Rotational Stability of a New Progressive Toric Hydrophobic Intraocular Lens With Gradually Decreasing Cylinder Power.

PURPOSE: To investigate the rotational stability of a new hydrophobic C-loop one-piece toric intraocular lens (IOL). METHODS: In this retrospective multicenter case series, the Avansee Preload1P Toric Clear (Kowa Co Ltd) was implanted using a digital marking system. Its orientation was assessed with retroillumination photographs at 1 hour, 1 day, 1 week, 1 month, 3 months, and 6 months. The mean rotation at each follow-up examination and percentage of eyes with a rotation within 5° and 10° were recorded. RESULTS: Seventy-two eyes were enrolled and completed the 3-month follow-up examination; data for the 6-month follow-up examination were obtained in 56 eyes. From the first postoperative to the 3-month examination, the mean arithmetic and absolute rotations were 0.58° ± 2.97° and 1.44° ± 2.65°, respectively. During this period, the rotation was 10° or less in 71 of 72 eyes (98.6%) and 5° or less in 67 of 72 eyes (93.1%). In the subgroup of 56 eyes with a 6-month follow-up, the mean arithmetic and absolute rotations were 0.95° ± 2.86° and 2.27° ± 1.96°, respectively, from the first to the last examination. During this period, the rotation was 10° or less in 100% of eyes and 5° or less in 53 of 56 eyes (94.6%). CONCLUSIONS: The new toric IOL has high rotational stability. The measured values were better than the corresponding values previously reported for other toric IOLs at all times considered up to 3 months and similar to them at 6 months. It satisfies the International Organization of Standardization and American National Standards Institute requirements. [J Refract Surg. 2023;39(6):374-380.].

Live surgery outcomes in cataract surgery.

PURPOSE: To evaluate and compare the outcomes of live surgery (LS) and no-live surgery (NLS) on cataract surgery with implantation of different types of intraocular lenses (IOLs). METHODS: Retrospective, contralateral eye, case series of patients that underwent cataract surgery in live or non-live view during two consecutive editions of national meetings. Both eyes of the same patients were implanted with the same IOL, one in LS and the other in NLS. RESULTS: 108 eyes of 54 patients, aged between 50 and 82 (72 ± 8.2) and implanted with different types of IOLs, were reviewed. Both eyes in each patient were well matched at baseline in terms of intraocular biometric characteristics, corneal curvature and endothelial cell density (ECD) (p > 0.05). There are no statistically significant differences between the biometric and topographic parameters, aberrometric data and the loss of ECD in the post-operative outcomes (p > 0.05). However, comparing the different types of IOLs, there is a significant loss of ECD in eyes implanted with a toric IOL during LS (p = 0.0014 and p = 0.04, in 2017 and 2018 edition respectively). CONCLUSIONS: In this series of live cataract surgery, eyes operated in LS or NLS have comparable outcomes, underlying the importance and the benefits of live view in terms of medical education and the low-risk of complications. Nevertheless, we have found a significant increase in ECD loss in patients implanted with toric IOLs during LS.

Comparison of clinical performance and subjective outcomes between two diffractive trifocal intraocular lenses (IOLs) and one monofocal IOL in bilateral cataract surgery.

BACKGROUND: To compare clinical outcomes and subjective experience after bilateral implantation of two diffractive trifocal and one monofocal intraocular lenses (IOLs). METHODS: Fourty-eight patients received bilateral implantation of the RayOne Trifocal IOL (Rayner), the AcrySof IQ PanOptix IOL (Alcon), or the AcrySof IQ SN60WF IOL (Alcon). At 1-month, 3-month, and 12-month follow-up visits, the tested outcomes were monocular and binocular uncorrected and corrected distance, intermediate at 70 cm, and near at 30 cm visual acuities, subjective refractive outcomes, defocus curves, contrast sensitivity and ocular aberrometry. Subjective patient satisfaction in terms of visual disturbance and spectacle independence was also evaluated. RESULTS: Each group comprised 32 eyes (16 patients). Refractive outcomes of RayOne and PanOptix IOLs were comparable. Both trifocal IOLs demonstrated superior visual acuity to the AcrySof monofocal IOL at near and intermediate ranges and along the defocus curves at all points other than at 0.0 D. The patient satisfaction results were comparable between the RayOne and PanOptix trifocal IOL groups. CONCLUSIONS: Both trifocals performed similarly providing good visual outcomes at all distances, demonstrating superior visual acuity compared to the monofocal IOL. Patients implanted with these trifocal IOLs reported similar levels of quality of vision and satisfaction. The RayOne trifocal and PanOptix IOLs are a valuable alternative for patients wishing to seek spectacle independence and low visual disturbances when undergoing cataract surgery.

