The Effect of Upper Eyelid Blepharoplasty on Corneal Tomography and Epithelial Profile.

Introduction: Upper tarsal mechanical forces influence corneal epithelial thickness profile, which could modulate corneal astigmatism. Upper eyelid blepharoplasty reduces upper tarsal strength and may have an impact on ocular surface. The aim of this study is to evaluate the effect of upper eyelid blepharoplasty on corneal epithelial thickness profile, astigmatism and aberrations. Methods: Patients with dermatochalasis underwent bilateral upper eyelid blepharoplasty. Anterior segment optical coherence tomography (AS-OCT) (Zeiss Cirrus 5000 HD-OCT) and Pentacam (Oculus, Wetzlar Germany) were performed before surgery and in the 8th postoperative week. Corneal epithelial thickness, keratometry, aberrations and asphericity were considered for statistical purposes. Only right eyes were considered. A p-value lower than 0.05 was considered significant. Results: Thirty eyes of 30 patients were included. The degree of astigmatism did not change after surgery (0.95D vs 0.83D, p=0.23). The difference between preoperative and postoperative steepest axis was 3.1° (p=0.04) with a tendency to change toward the vertical meridian. Mean epithelial thickness was higher in the inferior region both pre- and postoperatively and did not change. ET in the superior octant was lower (42 µm vs 45 µm, p<0.01) and the difference between inferior and superior octants (I-S) was higher (7 µm vs 3 µm, p<0.001) before surgery. There were no statistically significant changes in corneal aberrations (p=0.52) and asphericity (p=0.41) after surgery. Conclusion: Our results support that upper tarsus pressure influences epithelial thickness profile and, consequently, the corneal steepest keratometry. These results lead us to postulate that upper eyelid blepharoplasty may influence biometric and keratometric measurements.

Corneal Epithelial Thickness Changes After Topical Treatment of Dry Eye Disease in Primary Sjögren Syndrome.

Purpose: To evaluate the changes on epithelial thickness before and after topical treatment in primary Sjögren syndrome-associated dry eye disease (SS-DED). Methods: This was a prospective study that included referred women with SS-DED and healthy age-matched controls. Corneal epithelial thickness was evaluated using high-definition anterior segment optical coherence tomography (Cirrus 5000 HD-OCT) in the baseline first consultation, and four weeks after treatment with preservative free 1mg/1mL sodium hyaluronate. Schirmer test 1 (ST1), tear break-up time (TBUT), tear meniscus height (TMH), SICCA Ocular Surface Score (SICCA OSS) and Ocular Surface Disease Index (OSDI) were evaluated. Statistical significance was defined as p-value <0.05. Results: The study included 40 eyes, 20 with SS-DED and 20 controls. At baseline, SS-DED patients had lower ST1 (11.1 ± 2.2mm vs 14.1 ± 3.1mm, p<0.01), faster TBUT (9.1 ± 1.8s vs 13.2 ± 1.1s, p<0.01) and lower TMH (211.2 ± 68.4 µm vs 217.2 ± 60.1µm; p<0.01) than the control group, whereas SICCA OSS and OSDI were higher (p<0.01). The superior epithelium was thinner in SS-DED group (41.1 ± 3.2 µm vs 43.1± 2.3 µm, p<0.01). After treatment, ST1, TBUT, TMH, SICCA OSS, and OSDI improved (p<0.01), and superior epithelium thickened (p<0.01) in the SS-DED group. Conclusion: Treatment with sodium hyaluronate improved ST1, TBUT, TMH, SICCA-OSS, and OSDI score. Superior epithelium tends to be thinner in SS-DED but becomes thicker with treatment. Our results seem to illustrate the morphological changes in the corneal epithelium in DED, which could be further recognized as a clinical biomarker of SS-DED.

Tobacco effects on ocular surface, meibomian glands, and corneal epithelium and the benefits of treatment with a lipid-based lubricant.

