Comparison of Ex-PRESS P-200 mini-shunt implantation and standard trabeculectomy for open-angle glaucoma: four-year follow-up.

Introduction: The study aimed to evaluate the efficacy and safety in 4-year follow-up of Ex-PRESS P-200 mini-shunt implantation versus standard trabeculectomy. Material and methods: A single-center retrospective study on patients diagnosed with open-angle glaucoma with failed medical treatment and who underwent Ex-PRESS device implantation or standard trabeculectomy was conducted. Seventy-three eyes were included in the analysis, 33 with Ex-PRESS P-200 implantation and 40 with standard trabeculectomy. Results: Significant decreases in the intraocular pressure (IOP) were observed after surgery and at all follow-ups in both groups (p < 0.001) with no significant difference between the two groups (p > 0.40). No significant differences with regard to post-operative medications were observed (p > 0.10). Excepting the 3-year follow-up, when just a borderline significant difference regarding the visual acuity between the Ex-PRESS and standard trabeculectomy group was observed (p = 0.0504), the Ex-PRESS groups showed significantly better visual acuity at 6 weeks (p = 0.0324), 1 year (p = 0.0168), 2 years (p = 0.0162), and 4 years (p = 0.0111). Hypotony occurred more frequently among the Ex-PRESS group, while cataract occurred more frequently among those with standard trabeculectomy, without significant differences between groups (p > 0.09). No difference in hazard of failure was observed between interventions (HR = 0.72, p = 0.523). Conclusions: Both procedures provided good control of IOP and decreased the number of postoperative medications. The advantage of the Ex-PRESS shunt is the better visual acuity, but its main limitation is the cost.

Performances of Corneal Topography and Tomography in the Diagnosis of Subclinical and Clinical Keratoconus.

Aim: The purpose of the study was to assess the efficacy of topographical and tomographical indices given by the Pentacam (pachymetric, tomopetric, and aberometric) in clinical and subclinical keratoconus (KCN) diagnosis. Material and Methods: In this observational analytic retrospective study, patients with abnormal findings in topography and tomography maps but with no signs on clinical examination (subclinical KCN group, sKCN), patients with clinical keratoconus (KCN group), and healthy subjects (Control group) were evaluated. Results: The KCN group proved significantly different (p < 0.001) values of the investigated parameters than the Control group. Eleven out of 28 investigated parameters proved significantly different in the sKCN group compared to controls (p < 0.001). Two topographic measurements, namely I-S (cut-off = 1.435, a large value indicates the presence of KCN) and CCT (cut-off = 537, a small value indicates the presence of KCN), showed AUCs equal to 1 [0.999 to 1]. Six other Pentacam measurements, including Back maximum keratometry (Back Kmax) proved to be excellent parameters for case-finding and screening. In distinguishing sKCN from normal eyes, Pentacam index of vertical asymmetry (IVA), inferior-superior difference (I-S) value, thinnest point (TP), Belin Ambrosio Enhanced Ectasia Display (BAD_D) and root mean square total (RMS total) performed best. Conclusions: In distinguishing sKCN from normal eyes, Back Kmax, IVA, I-S, and RMS total values demonstrated higher accuracy and utility. Six indices, namely ISV, IVA, KISA, PRC, RMS-HOA, and Back Kmax demonstrate excellent utility in case-finding and screening for clinical KCN.

Long term visual outcomes in cataract surgery with bilateral implantation of the Extended Depth of Focus Intraocular Lens - Mini Well Ready type.

Purpose: To evaluate the refractive results, visual outcomes and patients' satisfaction of a new extended depth-of-focus (EDOF) intraocular lens (IOL). Setting: Oculens Clinic, Cluj-Napoca, Romania. Design: Retrospective, single-center, observational study. Methods: 104 eyes of 52 patients undergoing cataract surgery with implantation of the Mini Well Ready EDOF-IOL (SIFI, Catania, Italy) were included in the study. Visual acuity at distance, intermediate and near was evaluated at 1, 6 and 12 months. Refractive results, contrast sensitivity, defocus curve and photic phenomena were also assessed. Results: The mean age of patients was 66.04±7.82. A significant reduction of the spherical equivalent and improvement of corrected distance visual acuity (CDVA) was observed (p<0.0001) after the surgery. All eyes obtained a CDVA of 0.5 or better at one month. All eyes achieved a corrected intermediate visual acuity (CIVA) of 0.5 or better and a corrected near visual acuity (CNVA) of 0.5 or better. At 12 months the spherical equivalent was within -0.5- +0.5 diopters (D). Conclusions: The EDOF-IOL offers good visual outcomes at distance, intermediate and near vision, providing an adequate contrast sensitivity and low rate of visual disturbances.