Supporting IOL'S in a Deficient Capsular Environment: The Tale of No "Tails".

PURPOSE: To evaluate the efficacy and safety of the following three distinct surgical procedures for secondary IOL implantation without capsular support: Iris-claw lens, flanged transscleral fixated IOLs (Yamane technique), and sutureless transscleral hook IOL fixation (Carlevale IOL). MATERIALS AND METHODS: In this retrospective comparative study, three different sutureless IOL implantation techniques were compared in patients without any capsular support. Visual acuity and outcomes were analyzed in 24 eyes of 23 patients (14 male and 9 female). Study included 13 iris-claw lenses (Artisan Ophtec), 6 flanged transscleral fixated IOLs (Yamane technique using a MA60MA Alcon Inc IOL), and 5 transscleral Carlevale IOLS (Carlevale IOL, Soleko, Italy). RESULTS: logMAR mean best-corrected visual acuity (BCVA) improved from 0.49 ± 0.19 to 0.19 ± 0.10 at three months after surgery (p < 0.05). Postoperative BCVA was similar in all three groups, and no intergroup difference was noted. Three eyes (12.5%) had a raised IOP >25 mmHg, 2 eyes (8%) presented a subluxated/dislocated IOL, 4 eyes (16%) had corneal edema longer than 7 days, 3 eyes (12.5%) had irregular pupil profile, 2 eyes (8%) had vitreous hemorrhage, 7 eyes had (29%) corneal astigmatism over 3 diopters, and one patient (4%) developed cystoid macular edema (CME). CONCLUSIONS: All three surgical procedures can be considered adequate to correct aphakia in patients without capsular support with significant improvement in visual acuity and low complication.

One Year Outcomes and Stability of a Novel Scleral Anchored Intraocular Lens.

PURPOSE: To assess one year results and stability of the implantation of a scleral anchored intraocular lens (IOL). DESIGN: Interventional prospective case series. METHODS: Sixty eyes of 60 patients affected by either aphakia or IOL dislocation were included in this study. Patients underwent vitrectomy, scleral fixation of the IOL, and, if present, dislocated IOL removal. Patients were evaluated preoperatively and at 1, 3, 6, and 12 months after surgery by best-corrected distance visual acuity (BCVA) assessment, intraocular pressure (IOP) measurement, corneal specular microscopy, and optical coherence tomography (OCT) of both the macula and anterior segment. RESULTS: At twelve months, mean BCVA significantly improved (p < 0.0001), and none of the patients experienced a decrease of visual acuity. A 10% decrease of endothelial cell count occurred after surgery. Cystoid macular edema occurred in three patients (5%). A transient increase of intraocular pressure was noted in 7 cases (12%). At one month, horizontal and vertical IOL tilt was 1.04 ± 0.87 and 0.74 ± 0.71 degrees, respectively, and did not significantly change in the follow-up (p > 0.05). None of the patients had decentration or dislocation of scleral-fixated IOL during the follow-up. CONCLUSION: Implantations of scleral plug fixated IOL provide good visual results, low complication rate, and excellent stability of the lens until one-year follow-up.

Utility of anterior segment optical coherence tomography in the surgical planning of superficial sclerectomy in oculodermal melanocytosis (nevus of Ota): A case report and review of literature.

