Visual acuity after cataract surgery in patients with optic neuropathies.

PURPOSE: To compare visual acuity outcomes of cataract surgery between patients with and without non-glaucomatous optic neuropathies. METHODS: Retrospective case-control study of patients with and without optic neuropathies who underwent cataract surgery from 2010 to 2017. For all eyes, the last preoperative best corrected visual acuity (BCVA) and first BCVA greater than 1 month postoperatively (to ensure sustained refractive stabilization) were recorded in logarithm of the minimum angle of resolution (logMAR) units. RESULTS: Thirty patients (42 eyes) with optic neuropathies and 30 control patients (42 eyes) underwent uncomplicated cataract surgery. The mean age at surgery was significantly younger in the optic neuropathy group (64 versus 71.2 years, p < 0.01). The mean improvement in visual acuity in the optic neuropathy group was 0.4 ± 0.6 logMAR units (roughly 4 Snellen lines) from 0.7 ± 0.8 units preoperatively to 0.3 ± 0.5 postoperatively. Between the cases and controls, there was no significant difference in preoperative BCVA (p = 0.48), postoperative BCVA (p = 0.42), or the mean improvement in BCVA (p = 0.82). When stratified by optic neuropathy subtype, patients with optic neuropathies secondary to multiple sclerosis (n = 12) or non-arteritic ischaemic optic neuropathy (n = 11) had significant improvement in BCVA postoperatively (p < 0.01 and p = 0.03, respectively). CONCLUSION: Contrary to what may be expected from such a severe ocular comorbidity, our data suggest that the mean BCVA improvement after cataract surgery in patients with non-glaucomatous optic neuropathies was comparable to that of control patients. Cataract surgery may be performed in patients with both optic neuropathies and advanced cataracts with a reasonable preoperative expectation that visual acuity improvement can be significant.

Penetrating Keratoplasty Using the Femtosecond Laser: A Comparison of Postoperative Visual Acuity and Astigmatism by Suture Pattern.

PURPOSE: To compare the effect of 3 common suturing techniques on eyes that received femtosecond laser-enabled penetrating keratoplasty (FLEK) with a zig-zag configuration at the Gavin Herbert Eye Institute, University of California- Irvine, California. METHODS: This is a retrospective chart review of a series of 319 eyes of 286 patients who underwent FLEK with a zig-zag configuration. One hundred fifty-seven eyes had running sutures, 136 eyes had simple interrupted sutures, and 26 eyes had combined sutures (single running and simple interrupted). The main outcome measures were uncorrected distance visual acuity, best spectacle-corrected visual acuity (BSCVA), and topographic astigmatism (TCyl). These parameters were recorded for the first year of follow-up regardless of suture removal status and also after full suture removal. RESULTS: At 3 months, the BSCVA of the running, interrupted, and combined suture groups was 0.22 (±0.2), 0.41 (±0.3), and 0.29 (±0.1), respectively (P < 0.01). The mean TCyl of the running, interrupted, and combined groups at 3 months was 3.95 (±2.7), 6.41 (±4.4), and 5.44 (±3.3) D, respectively (P < 0.01) All sutures were removed in 190 of 319 eyes, and at the last recorded visit, the mean BSCVA was 0.18 (±0.2), 0.34 (±0.2), and 0.19 (±0.2) logarithm of the minimum angle of resolution in the running, interrupted, and combined groups, respectively (P < 0.01) and mean TCyl was 4.51 (±2.8), 5.62 (±3.7), and 4.57 (±2.9) D, respectively (P = 0.11). CONCLUSIONS: Better visual acuity after full suture removal was observed in the running suture group; however, the subgroups of patients with keratoconus were similar after all sutures were removed.