Combination of Inverted ILM Flap Technique and Subretinal Fluid Application Technique for Treatment of Chronic, Persistent and Large Macular Holes.

INTRODUCTION: The choice of surgical treatment for chronic, persistent and large full-thickness macular holes (FTMH) continues to be undefined and challenging, as some of these cases remain refractory to the treatment. We report the efficacy of combination of inverted internal limiting membrane flap technique (IILMFT) and subretinal application of the fluid (SR fluid application) technique for treatment of refractory FTMHs. METHODS: Nine patients (nine eyes) were enrolled into this retrospective non-randomized exploratory consecutive case series study. All patients were diagnosed with chronic, persistent or large FTMH and were treated with a combination of IILMFT and SR fluid application technique. The following outcome parameters were analysed during 1- and 6-month follow-up visits: anatomical FTMH closure rate on spectral domain optical coherence tomography (SD-OCT), best-corrected visual acuity (BCVA), degree of postoperative retinal displacement. RESULTS: The mean preoperative diameter of FTMH was 542.0 µm (range 154-1930 µm). Final closure of FTMH was achieved in nine of nine cases (100%). In one case a second operation was required because of postoperative rhegmatogenous retinal detachment. The mean BCVA after the FTMH closure increased from 1.0 logMAR (0.7-1.3) to 0.4 logMAR (0.2-0.8 logMAR) (W = 2.67; p = 0.008). A positive correlation was revealed between preoperative BCVA and axial length (ρ = 0.67, p = 0.048), between preoperative BCVA and duration of the symptoms (ρ = 0.818, p = 0.007), as well as between postoperative BCVA at 1-month follow-up and BCVA at 6-month follow-up (ρ = 0.821, p = 0.007). CONCLUSION: Combination of IILMFT with SR fluid application technique for refractory FTMH surgery appears to be effective and safe. Improvement of anatomical and visual outcomes after the single surgery benefits from and is ensured by the advantages of both novel surgical approaches.

ADVERSE EVENTS OF THE ARGUS II RETINAL PROSTHESIS: Incidence, Causes, and Best Practices for Managing and Preventing Conjunctival Erosion.

PURPOSE: To analyze and provide an overview of the incidence, management, and prevention of conjunctival erosion in Argus II clinical trial subjects and postapproval patients. METHODS: This retrospective analysis followed the results of 274 patients treated with the Argus II Retinal Prosthesis System between June 2007 and November 2017, including 30 subjects from the US and European clinical trials, and 244 patients in the postapproval phase. Results were gathered for incidence of a serious adverse event, incidence of conjunctival erosion, occurrence sites, rates of erosion, and erosion timing. RESULTS: Overall, 60% of subjects in the clinical trial subjects versus 83% of patients in the postapproval phase did not experience device- or surgery-related serious adverse events. In the postapproval phase, conjunctival erosion had an incidence rate of 6.2% over 5 years and 11 months. In 55% of conjunctival erosion cases, erosion occurred in the inferotemporal quadrant, 25% in the superotemporal quadrant, and 20% in both. Sixty percent of the erosion events occurred in the first 15 months after implantation, and 85% within the first 2.5 years. CONCLUSION: Reducing occurrence of conjunctival erosion in patients with the Argus II Retinal Prosthesis requires identification and minimization of risk factors before and during implantation. Implementing inverted sutures at the implant tabs, use of graft material at these locations as well as Mersilene rather than nylon sutures, and accurate Tenon's and conjunctiva closure are recommended for consideration in all patients.

One-Year Safety and Performance Assessment of the Argus II Retinal Prosthesis: A Postapproval Study.