PURPOSE: to report the utility of Anterior Segment Optical Coherence Tomography (AS OCT) for planning superficial sclerectomy in a patient with nevus of Ota. OBSERVATIONS: Oculodermal melanocytosis, also called nevus of Ota, is a benign pigmentary disorder that involves the skin innervated by the first and second branches of the trigeminal nerve. To reduce these black or brownish lesions, different surgical treatments have been reported, such as flipped scleral flap, sclera allograft and the grabbing method. Superficial sclerectomy is a recent technique that has proven effective in improving scleral pigmentation. Although this procedure allows the operating time to be reduced and results in a smoother scleral bed surface, it has a limitation, represented by the difficulty of estimating the depth of the sclerectomy: an inaccurate estimate or incorrect depth could cause an inadequate deep scleral dissection with excessive weakening of the sclera. We report a case of a 27-year-old patient with nevus of Ota undergoing superficial sclerectomy. The depth of scleral pigmentation was evaluated with AS OCT images before the surgery, allowing a superficial sclerectomy to be performed with a precalibrated diamond blade. CONCLUSIONS AND IMPORTANCE: In oculodermal melanocytosis (nevus of Ota) the use of AS OCT images showing the depth of scleral pigmentation could lead to the most effective and safest surgical choice for each case.

In vivo evaluation of a 1-piece foldable sutureless intrascleral fixation intraocular lens using ultrasound biomicroscopy and anterior segment OCT.

PURPOSE: To evaluate the optic plate and haptics of a specially designed sutureless intrascleral-fixated intraocular lens (IOL) using ultrasound biomicroscopy and anterior segment optical coherence tomography (AS-OCT). SETTING: Department of Ophthalmology, San Marino Hospital, Republic of San Marino. DESIGN: Retrospective observational case series. METHODS: Eyes that underwent intrascleral fixation with IOL implantation (Carlevale) were included. Preoperative and postoperative refractive outcomes were reported. Optic plate tilt and haptics position were assessed with ultrasound biomicroscopy, whereas intrascleral plug depth and conformation were evaluated with AS-OCT. RESULTS: The study comprised 10 aphakic eyes. Postoperative visual acuity improved in all patients. At postoperative month 3, 3 eyes (30%) had a vertical tilt of more than 100 µm, whereas no horizontal tilt was observed in any patient. The mean vertical intraocular tilt was 0.19 ± 0.22 mm. Of 20 haptics, 13 (65%) passed through the ciliary sulcus, 4 (20%) posterior to the ciliary body, and 3 (15%) through the ciliary body. AS-OCT scans showed a mean intrascleral plug depth of 247.20 ± 62.82 µm in the nasal sector and 265.50 ± 30.11 µm in the temporal sector, with adequate integration of the T-shaped plugs in the scleral tissue. CONCLUSIONS: This secondary IOL showed good intraocular stability and safe haptics fixation, making it suitable for the intrascleral fixation technique. The specific foldable design results in a low predisposition to optic plate tilt and haptic torsion. In long eyes, the sulcus-to-sulcus distance should be carefully evaluated preoperatively because the flexible structure of the IOL could be subjected to excessive stretching.

A novel intraocular lens designed for sutureless scleral fixation: surgical series.

PURPOSE: To report a retrospective series of patients implanted with a novel hydrophilic acrylic single-piece intraocular lens (IOL) designed for sutureless scleral fixation (FIL-SSF Carlevale lens, Soleko, Italy) injectable through a 2.2-mm incision. METHODS: Seventy-eight patients with minimum 6-month follow-up were divided into 6 groups: dropped nucleus, luxated IOL, trauma, aphakia, IOL exchange, and Marfan's syndrome. Surgery included peritomy and scleral flap creation at 3 and 9 o'clock position. The IOL was then injected and grasped with 25G forceps through a hole created 2 mm posterior to the limbus underneath the sculped scleral flap. RESULTS: The study included 78 patients (mean age 71.9 ± 12.6 years) and average follow-up 10.2 ± 4.2 months. Average surgery duration was 69.4 ± 26.1 min and vision significantly improved from 0.86 ± 0.56 logMAR to 0.38 ± 0.42 logMAR at 6 months post-operative (p < 0.001). Intraoperative complications included corneal edema, retinal tears, and vitreous bleeding each in 2/78 patients (2.5%); 1/78 (1.3%) localized retinal detachment and 1/78 (1.3%) rupture of one T-shaped IOL harpoon. Post-operative complications included 4/78 (5.1%) cystoid macular edemas, 2/78 retinal tears, 2/78 retinal detachments, 2/78 developed ocular hypertension, and 1/78 corneal decompensation requiring DSAEK. CONCLUSION: The Carlevale lens is designed for sutureless intrascleral fixation and can be successfully used in a variety of indications including difficult trauma cases with good rehabilitation. An implant requires experience and delicate manipulation.

