, and ≥20/200, respectively. Poor visual outcomes were significantly associated with older age (OR: 4.55 for age >70 years), female gender (OR: 4.64), ocular comorbidities (OR: 7.68), surgically challenging eyes (OR: 7.33), long and short eyes (versus eyes with normal axial length, OR: 3.24), and being operated on by a novice surgeon (OR: 2.41). The leading contributory reasons for unfavorable outcome, in descending order were maculopathy (17%), posterior capsule opacification (PCO, 11.8%), corneal opacity (5.7%), and degenerative myopia (5.4%). CONCLUSION: Maculopathy, PCO, corneal opacity, degenerative myopia and ARMD may contribute to unfavorable outcomes in cataract surgery.

Triamcinolone acetonide as an adjunct to bevacizumab for prevention of corneal neovascularization in a rat model.

PURPOSE: To evaluate the short-term effects of a single subconjunctival injection of triamcinolone acetonide as an adjunct to subconjunctival bevacizumab for prevention of corneal neovascularization in rats. METHODS: Chemical cauterization was performed in the central cornea of the right eye in 48 male Sprague-Dawley rats (4 eyes were excluded due to perforation and/or infection). Immediately after the injury, the rats were randomly assigned to four treatment groups: controls (n=10), received subconjunctival injection of 0.02 mL balanced salt solution; group 1 (n=12), received 0.02 mL bevacizumab (25 mg/mL); group 2 (n=11), were treated with 0.02 mL triamcinolone acetonide (40 mg/mL); and group 3 (n=11), received both bevacizumab and triamcinolone acetonide. On days 7 and 14 after cauterization, digital photographs of the corneas were taken and the area of neovascularization was calculated and compared among the study groups. RESULTS: The area of corneal neovascularization in all three treatment groups was less than the controls (P<0.05 for all comparisons). On day 7, the corneal avascular area was largest in group 3 (63%). On day 14, the area of corneal neovascularization in groups 2 and 3 was smaller than that in group 1 (P=0.031 and 0.011, respectively), but the difference between groups 2 and 3 was not statistically significant (P=0.552). Microscopic evaluation of the cornea was compatible with gross findings; inflammation and the number of new vessels was the least in group 3. CONCLUSION: Triamcinolone acetonide was more effective than bevacizumab in inhibiting corneal neovascularization. Its adjunctive administration to bevacizumab resulted in even better prevention of corneal neovascularization. However, the produced combined effect was less than the sum of their separate effects and did not match additive or synergistic interactions.

An algorithm for glaucoma screening in clinical settings and its preliminary performance profile.

PURPOSE: To devise and evaluate a screening algorithm for glaucoma in clinical settings. METHODS: Screening included examination of the optic disc for vertical cupping (≥0.4) and asymmetry (≥0.15), Goldmann applanation tonometry (≥21 mmHg, adjusted or unadjusted for central corneal thickness), and automated perimetry. In the diagnostic step, retinal nerve fiber layer imaging was performed using scanning laser polarimetry. Performance of the screening protocol was assessed in an eye hospital-based program in which 124 non-physician personnel aged 40 years or above were examined. A single ophthalmologist carried out the examinations and in equivocal cases, a glaucoma subspecialist's opinion was sought. RESULTS: Glaucoma was diagnosed in six cases (prevalence 4.8%; 95% confidence interval, 0.01-0.09) of whom five were new. The likelihood of making a definite diagnosis of glaucoma for those who were screened positively was 8.5 times higher than the estimated baseline risk for the reference population; the positive predictive value of the screening protocol was 30%. Screening excluded 80% of the initial population. CONCLUSION: Application of a formal screening protocol (such as our algorithm or its equivalent) in clinical settings can be helpful in detecting new cases of glaucoma. Preliminary performance assessment of the algorithm showed its applicability and effectiveness in detecting glaucoma among subjects without any visual complaint.

Erythropoietin levels in aqueous humor of patients with glaucoma.

PURPOSE: To compare the aqueous concentration of erythropoietin (EPO) in eyes with primary open-angle (POAG), pseudoexfoliative (PXFG), and neovascular (NVG) glaucoma with age-matched eyes with cataracts, and to correlate its concentration with other factors including age, gender, intraocular pressure (IOP), type of glaucoma, and severity of glaucoma. METHODS: In this prospective non-randomized comparative study, a total of 26 eyes with cataracts (control group) and 92 glaucomatous eyes (POAG, 40 eyes; PXFG, 26 eyes; NVG, 26 eyes) were enrolled. Aqueous samples (0.1 to 0.2 ml) were obtained during phacoemulsification, trabeculectomy, phacotrabeculectomy, or Ahmed valve glaucoma implants. The aqueous concentration of EPO was measured using an enzyme-linked immunosorbent assay. RESULTS: The mean±SEM aqueous level of EPO was statistically significantly higher in eyes with glaucoma (56.7±9.3 mIU/ml) compared to the control group (0.8±0.51 mIU/ml; p<0.001). Eyes with NVG had the highest aqueous level of EPO. Aqueous EPO concentrations remained considerably elevated even in eyes with controlled IOP in all three types of glaucoma. Eyes with PXFG displayed the greatest change in aqueous EPO concentration proportionate to the IOP level. In simple regression analysis, IOP, mean deviation, and the type of glaucoma were the factors that had a statistically significantly positive correlation with the aqueous level of EPO (p=0.011 and <0.001, respectively). Only the type of glaucoma remained statistically significant in the multiple regression analysis (adjusted R(2)=0.278). CONCLUSIONS: Compared to the control group, the aqueous humor EPO concentration is increased in eyes with POAG, PXFG, and NVG, both with and without controlled IOP. The aqueous level of EPO was more proportionate to the level of IOP in eyes with PXFG compared to eyes with POAG and NVG.