High-Resolution Wavefront-Guided Photorefractive Keratectomy and Accelerated Corneal Crosslinking for Stabilization and Visual Rehabilitation of Keratoconus Eyes.

PURPOSE: To evaluate the visual and refractive outcomes after high-resolution wavefront-guided (HRWG) surface ablation with corneal crosslinking (CXL) in keratoconus eyes. PATIENTS AND METHODS: In this prospective, interventional case series, 47 eyes of 28 progressive keratoconus patients older than age 18 were enrolled. All patients underwent HRWG photorefractive keratectomy (PRK) with simultaneous accelerated CXL. The study parameters were manifest refraction spherical equivalent (MRSE), keratometric outcomes, uncorrected (UDVA) and corrected distance visual acuity (CDVA) at postoperative 6 and 12 months. RESULTS: There was improvement in mean MRSE from -2.39±1.89 D preoperatively to -0.13 ± 0.68 D at 12 months, with corresponding improvement in UDVA from 0.77 ± 0.35 logMAR to 0.08 ± 0.12 logMAR and CDVA from 0.10 ± 0.11 logMAR to 0.02 ± 0.04 logMAR. Preoperative flat and steep keratometry (K) were 4wct 32.49 ± 1.67 D and 45.94 ± 2.10 D, respectively, and at postoperative 12 months were 41.36 ± 2.08 D and 42.65 ± 2.78 D, respectively. At postoperative 12 months, visual and refractive outcomes were maintained. Comparisons between preoperative and postoperative 12 month timepoints were statistically significant for all parameters. CONCLUSION: Simultaneous wavefront-guided PRK followed by CXL is a promising treatment for the visual rehabilitation of keratoconus patients.

High-resolution wavefront-guided surface ablation with corneal cross-linking in ectatic corneas: a pilot study.

PURPOSE: A preliminary study to evaluate the outcomes of high-resolution wavefront-guided (HRWG) photorefractive keratectomy (PRK) with simultaneous corneal cross-linking (CXL) in ectasia eyes. METHODS: Sixteen eyes of 11 patients (mean age 31.9±9.8 years; range: 15-48 years) with keratoconus or post-laser-assisted in situ keratomileusis ectasia underwent HRWG PRK with simultaneous CXL. Manifest refraction, uncorrected (UDVA) and corrected distance visual acuity (CDVA), and keratometric and aberrometric outcomes are reported at 12 months. RESULTS: Significant improvement was observed postoperatively in visual acuity, refraction, and keratectomy in all eyes. At postoperative 12 months, 87.5% eyes were within ±1.0 D of attempted correction and 81.25% of eyes had a postoperative UDVA of 20/32 or better. A gain of 2 or more lines of CDVA was observed in 12.5% (2/16) of eyes and there was no change in CDVA lines in 25% (4/16) eyes. A substantial reduction in higher-order aberrations was observed in all eyes postoperatively; however, the improvement was not statistically significant. CONCLUSION: The outcomes of HRWG PRK in ectasia eyes with estimated residual stromal bed thickness of at least 350 µm (without epithelium) are promising at postoperative 1 year and provide surgeons with a valuable tool to improve vision with a high degree of refractive predictability.

Desprendimiento de Retina Bilateral Asociado al Bungee Jumping: Reporte de Caso / Bilateral retinal detachment associate to bungee jumping: Case report

Objetivo: Describir el caso de un paciente joven con antecedente de miopía bilateral y degeneración en Lattice en el ojo izquierdo (OI), que desarrolló un desprendimiento de retina bilateral después de realizar una actividad de alto riesgo tipo bungee jumping. Diseño: Reporte de caso. Metodología: Reporte de caso retrospectivo mediante la recopilación de datos clínicos, estudios imagenológicos y valoraciones postoperatorias. Resultado: Recuperación de la agudeza visual posterior a tres procedimientos quirúrgicos de 20/400 en ojo derecho (OD) y de 20/30 en OI en el paciente con antecedente de desprendimiento de retina bilateral. Conclusión: El desprendimiento de retina traumático secundario a actividades de alto riesgo donde está implicado el movimiento de latigazo es poco común, sin embargo, la identificación temprana de patologías como la miopía y degeneración en lattice, en personas que van a realizar deportes extremos, debe considerarse. También es importante que las compañías que promocionan este tipo de actividades conozcan esta patología, ya que a pesar de ser infrecuente, puede llegar a desarrollarse.