PURPOSE: Our aim was to evaluate the ocular surface in chronic smokers and to assess the benefit of sodium hyaluronate (SH) versus semi-fluorinated alkane (SFA) eyedrops on tear film, meibomian glands, and corneal epithelial thickness (CET). METHODS: This prospective randomized single-blinded study included smokers, who applied one eyedrop of Hyabak® on one eye (SH group) and one eyedrop of EvoTears® on the fellow eye (SFA group) 4 times daily for 2 months, and age-matched non-smokers. Ocular surface parameters, including tear film break-up time (TBUT) test and corneal fluorescein staining (CFS) score, lipid layer thickness (LLT), meibography (LipiView®), and CET measurements (Zeiss Cirrus HD-5000®), were assessed at baseline and after treatment. RESULTS: Seventy-eight eyes were included in the smokers group (39 in the SH subgroup and 39 in the SFA subgroup) and 42 eyes in the control group. At baseline, the smokers group had a higher prevalence of dry eye (100% vs 0%, p < 0.001) and of meibomian gland dysfunction (MGD) and lower CET measurements than controls (p < 0.05). TBUT, CFS, and LLT (controls vs SFA group: 64.02 ± 1.87 nm vs 49.56 ± 4.33 nm, p = 0.05) improved in the SFA subgroup after treatment, but not in the SH subgroup, and became equivalent to those of controls. Prevalence of dry eye decreased in the smokers group after treatment (controls vs SH group vs SFA group: 0% vs 12.82% vs 16.26%, p > 0.05). Meibomian gland morphological parameters and CET did not improve after treatment (p < 0.05). CONCLUSIONS: Smoking is associated with dry eye, MGD, and corneal epithelial thinning that seem to be only partially reversible with topical lubricants, preferably SFA.

Corneal Epithelium Asymmetry in Children With Atopy: The Effect of Hand Dominance.

Purpose: To evaluate the effect of eye rubbing on the epithelial thickness profile in tomographically normal corneas by AS-OCT and to compare right and left eyes in right-handed children. Methods: Thirty right-handed boys (mean age 11.2 years) with ocular allergy and history of eye rubbing were evaluated using Scheimpflug (Pentacam HR, Oculus Wetzlar, Germany) and anterior segment optical coherence tomography. Epithelial thickness (ET) and full corneal thickness (CT) parameters were compared between right and left eyes with a non-parametric Mann-Whitney test. A p-value lower than 0.05 was considered for statistical significance. Results: No eyes had topometric nor tomographic criteria for keratoconus. The min-max ET was lower in right eyes (-2.8 µm vs -3.5; p = 0.02). The difference between inferior and superior (I-S) octants was lower in right eyes (1.1 µm vs 1.9 µm; p = 0.03) as a result of inferotemporal thinning. The highest ET difference was registered between nasal and temporal octants and was more pronounced in the right eyes (2 µm vs 3.1 µm; p < 0.001). Conclusion: AS-OCT analyses reveal different epithelial thickness patterns between the eyes in young atopic patients, likely eye rubbers. Inferior and temporal epithelial thickness seem to be more affected by thinning in the eye on the side of the dominant hand.

Comparative evaluation of visual outcomes after bilateral implantation of an advanced or conventional monofocal intraocular lens.

PURPOSE: To assess the clinical outcomes and patient satisfaction of the Tecnis Eyhance, an advanced monofocal intraocular lens (IOL), compared to a conventional monofocal IOL. DESIGN: Retrospective case-control study. METHODS: This study included 120 eyes of 60 patients (30 patients in each group) who underwent bilateral cataract surgery either with the implantation of conventional monofocal IOLs (Tecnis PCB00), as a control group, or advanced monofocal IOLs (Tecnis Eyhance ICB00). Ophthalmological evaluation included the measurement of binocular corrected distance visual acuity (CDVA), monocular and binocular uncorrected distance visual acuity (UDVA), and uncorrected intermediate VA (UIVA). In addition the binocular defocus curve was analyzed. Furthermore a subjective questionnaire (Catquest-9SF) was used to assess vision and life quality. RESULTS: The average binocular UDVA was 20/22 in the ICB00 group and 20/20 in the PCB00 model (p = 0.62). The average monocular UIVA was 20/32 in the ICB00 group and 20/40 in the control group (p < 0.001). We found the binocular UIVA, had a mean value of 20/30 in the ICB00, compared to 20/40 in the control group (p < 0.001). The reported dysphotopsia was not significantly different between both groups (p = 0.56). Regarding the life quality questionnaire, the ICB00 group showed less difficulty in activities requiring intermediate vision. CONCLUSION: Our results demonstrated a significant improvement in visual acuity for intermediate distance in the ICB00 group compared to the control group, without compromising distance visual acuity. We also found a greater capability for intermediate distance activities (namely for computer use and reading price tags) when comparing ICB00 patients with the control group.