One year outcomes after small incision lenticule extraction ReLEX in the correction of myopia and myopic astigmatism.

PURPOSE: To report the visual and refractive outcomes of small incision lenticule extraction ReLEX (SMILE) technique using VisuMax femtosecond laser in myopia and myopic astigmatism patients. MATERIAL AND METHODS: A non-randomized clinical study has been conducted on patients with myopia and myopic astigmatism who underwent ReLEX SMILE technique, using the Zeiss VisuMax Laser system (Carl Zeiss Meditec AG, Jena, Germany) at Oculens Clinic, Cluj-Napoca, Romania. Patients older than 18 years, with ocular astigmatism up to -5 diopters (D), spherical equivalent up to -10.00 D, corrected distance visual acuity (CDVA) of 0.3 or better before the surgery, stable refraction for one year, and with a minimum calculated post operator residual stromal bed of 250µ were included in the study. RESULTS: The study involved a total of 25 myopic eyes (median of sphere diopters equal with -4D) and 67 myopic astigmatic eyes (median of cylinder diopters equal with -1.5 D). The mean refractive spherical equivalent (MRSE) on patients with myopic eyes reduced from -4.25D (median) to -0.5D at one month follow-up, -0.25 D at 6 and 12 months. The mean refractive spherical equivalent (MRSE) on patients with astigmatic myopic eyes reduced from-6.25 D to -0.67 D at one month, -0.62 D at six and twelve months. The value of sphere decreased postoperatively on myopic eyes with a median of -0.25D at one, six and twelve months. The value of cylinder decreased postoperatively on myopic astigmatic eyes with a median of -0.50 D at one month, -0.25 D at six months and -0.50 D at 12 months. At 6 and 12 months, 20 (80.0%) of myopic eyes were maintained within ±0.5 D and 22 (88.0%) with ±1D. On both groups (myopic eyes and myopic astigmatic eyes), statistically significant differences were observed when the keratometric baseline values were compared to each follow-up (P-values < 0.0001), without any significant differences between follow-ups (P-values>0.15). At 1-month follow-up, uncorrected distance visual acuity (UDVA) was better than or equal to 0.5 in 88.0% of myopic eyes and 82.1% of myopic astigmatic eyes. UDVA remained stable in all cases of myopic eyes at six months and the percentage increased at 92.0% in myopic eyes. UDVA slightly increased at 6-months (85.1%) and remained at the same value at 12-months in myopic astigmatism eyes. CONCLUSIONS: SMILE proved an effective and safe refractive corneal procedure and provided a predictable and stable correction of myopia and myopic astigmatism. SMILE technique demonstrated very good outcomes in terms of keratometric, cylinder, spherical measurements.

Comparative Results Between "Epi-Off" Accelerated and "Epi-Off" Standard Corneal Collagen Crosslinking-UVA in Progressive Keratoconus - 7 Years of Follow-Up.

