Accelerated corneal crosslinking in children with keratoconus: 5-year results and comparison of 2 protocols.

PURPOSE: To evaluate long-term clinical results of 2 different accelerated corneal crosslinking (CXL) protocols in pediatric patients with keratoconus. SETTING: Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN: Retrospective case-control study. METHODS: Patients who were younger than 18 years were included in the study. Group 1 received 4 minutes of illumination at 30 mW/cm, and Group 2 received 5 minutes of illumination at 18 mW/cm. Uncorrected and corrected distance visual acuities, manifest refraction, corneal topographic parameters, and corneal higher-order aberrations (HOAs) were evaluated at baseline and during 1-, 3-, and 5-year follow-up visits. RESULTS: A total of 143 eyes from 86 patients were included in the study. There were 30 eyes in Group 1 and 113 eyes in Group 2. The mean follow-up time was 4.15 ± 0.99 years. Mean keratometry (K) and/or maximum K progressed ≥1.00 diopter (D) in 7 eyes (23.3%) in Group 1 and 19 eyes (16.8%) in Group 2 (P = .411). Mean K and/or maximum K decreased ≥2.00 D in 2 eyes (6.7%) in Group 1 and 24 eyes (21.2%) in Group 2 (P = .06). In Group 1, there were no statistically significant differences in topographic parameters during follow-up. In Group 2, there was a statistically significant reduction in total HOA and coma during the 5-year visit when compared with the preoperative visit (P = .005 and P = .045, respectively). CONCLUSIONS: Accelerated CXL is beneficial in terms of halting the progression of keratoconus in pediatric patients throughout 5 years of follow-up examinations. An increased irradiance with a reduced application time reduces the topographic effects of CXL.

Evaluation of Choroidal Thickness in Patients with Proliferative and Non-Proliferative Macular Telangiectasia Using Enhanced Depth Imaging Optical Coherence Tomography.

Purpose: To compare subfoveal choroidal thickness (SFCT) in eyes with non-proliferative macular telangiectasia (MacTel) type 2 with or without subretinal neovascularization (SRNV) and healthy control eyes.Methods: Consecutive patients with non-proliferative and proliferative MacTel type 2 were included in the current study. For comparisons subjects with no ocular pathology were recruited and used as controls. Best corrected visual acuity (BCVA), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were evaluated. Since axial length (AL) may affect choroidal thickness, AL measurements were performed to avoid confusion in SFCT between the groups.Results: Of the 63 eyes of 38 MacTel type 2 patients, 38 eyes had only MacTel type 2 (group 1) and 25 eyes had SRNV caused by MacTel type 2 (group 2). Fourty eyes of 20 subjects served as controls (group 3). BCVA was found to be significantly higher in control group compared with group 1 and group 2 (p < .005). Whereas, no difference was detected between group 1 and group 2 (p = .75). No difference was noted in CMT between the groups (p = .35). Axial length measurement was very similar among all three groups (p = .62). After adjusting for age and axial length SFCT was significantly thinner in group 3 than the other groups (p < .001), but no statistically significant difference was found between group 1 and group 2.Conclusions: Choroidal thickness did not vary between eyes with MacTel type 2 with SRNV and without SRNV. Choroid was significantly thicker in MacTel type 2 with SRNV and without SRNV than healthy eyes.

Long-term (5 years) follow-up of small-incision lenticule extraction in mild-to-moderate myopia.

PURPOSE: To report long-term efficacy and safety of small-incision lenticule extraction (SMILE) in patients with mild-to-moderate myopia. SETTING: Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. DESIGN: Retrospective case series. METHODS: Medical records of patients who had SMILE for surgical correction of myopia or myopic astigmatism were retrospectively reviewed. Patients with a preoperative spherical equivalent (SE) of manifest refraction of 6.00 D or less and a 5-year follow-up period were included in the study. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities and SE were analyzed preoperatively and at 1 year, 3 years, and 5 years postoperatively. RESULTS: The study comprised 54 eyes (34 patients). The mean SE of the intended correction was -4.11 diopters (D) ± 0.98 (SD) and ranged from -1.38 to -5.88 D. The mean preoperative UDVA and CDVA were 1.08 ± 0.29 logarithm of the minimum angle of resolution (logMAR) and 0.02 ± 0.08 logMAR, respectively. At the 5-year follow-up, the mean difference between the intended and achieved SE was -0.13 ± 0.29 D. The mean postoperative UDVA and CDVA were 0.04 ± 0.09 logMAR and 0.00 ± 0.04 logMAR, respectively. At the 5-year follow-up, the SE was within ±0.50 D of the intended correction in 32 (93%) of the 34 patients and within ±1.00 D of intended correction in all patients. The SE at the 5-year follow-up was within ±0.50 D of the 1-year visit in 33 (98%) of all patients. No patient lost CDVA lines, and no vision-threatening events occurred during the surgery or the postoperative period. CONCLUSIONS: SMILE in mild-to-moderate myopia offers predictable correction of SE refractive error. Refractive results were stable at the long-term follow-up.

The outcomes of subtotal vitrectomy in macular surgeries: a single surgeon case series.

