Sodium hyaluronate 0.30% ocular gel versus sodium hyaluronate 0.18% eye drop in the treatment of moderate to severe dry eye disease.

PURPOSE: Compare 0.30% sodium hyaluronate (0.30%HA) ocular gel with 0.18%HA eye drops in terms of improvement of ocular signs and symptoms, in patients with moderate to severe dry eye disease (DED). METHODS: This was a multicentric, randomized, investigator-masked, non-inferiority, comparative study conducted over 84 days. Three visits were scheduled, testing fluorescein corneal and conjunctival staining (Oxford and Van Bijsterveld scores), tear film break-up time (TBUT), Schirmer test, DED symptoms, 5-Item-Dry-Eye-Questionnaire (5-DEQ), patient and investigator satisfaction and frequency of instillation. RESULTS: At Day 35 (D35) and Day 84 (D84), both groups (n = 35 each) had a significant improvement in corneal staining (p < 0.001) with no inter-group difference. Van Bijsterveld score improved earlier (D35) for 0.30%HA suggesting a faster effect on conjunctival epithelium healing. There was no difference between the two concentrations in terms of TBUT or Schirmer improvements; however, the Schirmer test increase was only significant for 0.30%HA at D35 (p = 0.040). At D35 and D84, both groups showed similar improvements of DED symptoms and DEQ-5 score. Furthermore, treatment satisfaction was similar for the 2 formulations suggesting that daily use of 0.30%HA do not cause gel-related blurred vision disturbances. Frequency of instillation was similar for both groups. CONCLUSION: Our study demonstrates the non-inferiority of 0.30%HA gel compared to 0.18%HA solution in patients with moderate to severe DED. Because of its gel formulation and higher HA concentration providing prolonged comfort without causing visual disturbances, 0.30%HA gel might be adapted for bedtime use or during the day in more severe conditions.

Multicountry clinical outcomes of a new nondiffractive presbyopia-correcting IOL.

PURPOSE: To evaluate the effectiveness and safety of a new presbyopia-correcting intraocular lens (IOL) with a nondiffractive design, DFT015, compared with an aspheric monofocal IOL, SN60WF. SETTING: 19 investigational sites in 4 countries: Australia, Canada, Spain, and the United Kingdom. DESIGN: Prospective, randomized, parallel-group, controlled, assessor- and patient-masked clinical study. METHODS: Participants aged ≥22 years with bilateral cataracts were randomized to DFT015 or SN60WF in a 5:4 ratio and masked until final postoperative follow-up at month 6. The primary effectiveness objective was superiority of DFT015 over SN60WF in mean monocular photopic distance-corrected intermediate visual acuity (DCIVA) at month 3. Secondary effectiveness objectives included noninferiority of DFT015 to SN60WF in mean monocular photopic corrected distance visual acuity (CDVA) and superiority in the mean monocular photopic distance-corrected near visual acuity (DCNVA) at month 3. Visual disturbances were assessed at month 6. RESULTS: 282 patients were randomized to DFT015 (n = 159) or SN60WF (n = 123). All effectiveness objectives were achieved at month 3 in first eyes. For monocular photopic results in first eyes, DFT015 demonstrated superior mean DCIVA (least squares means of -0.139 logMAR in favor of DFT015, P < .001), noninferior mean CDVA (97.5% upper confidence limit [UCL] of the difference was <0.1 logMAR) and superior mean DCNVA (95% UCL of the difference was <0.0 logMAR) compared with SN60WF at month 6. DFT015 exhibited a similar visual disturbance profile to that of SN60WF. CONCLUSIONS: DFT015 provided superior intermediate and near vision and a similar visual disturbance profile compared with an aspheric monofocal IOL.

A Comparison of Efficacy and Safety of Two Lipid-Based Lubricant Eye Drops for the Management of Evaporative Dry Eye Disease.