PURPOSE: The purpose of the present study was to assess the long-term efficiency and safety of the "epi-off" accelerated CXL (9 mW/cm2 for 10 minutes) in comparison to the standard "epi-off" CXL (3 mW/cm2 for 30 minutes) in terms of topographical and keratometric parameters, refractive data and visual outcomes at 7 years of follow-up, in progressive keratoconus. MATERIAL AND METHOD: A retrospective and comparative study was performed. A total of 183 eyes from 183 patients with documented progressive keratoconus were included in the study. The patients were divided in two groups: 93 eyes from 93 patients underwent "epi-off" standard cross-linking technique (3 mW/cm2 for 30 minutes) (S-CXL group) and 90 eyes from 90 patients underwent accelerated "epi-off" corneal CXL technique (9 mW/cm2 for 10 minutes) (A-CXL group). RESULTS: Improvements in uncorrected distance visual acuity (UDVA) were statistically significant compared to baseline values in both groups at each time-point visit (p=0.0421 at 1 year, p=0.0411 at 7 years for A-CXL and p=0.0375 at 1 year, p=0.0389 at 7 years for S-CXL). At 7 years there was a statistically significant increase in CDVA (p=0.039 in the A-CXL group and p=0.0343 in the S-CXL group at 7 years). Statistically significant reduction was noticed in Ksteep (p=0.0411 in A-CXL group and p=0.0224 in S-CXL group), Kflat (p=0.0198 in A-CXL group and p=0.008 in S-CXL group), K mean (p=0.0106 in A-CXL group and p=0.0193 in S-CXL group) and Kmax (p=0.0413 in A-CXL group and p=0.054 in S-CXL group) at 7 years, compared to baseline values, in both groups, but without any statistically difference between the two procedures, at all time-point visits (p>0.05). CONCLUSION: The long-term outcomes of "epi-off" accelerated corneal collagen crosslinking-UVA (9 mW/cm2 for 10 minutes) are similar to standard "epi-off" corneal collagen crosslinking procedure in the treatment of progressive keratoconus.

Refractive Lens Exchange in Hyperopic Presbyopes with the Acrysof IQ Panoptix Intraocular Lens: One-Year Results and Analysis of the Literature.

PURPOSE: To assess the functional and refractive outcomes in hyperopia and presbyopia correction by clear lens exchange with the intraocular trifocal artificial lens (IOL) Acrysof IQ Panoptix implant at 1 year. MATERIALS AND METHODS: A number of 128 eyes (64 patients) underwent clear lens exchange with placement of the trifocal IOL Acrysof IQ Panoptix implant for hyperopia and presbyopia. Prior to the surgery the patients had a complete ocular examination. In all cases the artificial lens was implanted in the bag without any intraoperative complications. Visual acuity (VA) at distance, intermediate and near and ocular refraction were evaluated at 4 weeks, 6 and 12 months postoperatively. RESULTS: The mean age was 53.49 ±7.377 years old (range 40-73 years). As high as 51.57% of the patients were males and 48.43% were females. The mean achieved refraction was 0.26 ± 0.73D. Almost 60.93% of patients were within ±0.25D of the target refraction, with 82.03% eyes within ±0.50D of the planned correction. At 1 year after surgery, 96.45% of eyes had a stable refraction (p >0.05). At 1 year, a total of 92.25%, 89.92% and 91.47% achieved a monocular uncorrected distance, intermediate and near visual acuity of 0.2 logarithm of the minimum angle of resolution or better, respectively. At the same time point, a total of 95.35%, 91.47% and 93.80% achieved a binocular uncorrected distance, intermediate and near visual acuity of 0.2 logarithm of the minimum angle of resolution or better, respectively. There was no statistically significant difference (p>0.05) between the postoperative uncorrected and best corrected VA (distance, intermediate, near) at 6 months and postoperative uncorrected and best corrected VA (distance, intermediate, near) at 12 months. None of our patients had any intraoperative complications. Two cases (1.56%) developed posterior capsule opacification. Twelve patients (18.75%) complained about photic phenomena such as glare and haloes, but this symptom disappeared after 6 months postoperatively. As high as93.56% of patients had a high satisfaction with the outcomes of the surgery. Spectacle independence was obtained in 97.65% eyes. CONCLUSION: The Acrysof Panoptix trifocal artificial lens offers a good vision at distance, intermediate and near, with a good quality of vision and refraction.

Comparative Results of "Epi-Off" Conventional versus "Epi-Off" Accelerated Cross-Linking Procedure at 5-year Follow-Up.

