Computer-Based Tutorial to Enhance the Informed Consent Process for Cataract Surgery in Serbian- or Turkish-Speaking Patients.

INTRODUCTION: This study analyses if a translated version of the CatInfo tool increases the knowledge of Serbian- and Turkish-speaking patients about cataract surgery. METHODS: In total, 61 cataract patients, literate in Serbian or Turkish, were randomly allocated into two groups. Via an interactive computer-based tool ("CatInfo"), patients either saw a detailed audio-visual presentation about cataract surgery (study group) or a "placebo" video (control group). Afterwards, all participants had a face-to-face discussion with an ophthalmologist. Immediately after the interview and on the day of surgery, all patients had to fill out a questionnaire including knowledge and demographic questions. Patients in the study group were further asked about their satisfaction with the CatInfo tool and the usefulness of such a device before other interventions. RESULTS: Patients in the study group answered significantly more questions correctly compared to the control group, and this information gain remained stable over a 1-week period. There was a significant low negative correlation between educational level and the test results, whereas age and computer habits of the participants did not have an influence on correct answers. Satisfaction with the CatInfo tool was high in the Serbian and the Turkish group (96% and 84%, respectively), and 92% of Serbian patients as well as 62% of the Turkish patients rated that they could imagine to use such a device before any other surgery. DISCUSSION/CONCLUSION: The translated version of the CatInfo tool improved patients' knowledge, and this information gain remained stable until the day of the surgery.

Results of ethanol-assisted epithelium-on corneal cross-linking with and without intrastromal corneal ring implantation.

PURPOSE: To evaluate the topographic, refractive, and pachymetric changes after ethanol-assisted transepithelial corneal cross-linking (CXL) to stabilize progression of keratoconus (KC). PATIENTS AND METHODS: This study retrospectively evaluated the long-term topographic, refractive, and pachymetric changes in patients diagnosed with KC who underwent corneal cross-linking and/or intrastromal corneal ring segment (ICRS) implantation. The subjects were divided into three groups, corresponding to eyes treated with CXL alone (group 1), CXL and ICRS at the same time (group 2), and CXL after ICRS implantation (group 3). Corrected visual acuity and refraction, steep keratometry (SteepK) values, steepest keratometry reading on sagittal curvature map, and corneal thickness were recorded preoperatively and at each visit. Changes between measurements were assessed during follow-up. RESULTS: Corrected distant visual acuity (CDVA) values improved in all groups compared with baseline, but the differences were not statistically significant except for the first year (p > 0.05). In groups 1 and 3, SteepK values did not change statistically significantly during the entire follow-up (p > 0.05). In group 2, SteepK values statistically significantly decreased at all follow-up examinations compared with baseline, determined as the first month after ICRS implantation (p < 0.05). Complication rates were acceptable without any need for surgical intervention. CONCLUSIONS: Single-session ethanol-assisted transepithelial CXL with or without ICRS implantation was a safe and effective procedure to halt progression of KC.

Corneal densitometry evaluation in archipelago keratitis.

To report a case of archipelago keratitis and its improvement as evaluated by corneal densitometry. A review of the patient's record and relevant literature. A 57-year-old man presented with blurred vision associated with photophobia and halos around lights. Slit-lamp examination revealed multiple confluent, nummular subepithelial infiltrates. The infiltrates were unresponsive to topical nonsteroidal anti-inflammatory drops. The treatment was changed to topical steroids and oral acyclovir and a diagnosis of archipelago keratitis was made. The patient showed quick response to the treatment and the infiltrates disappeared within 5 weeks. However, no clear changes were observed initially by slit-lamp but corneal densitometry allowed us to evaluate improvement as the density value decreased from 96.5 to 38.6. After 10 days of treatment all the symptoms were resolved. Archipelago keratitis responded well to topical steroids and oral acyclovir. We describe the use of corneal densitometry complementary to slit-lamp examination in the clinical observation of archipelago keratitis.

Intraoperative and early postoperative flap-related complications of laser in situ keratomileusis using two types of Moria microkeratomes.