Impact of Graves Disease on Ocular Surface and Corneal Epithelial Thickness in Patients With and Without Graves Orbitopathy.

PURPOSE: Our aim was to assess ocular surface and tear film stability and corneal epithelial thickness (CET) in patients with Graves disease (GD) with and without Graves orbitopathy (GO). METHODS: This study included healthy age-matched controls and patients with GD. Symptoms (Ocular Surface Disease Index questionnaire) and signs (schirmer test and tear breakup time test) of dry eye disease were determined, according to the International Dry Eye Workshop II criteria of DED. CET map was also assessed. RESULTS: Twenty-four eyes were included in the control group, with a mean age of 41.00 ± 13.65 years, and 34 in the GD group, 18 with GO and 16 without GO, with a mean age of 44.44 ± 13.95 and 45.75 ± 10.59 years, respectively. All patients with GO had inactive disease (mean clinical activity score: 1.33 ± 0.69). Patients with GD had higher proportion of clinical diagnosis of dry eye disease (GO vs. GD without GO vs. controls: 77.77% vs. 75.00% vs. 4.17%), with higher Ocular Surface Disease Index (GO vs. GD without GO vs. controls: 15.44 vs. 15.06 vs. 9.88) and lower tear breakup time test (GO vs. GD without GO vs. controls: 6.33 s vs. 7.25 s vs. 11.63 s). Superior CET was lower in patients with GD (P < 0.05). No differences were found between patients with and without GO (P > 0.05). CONCLUSIONS: GD negatively influenced ocular surface and CET, with a higher level of eye dryness and corneal thinning regardless of GO status, suggesting that subclinical chronic inflammation may play a role in the pathogenesis of tear film and ocular surface stability.

Retinal vascular impairment in patients newly diagnosed with obstructive sleep apnea syndrome.

BACKGROUND: To evaluate retinal morphological and vascular parameters in patients recently diagnosed with obstructive sleep apnea syndrome (OSAS) and determine the correlation between retinal vascular density and the severity of OSAS. METHODS: We performed a retrospective study on the retinal vasculature of patients with OSAS and age-match healthy controls. OSAS was confirmed by full-night cardiorespiratory polygraphy. Patients were divided into three groups according to disease severity given by apnea-hypopnea index (AHI) i.e., mild, moderate or severe. Retinal thicknesses and vascular density were compared among groups, for both the macula and optic disc. Correlation between vascular density and clinical features were also assessed. RESULTS: The study included 30 eyes of patients with OSAS and 12 controls. No differences were found regarding retinal thickness in both the macula and the optic disc between OSAS patients and controls. In contrast, significant differences were found in the peripapillary vessel density between groups versus control patients. The greatest difference being between severe OSAS and controls (49.4% ± 2.1 versus 40.4% ± 4.2 respectively, p=0.01). Peripapillary vessel density was found to significantly and negatively correlate with AHI (p=0.02; r= -0.74) and directly correlate with the lowest percutaneous oxygen saturation (p=0.02; r= 0.58). CONCLUSIONS: This study indicates that OSAS is associated with retinal microvasculature impairment, that seems to mainly affect the optic disc. This suggests that microvascular damage increases with the increasing severity of OSAS. As such, prospective trials are needed to clarify if this vascular peripapillary damage precedes glaucomatous optic neuropathy in OSAS patients.

Corneal Epithelial Thickness Profile in Healthy Portuguese Children by High-Definition Optical Coherence Tomography.