PURPOSE: The aim of our study was to compare the long-term efficacy and safety of "epi-off" conventional and "epi-off" accelerated corneal cross-linking (CXL) in patients with progressive keratoconus. METHODS: "Epithelial-off" ("Epi-off") CXL using the conventional technique (3 mW/cm2, 30 minutes) was performed in 93 eyes of 93 patients (S-CXL group) and "epi-off" accelerated method (9 mW/cm2, 10 minutes) in 76 eyes of 76 patients with progressive KCN (A-CXL group). Cases with different stages of keratoconus and topographic evidence of progression were included. Main outcomes comprised refraction, keratometry measurements, uncorrected (UCVA) and best-corrected visual acuity (BCVA), and topographical indices. Micromorphological analysis was assessed by anterior segment ocular coherence tomography (AS-OCT). The follow-up period was 5 years. RESULTS: In both groups, Kflat presented similar results: decrease at 1 year (p=0.465), at 2 years (p=0.672), at 3 years (p=0.198), at 4 years (p=0.32), and at 5 years (p=0.864). In both groups, Ksteep presented a similar decrease at 1 year (p=0.709), at 2 years (p=0.455), at 3 years (p=0.43), at 4 years (p=0.57), and at 5 years (p=0.494), with no statistically significant difference. Decrease in Kavg was similar in both groups at all analyzed time points (p=0.18 at 1 year, p=0.093 at 2 years, p=0.57 at 3 years, p=0.154 at 4 years, and p=0.247 at 5 years). Kmax had a similar decrease in both groups at 1 year (p=0.06), at 2 years (p=0.09), at 3 years (p=0.126), at 4 years (p=0.113), and at 5 years (p=0.114). There was no statistically significant difference between the cylinder decrease in both groups (p=0.349 at 1 year, p=0.6782 at 2 years, p=0.299 at 3 years, p=0.0943 at 4 years, and p=0.144 at 5 years). The BCVA values were statistically significantly higher than the preoperative values in both groups at all time points (p < 0.05). Topographical indices such as thinnest corneal point (TP), corneal volume (CV), index vertical asymmetry (IVA), index of vertical asymmetry (ISV), index of height asymmetry (IHA), index of height decentration (IHD), Belin/Ambrosio Enhanced Ectasia Display (BAD_D), and Ambrosio retinal thickness (ART Max) were significantly statistically decreased compared with baseline at all time points, in both groups. CONCLUSION: "Epi-off" accelerated and conventional CXL have the same efficacy in terms of improvement in visual and topographic outcomes.

Results in keratoconus correction with Kerasoft 3 Contact lenses.

Introduction: The purpose of the paper was to evaluate the indications, fitting, advantages and functional results of Kerasoft 3 contact lenses in keratoconus. Material and method: A retrospective single center study was performed at Oculens Private Clinic in Cluj-Napoca, Romania. Our study included 61 eyes of 35 patients diagnosed with keratoconus in different stages of evolution fitted with Kerasoft 3 lens. The study was undergone between August 2015 and January 2019. Results: In our study, the mean age of the patients was 26.36±8.69 years. The group of study included 80.32% males and 19.62% females. Regarding previous surgeries, CXL was performed in 25 eyes, ICR in 1 eye, CXL and ICR in 15 eyes. The mean BCVA habitual was 0.38±0.19 logMar and with the lens 0.22±0.23 logMar (p<0.01). Spherical equivalent (SE) at baseline was -5.78 and after fitting the lens it decreased to -0.46. Comfort and tolerance level were maximum in all cases. No significant complications were noted with the use of contact lens. Conclusions: Kerasoft 3 contact lenses provide many of the benefits of RGP lenses (avoiding RGP's discomfort and allergic reactions), along with excellent comfort, visual acuity, high oxygen permeability and longer wearing times. Abbreviations: CXL = cross-linking; ICR = intrastromal corneal ring; BCVA = best corrected visual acuity; SE = spherical equivalent; RGP = rigid gas permeable contact lenses.

Morphological and Functional Outcomes after Intravitreal Dexamethasone Injection for Macular Edema in Patients with Central Vein Occlusion at 48-Week Follow-Up.