The purpose of this study is to describe the incidence, management, and visual outcomes of intraoperative and early postoperative flap-related complications of laser in situ keratomileusis (LASIK) surgery using two types of Moria M2 microkeratomes. This retrospective analysis was performed on 806 primary LASIK cases. The intraoperative and early postoperative flap-related complications were identified and categorized according to type of Moria microkeratome. There were 52 intraoperative and early postoperative complications--one case of partial flap (0.124 %), one case of free flap (0.124 %), one case of small flap (0.124 %), 13 cases of epithelial defect (1.61 %), 12 cases of flap striae (1.49 %), 10 cases of diffuse lamellar keratitis (1.24 %), 10 cases of interface debris (1.24 %), three cases of epithelial ingrowth (0.37 %), and one case of microbial infection (0.124 %). The overall incidence of flap complications was 6.45 %. There were 27 right eye (6.73 %) and 25 left eye (6.17 %) complications. The incidence of complications with the Moria automated metallic head 130 microkeratome was 4.22 % and with the Moria single-use head 90 microkeratome was 2.23 %. We observed one culture-negative interface abscess which was cured with surgical cleaning and intensive medical treatment. The most common complication encountered was epithelial defects, followed by flap striae. Our study showed that LASIK with a microkeratome has a relatively low incidence of intraoperative and early postoperative flap complications. The authors have no financial interest in any of the issues contained in this article and have no proprietary interest in the development of marketing of or materials used in this study.

In Vivo Confocal Microscopy Findings After Anterior Stromal Puncture in the Treatment of Recurrent Corneal Erosion Syndrome.

Objectives: The objectives of the study are to show up the healing processes after anterior stromal puncture (ASP) in the cornea using in vivo confocal microscopy (IVCM) and to investigate the efficacy of ASP in the treatment of recurrent corneal erosion (RCE). Methods: This is a prospective, non-randomized, consecutive series. Twenty-three eyes of 19 patients diagnosed with RCE were evaluated between March 2020 and January 2022. Outcome measures included age, sex, laterality, etiology of RCE, duration and recurrence of symptoms, additional treatments required, and complications. IVCM was performed on the same day, at 1st week, 1st, and 6th month. Results: Mean age was 41.5±11.3 years, 63.2% of patients were female and 65.2% of eyes had unilateral involvement. Corneal trauma (56.5%) was the most common cause. Mean follow-up was 21.1 months (range 8-33). At the final follow-up, 69.5% of eyes were symptom free, 17.4% required a second ASP, and 13% needed a third ASP. At the 1st week, the epithelium became intact. An increase in activated keratocytes and dendritic cells (DCs) with beading of nerve fibers was observed. At 1st month, DCs and activated keratocytes were still present. At the 6th month, a scar was left. The superficial and basal epithelial cell formation and subbasal corneal nerve plexus returned to normal. Conclusion: IVCM has a superiority in visualizing cornea at cellular level. After ASP which is a safe, practical, and cost-effective treatment option in paracentral or peripherally located RCE, IVCM may help the surgeon to better observe and understand the post-healing processes and explain the recurrences.

Comparison of surgically induced astigmatic changes after cataract surgery in post-Laser in situ keratomileusis corneas versus virgin eyes.

PURPOSE: Postoperative refraction in modern mi-croincision cataract surgery gained extra importance in patients with the previous laser-assisted in situ keratomileusis (LASIK) surgery. The surgically induced astigmatic changes in those eyes may differ not only in magnitude but also in direction compared to virgin corneas. This study aimed to compare the surgically induced astigmatic changes after microscopic cataract surgery between post-LASIK corneas and virgin eyes. METHODS: Cases that underwent microincision cataract surgery in eyes with and without previous LASIK surgery were reviewed. The demographics, the axial length at cataract surgery, the central corneal thickness, spheric and cylindric values, keratometry readings, and postoperative posterior corneal astigmatism were retrospectively evaluated. A modified Alpins method was used for astigmatic vector analysis, and baseline astigmatism, surgically induced astigmatism, difference vector, flattening effect, and torque were assessed. RESULTS: A total of 42 eyes from 24 subjects was evaluated. Group I consisted of 14 eyes with the previous LASIK, and Group II included 28 eyes without any refractive surgery. Preoperative mean central corneal thickness in Group I was significantly thinner (p=0.012). There was no significant difference in baseline astigmatism between the groups regarding magnitude and power vectors. After microincision cataract surgery, there were no significant differences in mean spheric and cylindric values and mean keratometry readings (all p>0.05). However, surgically induced astigmatism and difference vector were significantly higher on J45 vector component in post-LASIK eyes and microincision cataract surgery steepening effect on post-LASIK corneas was significantly higher than those in virgin eyes (p=0.001, p=0.002 and p=0.018, respectively). CONCLUSIONS: Cataract surgery has steepened the corneas in both groups with a significantly higher steepening effect in post-LASIK eyes. Certainly, corneal topography cataract surgery is particularly helpful to provide more precise surgically induced astigmatism interpretations.