INTRODUCTION AND OBJECTIVE: To evaluate corneal epithelial thickness (ET) and corneal thickness (CT) profiles in healthy eyes of Portuguese children and provide information to establish the first normative Caucasian database for these age group. METHODS: Sixty healthy eyes of 60 children aged between 8 and 18 were evaluated using the Cirrus high-definition optical coherence tomography device. The average ET and CT were assessed using Cirrus Review Software with predefined concentric corneal ring-shaped zones. Specific regions of ET (central, superior, inferior, temporal, nasal, superonasal, inferotemporal, superotemporal and inferonasal) were also assessed. The mean ET, the mean CT and the difference of ET in corresponding octants were compared by gender. Correlations between central epithelial thickness (CET), age and refractive error were evaluated. RESULTS AND DISCUSSION: The average ET was lower in the peripheric zones, whereas the average CT was higher. ET was thinner in the superior area than in the inferior (p<0.05). ET was thicker in boys than in girls (p<0.05), but CT did not differ. CET was not correlated with older age or refractive error. CONCLUSION: Optical coherence tomography analysis of ET reveals that it is thinner in the periphery, where the CT is thicker. Unlike CT, ET seems to be influenced by gender. ET profile proved to be a useful tool in keratoconus diagnosis and subclinical keratoconus detection in adults. As epithelial changes occur early in the disease and keratoconus is more aggressive in pediatric population, a normative database of ET profile could contribute to enhance early recognition of the disease in this age group.

The effect of insulin pump therapy in retinal vasculature in type 1 diabetic patients.

BACKGROUND/OBJECTIVES: Continuous subcutaneous insulin infusion (CSII) is a treatment for type 1 diabetes that improves metabolic control and reduces micro and macrovascular complications. The aim of this study was to compare the effect of CSII versus traditional multiple daily injections (MDI) therapy on retinal vasculature. METHODS: We performed a prospective study with type 1 diabetic patients with no prior history of ocular pathology other than mild diabetic retinopathy. The patients were divided into two groups according to their therapeutic modality (CSII vs MDI). The retinal nerve fiber layers thickness and vascular densities were compared between groups in both macula and optic disc. The correlations between vascular density and clinical features were also determined. Statistical significance was defined as p < 0.05. RESULTS: The study included 52 eyes, 28 in the insulin CSII group. The mean age was 36.66 ± 12.97 years, with no difference between groups (p = 0.49). The mean glycated hemoglobin (HbA1c) was found to be lower in the CSII group (7.1% ± 0.7 vs 7.5% ± 0.7 p < 0.01). The parafoveal vascular density was found to be higher in the CSII group (42.5% ± 0.4 vs 37.7% ± 0.6, p < 0.01). We found an inverse correlation between HbA1c value and parafoveal vascular densities (p < 0.01, r = -0.50). CONCLUSION: We found that CSII provided better metabolic control than MDI and this seemed to result in higher parafoveal vascular density. As lower vascular density is associated with an increased risk of diabetic retinopathy, these results suggest that CSII could be the safest therapeutic option to prevent retinopathy.

Preliminary Clinical Outcomes of a New Enhanced Depth of Focus Intraocular Lens.

PURPOSE: To assess the preliminary clinical outcomes and patient satisfaction of the new enhanced depth of focus (EDOF) LuxSmart™ intraocular lens IOL and to compare with a conventional monofocal IOL (Akreos™) in patients who had undergone bilateral cataract surgery. METHODS: Twelve patients underwent bilateral LuxSmart IOL implantation, and twelve underwent bilateral Akreos IOL implantation. Best-corrected distance (CDVA) and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 66cm, uncorrected near visual acuity (UNVA) at 40cm and defocus curve were assessed. Patients-reported visual function was inquired by Catquest-9SF. The presence of photic phenomena was evaluated. A p-value lower than 0.05 was considered for statistical significance. RESULTS: The mean IOL power was +21.90D in LuxSmart group and +22.30D in Akreos. Monocular UDVA (p = 0.32) and CDVA (p = 0.52) did not differ between groups. The average binocular UIVA (0.18 ± 0.12 logMAR vs. 0.30 ± 0.13 logMAR, p < 0.001) and UNVA (0.38 ± 0.14 logMAR vs. 0.44 ± 0.17 logMAR, p = 0.02) were higher in LuxSmart IOL group. No patients reported disabling photic phenomena in either group. CONCLUSION: This study shows that new LuxSmart EDOF IOL achieved higher performance for intermediate and near vision compared with a conventional monofocal IOL, without increasing the risk of dysphotopsias. LuxSmart may be an attractive and safe option for patients who desire spectacle independence for distance and intermediate vision after cataract surgery.

