Effect of laser photocoagulation, antiangiogenic therapy or a combined treatment on refractive outcomes of newborns with ROP.

PURPOSE: To determine the refractive outcome after treatment with laser photocoagulation, intravitreal antiangiogenic injection or both, for the treatment of type 1 ROP and/or aggressive posterior ROP using defocus equivalent terms. These results will be compared with the spherical equivalent (SE) notation in an initial refraction (during the first 3 years after treatment) and in a final evaluation (three years after treatment). METHODS: Clinical charts review of preterm patients who developed type 1 ROP and/or aggressive posterior ROP who were treated with laser photocoagulation, intravitreal antiangiogenic injection, or both, between January 2007 and December 2014 at Fundación Oftalmológica de Santander were reviewed. Refractive error was evaluated at two different time points in three different treatment groups. RESULTS: Seventy-seven eyes (56 patients) with ROP diagnosis treated with laser, antiangiogenics or in a combined scheme were included. Median gestational age was 29 weeks (IQR = 3), median birth weight was 1100 (IQR = 335) and mean corrected age at the time of treatment was 37.3 weeks (SD 2.2). Refractive outcomes in SE terms for the first refraction had a median of -0.50 diopters and in defocus terms, 4.00 diopters (D). For the second refraction, -3.00 diopters and 4.00 diopters (D), respectively. Pearson correlation test result for the first measurement was 93% (p = 0.000) and for the second evaluation was 99% (p = 0.000). CONCLUSIONS: Low birth weight had a statistically significant association to the increase of the refractive outcome. The high correlation between SE and DE for refractive errors allows us to confirm that DE is an appropriate metric to report refractive outcomes in this group of patients due to the presence of combined refractive ametropias.

Macular and choroidal thicknesses in a healthy Hispanic population evaluated by high-definition spectral-domain optical coherence tomography (SD-OCT).

PURPOSE: To report normal values of macular and choroidal thickness obtained from a healthy Hispanic population using Optovue (Optovue Inc, Freemont CA, USA) spectral domain optical coherence tomography (SD-OCT). DESIGN: Observational, cross-sectional, correlation study. METHODS: A total of 290 eyes (145 healthy subjects) were included; 69% of subjects were female. The median age was 39 ± 29 years (IQR), with a range between 18 and 89 years. The study sample was stratified into three age groups: Group 1, 18-40 years (50.3%), Group 2, 41-60 years (30.7%), and Group 3, older than 61 years (19%). Central macular, perifoveal (inner quadrants), and parafoveal (outer quadrants) thicknesses were estimated. In addition, central and peripheral choroidal thicknesses were estimated. Data analysis was performed to calculate the standardized mean difference according to the variance (Student's t-test) and its differences with Epidat 4.1. RESULTS: Median macular central thickness was 250 ±30 µm (IQR) with Optovue. Median central choroidal thickness was 263 ± 48 µm (IQR). Median central choroidal thickness was greater than mean peripheral thickness. Macular evaluation showed a statistically significant difference in central, perifoveal, and parafoveal thicknesses, with lower values being recorded for the study sample compared with the manufacturer's data. CONCLUSIONS: SD-OCT has become a useful tool to obtain high-resolution images of the macula and choroid. This method allows precise assessment of the retinal and choroidal layers to diagnose and follow up posterior segment diseases. We are reporting normal cut-off values of macular and choroidal thicknesses in healthy Hispanic subjects evaluated with Optovue SD-OCT as new diagnostic normal parameters for research and clinical activities.

Single-Segment Intacs Severe Keratoconus 80% Stromal Depth Insertion With a Femtosecond Laser for Asymmetric Keratoconus: A Case Series.

PURPOSE: To study the efficacy of inferior, single-segment, 80% stromal depth Intacs severe keratoconus (SK) intracorneal ring segment implantation. DESIGN: A prospective case series. METHODS: Eighteen eyes from 15 patients with asymmetric keratoconus underwent 80% stromal depth Intacs SK single inferior segment implantation, using an IntraLase femtosecond laser for tunnel creation. Parameters studied included preoperative and postoperative uncorrected and best-corrected visual acuity (VA), manifest refraction and elevation-based computerized corneal topography. RESULTS: Patients' VA was tested with Early Treatment Diabetic Retinopathy Study (ETDRS) chart. All the eyes demonstrated a significant ETDRS line improvement of 5.4 ± 2.0 after a follow-up period of 8.9 ± 3.9 months. Thirteen eyes (72%) showed a line improvement of 4 or more. Best-corrected VA remained unchanged in 8 eyes (44%) while 7 eyes (39%) showed a line improvement of 1 to 8. Sixteen eyes (89%) had a significant change in manifest cylinder [3.0 ± 2.2 diopters (D)]. Of the 18 eyes, astigmatism reduction was 3.44 ± 1.98 D, from 5.6 ± 2.2 D preoperatively to 2.5 ± 1.5 D postoperatively (P < 0.05). Implant placement reduced both preexisting hyperopic and myopic spheres in 14 cases (78%). Although one case showed a significant postoperative regression of the obtained correction, Intacs SK implantation was safe and effective in all the other cases. CONCLUSIONS: Femtosecond laser-assisted single-segment Intacs SK (80% depth intrastromal placement) is a safe and effective technique for improving uncorrected and best-corrected VA and correcting both spherical and cylindrical refractive errors in eyes with severe asymmetric keratoconus.