PURPOSE: The purpose of the study was to assess the efficacy of intravitreal dexamethasone implant (IDI: Ozurdex®) injection in eyes with macular edema due to retinal vein occlusion. Material and Method. A retrospective, nonrandomized study was conducted in patients with macular edema (ME) due to retinal vein occlusion (RVO) who undertook intravitreal Ozurdex® as first-line treatment. We performed a complete ocular exam including macular OCT. RESULTS: The mean BCVA (logMar) improved from 0.420.42 ± 0.23 logMar at baseline to 0.21 ± 0.23 logMar at 48 weeks in the BRVO group and from 0.72 ± 0.16 logMar at baseline to 0.31 ± 0.23 logMar at 48 weeks in the CRVO group. In both groups, CFT values decreased significantly compared to baseline (p < 0.0001 at each timepoint). Reinjection for recurrent macular edema after 18 weeks was indicated in five eyes (41.67%) in the BRVO group and in six eyes (25%) in the CRVO group. Cataract developed in two eyes (16.67%) in the BRVO group and in one eye (4.17%) in the CRVO group. The IOP was higher than 25 mmHg in two cases in the BRVO group (16.66%) and in three cases (8.33%) in the CRVO group. CONCLUSION: Ozurdex® injected intravitreally significantly improved the mean CFT and BCVA in eyes with macular edema due to retinal vein occlusion.

10-Year Results of Standard Cross-Linking in Patients with Progressive Keratoconus in Romania.

PURPOSE: The purpose of the current study was to evaluate the long-term functional results based on keratometric measurements, spherical and cylinder equivalent in patients with progressive keratoconus treated with conventional "epi-off" corneal collagen cross-linking (CXL). METHODS: We conducted a retrospective study in which 113 eyes from 90 keratoconus-treated patients with CXL between 2006 and 2008 in Oculens Eye Clinic from Cluj-Napoca, Romania, were included. The diagnosis of keratoconus was based on corneal topography and its clinical signs. All patients were evaluated preoperatively, and a follow-up was performed at 1, 3, and 6 months and every year from 1 to 10 years after conventional CXL. RESULTS: All keratometry measurements improved significantly during the follow-up. Compared to preoperative values, the improvement of K max become statistically significant at 1 year after CXL (mean change compared to baseline -0.9 D, p < 0.001) and remained statistically significant thereafter up to 10 years (mean change compared to baseline -2.3 D, p < 0.001). As compared to preoperative values, mean spherical equivalent and mean cylinder improved during the follow-up, from a mean of -6.22 D before CXL to a mean value of -5.0 at 10 years, following CXL for spherical equivalent and from -4.4 D at baseline to -3.4 D at 10 years for cylinder (p < 0.05 for both). Uncorrected visual acuity increased, remaining statistically significant, by 0.104 logMAR at 10 years after CXL (p=0.0015), and best-corrected visual acuity increased by 0.135 logMAR at 10 years after CXL (p=0.015). We did not observe any case of severe complication. CONCLUSION: Our results show that CXL has a favorable effect on the progression of KC. The reduced K values, cylinder and spherical equivalent, and increased visual acuity remained the same 10 years after the procedure.

Comparative Results Between "Epi-Off" Conventional and Accelerated Corneal Collagen Crosslinking for Progressive Keratoconus in Pediatric Patients.

PURPOSE: The aim of our study was to evaluate the efficacy and safety of epi-off conventional and accelerated corneal collagen cross-linking in the treatment of progressive keratoconus in pediatric patients up to 4 years after treatment. PATIENTS AND METHODS: Conventional (standard) CXL epi-off technique was performed in 37 eyes (S-CXL group) and accelerated CXL in 27 eyes (A-CXL group). Refraction, keratometry, cylindrical equivalent, spherical equivalent, slit lamp examination, pachymetry, corneal tomography, anterior segment ocular coherence tomography and visual acuity were performed up to 4 years. RESULTS: In the S-CXL group: the flat K values decreased from 47.41±3.39 D to 45.36±3.62 D at 4 years (p=0.004); steep K decreased from 51.98±4.11 to 50.21±4.81 D at 4 years (p=0.0078); mean K decreased with 1.99 D at 4 years (p=0.009). In the A-CXL group: the flat K values decreased from 46.97±4.17 D to 44.97±4.24 D at 4 years (p=0.048); steep K decreased from 50.55±4.10 D to 48.75±4.17 D at 4 years (p=0.0287); mean K decreased from 48.79±3.86 D to 46.86±4.11 D at 4 years (p=0.0356). The preoperative mean UCVA in the S-CXL group was 0.8 ±0.23 logMar and improved during the follow-up reaching 0.65 ±0.24 logMar at 4 years (p=0.072). The baseline mean UCVA in A-CXL group was 0.77±0.25 logMar and increased during the follow-up to 0.63 ±0.25 logMar at 4 years (p=0.0039). A similar improvement of BCVA was observed during the follow-up. CONCLUSION: Epi-off conventional and accelerated CXL are efficient procedures for progressive keratoconus in pediatric patients. Accelerated and conventional CXL were comparable at all time points and both represent viable options for the therapy of KC in these patients.