Comparison of Postoperative Corneal Astigmatism Induced by Two Different Corneal Incisions during Microincisional Cataract Surgery.

Objectives: Clear corneal incision (CCI) architecture in modern microincision cataract surgery (MICS) plays an undeniable role in postoperative refraction. The goal of this study was to evaluate the effect of hinge incision prior to two-step CCI on postoperative refractive astigmatism after cataract surgery and to demonstrate the schematic presentation of these postoperative astigmatic changes via double-angle polar plots. Methods: This study involved a consecutive case series of patients who had MICS. The first incision was performed as a two-step CCI, whereas the second was made as a hinge incision prior to 2-step CCI. The preoperative corneal and postoperative refractive astigmatism and surgically induced astigmatism (SIA) were calculated by vectorial analysis. Hotelling's T2 test was performed to compare the centroid values of preoperative and postoperative corneal astigmatism. Results: A total of 63 eyes from 57 subjects were evaluated. Group I consisted of 27 eyes with the two-step CCI, and Group II included 36 eyes with the hinge incision prior to two-step CCI. No significant difference was found between the groups in terms of age, sex, axial length, keratometry readings, implanted intraocular lens power, and postoperative spherical equivalent. The centroids of corneal astigmatism postoperatively increased to 0.21 D at 87.6°±0.61 with no significance in Group I (p=0.525) and to 0.70 D at 90.6°±0.47 with significance in Group II (p=0.032). The difference in postoperative centroids between the two groups was also significantly different (p=0.043). Finally, the centroids of SIA were 0.12 D at 85.5°±0.50 and 0.22 D at 91.1°±0.49 for Group I and Group II, respectively, with no significance. Conclusion: A hinge incision did not have an unfavorable effect on postoperative refractive astigmatism; therefore, it may be preferred for controlled entrance to the anterior chamber.

The Effect of Anterior Segment Depth on the Accuracy of 7 Different Intraocular Lens Calculation Formulas.

Objectives: To evaluate the effect of anterior segment depth (ASD; sum of anterior chamber depth and lens thickness) on the accuracy of 7 intraocular lens formulas calculated in patients with axial length (AL) between 22.5 and 24.5 mm. Materials and Methods: In this retrospective study, patients who underwent cataract surgery were divided into three groups based on their ASD measurements (Group I: ASD <7.30 mm, Group II: ASD between 7.30-7.90 mm, Group III: ASD >7.90 mm). The mean predictive error (MPE), mean absolute error (MAE), and median absolute error (MedAE) values of each group were compared. The effect of ASD on the predictive error (PE) of each lens formula was additionally tested in subgroups based on mean keratometry (K) values (Subgroup I: K <42.0 D, Subgroup II: K between 42.0-44.5 D, Subgroup III: K >44.5 D). Results: The study included 184 eyes of 184 patients. In Group I, all formulas except Olsen OLCR and Barrett II had clinically myopic MPEs. In Group II, the MPEs of all lens formulas except Barrett II were statistically non-different from zero (p>0.05). In Group III, the MPEs of all lens formulas were found to be statistically hyperopic. In Group III, all formulas except Olsen OLCR were significantly shifted to more hyperopic results when compared with Groups I and II (p<0.05). ASD was positively correlated with the PEs of the SRK/T, Holladay I, Hoffer Q, Barrett II, Hill-RBF, and Haigis formulas. In cases with mean K greater than 42.0 D, ASD was similarly correlated with PE for all formulas except Olsen OLCR. Conclusion: In eyes with AL between 22.5 and 24.5 mm, the predictions of lens formulas were significantly hyperopic in cases with greater ASD.

Recent studies provide an updated clinical perspective on blue light-filtering IOLs.