IMPORTANCE: The Argus II Retinal Prosthesis System is indicated for patients with vision loss due to severe to profound outer retinal degeneration, a group with few treatment options. OBJECTIVES: To collect postapproval safety and visual function data for the Argus II. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, postapproval clinical trial conducted at 9 sites in Germany and Italy. Data were collected from December 2, 2011, to September 30, 2017, and patients were followed-up for 12 months or longer. Patients were 25 years or older with severe to profound outer retinal degeneration, some residual light perception or the ability of the retina to respond to electrical stimulation, and a history of useful form vision and were already planning to undergo Argus II implantation. MAIN OUTCOMES AND MEASURES: The primary end point of this study was the nature and rate of adverse events. Secondary end points included 3 visual function tests: square localization (SL), direction of motion, and grating visual acuity (GVA). RESULTS: Forty-seven patients were followed for 12 months or longer after implant. Mean (SD) age was 56 (12) years, 37 (79%) had retinitis pigmentosa, and 27 (57%) were male. Through the first 12 months postimplantation, 23 patients (49%) experienced 51 nonserious adverse events and 12 (26%) experienced 13 serious adverse events (SAEs), 9 of which were judged to be related to the Argus II, and 4 of which were judged to be related to the procedure. The most common SAE was conjunctival erosion, reported in 4 patients. No significance testing was done for group analysis for the SL or direction-of-motion tests. When averaged across the group, patients' accuracy on the SL test, but not on the direction-of-motion test, appeared better when the Argus II was on than when it was switched off. For GVA, more patients at each point in time achieved the 2.9 GVA cutoff in the implanted eye when the Argus II was on compared with it switched off. CONCLUSIONS AND RELEVANCE: Safety and visual function outcomes in this clinical practice setting cohort of patients with Argus II implants were consistent with previously reported results. Longer follow-up of these patients and data from additional patients are required to better outline the risks and benefits of this approach to addressing blindness secondary to severe-to-profound outer retinal degeneration. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01490827.

Intraoperative aberrometry-based aphakia refraction in patients with cataract: status and options.

AIM: To explore the application of intraoperative wavefront aberrometry (IWA) for aphakia-based biometry using three existing formulae derived from autorefractive retinoscopy and introducing new improved formulae. METHODS: In 74 patients undergoing cataract surgery, three repeated measurements of aphakic spherical equivalent (SE) were taken. All measurements were objectively graded for their quality and evaluated with the 'limits of agreement' approach. ORs were calculated and analysis of variance was applied. The intraocular lens (IOL) power that would have given the target refraction was back-calculated from manifest refraction at 3 months postoperatively. Regression analysis was performed to generate two aphakic SE-based formulae for predicting this IOL. The accuracy of the formulae was determined by comparing them to conventional biometry and published aphakia formulae. RESULTS: In 32 eyes, three consecutive aphakic measurements were successful. Objective parameters of IWA map quality significantly impacted measurement variability (p<0.05). The limits of agreement of repeated aphakic SE readings were +0.66 dioptre (D) and -0.69 D. Intraoperative biometry by our formula resulted in 25% and 53% of all cases ±0.50D and ±1.00 D within SE target, respectively. A second formula that took axial length (AL) into account resulted in improved ratios of 41% and 70%, respectively. CONCLUSIONS: A reliable application of IWA to calculate IOL power during routine cataract surgery may not be feasible given the high rate of measurement failures and the large variations of the readings. To enable reliable IOL calculation from IWA, measurement precision must be improved and aphakic IOL formulae need to be fine-tuned.

A Case of a Bilateral Cicatricial Upper Eyelid Entropion After Hematopoietic Stem Cell Transplantation in Mucopolysaccharidosis Type I.

Minor eyelid abnormalities are commonly encountered in mucopolysaccharidosis, but only rarely leading to a clinically relevant situation. The authors report a clinical case of severe bilateral cicatricial entropion of the upper eyelids, leading to recurrent conjunctival infections, corneal erosion, persistent epiphora, and a major decline in life quality in a 7-year-old boy with mucopolysaccharidosis type I who underwent hematopoietic stem cell transplantation at 1.6 years old. A bilateral anterior lamellar repositioning including eyelid split and cryoepilation was performed to correct bilateral upper eyelid entropium and trichiasis. Three months after the surgical intervention, the patient showed a persistent regular eyelid position with only mild recurrent right-sided lateral upper eyelid entropion. A significant reduction in conjunctival infections and epiphora with complete discontinuation of topical therapy was achieved. Although mucopolysaccaridosis is associated with eyelid abnormalities, the authors conclude that the described case is most likely due to chronic graft versus host disease.

LASIK and PRK in hyperopic astigmatic eyes: is early retreatment advisable?