PURPOSE: To investigate the outcomes of subtotal vitrectomy in epiretinal membrane (ERM) and idiopathic macular hole (IMH) surgeries. METHODS: The patients who underwent vitrectomy for primary ERM and IMH were included. After the truncation of posterior hyaloid, cortical vitreous was incompletely removed and anterior vitreous was left in place. The main outcome measure was the complications of the surgical technique during the postoperative 12 months of follow-up. RESULTS: Fifty-two eyes were included. Thirty-seven eyes had ERM, and 15 had IMH. During the 12 months of follow-up period, 33% of the phakic patients showed progression in the lens opacities and required cataract surgery. Other postoperative complications were listed as follows: transient intraocular pressure increase in 3 (5.9%), endophthalmitis in 1 (2.0%), and retinal detachment in 1 patient (2.0%). CONCLUSION: Subtotal vitrectomy seems as an effective and safe surgical technique in the treatment of macular diseases.

Subtotal vitrectomy in idiopathic macular hole surgery.

PURPOSE: To assess the outcomes of subtotal vitrectomy in idiopathic macular hole (IMH). METHODS: The patients with idiopathic IMH who had undergone vitreoretinal surgery and followed up for at least 12 months post-operatively were included. First the posterior hyaloid was detached, then cortical vitreous was removed incompletely by leaving anterior vitreous intact. Internal limiting membrane was peeled with the aid of brilliant blue. A non-expanding volume of perfluoropropane was used as a tamponade and face-down positioning for 5 days was suggested to the patients. The main outcome measure was the closure rate of IMH. RESULTS: Forty-three eyes were included. The mean follow-up time was 15.0 ±â€¯3.8 months after surgery. Single surgery anatomical success was 86.0%. The mean BCVA at baseline, month 1, 3, 6, 12 and at the last follow-up was 0.99 ±â€¯0.33 LogMAR (0,5-1.80), 1.04 ±â€¯0.33 LogMAR (0.5-1.8), 0.94 ±â€¯0.46 LogMAR (0.3-3.0), 0.84 ±â€¯0.33 LogMAR (0.3-1.5), 0.82 ±â€¯0.35 (0.2-1.5), and 0.70 ±â€¯0.34 (0.1-1.5) (p > 0.05, for all). The mean visual acuity increased by 2.9 lines at the last follow-up visit and 51.2% of the patients gained ≥ 3 lines of vision. CONCLUSION: The results of this study indicated limited core vitrectomy as a safe and effective surgical technique in the treatment of IMH, resulting in acceptable functional and anatomical outcomes without significant intra- and post-operative complications.

Aflibercept in macular edema secondary to retinal vein occlusion: A real life study.

PURPOSE: To evaluate the real life outcomes of intravitreal aflibercept (IVAfl) treatment in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) during the first year of treatment. METHODS: Retrospective case series. Newly diagnosed or persistent ME patients secondary to RVO who were treated with IVAfl and had a follow-up period of at least 12 months were included. Twenty-two patients (54.8%) received 3 loading month loading doses IVAfl initially, whereas 20 patients (45.2%) did not receive. Then the patients were treated on an as-needed treatment regimen. Primary outcome measures of this study included the change in best corrected visual acuity (BCVA) and central retinal thickness (CRT). Secondary outcome measures were the number of visits and injections. RESULTS: Forty-two eyes of 42 patients were included. Fourteen patients (33.3%) had central RVO, and 28 (66.7%) had branch RVO. Mean BCVA at baseline and month 12 was 0.98 ± 0.58 and 0.82 ± 0.65 LogMAR, respectively (p = 0.04). Mean CRT at baseline and month 12 was 511 ± 141 and 304 ± 95 µm, respectively (p < 0.0001). Mean number of visits was 5.9 ± 2.1 (range 3-11) and injections was 3.2 ± 1.7 (range 1-8) at month 12. CONCLUSION: In conclusion, IVAfl treatment seemed to be effective in patients with ME secondary to RVO with respect to visual and anatomical outcomes in real life. In this study the number of visits and injections was lower that randomized controlled trials, but the functional and anatomical outcomes are probably still acceptable.

Does Previous Open Renal Stone Surgery Affect the Outcome of Extracorporeal Shockwave Lithotripsy Treatment in Adults with Renal Stones?

PURPOSE: To evaluate the effects of previous ipsilateral open renal stone surgery (ORSS) on outcomes of extracorporeal shockwave lithotripsy (SWL) in adults with renal stones. MATERIALS AND METHODS: A total of 2097 renal units with renal stones underwent SWL treatment at our institution between March 1997 and February 2013. One thousand eight hundred thirty-nine (87.7%) of these had no history of ORSS and were categorized as group 1, and 258 (12.3%) patients having history of ipsilateral ORSS were categorized as group 2. Characteristics of patients, stone and treatment, stone-free, and complications rates were documented in detail and compared in each group. These groups were also subclassified into four subgroups according to the stone location. RESULTS: The stone-free rates were statistically higher in group 1 than group 2 (73.2% and 61.6%, respectively). There were no differences between groups regarding the complications and steinstrasse. The stone-free rate of SWL for stones located at lower calix has significant difference according to groups 1 and 2 (64% vs 48.4%, p = 0.001). Logistic regression analysis showed that history of ORSS increased SWL failure rate 1.39 times. CONCLUSION: Overall stone-free rates after SWL treatment was found to be significantly lower in patients with the history of ORSS than in patients without, and this finding was significantly prominent for lower calix stones. We believe that retrograde intrarenal surgery or mini- /micro-percutaneous nephrolithotripsy, despite its possible difficulties in accessing due to anatomical changes, might be a good alternative for SWL.