Comparative Results in a Combined Procedure of Intrastromal Corneal Rings Implantation and Cross-linking in Patients with Keratoconus: A Retrospective Study.

INTRODUCTION: Corneal thinning disorders caused by keratoconus often lead to protrusion, irregular astigmatism, and even perforation. Keratoconus, like other corneal ectasia, does not have a known cause. Severe cases of keratoconus may require correction or restoration of tectonic integrity of the cornea by surgical means. Intracorneal ring segments are a new modality in the treatment of corneal ectactic disorders. A new technique of stopping the evolution of keratoconus and strengthening the cornea is combining techniques of intrastromal corneal ring implantation and corneal collagen cross-linking. The objective of the study is to compare the effectiveness of combined procedures: intrastromal corneal ring implantation followed by cross-linking, with cross-linking followed by intrastromal corneal ring implantation. METHODS: The study comprised two groups of patients with different evolutionary stages of keratoconus, which met the eligibility criteria for intrastromal corneal ring segment implantation and corneal collagen cross-linking. Group 1 included patients (41 eyes) who underwent intrastromal corneal ring implantation followed by cross-linking and group 2 (30 eyes) included patients who underwent cross-linking first followed by intrastromal corneal ring implantation. RESULTS: A decrease in Km values of about 1.5 D and refraction was observed in group 1, compared to a decrease in Km values of about 1 D and refraction in group 2. Recovery of visual acuity was higher in group 1 than group 2. CONCLUSIONS: The sequence of intrastromal corneal ring implantation followed by cross-linking proved to be more effective in reducing Km values, spherical equivalent and cylinder compared with cross-linking followed by intrastromal corneal ring implantation.

[Ozurdex, modern therapy for macular edema in central retinal vein occlusion]. / Ozurdex - terapia moderna a edemului macular din obstructia de vena centrala retiniana.

We present a case report of a 56 years old patient with central retinal vein occlusion and macular edema. Intravitreal Ozurdex was effective: the disappearance of the macular edema and improvement of the visual acuity were noticed. Panretinal photocoagulation performed avoided the proliferative retinopathy.

[Phacoemulsification and diabetic eye]. / Pseudofakul si ochiul diabetic.

THE PURPOSE OF THIS STUDY: Is to display the influence of diabetes on the course of the operation, postoperative complications and functionals results in operated primary cataract. MATERIAL AND METHODS: We performed a study on 134 eyes with cataract and diabetes operated in the Universitary Eye Hospital and Optilens Eye Clinic from Cluj-Napoca. RESULTS: The majority of patients (83.58%) had noninsulinodependent diabetes. Background diabetic retinopathy was present in 27 cases, associated with the diabetic maculopathy in 8 eyes. In 3 cases was present preproliferative diabetic retinopathy and in one eye it was discovered proliferative retinopathy. EEC + PC-IOL was performed in 81 eyes, mini-nuc in 37 cases and in 16 eyes phacoemulsification with PC-IOL. Postoperative the complications were less in the cases operated with mini-nuc and phacoemulsification. Visual acuity was better in eyes without diabetic retinopathy. CONCLUSIONS: 1. The modern surgical techniques of cataract surgery reduce significant the frequency of postoperative complications. 2. Functional results depends on the presence of diabetic retinopathy.