PURPOSE: To analyze the refractive and keratometric stability in hyperopic astigmatic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) during the first 6 months after surgery. PATIENTS AND METHODS: This retrospective cross-sectional study included 97 hyperopic eyes; 55 were treated with LASIK and 42 with PRK. Excimer ablation for all eyes was performed using the ALLEGRETTO excimer laser platform using a mitomycin C for PRK and a mechanical microkeratome for LASIK. Keratometric and refractive data were analyzed during three consecutive follow-up intervals (6 weeks, 3 months, and 6 months). The corneal topography was obtained using Scheimpflug topography, and subjective refractions were acquired by expert optometrists according to a standardized protocol. RESULTS: After 3 months, mean keratometry and spherical equivalent were stable after LASIK, whereas PRK-treated eyes presented statistically significant (P<0.001) regression of hyperopia. In eleven cases, hyperopic regression of >1 D occurred. The optical zone diameter did not correlate with the development of regression. CONCLUSION: After corneal laser refractive surgery, keratometric changes are followed by refractive changes and they occur up to 6 months after LASIK and for at least 6 months after PRK, and therefore, caution should be applied when retreatment is planned during the 1st year after surgery because hyperopic refractive regression can lead to suboptimal visual outcome. Keratometric and refractive stability is earlier achieved after LASIK, and therefore, retreatment may be independent of late regression.

Scheduled versus Pro Re Nata Dosing in the VIEW Trials.

PURPOSE: To analyze visual acuity (VA) outcomes before and after preplanned treatment regimen change in the VIEW studies at week 52 (W52). DESIGN: Multiple post hoc analyses for retrospectively defined subgroups in 2 multicenter, multinational, double-masked trials. PARTICIPANTS: Two thousand four hundred fifty-seven neovascular age-related macular degeneration (AMD) patients. METHODS: Patients were randomized to treatment with 0.5 mg ranibizumab given monthly, a 0.5-mg or 2-mg intravitreal aflibercept injection given monthly, or 2 mg intravitreal aflibercept given every other month, after 3 initial monthly doses, up to W52. From W52 through W96, patients received their original dosing assignment using a capped pro re nata (PRN) regimen, with defined retreatment criteria based on VA and morphologic signs of disease activity and mandatory dosing at least every 12 weeks. MAIN OUTCOME MEASURES: Best-corrected VA (BCVA) and optical coherence tomography assessments were mandatory at all visits from baseline to W96. Outcomes were changes in BCVA and central retinal thickness. Outcomes were evaluated in all patients who completed 2 years of the VIEW studies using the last observation carried forward method for missing data at interim visits. RESULTS: After W52, approximately 20% of patients lost 5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or more across all treatment arms with PRN treatment. Patients who met the retreatment criterion of loss of 5 ETDRS letters or more in the first quarter of the PRN dosing phase did not recover; mean final VA loss across the 4 study arms was -4.4 to -5.8 letters. Outcomes of these patients up to W52 were indistinguishable from those of the overall population. There were no differences between groups in serious ocular adverse events or Anti-Platelet Trialists' Collaboration arterial thromboembolic events through W96. CONCLUSIONS: These analyses suggest that there are subgroups of patients for whom VA outcomes in the second year of the VIEW studies were less stable than in the first year and for whom W52 seems to be an important inflection point. Although alternate reasons specific to the nature of the underlying AMD cannot be fully excluded, the switch in treatment regimen at W52 is a plausible explanation.

Screening for Subclinical Keratoconus Using Swept-Source Fourier Domain Anterior Segment Optical Coherence Tomography.

PURPOSE: To discriminate between subclinical fellow eyes of patients with keratoconus (scKCE) and normal eyes (NE) using swept-source Fourier-domain anterior segment optical coherence tomography (SS-OCT). SETTING: University Medical Center Hamburg-Eppendorf, Germany. DESIGN: Retrospective cross-sectional study. METHODS: NE (both eyes with a KISA% Index <60; N = 213) and scKCE (KISA% Index <60, but an index of >100 in the fellow eye; N = 61) eyes were grouped according to the KISA% Index. Topography and tomography data were obtained by SS-OCT (Casia SS1000) and reviewed retrospectively. Receiver operating characteristics were performed for Casia SS1000 integrated automated parameters and newly computed indices. Additionally, discriminant functions were calculated for the automated single parameters, the computed indices, and the combination of both. RESULTS: An accuracy ≥0.7 was reached for 28 (8 automated and 20 newly computed parameters) of 785 parameters. Fourier analysis posterior higher-order irregular astigmatism revealed the highest accuracy with 0.81. By combining automated parameters with the newly computed indices in 1 discriminant function, an area under the curve of 0.92 with a corresponding accuracy of 0.85 was achieved. CONCLUSIONS: SS-OCT is able to discriminate between NE and scKCE with high accuracy. Automated single parameters and newly computed indices were combined to further improve this accuracy.