Enhanced Ectasia Detection Using Corneal Tomography and Biomechanics.

PURPOSE: To test the accuracy of the Tomographic and Biomechanical Index (TBI) for ectasia detection in an independent population from the original study. DESIGN: Retrospective case-control study. METHODS: Subjects: Patients were grouped according to clinical diagnosis including corneal topography (front-surface curvature): Normal group, including 1 eye randomly selected from 312 patients with normal corneas; Keratoconus group, including 1 eye randomly selected from 118 patients with keratoconus; a nonoperated ectatic eye from 57 patients with very asymmetric ectasia (57 eyes, VAE-E group), and the nonoperated fellow eye with normal topography (57 eyes, VAE-NT group). MAIN OUTCOME MEASURES: The ability of TBI to distinguish normal and ectatic corneas; and comparison with other indexes, including the Belin/Ambrósio Deviation Index (BAD-DI) and the Corvis Biomechanical Index (CBI), considering the areas under receiver operating characteristic curves (AUCs). RESULTS: The AUC of the TBI was statistically higher than all other tested parameters (DeLong, P < .001). Considering all cases, the cut-off value of 0.335 for the TBI provided a sensitivity of 94.4% and a specificity of 94.9% (AUC = 0.988; 95% confidence interval [CI] 0.982-0.995). Considering the VAE-NT group, optimized TBI cut-off value of 0.295 provided a sensitivity of 89.5% and a specificity of 91.0% (AUC = 0.960; 95% CI 0.937-0.983). CONCLUSION: The TBI was more accurate than all parameters tested for differentiating normal from ectatic corneas. The TBI may epitomize ectasia susceptibility and distinguish cases with fruste disease from true unilateral cases among the eyes with normal-topography VAE.

Manejo do astigmatismo residual após implante de lente intraocular / Management of residual astigmatism after intraocular lens implantation

RESUMO Relatamos um caso de astigmatismo residual, após cirurgia de catarata com implante de lente intra-ocular (LIO) tórica (Acrysof Toric, Alcon, Frot Worth TX). A refração residual (+1,25 -2,50 x 105º) e o posicionamento da LIO implantada neste olho, foram correlacionados com a aberrometria total obtida por ray tracing de pontos individuais integrada à da face anterior da córnea obtida por topografia de Plácido, para cálculo das aberrações internas (iTrace, Tracey, Technologies, Houston TX). O cálculo do eixo ideal da LIO, para minimizar a refração residual foi realizado de acordo com Berdahl & Hardten (astigmatismfix.com). A rotação da LIO foi realizada com sucesso 5 meses após a cirurgia inicial para o eixo indicado, reduzindo o erro residual para +0,25 -0,25 x 61º e promovendo reabilitação visual sem correção de 20/20.

ABSTRACT We report a case of residual astigmatism after cataract surgery with toric intraocular lens (IOL) implantation (Acrysof Toric, Alcon, Frot Worth TX). Residual refraction (+1,25 -2,50 x 105º) and IOL positioning were correlated with total ray-tracing wavefront aberrometry integrated with anterior corneal surface Placido-based topography to calculate internal aberrations (iTrace, Tracey Technologies, Houston TX). The ideal IOL axis to minimize residual refraction was calculated with Berdahl & Hardten (astigmatismfix.com). IOL rotation to the indicated axis was successfully performed 5 months after initial surgery, reducing residual error to +0,25 -0,25 x 61º, promoting visual reabilitation, with final uncorrected distance visual acuity 20/20.

Dynamic corneal deformation response and integrated corneal tomography.

Measuring corneal biomechanical properties is still challenging. There are several clinical applications for biomechanical measurements, including the detection of mild or early forms of ectatic corneal diseases. This article reviews clinical applications for biomechanical measurements provided by the Corvis ST dynamic non contact tonometer.