Medical Therapy and Scleral Windows for Uveal Effusion Syndrome: A Case Series and Literature Review.

INTRODUCTION: Uveal effusion syndrome (UES) is a rare ocular disease causing idiopathic uveal effusion, often with associated ciliochoroidal and retinal detachment. UES diagnosis is challenging because of overlapping features with other ocular inflammatory, neoplastic, iatrogenic, and drug-induced causes of uveal effusion. While several successful surgical treatments have been described, such as full-thickness or partial-thickness sclerectomy, medical therapies may also have a therapeutic role. OBJECTIVE: To provide an updated review of the published literature on the course of the disease, medical and surgical management strategies, as well as newer treatment modalities.

The historical development and an overview of contemporary keratoprostheses.

Corneal blindness is a major cause of ocular morbidity that affects 4.5 million people worldwide. Though penetrating keratoplasty is an excellent option for most patients with corneal blindness, there are various conditions for which corneal transplantation carries a low likelihood of success. In cases of multiple failed transplants, the keratoprosthesis, an artificial cornea, is a well-documented surgical option, though few models are commercially available. Keratoprostheses also provide a solution to those in developing areas of the world who do not have access to penetrating keratoplasty owing to limitations in the supply of corneal donor tissue. We summarize the history of keratoprostheses, examine the various keratoprosthesis models used across the globe, and highlight efforts to improve the accessibility and biointegration of keratoprosthesis through novel technological developments.

A Case of Extensive Bilateral Idiopathic Sclerochoroidal Calcification and Review of Literature.

A 62-year-old Caucasian male was referred to retina for choroiditis and uveitis. Multiple areas of yellow irregularities were noted on fundus exam throughout the periphery of both eyes, corresponding to lesions at the sclerochoroidal junction on OCT. A diagnosis of sclerochoroidal calcifications (SCC) was confirmed by B-ultrasonography, fundus photography, OCT imaging, and fluorescein and indocyanine green angiography. Systemic metabolic studies were performed, which showed reduced renal function with increased serum calcium; however, SCC lesions in this case were most likely idiopathic. In this work, we report the clinical findings, appearance on multimodal imaging, and systemic associations of sclerochoroidal calcification. Sclerochoroidal calcifications are an unusual clinical finding that tends to be idiopathic, but a focused workup and specialist referral may be warranted to exclude systemic conditions associated with abnormal calcium-phosphate metabolism or hypokalemic metabolic alkalosis syndromes.

PRK Enhancement for Residual Refractive Error After Primary PRK: A Retrospective Study.

INTRODUCTION: The efficacy and safety of photorefractive keratectomy (PRK) has been well documented, but outcomes of PRK enhancement following PRK remain understudied. This study aimed to evaluate the safety, efficacy, and predictability of PRK enhancement in patients with residual refractive error after primary PRK and compare these results to prior studies as well as Food and Drug Administration (FDA) safety and efficacy clinical endpoints. METHODS: This non-randomized, retrospective chart analysis included eyes with a history of PRK that underwent PRK enhancement at a single center. Post-enhancement data were documented at 3-month and 1-year visits. Patient characteristics between the study group and a control group who underwent primary PRK only were compared. Safety and efficacy measures included change in uncorrected distance visual acuity (UDVA), change in corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), amount of induced astigmatism, and presence of serious adverse events. RESULTS: A total of 188 eyes from 141 patients were included. When compared to the control group, women underwent PRK enhancement at a higher rate than men (P = 0.004). The group undergoing PRK enhancement had a higher sphere (P = 0.013) and spherical equivalent (P = 0.004) than the control group at the time of primary PRK. MRSE was reduced to - 0.97 ± 0.72 D (- 2.25 to + 2.13 D) from pre-enhancement values of - 0.98 ± 0.66 D (- 2.75 to + 1.75 D) and stable over 12-month visits with 86% and 98% of eyes within ± 0.50 D and ± 1.00 D of target, respectively. UDVA of 20/20 or better was achieved in 75% of eyes. The UDVA of 75% of eyes remained the same or improved by 1 or more Snellen lines compared with pre-enhancement CDVA. CONCLUSION: Our results demonstrate that, when compared with previous studies, modern PRK enhancement after PRK has improved visual acuity and refractive outcomes. Though PRK enhancement is not an FDA approved procedure, we show that it meets or exceeds the FDA criteria for the correction of refractive error.

Refractive enhancements for residual refractive error after cataract surgery.