Detection of retinal changes in idiopathic Parkinson's disease using high-resolution optical coherence tomography and heidelberg retina tomography.

PURPOSE: The study was performed to analyse the retina of patients with Parkinson's disease (PD) for morphological changes compared to healthy controls (HC) using spectral-domain optical coherence tomography (SD-OCT) and confocal scanning laser ophthalmoscopy. METHODS: We enrolled 108 patients with idiopathic PD and 165 HC. All study participants underwent an ophthalmological examination to exclude ophthalmological disorder potentially interfering with the retinal analyses. Peripapillary retinal nerve fibre layer (RNFL) thickness and macular thickness and volume were measured by a SD-OCT device (Heidelberg Spectralis(®) ). Stereometric parameters of the optic disc were acquired by Heidelberg Retina Tomograph (HRT III). RESULTS: The RNFL thickness did not significantly differ between patients with PD and HC. The thickness of the central minimum and the centre of the macular area were significantly reduced in patients with PD, while the total macular volume did not significantly differ between the groups. Furthermore, we noted an inverse correlation between the central minimum thickness and the disease severity (assessed by the Hoehn and Yahr scale). HRT data showed no significant differences. CONCLUSION: The HRT device and the RNFL measurements of the SD-OCT did not prove to be a clinically valid diagnostic tool to distinguish eyes of patients with PD and HC. However, the macular region and especially the foveola (central minimum) with the highest density of photoreceptor cells seem to be more sensitive and might be potential biomarkers.

Flap-induced astigmatism in eyes with sphere myopia correction: Superior hinge using a rotating microkeratome versus nasal hinge using a linear microkeratome.

PURPOSE: To compare the effect of a rotating microkeratome (M2) and a linear microkeratome (SBK) on the change in the astigmatic component in eyes with preoperative plano refractive cylinder. SETTING: University Medical Centre Hamburg-Eppendorf, Hamburg, Germany. DESIGN: Retrospective case series. METHODS: An Allegretto excimer laser was used to perform laser ablation in myopic eyes of consecutive patients. The laser in situ keratomileusis (LASIK) procedure included mechanical flap preparation using a microkeratome, either a linear type with a single-use 90 µm head to create a nasal hinge or a rotating type with a single-use 90 µm head to create a superior hinge. The Alpins vector method was applied to describe the effects of LASIK on postoperative refractive cylinder. RESULTS: The study evaluated 1045 eyes of 852 patients. Although the mean overall efficacy and safety indices indicate the procedure was highly precise, safe, and efficient, there were statistically significant differences in surgically induced astigmatism (SIA) between the microkeratomes (P = .002). The postoperative refractive cylinder (ie, SIA) was 0.75 diopter (D) or more in 116 eyes (11.1%), 44 (12.8%) of 344 linear cases and 72 (10.3%) of 701 rotating cases. Independent of the type of microkeratome used, the SIA was slightly higher in eyes treated first; the mean magnitude of the induced astigmatism was 0.35 D. CONCLUSIONS: In approximately 10% of eyes with preoperative plano refractive myopia, the astigmatic component tended to be overcorrected. Nevertheless, independent of the type of microkeratome, the maximum mean magnitude of refractive cylinder documented was 0.35 D. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Scanning laser polarimetry and spectral domain optical coherence tomography for the detection of retinal changes in Parkinson's disease.

PURPOSE: Whether retinal degeneration is part of the degenerative processes in patients with Parkinson's disease (PD) is still unclear. This cross-sectional study was undertaken to compare the retinal morphology of patients with PD and healthy controls using spectral domain optical coherence tomography (SD-OCT) and scanning laser polarimetry (SLP). METHODS: Both eyes of patients with PD (n = 108) and healthy controls (n = 165) were examined using SD-OCT and SLP on the same day. Data on the thickness of the retinal nerve fibre layer (RNFL) of all quadrants and the macular area were acquired by OCT (Cirrus, Zeiss). The SLP device (Glaucoma diagnostics (GDx), Zeiss) measured the RNFL and calculated the nerve fibre index (NFI). All patients and probands were checked for concomitant ocular disorders by an ophthalmologist. Visual acuity, intraocular pressure (IOP), objective refraction and the anterior and posterior segment were assessed. RESULTS: Patients with PD showed a reduced macular volume and a reduced central subfield thickness in OCT examinations. The RNFL in the different quadrants did not differ significantly from that of controls. SLP data showed a reduced average RNFL thickness, a decreased thickness of the inferior quadrant and an increase of the NFI in patients with PD. CONCLUSION: PD may be associated with reduced thickness and volume of the macula and a reduced thickness of the RNFL in the inferior quadrant of the retina. Investigations using SD-OCT and SLP revealed distinct but significant differences between patients with PD and healthy controls.

