Novel Management of Ocular Surface Inflammation in Patients With Ocular Graft-Versus-Host Disease in the Setting of Cataract Surgery.

PURPOSE: To report the outcomes of cataract surgery in patients with ocular graft-versus-host disease (oGVHD) using a novel preoperative immunomodulatory regimen in a collaborative subspecialty care setting. METHODS: Retrospective case series of patients with oGVHD who underwent cataract surgery using a novel preoperative immunomodulatory regimen in a collaborative care setting. A preoperative regimen consisting of pooled human immune globulin 1%, autologous serum 50%, and methylprednisolone 1% eye drops was prescribed. Outcome measures included visual acuity (VA), ocular surface disease index (OSDI) score, lissamine green staining, and complications with a minimum of 2 years of follow-up. RESULTS: Thirty-five eyes from 20 patients with oGVHD were studied. The mean age was 59 years (range 30-70 years). A healthy comparison group included 35 eyes from 24 patients with a mean age of 63 years (range 44-74 years). At the 2-year follow-up, the mean corneal staining score was 2.3/15, the mean OSDI score was 37.5, and the mean VA was 20/30 (logarithm of the minimal angle of resolution 0.17). The global complication rate was 2.8% at the last follow-up with no difference versus a healthy comparison group. CONCLUSIONS: A collaborative care model improving ocular surface health before cataract surgery with dry eye and cataract subspecialists can optimize outcomes in patients with oGVHD.

Subclinical Keratoconus Detection and Characterization Using Motion-Tracking Brillouin Microscopy.

PURPOSE: To characterize focal biomechanical alterations in subclinical keratoconus (SKC) using motion-tracking (MT) Brillouin microscopy and evaluate the ability of MT Brillouin metrics to differentiate eyes with SKC from normal control eyes. DESIGN: Prospective cross-sectional study. PARTICIPANTS: Thirty eyes from 30 patients were evaluated, including 15 eyes from 15 bilaterally normal patients and 15 eyes with SKC from 15 patients. METHODS: All patients underwent Scheimpflug tomography and MT Brillouin microscopy using a custom-built device. Mean and minimum MT Brillouin values within the anterior plateau region and anterior 150 µm were generated. Scheimpflug metrics evaluated included inferior-superior (IS) value, maximum keratometry (Kmax), thinnest corneal thickness, asymmetry indices, Belin/Ambrosio display total deviation, and Ambrosio relational thickness. Receiver operating characteristic (ROC) curves were generated for all Scheimpflug and MT Brillouin metrics evaluated to determine the area under the ROC curve (AUC), sensitivity, and specificity for each variable. MAIN OUTCOME MEASURES: Discriminative performance based on AUC, sensitivity, and specificity. RESULTS: No significant differences were found between groups for age, sex, manifest refraction spherical equivalent, corrected distance visual acuity, Kmax, or KISA% index. Among Scheimpflug metrics, significant differences were found between groups for thinnest corneal thickness (556 µm vs. 522 µm; P < 0.001), IS value (0.29 diopter [D] vs. 1.05 D; P < 0.001), index of vertical asymmetry (IVA; 0.10 vs. 0.19; P < 0.001), and keratoconus index (1.01 vs. 1.05; P < 0.001), and no significant differences were found for any other Scheimpflug metric. Among MT Brillouin metrics, clear differences were found between control eyes and eyes with SKC for mean plateau (5.71 GHz vs. 5.68 GHz; P < 0.0001), minimum plateau (5.69 GHz vs. 5.65 GHz; P < 0.0001), mean anterior 150 µm (5.72 GHz vs. 5.68 GHz; P < 0.0001), and minimum anterior 150 µm (5.70 GHz vs. 5.66 GHz; P < 0.001). All MT Brillouin plateau and anterior 150 µm mean and minimum metrics fully differentiated groups (AUC, 1.0 for each), whereas the best performing Scheimpflug metrics were keratoconus index (AUC, 0.91), IS value (AUC, 0.89), and IVA (AUC, 0.88). CONCLUSIONS: Motion-tracking Brillouin microscopy metrics effectively characterize focal corneal biomechanical alterations in eyes with SKC and clearly differentiated these eyes from control eyes, including eyes that were not differentiated accurately using Scheimpflug metrics. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Motion-Tracking Brillouin Microscopy Evaluation of Normal, Keratoconic, and Post-Laser Vision Correction Corneas.