BACKGROUND: Recent reviews of blue light-filtering intraocular lenses (IOLs) have stated their potential risks for scotopic vision and circadian photoentrainment. Some authors have challenged the rationale for retinal photoprotection that these IOLs might provide. Our objective is to address these issues by providing an updated clinical perspective based on the results of the most recent studies. METHODS: This article evaluates the currently available published papers assessing the potential risks and benefits of blue light-filtering IOLs. It summarizes the results of seven clinical and two computational studies on photoreception, and several studies related to retinal photoprotection, all of which were not available in the previous reviews. These results provide a clinical risk/benefit analysis for an updated review for these IOLs. RESULTS: Most clinical studies comparing IOLs with and without the blue light-filtering feature have found no difference in clinical performance for; visual acuity, contrast sensitivity, color vision, or glare. For blue light-filtering IOLs, three comparative clinical studies have shown improved contrast sensitivity and glare reduction; but one study, while it showed satisfactory overall color perception, demonstrated some compromise in mesopic comparative blue color discrimination. Comparative results of two recent clinical studies have also shown improved performance for simulated driving under glare conditions and reduced glare disability, better heterochromatic contrast threshold, and faster recovery from photostress for blue light-filtering IOLs. Two computational and five clinical studies found no difference in performance between IOLs with or without blue light-filtration for scotopic vision performance and photo entrainment of the circadian rhythm. The rationale for protection of the pseudophakic retina against phototoxicity is discussed with supporting results of the most recent computational, in-vitro, animal, clinical, and epidemiological investigations. CONCLUSIONS: This analysis provides an updated clinical perspective which suggests the selection of blue light-filtering IOLs for patients of any age, but especially for pediatric and presbyopic lens exchange patients with a longer pseudophakic life. Without clinically substantiated potential risks, these patients should experience the benefit of overall better quality of vision, reduced glare disability at least in some conditions, and better protection against retinal phototoxicity and its associated potential risk for AMD.

Phacoemulsification with intravitreal bevacizumab and triamcinolone acetonide injection in diabetic patients with clinically significant macular edema and cataract.

PURPOSE: The purpose of this study was to evaluate the results of phacoemulsification with intravitreal bevacizumab and triamcinolone acetonide injection in patients with diabetic clinically significant macular edema and cataract. METHODS: The records of 22 diabetic patients, with clinically significant macular edema and cataract who have undergone phacoemulsification with intravitreal injection of 1.25 mg bevacizumab and 2 mg triamcinolone acetonide, were retrospectively evaluated. All patients have undergone focal or modified grid argon laser photocoagulation 1 month after the surgery. All patients were evaluated by spectral OCT/OCT SLO before, 1 month, and 3 months after the surgery. The main parameters were the best-corrected visual acuity (BCVA) and central macular thickness (CMT). Paired samples t-test was used for statistical analysis. RESULTS: The mean initial best-corrected visual acuity was 0.15 ± 0.09 (0.05-0.3), whereas it was 0.6 ± 0.28 (SD) (0.3-0.7), 0.6 ± 0.22 (SD) (0.4-0.7) at 1 month and 3 months after the surgery, respectively. The BCVA levels recorded at 1 month and 3 months after the surgery were significantly higher than the initial BCVA (P = 0.002). The mean initial CMT was 392.2 ± 109.5 µm, whereas it was 295 ± 57.2 µm and 265.5 ± 30.3 µm at 1 month and 3 months after the surgery, respectively. The CMT values recorded at 1 month and 3 months after the surgery were significantly lower than the initial CMT (P < 0.001, P < 0.001). CONCLUSION: Phacoemulsification with intravitreal injection of bevacizumab and triamcinolone acetonide provides a decrease in CMT with a gain in BCVA in diabetic patients with clinically significant macular edema and cataract.

Logistic Regression Model Using Scheimpflug-Placido Cornea Topographer Parameters to Diagnose Keratoconus.