Sustained Neural Stem Cell-Based Intraocular Delivery of CNTF Attenuates Photoreceptor Loss in the nclf Mouse Model of Neuronal Ceroid Lipofuscinosis.

A sustained intraocular administration of neurotrophic factors is among the strategies aimed at establishing treatments for currently untreatable degenerative retinal disorders. In the present study we have analyzed the neuroprotective effects of a continuous neural stem (NS) cell-based intraocular delivery of ciliary neurotrophic factor (CNTF) on photoreceptor cells in the nclf mouse, an animal model of the neurodegenerative lysosomal storage disorder variant late infantile neuronal ceroid lipofuscinosis (vLINCL). To this aim, we genetically modified adherently cultivated NS cells with a polycistronic lentiviral vector encoding a secretable variant of CNTF together with a Venus reporter gene (CNTF-NS cells). NS cells for control experiments (control-NS cells) were modified with a vector encoding the reporter gene tdTomato. Clonal CNTF-NS and control-NS cell lines were established using fluorescent activated cell sorting and intravitreally grafted into 14 days old nclf mice at the onset of retinal degeneration. The grafted cells preferentially differentiated into astrocytes that were attached to the posterior side of the lenses and the vitreal side of the retinas and stably expressed the transgenes for at least six weeks, the latest post-transplantation time point analyzed. Integration of donor cells into host retinas, ongoing proliferation of grafted cells or adverse effects of the donor cells on the morphology of the host eyes were not observed. Quantitative analyses of host retinas two, four and six weeks after cell transplantation revealed the presence of significantly more photoreceptor cells in eyes with grafted CNTF-NS cells than in eyes with grafted control-NS cells. This is the first demonstration that a continuous intraocular administration of a neurotrophic factor attenuates retinal degeneration in an animal model of neuronal ceroid lipofuscinosis.

Wikipedia--challenges and new horizons in enhancing medical education.

BACKGROUND: Wikipedia gains growing attention as a provider of health information. This study aimed to investigate the use, relevance and challenges of Wikipedia among medical students. METHODS: An online questionnaire was made accessible to students at five medical universities in Germany, Austria, and Norway. Besides demographical data, the questions covered the role of Wikipedia in the academic life of medical students. The questionnaire investigated if the students had ever found erroneous medical entries and whether they corrected these. RESULTS: A frequent use of Wikipedia in general is statistically significant correlated with a frequent use in medical studies (p < 0.001). Information retrieved from Wikipedia is predominantly critically appraised either by comparing it to profound knowledge (79%) and/or to specific literature (75%). Despite most (97%) respondents disclosed that they already had found false information in Wikipedia, recognized errors were seldomly corrected (~20%). CONCLUSIONS: The information retrieved from Wikipedia is critically appraised. However, we found shortcomings in handling erroneous entries. We argue for professional responsibility among medical students in dealing with this dynamic resource. Moreover, we encourage medical schools to supplement information to Wikipedia to further benefit from the vast possibilities of this platform.

LASIK for spherical refractive myopia: effect of topographic astigmatism (ocular residual astigmatism, ORA) on refractive outcome.

