Comparison of Toric Implantable Collamer Lens and Toric Artiflex Phakic IOLs in Terms of Visual Outcome: a Paired Contralateral Eye Study.

PURPOSE: This study sought to compare the postoperative visual outcomes of toric implantable collamer lens (T-ICL) with toric Artiflex (T-Artiflex) lenses. DESIGN: Alternating treatment, contralateral eye matched clinical study. METHODS: This study compared 82 eyes of 41 patients with T-ICL lenses in one eye and toric Artiflex implantation in the contralateral eye to correct myopic astigmatism. Safety, efficacy, predictability, astigmatic vector changes, contrast sensitivity, endothelial cell count, and possible adverse events were assessed at least 12 months postoperatively. RESULTS: After a mean follow-up of 12 months, the safety index was mean 1.40 ± 0.70 in the T-ICL group and 1.20 ± 0.21 in the T-Artiflex group. Furthermore, their mean efficacy indexes were 1.24 ± 0.42 and 1.08 ± 0.23, respectively (P = .029). A total of 39 eyes (95%) in the T-ICL group and 41 eyes (100%) in the T-Artiflex group were within ±1.00 diopter (D) of emmetropia and 33 eyes (80%) and 34 eyes (83%) were within ±0.5 D of emmetropia, respectively. Vector analysis revealed mean index of success as large as 0.25 ± 0.22 in the T-ICL group and 0.24 ± 0.15 in the T-Artiflex group. Postoperative contrast sensitivities were equal in both groups under mesopic conditions for any given spatial frequency. There was an endothelial loss of 2.18% and 1.95% in the T-ICL and T-Artiflex groups, respectively. There were no significant complications in any of the groups. CONCLUSIONS: Both lenses showed promising results in terms of safety, efficacy, and predictability for correction of myopic astigmatism. As shown in this paired-eye study, most outcomes were almost identical, and neither of these lenses were clinically superior to the other.

Toric Intraocular Lens for Astigmatism Correction in Cataract Patients.

BACKGROUND: To assess the clinical consequences of AcrySof toric intraocular lens (IOL) and Hoya toric IOL implantation to correct preexisting corneal astigmatism in patients undergoing cataract surgery. MATERIALS AND METHODS: In this study, we examined 55 eyes of 45 patients with at least 1.00 D corneal astigmatism who were scheduled for cataract surgery. After phacoemulsification, toric IOL was inserted and axis was aligned. We observed the patients, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, manifest refraction, and IOL axis alignment 6 months after surgery. RESULTS: After 6 months, the UDVA was 0.17 ± 0.17 logMAR in the AcrySof group and 0.17 ± 0.18 logMar in the Hoya group. More than 78% of eyes in the AcrySof group and 80% of eyes in the Hoya toric IOL achieved a UDVA of 20/40 or better. In the AcrySof group, the mean preoperative corneal astigmatism was 2.73 ± 0.92 D. The mean postoperative refractive astigmatism was 0.84 ± 0.63 D. In the Hoya group, the preoperative corneal astigmatism was 2.58 ± 0.76 D and the postoperative refractive astigmatism was 0.87 ± 0.66 D (P < 0.05). The mean AcrySof IOL axis rotation was 1.88° ± 3.05°. In the Hoya group, the mean axis rotation was 1.53° ± 3.66°. All changes in visual and refractive data before and after surgery were statistically significant (P < 0.05). There was no significant difference between the two groups regarding refractive and visual outcome after surgery (P > 0.05 for all). CONCLUSION: Implantation of AcrySof toric IOL and Hoya toric IOL was an effective way to correct preexisting corneal astigmatism in cataract surgery.

Comparison of Scheimpflug and swept-source anterior segment optical coherence tomography in normal and keratoconus eyes.

PURPOSE: The purpose of the study was to assess the agreement of anterior segment optical coherence tomography with its older well-known opponent i.e., Sheimpflug imaging in evaluation of the cornea in normal and keratoconus subjects. METHODS: 107 normal and 56 keratoconus eyes were evaluated with the anterior segment optical coherence tomography followed by the Scheimpflug imaging. Parameters included axial keratometry data in both of steep and flat meridians, mean keratometry and the astigmatism values in the central 4.0 mm zone, central, thinnest and apex corneal thicknesses, Q-value in 8 mm zone and pupil diameter. Corneal topographic maps were recorded and were evaluated for anterior highest and lowest points, posterior highest and lowest points. Average values were recorded for analysis. RESULTS: All anterior cornea keratometry indices showed perfect agreement between two devices in normal corneas; while the level of agreement in keratoconus cases ranged from moderate to strong. All posterior keratometry indices also showed perfect agreement in both groups; except for flat K in normal corneas and steep K in KC ones. The amount of corneal cylinder in normal corneas had perfect agreement, and moderate to strong agreement in anterior/posterior cornea in keratoconus group. Anterior highest and lowest points showed strong and perfect agreement in normal and keratoconus cases, respectively. Posterior highest and lowest points showed strong agreement in normal cases. Thickness indices (central, thinnest, and apex thicknesses) showed perfect agreement between two devices in both normal and KC groups. Mean values of anterior and posterior highest points were statistically higher in Scheimpflug system. CONCLUSIONS: Although two imaging technologies had statistically numerical different output, it seems that they have a good agreement in most parameters.