PURPOSE: To characterize focal biomechanical differences between normal, keratoconic, and post-laser vision correction (LVC) corneas using motion-tracking Brillouin microscopy. DESIGN: Prospective cross-sectional study. METHODS: Thirty eyes from 30 patients (10 normal controls [Controls], 10 post-LVC, and 10 stage I or II keratoconus [KC]) had Scheimpflug and motion-tracking Brillouin microscopy imaging using a custom-built device. Mean, maximum (max) and minimum (min) Brillouin shift, spatial standard deviation, and max-min values were compared. Min values were correlated with local Brillouin values at multiple Scheimpflug imaging locations. RESULTS: Mean (P < .0003), min (P < .00001), spatial standard deviation (P < .01), and max-min (P < .001) were significantly different between the groups. In post hoc pairwise comparisons, the best differentiators for group comparisons were mean (P = .0004) and min (P = .000002) for Controls vs KC, min (P = .0022) and max-min (P = .002) for Controls vs LVC, and mean (P = .0037) and min (P = .0043) for LVC vs KC. Min (area under the receiver operating characteristic = 1.0) and mean (area under the receiver operating characteristic =  0.96) performed well in differentiating Control and KC eyes. Min values correlated best with Brillouin shift values at the thinnest corneal point (r2 = 0.871, P = .001) and maximum keratometry value identified in the tangential curvature map (r2 = 0.840, P = .002). CONCLUSIONS: Motion-tracking Brillouin microscopy effectively characterized focal corneal biomechanical alterations in LVC and KC and clearly differentiated these groups from Controls. Primary motion-tracking Brillouin metrics performed well in differentiating groups as compared with basic Scheimpflug metrics, in contrast to previous Brillouin studies, and identified focal changes after LVC where prior Brillouin studies did not.

The Most Cited Articles and Authors in Refractive Surgery.

PURPOSE: To provide a comprehensive analysis of the most highly cited articles and authors in refractive surgery. METHODS: The Scopus database was searched for articles pertaining to refractive surgery using multiple search terms to identify the top 100 most cited articles in refractive surgery. A publicly available database of more than 100,000 scientists that provides standardized information on multiple variables resulting in a composite indicator (C score) was searched to identify refractive surgery authors. A refractive surgery-specific composite score was created using only the authors' publications that were directly related to refractive surgery. RESULTS: The 100 most cited articles and 40 refractive surgery authors with the highest ranked C score were identified. The article with the most citations by Trokel et al has garnered nearly 800 citations to date. All articles included in the top 100 had 200 or more citations. The peak publication years were 1998 to 2001. Laser in situ keratomileusis (22), photorefractive keratectomy (18), and postoperative corneal ectasia and/or corneal biomechanics (16) were the most represented topics. Emory University generated the most articles (7) and the majority of publications (48%) originated in the United States. Steven E. Wilson, MD, had the highest refractive C score and Jorge L. Alió, MD, PhD, had the most refractive surgery articles and citations. Among all authors listed, the average number of refractive surgery publications was 97, with 35% of the group having more than 100 refractive surgery articles published. All authors on the list had more than 2,000 citations for their refractive surgery articles, whereas 38% had 4,000 or more citations. CONCLUSIONS: This list provides a comprehensive assessment of the most cited articles and authors in refractive surgery and demonstrates key focuses and trends in the field over time. [J Refract Surg. 2023;39(2):78-88.].

Comparison of Visual Outcomes and Patient Satisfaction After Bilateral Implantation of an EDOF IOL and a Mix-and-Match Approach.

PURPOSE: To evaluate visual outcomes at different distances (near, intermediate, and far), depth of focus, optical quality, quantitative dysphotopsia, and patient satisfaction in two groups. METHODS: The extended depth of focus (EDOF) only group (n = 40 eyes) was implanted bilaterally with an EDOF intraocular lens (IOL) and the mixed group (n = 40 eyes) was implanted with the same EDOF IOL in the dominant eye and a trifocal IOL in the fellow eye. At the 3-month postoperative visit, refractive outcomes and monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance visual acuities for far UDVA, CDVA, distance-corrected intermediate visual acuity (DCIVA) at 80 cm, uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA) at 40 cm, and binocular defocus curve were evaluated. RESULTS: The mean spherical equivalent (SE) 3 months postoperatively was -0.16 ± 0.41 diopters (D) in the EDOF only group and -0.39 ± 0.63 D in the mixed group. In the EDOF only group, binocular visual acuities were: UDVA = -0.04 ± 0.07 logMAR (20/18); CDVA = -0.04 ± 0.06 logMAR (20/18); DCIVA (80 cm) = 0.07 ± 0.19 logMAR (20/23); DCNVA (40 cm) = 0.32 ± 0.15 logMAR (20/42); and UNVA (40 cm) = 0.24 ± 0.17 logMAR (20/35). In the mixed group, binocular visual acuities were: UDVA = 0.03 ± 0.09 logMAR (20/21) (P = .08); CDVA = -0.01 ± 0.07 logMAR (20/20) (P = .25); DCIVA (80 cm) = 0.24 ± 0.23 logMAR (20/35) (P = .08); DCNVA (40 cm) = 0.19 ± 0.07 logMAR (20/31) (P = .03); and UNVA (40 cm) = 0.18 ± 0.10 logMAR (20/30) (P = .37). CONCLUSIONS: Effective restoration of visual acuity was demonstrated in both groups, with high levels of visual quality and patient satisfaction. Better results in near visual acuity were demonstrated in the mixed group. [J Refract Surg. 2019;35(7):408-416.].