PURPOSE: Diagnose keratoconus by establishing an effective logistic regression model from the data obtained with a Scheimpflug-Placido cornea topographer. METHODS: Topographical parameters of 125 eyes of 70 patients diagnosed with keratoconus by clinical or topographical findings were compared with 120 eyes of 63 patients who were defined as keratorefractive surgery candidates. The receiver operating character (ROC) curve analysis was performed to determine the diagnostic ability of the topographic parameters. The data set of parameters with an AUROC (area under the ROC curve) value greater than 0.9 was analyzed with logistic regression analysis (LRA) to determine the most predictive model that could diagnose keratoconus. A logit formula of the model was built, and the logit values of every eye in the study were calculated according to this formula. Then, an ROC analysis of the logit values was done. RESULTS: Baiocchi Calossi Versaci front index (BCVf) had the highest AUROC value (0.976) in the study. The LRA model, which had the highest prediction ability, had 97.5% accuracy, 96.8% sensitivity, and 99.2% specificity. The most significant parameters were found to be BCVf (p=0.001), BCVb (Baiocchi Calossi Versaci back) (p=0.002), posterior rf (apical radius of the flattest meridian of the aspherotoric surface in 4.5 mm diameter of the cornea) (p=0.005), central corneal thickness (p=0.072), and minimum corneal thickness (p=0.494). CONCLUSIONS: The LRA model can distinguish keratoconus corneas from normal ones with high accuracy without the need for complex computer algorithms.

Corneal higher-order aberrations after Descemet's stripping automated endothelial keratoplasty.

PURPOSE: To compare the corneal higher-order aberration (HOA) after Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PKP), and in age-matched controls. DESIGN: Cross-sectional, non-comparative interventional case series. PARTICIPANTS: Thirty-one eyes of 28 patients who underwent DSAEK, 20 eyes of 16 patients who underwent PKP, and 31 eyes of 31 control patients. INTERVENTION: The corneal topography and HOAs of the central 4- and 6-mm zones from anterior and posterior corneal surfaces were evaluated postoperatively with the Scheimpflug rotating imaging system (Oculus Gmbh, Wetzlar, Germany). MAIN OUTCOME MEASURES: Anterior and posterior corneal HOAs. RESULTS: The mean anterior corneal total HOAs of the central 4 and 6 mm were 0.599+/-0.288 microm and 1.215+/-0.496 microm, respectively, in eyes that underwent DSAEK; 1.730+/-0.826 microm and 3.349+/-1.490 microm, respectively, in eyes that underwent PKP; and 0.439+/-0.163 microm and 0.921+/-0.300 microm, respectively, in controls. Although the mean anterior corneal total HOAs of the central 4 and 6 mm were significantly higher in eyes that underwent PKP than in eyes that underwent DSAEK and in controls (P<0.01), there was no significant difference in anterior corneal total HOAs of the central 4 and 6 mm between eyes that underwent DSAEK and controls. The mean posterior corneal total HOAs of the central 4 and 6 mm were 3.680+/-1.586 microm and 7.142+/-3.011 microm, respectively, in eyes that underwent DSAEK; 2.957+/-1.238 microm and 5.314+/-2.095 microm, respectively, in eyes that underwent PKP; and 0.818+/-0.193 microm and 1.609+/-0.344 microm, respectively, in controls. Although there was no significant difference in posterior corneal total HOAs of the central 4 mm between the DSAEK group and the PKP group, the posterior corneal HOAs of the central 6 mm were significantly higher in the DSAEK group than in the PKP group (P<0.01). CONCLUSIONS: Although posterior corneal HOAs are significantly higher in eyes that underwent DSAEK, anterior corneal HOAs are not significantly different in eyes that underwent DSAEK than those of age-matched controls.

Wavefront-guided ablation retreatment using Iris registration.

PURPOSE: To evaluate the efficacy, predictability, safety, and intraoperative and postoperative complications of laser in situ keratomileusis (LASIK) retreatment in myopic eyes using wavefront-guided ablation with iris registration (IR). METHODS: Retrospective analysis was used to evaluate wavefront-guided retreatment with IR in a consecutive cohort of 77 eyes (57 patients) after LASIK. The eyes were divided into two groups: no previous retreatment group (group 1) (n = 63) and previous LASIK retreatment group (group 2) (n = 14). The primary outcome variables assessed postoperatively at 1, 3, and 6 months were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and pre- and postretreatment changes in manifest refraction. RESULTS: The mean preretreatment spherical equivalent in group 1 was reduced from -0.5 +/- 1.0 diopter (D) (range -3 to 2.4) to 0.06 +/- 0.3 (range -0.9 to 0.6) (P < 0.002) at 6 months. In group 2, the mean preretreatment spherical equivalent was reduced from -0.9 +/- 1.24D (range -3.1 to -0.5) to 0.04 +/- 0.5 (range -1.0 to 1.1) (P < 0.049) at 6 months. At 6 months, UCVA was 20/20 or better in 92% in group 1 and 64% in group 2, of patients, respectively. No eyes lost more than one line of BCVA in group 1 and one eye (7%) lost two lines of BCVA in group 2. CONCLUSION: Wavefront-guided LASIK retreatment with IR after LASIK is an effective, predictable, and safe procedure in cases requiring a single retreatment. In contrast, eyes with previous retreatments showed less predictability and lower percentage of eyes with postoperative 20/20 UCVA.