Photorefractive keratectomy for patients with preoperative low Schirmer test value.

PURPOSE: To compare dry eye signs and symptoms between patients with preoperative low and normal Schirmer test after Photorefractive keratectomy (PRK). METHODS: In this prospective, nonrandomized, comparative case series, 76 eyes of 76 patients were preoperatively categorized into two groups according to selected criteria for characterization of tear film status: the low Schirmer test value (STV) group and the normal STV group. For the tear function assessment, we performed a Schirmer test with and without anesthesia, tear break-up time (TBUT) test, and measurement dry eye symptoms using the Farsi translation of Ocular Surface Disease Index (OSDI) questionnaire pre- and 3 months post-operation. RESULTS: Postoperatively, the Schirmer and TBUT values were significantly lower in both groups than preoperatively (all p < 0.05). Deterioration in tear secretion was significantly greater in the low STV group (p = 0.012), but tear stability was more compromised in the normal STV group (p = 0.021). The changes in OSDI score were not significant between the two groups. CONCLUSION: These results demonstrated that tear function deteriorates after PRK. Therefore, patients with low preoperative Schirmer test values should be thoroughly assessed for dry eye before proceeding with refractive surgery to eliminate postoperative complication.

Evaluation of the outcomes of corneal collagen cross-linking in progressive keratoconic eyes.

BACKGROUND: Corneal collagen cross-linking (CXL) is gaining popularity as a treatment in arresting the progression of keratoconus. It is a relatively new therapy using ultraviolet-A (UVA) with a photosensitizer to increase corneal stiffness. The purpose of this study was to evaluate visual, keratometric and topographic outcomes after corneal CXL in progressive keratoconic eyes. MATERIALS AND METHODS: In this prospective nonrandomized clinical study, 140 eyes of 110 patients with progressive keratoconus were treated by combined riboflavin/UVA CXL. Mean sphere, mean cylinder uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive spherical equivalent, corneal topography, pachymetry, and endothelial cell morphology were examined preoperatively and 12-24 months postoperatively. RESULTS: The preoperative mean sphere was -3.33 ± 3.13 diopter (D) and decreased to -3.09 ± 3.09 D (P = 0.007). The preoperative mean cylinder was -4.05 ± 2.29 D and changed to -3.79 ± 2.23 D (P = 0.011). UDVA changed from 0.95 ± 0.64 logarithm of the minimum angle of resolution (logMAR) to 0.85 ± 0.59 logMAR (P = 0.003). Thirty-five eyes (25%) gained one or more lines of preoperative UDVA, 87 eyes (62.1%) did not change and 18 eyes (12.8%) lost one or more lines of the preoperative UDVA. CDVA in 80% of the patients remained stable (no lines lost). Statistical analysis of keratometry, pachymetry, and endothelial cell count did not show the significant difference after surgery. CONCLUSION: Our study showed improvement in visual and refractive results of the corneal CXL and confirmed that CXL is the safe and effective procedure.

Flexible toric iris claw phakic intraocular lens implantation for myopia and astigmatism.

PURPOSE: To assess the visual and refractive outcomes of flexible toric iris claw phakic intraocular lens implantation for correction of moderate to high myopia with astigmatism. METHODS: In this non-randomized prospective study, 31 eyes of 18 patients including 8 male and 10 female subjects with mean age of 27.62±5.53 (range 19 to 38) years with moderate to high myopia and astigmatism underwent toric Artiflex (Ophtec BV, Groningen, Netherlands) phakic intraocular lens (PIOL) implantation. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were measured in logarithm of minimum angle of resolution (logMAR) notations. Manifest refraction, safety, efficacy, predictability and complications were measured 6 months after surgery. RESULTS: Pre-operatively, mean spherical equivalent (SE) refractive error was -9.68±1.92 (range -14.00 to -6.00) diopter (D) and mean cylinder was -2.79±1.06 (range -4.75 to -1.00) D. After a minimum of 6 months, mean SE was -0.38±0.27 (range -0.87 to 0.00) D and mean cylinder was -0.66±0.43 (range -1.50 to 0.00) D. SE was within 0.50 D of emmetropia in 63.8% and within 1.0 D of target refraction in 100% of eyes. UDVA was equal or better than 20/20 in 45.1% of eyes while CDVA was equal or better than 20/20 in 67.7%; 83.8% of eyes gained 1 or more Snellen lines of CDVA after surgery. No serious complications occurred in this series of cases. CONCLUSIONS: Implantation of the toric Artiflex PIOL is a safe and effective procedure for correction of moderate to high myopia with astigmatism.