PURPOSE: The aim of this study was to compare the efficacy of two lipid-based lubricant eye drops in patients with lipid-deficient dry eye. METHODS: This Phase IV, multicenter, prospective, double-masked study enrolled adults (aged ≥18 years) who had a tear film breakup time (TFBUT) of ≤15 seconds(s), and unanesthetized Schirmer I test of ≥3 mm to ≤12 mm in at least one eye, at both screening and baseline visits. Eligible patients (n=231) were randomized (1:1) and received either Systane® Balance (SYSB; n=117) or Refresh® Optive Advanced (RFO-Ad, n=114), four-times a day, for 35 days. The primary endpoint was non-inferiority for change from baseline in TFBUT at Day 35 (non-inferiority was established if the lower limit of the 95% confidence interval (CI) for the difference between the treatment groups was > -1.0 s); secondary endpoints (test of superiority) were change in TFBUT and global ocular discomfort visual analog scale (VAS) score at Day 35. Other endpoints included the impact of dry eye on everyday life (IDEEL) treatment satisfaction scores (inconvenience and effectiveness) and safety. RESULTS: At Day 35, the mean change from baseline in TFBUT was 0.998 s in the SYSB and 0.868 s in the RFO-Ad groups with a treatment difference: 0.130 s; (95% CI -0.34, 0.60; P<0.0001) demonstrating non-inferiority of SYSB to RFO-Ad. The global ocular discomfort VAS scores improved in both groups, with a mean change from baseline of -9.7 and -8.8 in SYSB and RFO-Ad groups (treatment difference -0.8; P=0.62), respectively. No meaningful difference was observed in IDEEL treatment effectiveness and treatment inconvenience scores between SYSB vs RFO-Ad (P>0.05 for treatment difference). Both treatments were well tolerated. CONCLUSION: SYSB lubricant eye drops were non-inferior to RFO-Ad for improvement in TFBUT in patients with lipid-deficient dry eye. Both lubricant eye drops improved TFBUT and ocular discomfort scores in patients with lipid-deficient dry eye.

Iritis, glaucoma and corneal decompensation associated with BrightOcular cosmetic iris implant.

PURPOSE: NewColorIris cosmetic iris implants have a record of high ocular morbidity and are no longer in use. Newer generation of iris implants, BrightOcular, have patented posterior grooves in order to decrease iris touch and facilitate aqueous flow around the implant. However, little is known about their safety despite their implantations in 10 countries. METHODS: Collaborative case series of patients who had bilateral implantation of cosmetic iris implants solely for cosmetic reasons. RESULTS: 12 cases were collected being distributed as Caucasian (10) and Asian (2), women (11) and man (1) and with a mean age of 32 years. Ocular manifestations were present in 11 subjects and included anterior uveitis (10 of 12; 83.3%), glaucoma (7 of 12; 58.3%) and corneal decompensation (6 of 12; 50%). Visual acuity was normal in seven, decreased in five with two having visual recovery following explantation of the implant. Glaucoma could not be controlled medically in two patients. CONCLUSIONS: Cosmetic iris implants carry the risk of ocular damage when implanted in the anterior chamber of normal phakic eyes.

Complications secondary to cosmetic artificial iris anterior chamber implants: a case report.

BACKGROUND: Artificial iris anterior chamber implants were originally developed for therapeutic purposes but have been used recently for the cosmetic alteration of eye colour. There is a growing body of evidence surrounding their associated risks. We report a case presenting with complications secondary to bilateral NewColorIris® implants, including the first report of pressure-induced stromal keratopathy in this context. CASE PRESENTATION: A thirty-eight year old South American man presented as an emergency in the UK with best corrected visual acuities of 1/60 OD and 6/18 OS, bilateral corneal decompensation, lens opacities and raised intraocular pressures 4 years following bilateral NewColorIris® implantation in Panama. Anterior segment optical coherence tomography demonstrated the direct apposition of the implant with the iris and iridocorneal angle, together with pressure-induced stromal keratopathy with a fluid interface between the corneal stroma and previous laser-assisted in situ keratomileusis flaps. We describe the successful combined medical and surgical management in this case to yield a final visual acuity 6/12 in both eyes. CONCLUSION: Artificial iris anterior chamber implants are associated with sight-threatening complications that can present years after their implantation. We caution against their use for the cosmetic alteration of eye colour.