Ex vivo photoactivated chromophore for keratitis-corneal crosslinking on inverted graft: new approach to manage interface infectious keratitis after deep anterior lamellar keratoplasty.

A 44-year-old man affected by keratoconus underwent deep anterior lamellar keratoplasty (DALK). Two weeks postoperatively, slitlamp examination showed grayish-white lesions in the donor-host interface. Corneal scraping and donor broth culture tested negative for both bacteria and fungi. In vivo confocal microscopy showed elongated particles resembling Candida pseudofilaments. Despite antimicrobial therapy, the clinical picture worsened, and surgical approach was chosen: the graft was peeled off and inverted (epithelium facing down), and ex vivo photoactivated chromophore for infectious keratitis-corneal crosslinking (PACK-CXL) was performed; the recipient bed was washed with antibiotics/antifungals and the graft resutured. Microbiological and histological evaluations of biopsy specimen tested positive for Candida albicans. Postoperative slitlamp examination revealed a progressive recovery of graft transparency with disappearance of the infiltrates. To the authors' knowledge, this is the first report of ex vivo PACK-CXL on inverted DALK graft for the treatment of interface infectious keratitis. This technique allowed the resolution of the infection while sparing the use of new donor tissue.

Limited Vitrectomy versus Complete Vitrectomy for Epiretinal Membranes: A Comparative Multicenter Trial.

PURPOSE: To evaluate whether limited vitrectomy is as effective as complete vitrectomy in eyes with epiretinal membrane (ERM) and to compare the surgical times and rates of complications. METHODS: In this multicentre European study, data of eyes with ERM that underwent vitrectomy from January 2017 to July 2018 were analyzed retrospectively. In the limited vitrectomy group, a posterior vitreous detachment (PVD) was induced up till the equator as opposed to complete PVD induction till the vitreous base in the comparison group. Incidence of iatrogenic retinal breaks, retinal detachment, surgical time, and visual outcomes were compared between groups. RESULTS: We included 139 eyes in the analysis with a mean age being 72.2 ± 6.9 years. In this, sixty-five eyes (47%) underwent limited vitrectomy and 74 eyes (53%) underwent complete vitrectomy. Iatrogenic retinal tears were seen in both groups (5% in limited vitrectomy versus 7% in complete vitrectomy, p=0.49). Retinal detachment occurred in 2 eyes in the limited vitrectomy group (3%) compared to none in the complete vitrectomy group (p=0.22). Best-corrected visual acuity (BCVA) and central macular thickness improved significantly with no intergroup differences (p=0.18). Surgical time was significantly shorter in the limited vitrectomy group with 91% surgeries taking less than 1 hour compared to 71% in the complete vitrectomy group (p < 0.001). CONCLUSION: A limited vitrectomy is a time-efficient and effective surgical procedure for removal of epiretinal membrane with no additional complications.

Evaluation of the Morphology of Ganglion Cell Complex and Functional Outcomes after Internal Limiting Membrane Peeling with Macular Abrasion in Idiopathic Macular Hole.

AIM: This study aims to evaluate the morphology of ganglion cell complex (GCC) along with functional outcomes in patients undergoing vitrectomy with ILM peeling and macular abrasion with Tano diamond dusted membrane scrapers (DDMS) for three different stages of the idiopathic macular hole (IMH). METHODS: This retrospective study was conducted between April 2019 and December 2019. 33 patients with IMH were included and divided into three groups: stage I, stage II, and stage IV. All patients were subjected to vitrectomy with ILM peeling. Gentle and vigorous macular abrasion was additionally performed for stage II and stage IV patients, respectively. The best-corrected visual acuity (BCVA), GCC thickness (measured by spectral domain-optical coherence tomography (SD-OCT)), and photopic contrast sensitivity (Rodenstock CV 900 Chart Panel) were determined before surgery and at 1- and 3-month follow-ups. RESULTS: Closure of MH was achieved in all the patients. The difference between the preoperative and one- and three-month postoperative values of BCVA was statistically significant in the three groups (P < 0.01). Contrast sensitivity progressively improved in all patients and was statistically significant (P < 0.01). The reduction in GCC thickness during follow-up was 34%-42% of the preoperative measurements. On comparing the mean GCC thickness of the operated and healthy eyes, it was not statistically significant in stage I patients. However, the same when done in stage II and IV was statistically significant with P value < 0.05 and P < 0.01, respectively. CONCLUSION: Combining ILM peeling with macular abrasion in advanced stages of MH may facilitate its closure without significantly affecting the functional outcome.

