Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes.

PURPOSE: To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes. METHODS: A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included. RESULTS: In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°. CONCLUSION: Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.

Traumatic expulsive iridodialysis after small-incision sutureless cataract surgery.

Phacoemulsification with intraocular lens (IOL) implantation was performed in the right eye of an 84-year-old woman using a small clear corneal incision. Ten weeks after surgery, the patient fell, which caused traumatic iridodialysis and hyphema with expulsion of the iris through the surgical corneal incision. Apart from a transient rise in intraocular pressure, no other complication was identified and the visual acuity returned to 20/20 within 2 months. The IOL remained in situ and undisturbed in the capsular bag, and the retina remained flat, suggesting that an IOL in the capsular bag may provide a stable barrier to prevent tissue loss from the posterior segment.

Clinical outcomes of keratitis.

OBJECTION: To analyse the patient, clinical and microbiological variables associated with poor outcomes from keratitis in patients presenting to a major public hospital in Australia. METHODS: A retrospective audit of the records of all patients who had a corneal scraping in 5 years at Princess Alexandra Hospital (Brisbane, Australia) was carried out. The outcome of a patient's episode of keratitis was classified as poor if they had final visual acuity of 6/60 or worse; had vision loss during treatment; or a complication of keratitis; or needed surgical intervention. RESULTS: A final outcome was established in 207 cases during the 5-year period. Final vision of 6/12 or better was found in 48% (100) of cases while a poor outcome was seen in 28% (58). Linear regression showed poor outcomes were directly associated with age (P < 0.001) and disease severity (P < 0.001). Univariate analysis indicated that poor outcomes were more likely in patients who had had prior ocular surgery (P = 0.005) or ocular surface disease (P = 0.01) and were also associated with presenting visual acuity of worse than 6/60 (P < 0.001) and isolation of Streptococcus pneumoniae (P = 0.002). While patients with traumatic keratitis, contact lens-related keratitis or negative corneal cultures (P = 0.009) were more likely to have good outcomes. Multivariate analysis showed that the relative risk of a patient having a poor outcome was 4.3x (CI 2.0-9.5) if they had severe keratitis, 4.1x (CI 1.8-9.5) if they had keratitis related to ocular surface disease and 3.8x (CI 1.8-8.3) if they were over 50 years old. CONCLUSIONS: An outcome of poor vision, vision loss during treatment, surgical intervention or complication of keratitis is more likely in patients with severe keratitis, keratitis related to prior ocular surface disease or older age.

Effect of hinged lamellar keratotomy on post-keratoplasty astigmatism and vision.

PURPOSE: To show that hinged lamellar keratotomy alone affects refraction and vision in post-keratoplasty eyes. METHODS: A retrospective, non-comparative, interventional case series was conducted on 28 eyes of 26 patients who had two-stage laser in situ keratomileusis (LASIK) after penetrating keratoplasty. Records were reviewed with respect to the hinged lamellar keratotomy component of the procedure. The interval between keratoplasty and keratotomy was at least 1 year, and the follow-up period averaged 29 +/- 10 days. The Automated Corneal Shaper with nasal hinge was used. In addition to basic empirical astigmatism calculations, the Alpins method of astigmatism analysis was also employed to ensure that the influence of changes in cylinder axis were correctly taken into account when calculating the refractive change. RESULTS: Surgically induced astigmatism from hinged lamellar keratotomy was not statistically significant in this series; however, the range in values (-9.06 to +7.57 D) has potential clinical ramifications. Nearly 70% of cases studied experienced surgically induced astigmatism of at least 2 D. Mean preoperative uncorrected vision was logMAR 1.06 +/- 0.41, which improved marginally postoperatively to logMAR 1.03 +/- 0.44 (P = 0.36). Best spectacle-corrected visual acuity averaged logMAR 0.21 +/- 0.16 preoperatively, improving to logMAR 0.09 +/- 0.15 (range -0.18 to 0.42) postoperatively, which was a statistically significant improvement (P < 0.01). No difference in refractive or visual outcomes was identified when those with keratoconus were compared to those with other underlying corneal disease processes. CONCLUSION: Although mean surgically induced astigmatism was not statistically significant, hinged lamellar keratotomy caused considerable changes in astigmatism in nearly 70% of post-keratoplasty eyes studied. This suggests that clinically significant inaccuracies may result if a one-stage LASIK procedure is performed on such patients. The authors suggest that reassessment of refraction after keratotomy may improve refractive outcomes.