Wavefront-optimized laser in situ keratomileusis with the Allegretto Wave Eye-Q excimer laser and the FEMTO LDV Crystal Line femtosecond laser: 6 month visual and refractive results.

PURPOSE: To present the first reported series of patients undergoing myopic LASIK with the FEMTO LDV Crystal Line femtosecond laser and the WaveLight Allegretto Eye-Q excimer laser. We report the uncorrected and corrected distance visual acuity (UDVA and CDVA), refractive predictability, efficacy and safety of laser in situ keratomileusis (LASIK) performed with the above laser platforms. METHODS: This prospective interventional case series study evaluated consecutive eyes with low to moderate myopic astigmatism that underwent LASIK with the FEMTO LDV Crystal Line femtosecond laser and the WaveLight Allegretto Eye-Q 400 Hz excimer laser. Visual and refractive changes as well as complications were evaluated after wavefront-optimized laser treatment. RESULTS: Four hundred and forty four patients (887 eyes) reached the 6-month time gate. Mean age at time of procedure was 31 years (range: 20-59). Mean pre-op spherical-equivalent (SE) was -3.44 diopters (D)±1.34D (range: -0.50 to -7.00) whilst the postoperative spherical equivalent decreased to -0.08±0.31D (range -2.25 to 1.00). At 6-month follow up, 96.9% of patients had monocular uncorrected distance visual acuity of 20/20 or better with 95.2% of patients within ±0.5D of intended refractive outcome. All patients achieved 20/20 binocular distance uncorrected visual acuity. No significant intra-operative or postoperative complications were encountered during the 6-month follow-up period. CONCLUSIONS: The combination of the above laser platforms provides safe, effective and predictable results in correcting compound myopic astigmatism with excellent visual outcomes.

Traumatic insertion of eyelashes into corneal stroma.

An unusual case of eyelashes being traumatically inserted into the corneal stroma is presented. A 75-year-old hit her right eye with her own fist, presenting with intra-corneal eyelashes. All remained entirely within the cornea, with no breach of the endothelium. They seemed to have tracked there first through the superior conjunctiva and then the superior limbus. The lashes were surgically removed, with good visual recovery. The authors present a short review of intra-ocular eyelash insertion.

Corneal inlay implantation in a young pseudophakic patient.

UNLABELLED: We describe the surgical correction of a 32-year-old pseudophakic patient with the Kamra corneal inlay. To our knowledge, this is the youngest patient to have such a procedure. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Spontaneous corneal clearance despite graft removal in Descemet stripping endothelial keratoplasty in Fuchs endothelial dystrophy.

PURPOSE: To report spontaneous corneal clearing with improved visual acuity and central endothelial cell repopulation after the removal of a dislocated donor button following Descemet stripping endothelial keratoplasty (DSEK). METHODS: Interventional case report. RESULTS: An 84-year-old woman with decreased visual acuity in the right eye secondary to Fuchs endothelial dystrophy and cataract underwent combined cataract extraction, intraocular lens implantation, and DSEK. After primary graft failure, the resulting detached, opaque, and retracted donor lenticule was removed from the eye 2 months after the initial surgery and not replaced. The cornea started to clear after the donor button removal with central endothelial cell repopulation. CONCLUSIONS: Corneal deturgescence is not strictly dependent on donor lenticule adhesion to the host posterior stromal surface. Endothelial cell migration and repopulation of the central cornea can occur after DSEK and after the removal of the failed endothelial graft, with corneal clearing and improved visual outcomes.

A rare case of penetrating ocular injury secondary to a boa constrictor bite.