Purpose: To describe the case of a young patient with a history of bilateral pathologic myopia and lattice degeneration in the left eye who developed bilateral retinal detachment after making a bungee jumping activity. Design: Case report. Methods: A descriptive, case report study type was performed by collecting clinical data, imaging studies and postoperative evaluations. Result: Subsequent recovery of visual acuity after three surgical procedures of 20/400 in right eye and 20/30 in the left eye in the case report patient with a history of bilateral retinal detachment. Conclusion: Traumatic retinal detachment secondary to high-risk activities where is involved the whipping motion is uncommon, however, early identifi cation of diseases as myopia and lattice degeneration in people who practice this extreme sports should be identifi ed. It is also important that companies promoting such activities acquire knowledge about it, taking into account, that despite it is a rare disease, it may develop.

Neovascularización Coroidea Idiopática y Terapia Antiangiogénica con Recuperación Total de Agudeza Visual: reporte de caso / Idiopathic Choroidal Neovascularization and Antiangiogenic Therapy with Full Recovery of Visual Acuity: case report

Objetivo: presentar el caso de un paciente joven con neovascularización coroidea idiopática, con importante compromiso visual unilateral y que con la inyección intravítrea de aflibercept mensual, por tres meses, recuperó completamente la agudeza visual. Diseño: reporte de caso. Método: se realizó un estudio descriptivo tipo reporte de caso, mediante la recopilación de datos clínicos, estudios imagenológicos y valoraciones postoperatorias. Resultados: mejoría significativa de agudeza visual en paciente con neovascularización coroidea idiopática en ojo izquierdo posterior a tres inyecciones intravítreas de aflibercept mensual. El paciente mejoró de 20/400 a 20/20 al completar el esquema terapéutico. Conclusiones: el esquema de antiangiogénico resultó ser útil para el tratamiento de neovascularización coroidea idiopática en un paciente joven, logrando una recuperación visual y anatómica completa.

Objective: to present the case of a young patient with idiopathic choroidal neovascularization, with significant unilateral visual impairment. He fully recovered visual acuity by appliyng monthly intravitreal aflibercept, for three months. Design: case report. Method: a descriptive, case report study type was performed by collecting clinical data, imaging studies and postoperative evaluations. Results: Significant visual acuity improvement was obtained in the present patient with idiopathic choroidal neovascularization after three monthly intravitreal injections of aflibercept. The patient improved from 20/400 to 20/20 when treatment was completed. Conclusions: antiangiogenic schemev could be useful for the treatment of idiopathic choroidal neovascularization, achieving a complete visual and anatomical recovery.

Modifiable endoscopic factors that influence the adenoma detection rate in colorectal cancer screening colonoscopies.

BACKGROUND: Adenoma detection rate (ADR) has become the most important quality indicator for colonoscopy. OBJECTIVE: The aim of this study was to investigate which modifiable factors, directly related to the endoscopic procedure, influenced the ADR in screening colonoscopies. DESIGN: Observational, nested study. SETTING: Multicenter, randomized, controlled trials. PATIENTS: Asymptomatic people aged 50 to 69 years were eligible for a multicenter, randomized, controlled trial designed to compare colonoscopy and fecal immunochemical testing in colorectal cancer screening. A total of 4539 individuals undergoing a direct screening colonoscopy were included in this study. INTERVENTION: Colonoscopy. MAIN OUTCOME MEASUREMENTS: Bowel cleansing, sedation, withdrawal time in normal colonoscopies, and cecal intubation were analyzed as possible predictors of adenoma detection by using logistic regression analysis, adjusted for age and sex. RESULTS: In multivariate analysis, after adjustment for age and sex, factors independently related to the ADR were a mean withdrawal time longer than 8 minutes (odds ratio [OR] 1.51; 95% CI, 1.17-1.96) in normal colonoscopies and split preparation (OR 1.26; 95% CI, 1.01-1.57). For advanced adenomas, only withdrawal time maintained statistical significance in the multivariate analysis. For proximal adenomas, withdrawal time and cecal intubation maintained independent statistical significance, whereas only withdrawal time longer than 8 minutes and a <10-hour period between the end of preparation and colonoscopy showed independent associations for distal adenomas. LIMITATIONS: Only endoscopic variables have been analyzed. CONCLUSION: Withdrawal time was the only modifiable factor related to the ADR in colorectal cancer screening colonoscopies associated with an increased detection rate of overall, advanced, proximal, and distal adenomas.