Outcomes of combining a trifocal and a low-addition bifocal intraocular lens in patients seeking spectacle independence at all distances.

PURPOSE: To assess the visual and refractive outcomes and patient satisfaction after cataract surgery in patients with a diffractive multifocal intraocular lens (IOL) with a low addition (add) power (+2.75 diopters [D]) (Tecnis ZKB00) in the dominant eye and a diffractive trifocal IOL (AT LISA tri 839MP) in the nondominant eye. SETTING: Augenärzte Gerl, Kretz, and Kollegen, Head Office, Ahaus, Germany. DESIGN: Prospective case series. METHODS: All patients had implantation of the low-add multifocal IOL in the dominant eye and a trifocal IOL in the fellow eye. Patients were evaluated preoperatively and 3 months postoperatively for monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intermediate and near visual acuities, the binocular defocus curve, and manifest refraction. Dysphotopic phenomena were objectively evaluated and subjective patient satisfaction questionnaires administered. RESULTS: The study included 42 patients (84 eyes). The mean postoperative spherical equivalent was -0.06 D ± 0.57 (SD). The binocular visual acuities were 0.00 ± 0.05 logarithm of the minimum angle of resolution (logMAR) (UDVA), 0.19 ± 0.11 logMAR (uncorrected intermediate visual acuity at 80 cm), 0.16 ± 0.10 logMAR (distance-corrected intermediate visual acuity at 80 cm), 0.11 ± 0.09 logMAR (uncorrected near visual acuity at 40 cm), and 0.08 ± 0.09 logMAR (distance-corrected near visual acuity at 40 cm). The binocular defocus curve showed a visual acuity of 0.20 logMAR or better between +0.50 D and -3.00 D. Of the patients, 92%, 92%, and 75% reported never wearing spectacles for distance, intermediate, or near distance, respectively. CONCLUSION: The mix-and-match approach seemed to provide functional visual performance at all distances while achieving spectacles independence in the majority of patients.

[Clinical Evaluation of a Novel Intraocular Lens with Enhanced Depth of Focus (EDOF) to Increase Visual Acuity for Intermediate Distances]. / Klinische Auswertung einer neuartigen Intraokularlinse mit erweiterter Tiefenschärfe (EDOF) zur Verbesserung der Sehkraft im Intermediärbereich.

BACKGROUND: Modern intraocular lens surgery has made great progress over the last few years towards creating independency of spectacles in daily life. Especially in the areas of distant and near visual acuity, optimisation has been possible. Nevertheless, with new media and requirements in professional life, there is an increasing need for optimisation of the intermediate range. In a prospective, non-randomised clinical study, the functional and refractive results after implantation of a novel intraocular lens with enhanced depth of focus were analysed. PATIENTS/MATERIAL AND METHODS: We have evaluated eleven patients after binocular implantation of the AT LARA 829MP (Carl Zeiss Meditec AG, Germany) 3 months after surgery. We examined refraction, corrected and uncorrected monocular and binocular distant visual acuity (CDVA, UDVA) as well as distance-corrected monocular and binocular visual acuity at different intermediate distances (with DCIVA 90, 80 and 60 cm) and 40 cm (DCNVA). We also performed defocus curve analysis. RESULTS: We found a mean increase of monocular CDVA from 0.35 to - 0.01 logMAR. Binocular DCIVA at 90, 80 and 60 cm was - 0.07, 0.04 and 0.07 logMAR, respectively. Even with a principle focus on intermediate distances, we found a functional DCNVA of 0.33 logMAR. Defocus curve analysis showed a visual acuity of 0.3 logMAR in a range of - 2.5 D to + 1.0 D. CONCLUSION: Binocular implantation of the AT LARA 829MP targeting emmetropia gives stable visual acuity from the distant to the near intermediate range, still with functional vision at the near distance of 40 cm.