Penetrating injuries from non-venomous snakebites are, thankfully, rare. They are, however, sight-threatening and the recent trend for using non-venomous snakes as props in the entertainment industry is increasing exposure of this hazard to people with no animal handling training. We report a case of a penetrating corneal injury in a 35 year old woman following a bite from a snake she had been given to hold for a photograph opportunity. The injury was repaired surgically and she had a good visual outcome, largely due to very good fortune in the site and nature of the injury. This case highlights the danger of exposing untrained handlers to snakes in the entertainment industry.

Sutureless large incision cataract extraction: Indications and results from two teaching hospital eye departments in the United Kingdom.

OBJECTIVE: To highlight the role of Sutureless Large Incision Cataract Extraction (SLICE) in the United Kingdom for the treatment of cataracts at high risk for intra- or postoperative complications. SETTING: Two University Hospitals in the United Kingdom MATERIALS AND METHODS: Retrospective case note review of planned SLICE performed over a 12-month period. RESULTS: SLICE was performed on 11 eyes of 11 patients (mean age, 79 years) having preoperative vision of hand motions (10 eyes) with very dense or mobile cataracts and high risk for phacoemulsification. Mean follow up was 12 weeks, with no operative or postoperative complications. Nine patients (without ocular or systemic comorbidity) achieved best corrected vision of 0.3 LogMAR (20/40) or better. CONCLUSIONS: SLICE is safe and effective for dense or mobile cataracts and can play a role in patients where conventional phacoemulsification carries higher risks of complications.

Complications and management of cosmetic anterior chamber iris implants.

PURPOSE: To report the management of complications due to cosmetic iris implantation. DESIGN: Interventional case report. METHODS: A 27-year-old female underwent bilateral anterior chamber NewColorIris implants in Panama to cosmetically change her eye colour. Two weeks later she presented as an eye emergency in London with corneal decompensation, raised intraocular pressure and significantly reduced vision. Bilateral explantation was performed with good postoperative recovery. RESULTS: Three months following explantation, visual acuity had normalized and intraocular pressure was within the normal range without medication. CONCLUSIONS: Cosmetic iris implantation can lead to potentially sight threatening complications. This is the first case to be reported in the United Kingdom. There is a lack of published safety data and their cosmetic application should be cautioned against.

Airbag-induced corneal flap.

PURPOSE: To describe a case of airbag-induced corneal flap in a previously normal cornea. METHODS: Case report. RESULTS: A 27-year-old woman presented with complete loss of vision in her left eye following a road traffic accident which involved airbag deployment. There was no previous ocular history. Examination revealed a large corneal flap of 6mm in diameter, extending to the depth of anterior stroma. This was accompanied by a traumatic optic neuropathy. One month follow-up revealed complete reattachment of the corneal flap. CONCLUSIONS: This is the first reported case of a corneal flap induced by airbag deployment in a cornea with previously normal architecture.

Visual outcome in cataract surgery complicated by vitreous loss in a district general hospital.

PURPOSE: To determine the visual outcome of patients following cataract surgery complicated by vitreous loss and to establish the factors, if any, that influenced the final visual outcome. METHODS: Retrospective review of all patients over a 1-year period who had planned phacoemulsification complicated by vitreous loss. Information was entered into a pre-devised proforma and the results analysed. RESULTS: Of the 1614 eyes operated on for cataract, 43 (2.66%) had surgery complicated by vitreous loss. The mean age of the patients experiencing surgical complications was 79.7 years (range 48-93 years). Twenty-three patients (53%) had at least one factor contributing to the difficulty of procedure, with dense cataract being the top factor in 11 patients. There was no statistically significant association between any pre-operative predisposing factor, stage at which vitreous loss occurred, grade of the surgeon and final visual outcome. When pre-existing co-morbidity was excluded, 26 of 30 (87%) patients achieved a best-corrected visual acuity of 6/12 or better post-operatively. Cystoid macula oedema was the underlying cause in 50% of those patients that lost one or more lines post-operatively. CONCLUSIONS: Surgeons at all levels of training had an acceptable complication rate, with the majority of patients achieving a good visual outcome. Dense cataract was the most common factor contributing to the complexity of the surgery.