PURPOSE: In eyes with a preoperative plano refractive cylinder, it would appear that there is no rationale for astigmatic treatment. The aim of this retrospective, cross-sectional data analysis was to determine the amount of topographic astigmatism in refractive plano eyes that results in reduced efficacy after myopic laser in situ keratomileusis (LASIK). METHODS: This study included 267 eyes from 267 consecutive myopic patients with a refractive plano cylinder. Receiver operating characteristic analysis was used to find the cut-off values of preoperative ocular residual astigmatism (= topographic astigmatism) that can best discriminate between groups of efficacy and safety indices in preoperative plano refractive cylinder eyes. RESULTS: Preoperative ocular residual astigmatism (ORA) (or topographic astigmatism) of ≤0.9 diopters (D) resulted in an efficacy index of at least 0.8 statistically significantly more frequently than eyes with a preoperative ORA of >0.9 D. Eyes with a high ORA preoperatively also had a high ORA postoperatively. Regression analysis showed that each diopter of preoperative ORA reduced efficacy by 0.07. CONCLUSION: A preoperative corneal astigmatism of ≥0.9 D could (partially) be taken into account in the LASIK design, even if the subjective refractive astigmatism is neutral.

Correlation of the KISA% index and Scheimpflug tomography in 'normal', 'subclinical', 'keratoconus-suspect' and 'clinically manifest' keratoconus eyes.

PURPOSE: To analyse tomographic changes in eyes classified as 'normal', 'keratoconus-suspect' and 'clinically manifest keratoconus' based on the established KISA% definition of Rabinowitz and Rasheed and to develop the category of 'subclinical keratoconus eyes' to expand the classification into a 'subtopographic' range. METHODS: Tomographic and topographic analyses of 670 eyes performed with a rotating Scheimpflug imaging system (Pentacam(®), Oculus Inc., Wetzlar, Germany) were retrospectively analysed. Based on the KISA% keratoconus classification system, eyes were assigned to a 'normal', 'keratoconus-suspect' or 'manifest keratoconus' group. In addition, a new group of 'subclinical keratoconus eyes' was analysed, comprising unsuspicious fellow eyes of patients with keratoconus. T-tests, Wilcoxon rank-sum test, receiver operating characteristics (ROC) and robust regression analyses were performed to correlate tomographic parameters with the increasing KISA% index. RESULTS: KISA%-grouped keratoconus eyes showed robust tomographic changes. By adding the subclinical group, although the concurrent topography was unchanged, we were able to demonstrate statistically significant changes for almost all tomographic parameters (parameters with highest sensitivity/specificity: ART_max, [0.69/0.69], BAD_D [0.66/0.66]). The highest coefficient of determination (R(2)) with the KISA% index was demonstrated for Ele_f_max (R(2) = 0.70), Ele_f_TP (R(2) = 0.69), Ele_b_TP (R(2) = 0.69) and BAD_D (R(2) = 0.68). CONCLUSION: We recommend the use of the expanded KISA% index (eKISA% index) as the basis for the definition of keratoconus and normal groups in future keratoconus research projects.

A new technology for applanation free corneal trephination: the picosecond infrared laser (PIRL).

The impact of using a Femtosecond laser on final functional results of penetrating keratoplasty is low. The corneal incisions presented here result from laser ablations with ultrafast desorption by impulsive vibrational excitation (DIVE). The results of the current study are based on the first proof-of-principle experiments using a mobile, newly introduced picosecond infrared laser system, and indicate that wavelengths in the mid-infrared range centered at 3 µm are efficient for obtaining applanation-free deep cuts on porcine corneas.

Postoperative refractive error after phacovitrectomy for epiretinal membrane with and without macular oedema.

PURPOSE: This study was initiated to investigate whether the presence of macular oedema influenced intraocular lens (IOL) power calculation in eyes with epiretinal membrane. METHODS: The files of patients undergoing combined phacoemulsification were retrospectively reviewed. Two groups were defined according to presence of macular oedema. The main outcome measure was the IOL power prediction error (PE). Secondary outcome measures were the correlation between preoperative macular thickness, absolute change of macular thickness and dioptric shift. The mean postoperative PE achieved with the Haigis formula was compared with the PE that would have been obtained had the SRKII and HofferQ formulas been used. RESULTS: We investigated 47 eyes of 47 consecutive patients. Regardless of the IOL formula used, the PE was on average higher in eyes without macula oedema (group 1). The myopic dioptric shift was dependent on preoperative macular thickness and absolute change of macular thickness. This association was more markedly pronounced in group 1. CONCLUSIONS: Increased retinal thickness is the main cause for underestimation of the cornea-photoreceptor layer distance, and therefore could contribute to inaccuracy in IOL power calculations. The current results show that a myopic shift tends to be less pronounced in cases where a macula oedema is present. Eyes with pure traction have less predictable refractive results in terms of higher PE and dioptric shift.