Intraocular lens power calculation in eyes with keratoconus.

PURPOSE: To assess the refractive accuracy of different formulas for intraocular lens (IOL) power calculation in eyes with keratoconus. SETTING: IRCCS Fondazione Bietti, Rome, Italy. DESIGN: Multicenter retrospective interventional study. METHODS: A consecutive series of eyes with keratoconus that had cataract surgery were evaluated. Keratometry, anterior chamber depth, and axial length were measured preoperatively with optical biometry; IOL power was calculated with the Barrett Universal II, Haigis, Hoffer Q, Holladay 1, and SRK/T formulas. Subjective refraction was assessed at 1 month. The mean prediction error (PE), median absolute error (MedAE) and percentage of eyes with a PE within ±0.50 diopters (D), ±0.75 D, and ±1.00 D were calculated. RESULTS: The final spherical equivalent was -0.52 D ±1.61 (SD). In the whole sample (41 eyes), the mean PE was positive (hyperopic surprise) with all formulas; the lowest PE (0.91 D) and MedAE (0.62 D) were obtained with the SRK/T formula. In stage I eyes (n = 21), the MedAE ranged between 0.43 and 0.91 D; the SRK/T formula achieved the lowest MedAE and the highest rate of eyes with a PE within ±0.50 (61.9%). In stage II eyes (n = 13), the MedAE ranged between 0.75 D and 1.50 D; the SRK/T formula achieved the lowest MedAE and the highest rate of eyes with a PE within ±0.50 (30.8%). In stage III eyes (n = 7), the MedAE was higher than 2.50 D with all formulas. CONCLUSIONS: In keratoconus eyes, all formulas led to a hyperopic refractive outcome. The SRK/T was the most accurate formula. The results were worse in advanced stages of the disease.

Influence of Posterior Corneal Astigmatism on Total Corneal Astigmatism in Eyes With Keratoconus.

PURPOSE: To measure posterior corneal astigmatism (PCA) and investigate its influence on total corneal astigmatism (TCA) in eyes with keratoconus. METHODS: Keratometric astigmatism (KA), PCA, and TCA were investigated by means of a dual Scheimpflug analyzer in patients with keratoconus. Vector analysis was carried out with the Næser polar value method. RESULTS: We enrolled 119 eyes. PCA magnitude averaged 0.77 ± 0.43 diopters (D) and exceeded 0.50, 1.00, and 2.00 D in 73.9%, 21.8%, and 16.8% of eyes, respectively. PCA averaged 0.95 ± 0.48, 0.55 ± 0.28, and 0.70 ± 0.35 D in eyes with with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism. The steepest posterior meridian was oriented vertically (between 61 and 119 degrees) in 55.5% of eyes, thus generating ATR astigmatism. The difference between the location of the steepest meridian of KA and that of TCA was >10 degrees in 8.4% of eyes. On average, KA overestimated TCA in eyes with WTR astigmatism by 0.16 D and underestimated TCA in eyes with ATR astigmatism by 0.22 D. The PCA power oriented along the steeper anterior corneal meridian averaged -0.83 ± 0.40, -0.40 ± 0.37, and -0.53 ± 0.43 D for WTR, ATR, and obliquely astigmatic eyes, respectively. Linear regression disclosed a statistically significant correlation (P < 0.0001, r = 0.16) between the meridional powers of TCA and PCA. CONCLUSIONS: In eyes with keratoconus, PCA displays large, variable values and is correlated to TCA. The influence of PCA on TCA cannot be disregarded when planning astigmatism correction by toric intraocular lenses.

Phenotypic Spectrum of Granular Corneal Dystrophy Type II in Two Italian Families Presenting an Unusual Granular Corneal Dystrophy Type I Clinical Appearance.