Keratopigmentation: Is it a Miracle or an Adventure?

OBJECTIVES: This study is an analysis of the cosmetic and functional results of patients who underwent keratopigmentation (KTP). METHODS: Sixteen eyes of 16 patients, 7 females (43.75%) and 9 males (56.25%) were included in the study. Intrastromal and superficial manual KTP were performed under general anesthesia. Patients with no light perception or with only light perception but total corneal opacification, prosthetic contact lens intolerance, or unwillingness to use a contact lens were studied. The main outcomes were postoperative patient's satisfaction, cosmetic results, pigment stabilization and surgical complications. A grading system (0-5 points) was used to assess patient satisfaction and the cosmetic results. RESULTS: The mean age of the patients was 30.5±12.06 years (range: 16-53 years). Black pigment was used in 10 patients (62.5%), a brownish color in 5 patients (31.25%) and a greenish, yellow, blue, and black color pigmentation was used for 1 patient (6.25%). The mean follow-up was 29.31±15.45 months (range: 8-52 months). In 2 of 16 patients, mild to moderate pigment loss was seen 12 months after the surgery and superficial KTP was repeated. Minimal pigment loss was seen in 5 patients, but the cosmetic results were satisfactory and no secondary surgical procedure was required. Pigment leakage underneath the conjunctiva was seen in only 1 patient. Otherwise, there were no complications associated with keratopigmentation. The postoperative mean patient satisfaction score was 4.18±0.75 points (range: 3-5 points). CONCLUSION: KTP is a safe surgical procedure that is easy to learn and perform, does not require expensive materials, and avoids more extensive and invasive reconstructive ocular procedures. Corneal KTP may have a great impact on future ophthalmic surgical practice from both therapeutic and cosmetic perspectives.

Herpetic keratitis after descemet stripping automated endothelial keratoplasty for failed graft.

OBJECTIVES: To report a case of herpetic epithelial keratitis after Descemet stripping automated endothelial keratoplasty (DSAEK) for a failed graft. METHODS: A 31-year-old female patient underwent DSAEK for failed graft in left eye. She previously had undergone penetrating keratoplasty for keratoconus in that eye. RESULTS: One week after DSAEK, the patient presented with pain in left eye. The cornea showed two epithelial defects with dendritic edges that involved the penetrating keratoplasty graft host junction and showed positive fluorescein staining. Diagnosis of herpes simplex virus keratitis was made and the patient was started on oral acyclovir and topical trifluiridine. The epithelial lesions showed complete resolution in 3 days. CONCLUSIONS: Herpes simplex virus epithelial keratitis can occur after DSAEK for failed grafts even in the absence of previous history of herpes simplex virus infection and should be considered in the differential diagnosis of postoperative epithelial defects.

Tandem scanning confocal microscopy of cornea after descemet stripping automated endothelial keratoplasty.

PURPOSE: To evaluate the changes in the corneal stroma after Descemet stripping automated endothelial keratoplasty (DSAEK) using tandem scanning confocal microscopy (CM). METHODS: Thirteen eyes of 13 patients who underwent DSAEK without preoperative corneal haze or scar obvious at the slit lamp, any ocular disease, and postoperative complication were included in the study. All patients were examined clinically and by CM 6 months after DSAEK. RESULTS: Six months after DSAEK, none of the eyes had clinically significant interface haze (i.e., haze affecting quantity or quality of vision) at slit lamp. The mean best spectacle corrected visual acuity was 0.18 +/- 0.12 (range 0-0.4) logMAR (Snellen 20/30). The CM revealed highly reflective particles in interface in six eyes, particles with mild surrounding increased reflectivity in four eyes, and no discernible interface in three eyes. The mean particles density at interface was 28.6 +/- 23.4 particles/mm. No significant keratocyte activation was seen in any case at the interface. The mean anterior stromal reflectivity was 431.2 +/- 269.1 confocal back scatter units (CBU) and the mean interface reflectivity was 65.9 +/- 46.9 CBU. The mean anterior stromal reflectivity was significantly greater than the mean interface reflectivity (P<0.01). Significant keratocyte activation with high reflectivity was seen in superficial anterior stroma in 8 of 13 eyes. CONCLUSIONS: Tandem scanning CM shows the presence of highly reflective particles at the level of the DSAEK interface that are morphologically similar to a laser in situ keratomileusis interface. The stromal reflectivity is more prominent in subepithelial layers than that of interface 6 months after DSAEK. However, the areas under the mean reflectivity peaks (CBU) corresponding to the flap interface and superficial anterior stroma do not seem to correlate with best spectacle corrected visual acuity results after the procedure.