Antifungal efficacy of soft contact lens disinfecting solutions against Fusarium solani and Candida albicans.

PURPOSE: The aim was to evaluate the disinfection properties of six multi-purpose contact lens disinfection solutions (MPDS) available in Iran against Fusarium solani and Candida albicans, based on the International Organization for Standardization (ISO) 14729 guidelines. METHODS: Three lots each of six multi-purpose solutions, namely, Renu MultiPlus, Solo Care Aqua, All-Clean soft, Contact All In One Advanced, Hippia, Ginza Multi-Purpose Solution and 0.9% normal saline solution were inoculated with standard strains of Fusarium solani (ATCC 36031) and Candida albicans (ATCC 10231). Surviving fungi were determined by counting colony-forming units on recovery plates at specified times. The mean log reduction in fungal numbers at the manufacturer's minimum recommended disinfection time was determined and compared with the criteria for stand-alone disinfection products for each MPDS against each fungal strain. RESULTS: Renu MultiPlus, Contact All In One Advanced and All-Clean Soft were effective in achieving the mean 1.0 log reduction in fungal numbers, based on ISO 14729 stand-alone primary acceptance criteria. Solo Care Aqua failed to achieve the ISO 14729 stand-alone primary acceptance criteria for Candida albicans. The other solutions were not effective against test microorganisms after the specified times. CONCLUSIONS: There were differences in the rates of disinfection efficacy. Generally, Renu MultiPlus, Contact All In One Advanced and All-Clean Soft exceeded the primary acceptance criteria of the ISO 14729 guidelines for stand-alone contact lens solutions.

Tear Film Break-up Time in Bipolar Disorder.

OBJECTIVE: Ocular dryness is a well-recognized adverse side effect of many topical and systemic medications. In psychiatry, patients who have consumed such drugs as lithium carbonate and sodium valproate frequently experience dry eye symptoms. The purpose of this study was to compare tear film stability between patients who use these drugs with those patients who are not on medication. METHODS: After obtaining informed consent, the tear film break up time (TBUT) test was performed in 96 eyes of 48 subjects. The subjects were placed in to three groups. Participants included two groups of euthymic bipolar disorder patients (16 cases each) with history of pharmacotherapy for more than two years. Patients in each group were taking only one type of mood stabilizer (lithium carbonate or sodium valproate). In addition,16 age-matched bipolar patients who did not take any topical or systemic medications were included in a control group. Values of TBUT were compared between the three groups using the student's t-test. RESULTS: The mean tear film break up time (TBUT) in test groups were 4.88 seconds± 0.34(lithium group), 4.81 seconds ± 1.60 (valproate group) and 15seconds± 2.0(control group), respectively. No statistically significant differences were observed between the first and the second groups in TBUT values, but significant differences were found between the two groups and the control group (P< 0.0001). CONCLUSION: The results of this study show that lithium carbonate and sodium valproate contribute to decrease of tear film break up time, resulting from dryness of the eyes.

Comparative efficacies of contact lens disinfecting solutions against Pseudomonas aeruginosa.

PURPOSE: The aim of the present study was to evaluate the disinfection properties of multipurpose contact lens disinfection solutions, based on the International Organization for Standardization (ISO) 14729 guidelines. METHODS: Three lots of each of six multi-purpose solutions were tested as follows: Renu MultiPlus, Solo Care Aqua, All-Clean Soft, Contact All-in one Advanced, Hippia, Ginza multi-purpose solution and 0.9% normal saline solution were inoculated with the standard strain of Pseudomonas aeruginosa (ATCC 9027). The surviving bacteria were quantified at specified times. An average logarithm reduction in bacterial numbers at the manufacturer's minimum recommended disinfection time was determined and compared with the criteria for stand-alone disinfection products for each multi-purpose disinfection solution against each bacterial strain. RESULTS: Renu MultiPlus, Solo Care, All-Clean Soft and Contact All-in one Advanced were effective in achieving a four logarithmic units reduction in the bacterial count; however, Renu MultiPlus and Solo Care Aqua resulted in the greatest reduction in bacterial numbers. The other solutions were not effective against Pseudomonas aeruginosa after specified times. CONCLUSIONS: Generally, Renu MultiPlus, Solo Care Aqua, All-Clean Soft and Contact All-in one Advanced meet the ISO 14729 guidelines for stand-alone contact lens solutions.