Conservative treatment of early and moderate pellucid marginal degeneration: a new refractive approach with intracorneal rings.

OBJECTIVE: To evaluate the use of the intracorneal ring (ICR; Intacs, Addition Technology, Inc., Fremont, CA) for the treatment of pellucid marginal degeneration (PMD). DESIGN: Case series. PARTICIPANTS: Eight patients with PMD who were intolerant to contact lenses received ICR segments in the superior cornea (0.25 mm thickness) and in the inferior cornea (0.45 mm thickness). The diagnosis was supported by Orbscan II tomography (Bausch & Lomb). MAIN OUTCOME MEASURES: Preoperative and postoperative uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), refractive astigmatism, and spherical equivalent were assessed. Changes in corneal shape were evaluated by corneal tomographic maps. RESULTS: The minimum follow-up was 12 months (range, 12-42 months; standard deviation [SD], 14.14). Uncorrected visual acuity improved in all 8 eyes (100%). At the last postoperative examination, 6 eyes (75%) had a BCVA > or =20/25; mean postoperative refractive astigmatism was -2.53 (range, -4.50 to -1.25; SD, 1.03). Mean postoperative spherical equivalent was -1.52 (range, -7.25 to +1.87; SD, 3.01). At the third postoperative month, refractive stability was obtained. No patients lost any Snellen lines of BCVA. No intraoperative and postoperative complications occurred. CONCLUSIONS: Intracorneal ring implantation is a promising new treatment for patients with early to moderate PMD and who are intolerant of contact lenses.

Posterior capsule opacification after phacoemulsification: silicone CeeOn Edge versus acrylate AcrySof intraocular lens.

PURPOSE: To compare the rates and morphologic features of posterior capsule opacification (PCO) after small-incision phacoemulsification and in-the-bag implantation of 2 foldable intraocular lenses (IOLs) over an 18-month follow-up. SETTING: Departments of Ophthalmology, Hospital of Conegliano, Conegliano, and Maggiore Hospital of Bologna, Bologna, Italy. METHODS: In an open clinical study, 78 cataract patients were randomly selected to have implantation of a silicone CeeOn Edge (Pharmacia) or acrylate AcrySof (Alcon) IOL after phacoemulsification cataract surgery. All the patients were operated on using a standard technique and in-the-bag IOL implantation. One eye in each patient was studied. Morphologic evaluation of PCO was performed using Evaluation of Posterior Capsule Opacification software. RESULTS: At 18 months in the CeeOn Edge group, 36 eyes (90%) had a clear posterior capsule and 4 (10%) had PCO that did not affect visual acuity. In the AcrySof group, 26 eyes (68%) had a clear posterior capsule, 11 (29%) had PCO that did not affect visual acuity, and 1 (3%) had PCO with a decrease of 2 or more lines of visual acuity that required a neodymium:YAG laser capsulotomy. No eye developed Elschnig pearls or stretched folds in the bag. The postoperative best corrected visual acuity ranged from 0.8 to 1.0 in 96% in the CeeOn Edge group and in 92% in the AcrySof group. No IOL haze or discoloration was observed in the CeeOn Edge group. Mild IOL decentration and tilting occurred in 4 AcrySof eyes; however, no glistenings were found any AcrySof IOL. CONCLUSIONS: Both the CeeOn Edge and AcrySof groups had a low incidence of PCO after an 18-month follow-up. The CeeOn Edge group had significantly less PCO than the AcrySof group. These results confirm that IOLs with square truncated edges create a barrier effect at the optic edge, reducing the overall incidence of PCO.