Comparison of three different diffractive multifocal intraocular lenses with a +2.5, +3.0, and +3.75 diopter addition power.

PURPOSE: To compare the functional outcomes and astigmatic tolerability after implantation of multifocal intraocular lenses (IOLs) with a +2.5, +3.0, and +3.75 diopter (D) addition power. METHODS: This study included 122 eyes of 61 patients who had bilateral cataract extraction and implantation of diffractive aspheric multifocal acrylic IOLs with +2.5 D (+2.5 group), +3.0 D (+3.0 group), and +3.75 D (+3.75 group) addition powers. 1-year after surgery, distance corrected near (DNVA) and intermediate (DIVA) visual acuities at 32, 40, 45, 50, 55, and 60 cm; and contrast sensitivity measurements under photopic, mesopic and mesopic with glare conditions; spherical and astigmatic defocus testing; distance-intermediate-near vision patient satisfaction levels; spectacle dependance; patient-reported outcomes were assessed binocularly. RESULTS: The +2.50 D group had better DIVA than both +3.0 group and +3.75 groups at 45 cm, 50 cm, 55 cm, and 60 cm (p < 0.05). The +3.75 group had better DNVA than both +2.5 and +3.0 IOL groups at 32 cm (p < 0.05). There was no significant difference in mean contrast values at all frequencies between three IOL groups (p > 0.05). The +2.50 D group showed better astigmatic tolerability than +3.00 group (at 2.00 D) and +3.75 group (at 1.50 D, and at 2.00 D) (p < 0.05). CONCLUSION: Multifocal IOLs with +2.5 add power have better intermediate vision, but worse near vision compared to multifocal IOLs with +3.00 D and +3.75 D add power. Multifocal IOLs with +2.50 D add power tend to have better astigmatic defocus tolerability than multifocal IOLs with +3.00 D and +3.75 D add powers.

Evaluation of internal refraction with the optical path difference scan.

PURPOSE: To evaluate internal refraction and its relation to other optical properties of the eye across a large range of refractive errors, which can provide useful information for the assessment and design of intraocular lenses and corneal ablation patterns. DESIGN: Cohort study. PARTICIPANTS: Three hundred ninety-four eyes of 197 healthy subjects with a mean age of 27+/-7 years (range, 18-42). METHODS: All eyes underwent optical path difference scans to evaluate corneal topography, whole and internal ocular refraction (determined by the subtraction of corneal refraction from whole ocular refraction), and total and higher-order aberrations (HOAs) were assessed. After the conversion of any spherocylindrical refractive errors to vectorial data (sphere equivalent, blurring strength; cylinder, J(0) [power of Jackson cross cylinder at 90 degrees and 180 degrees] and J45 [power of Jackson cross cylinder at 45 degrees and 135 degrees]), the distribution of internal refraction among refraction groups (high myopes, low to moderate myopes, hyperopes, mixed astigmats, and emmetropes) and relationships between internal refraction, corneal refraction, and wavefront aberrations were analyzed. The compensation relation and its rate between corneal and internal astigmatism was assessed by the compensation factor (CF). MAIN OUTCOME MEASURES: Whole ocular power and astigmatism, corneal power and astigmatism, internal power and astigmatism, CF for astigmatic data, location of the highest internal refraction zone, and wavefront aberrations. RESULTS: The highest refraction zone was mostly (90%) located in the center in myopes, whereas it was located at the nasal side (71%) in hyperopes. There was a significant correlation between whole ocular and internal powers (P<0.01), but no correlation was observed between corneal and internal powers (P>0.05). Internal astigmatism was mostly against the rule. The mean CF J(0) was 0.63+/-3.78 and CF J(45) was 0.57+/-2.47. The magnitude of the internal astigmatism under the 3-mm zone was correlated with the magnitude of corneal astigmatism (P<0.05). The distribution of astigmatic CF differed among refraction groups. There were significant correlations between internal power and spherical aberration (P<0.05) and internal cylinder under the 5-mm zone and HOAs (P<0.001). CONCLUSION: There is a remarkable tilt in internal refraction in hyperopes. Although there is a tendency of undercompensation of the corneal astigmatism by internal astigmatism in the entire group of eyes, the compensation differs among refraction groups.