Clinical, instrumental, and genetic findings are reported in Italian families with Type II Granular Corneal Dystrophies (GCD2) presenting an initial unusual presentation of a Granular Corneal Dystrophy Type I (GCD1) phenotypic spectrum in female descendants. Slit-lamp examinations showed the typical phenotypic features of GCD2 in both mothers and a phenotypic appearance of GCD1 in both daughters. Despite the different phenotypic onset, the genetic diagnostic testing revealed the presence of a mutation in the TGFB-I gene, typical of GCD2 in both cases, excluding GCD1. Patients who were clinically suspected of corneal dystrophy need a genetic confirmatory testing for certain diagnosis. Genetic test may help to find the specific mutation distinguishing between different phenotypic spectra with relative diagnostic and prognostic implications. The study demonstrates that the phenotypic spectrum of genetically confirmed granular corneal dystrophies in patients may change over time. Since the R124H mutation has also been described in clinically asymptomatic individuals prior to LASIK, who then develop dramatic deposition, suggesting that this particular mutation and phenotype may be sensitive to, precipitated, or modified by central cornea trauma, a careful familial anamnesis excluding cornel dystrophies and specific preoperative genetic test are recommended prior to LASIK.

Two-step LASIK with topography-guided ablation to correct astigmatism after penetrating keratoplasty.

PURPOSE: To assess the efficacy, predictability, stability, and safety of a two-step LASIK procedure using topography-guided ablation to correct astigmatism after penetrating keratoplasty. METHODS: Fifteen eyes of 15 patients underwent a two-step LASIK procedure at the Maggiore Hospital of Bologna, Italy. In the first step, a flap was created using the Hansatome microkeratome. In the second step, topography-guided ablation using the LaserSight LSX was planned with interactive software (CIPTA) once topographical and refractive stabilization had been obtained. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cylindrical correction, gain of lines of BSCVA, spherical equivalent refraction, and complications were analyzed. RESULTS: Minimum follow-up was 12 months (range: 12 to 30 months). Uncorrected visual acuity improved in all 15 (100%) eyes. At the last postoperative examination, 11 (73%) eyes had UCVA > or = 20/40. Nine (60%) eyes were within 1.0 diopter (D) of the attempted correction. Mean postoperative astigmatism was -1.67 (range: -3.5 to 0; standard deviation: 1.26). Index of success of astigmatic correction was 0.26. No patient lost Snellen lines of BSCVA. Intraoperative complications included two buttonhole flaps, and postoperative complications included one flap retraction. No further laser treatment was needed. CONCLUSIONS: The two-step LASIK procedure using topography-guided ablation reduces spherical and cylindrical refractive error due to penetrating keratoplasty. Topography-guided ablation also proved to be effective in correcting irregular astigmatism.

Conservative treatment of early and moderate pellucid marginal degeneration: a new refractive approach with intracorneal rings.

OBJECTIVE: To evaluate the use of the intracorneal ring (ICR; Intacs, Addition Technology, Inc., Fremont, CA) for the treatment of pellucid marginal degeneration (PMD). DESIGN: Case series. PARTICIPANTS: Eight patients with PMD who were intolerant to contact lenses received ICR segments in the superior cornea (0.25 mm thickness) and in the inferior cornea (0.45 mm thickness). The diagnosis was supported by Orbscan II tomography (Bausch & Lomb). MAIN OUTCOME MEASURES: Preoperative and postoperative uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), refractive astigmatism, and spherical equivalent were assessed. Changes in corneal shape were evaluated by corneal tomographic maps. RESULTS: The minimum follow-up was 12 months (range, 12-42 months; standard deviation [SD], 14.14). Uncorrected visual acuity improved in all 8 eyes (100%). At the last postoperative examination, 6 eyes (75%) had a BCVA > or =20/25; mean postoperative refractive astigmatism was -2.53 (range, -4.50 to -1.25; SD, 1.03). Mean postoperative spherical equivalent was -1.52 (range, -7.25 to +1.87; SD, 3.01). At the third postoperative month, refractive stability was obtained. No patients lost any Snellen lines of BCVA. No intraoperative and postoperative complications occurred. CONCLUSIONS: Intracorneal ring implantation is a promising new treatment for patients with early to moderate PMD and who are intolerant of contact lenses.