PURPOSE OF REVIEW: Advances in cataract surgery have allowed surgeons to achieve superior refractive outcomes but have also led to higher patient expectations. Despite ever-evolving technology, residual refractive errors still occur. Postcataract refractive enhancements may be required to deliver satisfactory visual outcomes. This review aims to discuss the potential causes of residual refractive errors and the various enhancement modalities to correct them. RECENT FINDINGS: A thorough preoperative workup to detect and address underlying pathologic causes of impaired vision should be performed prior to enhancement or corrective procedures. Corneal-based procedures are the safest and most accurate methods of correcting mild cases of residual refractive error. Hyperopic, high myopic, and high astigmatic errors are best managed with lens-based enhancements. Piggyback intraocular lenses (IOLs) are safer and more effective compared with IOL exchange. Toric IOL rotation and IOL exchange are ideally performed in the early postoperative period. SUMMARY: A multitude of options exist for effective correction of residual refractive errors. The choice on how to best manage these patients depends on many factors such as the cause of refractive error, type of IOL used, ocular comorbidities, and patient preference.

Use of presbyopia-correcting intraocular lenses in patients with prior corneal refractive surgery.

PURPOSE OF REVIEW: Corneal refractive surgery has achieved spectacle-free vision for millions of patients, but this aging population is now developing cataracts. Many of these patients may wish to avoid reliance on glasses after cataract surgery. Presbyopia-correcting intraocular lenses (IOLs) offer a solution, but corneal changes after refractive surgery may compound higher order aberrations and dysphotopic symptoms associated with these IOLs. This review aims to discuss potential factors that could aid in determining suitable postkeratorefractive candidates for presbyopia-correcting IOLs. RECENT FINDINGS: Studies investigating which preoperative measures influence outcomes are lacking. The few studies that have examined presbyopia-correcting IOLs in postkeratorefractive patients report that satisfactory outcomes are possible. However, recommendations for preoperative thresholds appear limited to expert opinion and studies involving virgin corneas. SUMMARY: As the number of presbyopia-correcting IOLs and postkeratorefractive patients grows, continued investigation into relevant preoperative factors and appropriate IOLs is required to make evidence-based decisions. The current literature shows that with rigorous counseling and appropriate patient selection, presbyopia-correcting IOLs can provide postkeratorefractive patients with satisfactory results and spectacle independence. In addition, the development of postoperative modifiable IOLs may prove to be the preferred option.

Initial Single-Site Experience Using SMILE for the Treatment of Astigmatism in Myopic Eyes and Comparison of Astigmatic Outcomes with Existing Literature.

PURPOSE: To assess a single site's initial experience with SMILE for the treatment of myopic astigmatism and compare outcomes and vector analysis results with the US Food and Drug Administration (FDA) results and published literature. PATIENTS AND METHODS: Forty-eight eyes (29 patients) with mean preoperative sphere of -5.11 ± 1.31 diopters (D) and cylinder of -1.12 ± 0.60 D underwent SMILE. Visual acuity, refractive, and vector analysis outcomes as well as subjective measures were reported at three and twelve months postoperatively and compared with FDA results and the published literature between 2014 and 2020 involving treatment of patients with mean cylinders of >-0.50 to ≤-3.00 D. RESULTS: At three and twelve months, 43 and 32 eyes were evaluated, respectively. At twelve months, mean cylinder power was reduced to -0.38 ± 0.38 D with 78.1% achieving ≤±0.50 D. Uncorrected distance visual acuity (UDVA) ≥20/20 was achieved in 77.4% of eyes by twelve months with 100% achieving ≥20/30 UDVA. No loss of corrected distance visual acuity was observed in eyes seen at twelve months. Correction index (CI) at twelve months was 0.90 indicating overall undercorrection of 10%. Twelve-month CI was 0.96, 0.90, and 0.83 in eyes with preoperative cylinders of <-1.00 D, ≥-1.00 to <-2.00 D, and ≥-2.00 D, respectively. Mean angle of error was -1.58 ± 11.61° ranging from -24.22° to 37.75°. CONCLUSION: We found SMILE to be an effective and safe means of achieving spectacle independence and improving visual acuity in patients with myopic astigmatism. SMILE has the potential for improved clinical outcomes with better nomogram guidance and advancements in technique. However, surgeons must be aware of the potential for undercorrection in with-the-rule astigmatism and at higher preoperative cylinders and as well as the potential for overcorrection in against-the-rule and lower preoperative cylinder astigmatism.