Corneal wavefront-guided retreatments for significant night vision symptoms after myopic laser refractive surgery.

PURPOSE: To evaluate the results of corneal wavefront (WF)-guided enhancements in patients with night vision symptoms and significantly high positive spherical aberration (SA) after myopic laser refractive surgery. DESIGN: Noncomparative, interventional case series. METHODS: Twenty-eight eyes of 20 patients with significant night vision symptoms and positive corneal SA (Z(4)(0)) higher than 0.5 microm after myopic laser refractive surgery were included in the study at Vissum-Instituto Oftalmologico de Alicante, Spain. Enhancement surgery was planned to remove residual refractive error and corneal SA (Z(4)(0)) in all cases. All patients underwent corneal WF-guided excimer laser retreatments using the ESIRIS/SCHWIND excimer laser system (Schwind Eye Tech Solutions, Kleinostham, Germany). The main outcome measures were visual symptoms, change in corneal SA (Z(4)(0)), and corneal asphericity (Q-value). RESULTS: Subjective reports of night vision symptoms were improved in all patients. Mean corneal SA (Z(4)(0)) decreased from 0.75 +/- 0.19 microm before surgery to 0.43 +/- 0.42 microm after surgery (P < .001). Mean asphericity in the 4.5-mm zone significantly decreased from 1.02 +/- 1.07 before surgery to 0.52 +/- 0.88 after surgery (P = .008), and the mean asphericity in 8 mm did not change significantly (P = .362). The mean spherical equivalent significantly shifted to hyperopia from -0.22 +/- 1.14 diopters (D) before surgery to 0.33 +/- 0.54 D after surgery (P = .025). CONCLUSIONS: Cornea wavefront-guided retreatment was effective in improving subjective night vision symptoms, reducing corneal SA, and decreasing asphericity in eyes that underwent myopic laser refractive surgery.

Ten-year follow-up of photorefractive keratectomy for myopia of less than -6 diopters.

PURPOSE: To evaluate the long-term outcomes of excimer laser myopic photorefractive keratectomy (PRK) for myopia of less than -6 diopters (D). DESIGN: Long-term (10-year) follow-up retrospective, interventional case series. METHODS: The study included 225 eyes of 138 myopic patients with spherical equivalent (SE) between 0 and -6 D treated with myopic PRK at the Instituto Oftalmológico de Alicante, Alicante, Spain, using the VISX 20/20 excimer laser (Santa Clara, California, USA). The main outcome measures were refractive predictability and stability, mean corneal keratometry, topographical cylinder, safety, efficacy, stability of visual acuity, and postoperative complications. RESULTS: At 10 years, 169 (75%) of 225 eyes were within +/- 1.00 D and 207 (92%) were within +/- 2.00 D. Ninety-five (42%) eyes underwent retreatments because of overcorrection, regression, or both. The mean SE slightly decreased (myopic regression) with a mean magnitude of -0.10 +/- 1.08 D over 10 years (-0.01 +/- 0.11 D per year). Forty-one (58%) of 225 eyes demonstrated increase in best spectacle-corrected visual acuity after 10 years. Only one eye lost eight lines because of significant cataract, and two eyes lost vision (one lost seven lines and the other lost four lines) because of posterior segment-related complications. The mean corneal haze score gradually decreased from 0.22 +/- 0.39 at three months to 0.01 +/- 0.09 at 10 years. CONCLUSIONS: Photorefractive keratectomy for myopia of less than -6 D is a safe and effective procedure in the long-term.