Visual and refractive outcomes of LASIK with the SCHWIND ESIRIS and WaveLight ALLEGRETTO WAVE Eye-q excimer lasers: a prospective, contralateral study.

PURPOSE: To compare the safety, efficacy, and predictability of LASIK with the SCHWIND ESIRIS and WaveLight ALLEGRETTO WAVE Eye-Q excimer laser platforms. METHODS: This prospective study comprised 44 eyes of 22 consecutive patients who were treated with LASIK using the Moria M2 microkeratome. One eye was treated with the SCHWIND ESIRIS laser and the fellow eye treated with the WaveLight ALLEGRETTO WAVE Eye-Q laser. All eyes operated with the SCHWIND ESIRIS were treated with standard aspheric ablation, whereas the eyes operated with the WaveLight ALLEGRETTO WAVE Eye-Q received treatment with three different ablation types according to the common practice at our clinic. Outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and proximity to target refraction at 6-month follow-up. RESULTS: At 6 months postoperative, mean decimal UCVA was 0.96+/-0.22 (range: 0.3 to 1.2) for ESIRIS eyes and 0.98+/-0.17 (range: 0.6 to 1.2) for ALLEGRETTO eyes (P=.57). Mean postoperative spherical equivalent refraction was -0.02+/-0.28 diopters (D) (range: -0.75 to +0.75 D) for ESIRIS eyes and 0.11+/-0.91 D (range: -1.00 to +3.88 D) for ALLEGRETTO eyes (P=.49). Of the ESIRIS eyes, 20/22 (91%) were within +/-1.00 D of target refraction and 20/22 (91%) were within +/-0.50 D of target refraction. Of the ALLEGRETTO eyes, 20/22 (91%) and 19/22 (86%) were within +/-1.00 D and +/-0.50 D, respectively, of target refraction. No patient lost > or =2 lines of BSCVA in either group. CONCLUSIONS: No differences were seen in safety and efficacy outcome parameters between the SCHWIND ESIRIS and WaveLight ALLEGRETTO WAVE Eye-Q excimer lasers when used according to a previously established treatment algorithm at our clinic in the treatment of refractive error.

Refractive lens exchange for presbyopia.

True presbyopia correction still remains one of the main challenges amongst eye professionals. Many corrective techniques exist including bifocal spectacle correction, monovision techniques both with corrective lenses and surgery, multifocal corneal excimer laser and refractive lens exchange with either accommodating or multifocal lenses. Refractive lens exchange was first described more than 10 years ago and has become more accepted in recent years with advancements in lens technology and improvements in surgical techniques. This article reviews developments in this field and current available lens options in the treatment of presbyopia.

Uses and safety profile of ciclosporin in ophthalmology.

Ciclosporin is a calcineurin inhibitor that acts by primarily inhibiting the action of T cells. Clinical trials in the early 1980s demonstrated that systemic ciclosporin was a promising steroid-sparing agent and was also effective in patients who are refractory to treatment with corticosteroids. However, recent years have witnessed the emergence of safer immunosuppressive agents due to the poor side-effect profile of systemic ciclosporin. Topical ciclosporin, however, has a much improved safety profile and is still used to treat a variety of ocular surface disorders including dry eye syndrome, vernal and atopic keratoconjunctivitis, severe blepharitis and high-risk corneal graft patients. This article reviews the uses and safety profile of systemic and topical ciclosporin in ophthalmology, as well as discussing alternative therapeutic agents available.

Airbag induced corneal ectasia.

PURPOSE: To report a case of airbag induced corneal ectasia. METHODS: Case report. RESULTS: A patient 3 years post-LASIK developed bilateral corneal ectasia worse in the right eye following airbag deployment in a road traffic accident. At last follow up, best corrected vision was 20/40 with -4.00/-4.00 x 25 in the right eye and 20/25 with -1.25/-0.50 x 135 in the left eye. CONCLUSIONS: This is a rare presentation of trauma induced ectasia in a patient post-LASIK. It is possible that reduction in biomechanical integrity of the cornea from prior refractive surgery contributed to this presentation.