Clinical outcomes of a toric continuous range of vision presbyopia-correcting intraocular lens.

PURPOSE: To evaluate the clinical outcomes of the toric version of a presbyopia-correcting intraocular lens (IOL) based on the combination of a diffractive-based extended depth-of-focus (EDOF) pattern and a diffractive multifocal platform. SETTING: Miranza COI Bilbao, Bilbao, Spain. DESIGN: Prospective case series. METHODS: 35 patients (51 to 84 years) with corneal astigmatism ranging from 0.75 to 2.19 diopters (D) undergoing bilateral cataract surgery with implantation of the Synergy Toric II IOL were evaluated during a 3-month follow-up. Visual acuity, refraction, defocus curve, and patient-reported outcomes with the Catquest-9SF questionnaire were analyzed. A vectorial analysis was used to analyze the accuracy of astigmatic correction. RESULTS: Mean 3-month monocular postoperative uncorrected distance, intermediate (80 cm) and near (40 cm) visual acuities were 0.06 ± 0.11 logMAR, 0.13 ± 0.12 logMAR, and 0.13 ± 0.09 logMAR, respectively. Mean monocular distance-corrected intermediate (80 cm) and near visual acuity (40 cm) were 0.11 ± 0.12 logMAR and 0.10 ± 0.10 logMAR, respectively. Mean binocular defocus curve showed visual acuities of 0.10 logMAR or better for defocus levels from +0.50 to -2.50 D. Residual cylinder was within ±0.50 D in 97.0% of eyes. The surgically induced astigmatism prediction error ranged between -0.49 D and 0.50 D, with a mean value of 0.04 ± 0.16 D. Mean absolute IOL rotation was 3.79 ± 2.94 degrees. Significant improvements were found in all Rasch-calibrated scores obtained with Catquest-9SF ( P < .001). CONCLUSIONS: The implantation of the toric presbyopia-correcting IOL evaluated provides an efficacious astigmatic correction while providing a fully restoration of the visual function across different distances.

Ab-externo canaloplasty with and without suture in highly myopic eyes.

PURPOSE: To evaluate the effectiveness of ab-externo canaloplasty using the iTrack canaloplasty microcatheter (Nova Eye Inc, Fremont, California), with or without suture, in glaucoma patients with high myopia. METHODS: This was a prospective, single-center, single-surgeon, observational study comparing the outcomes of ab-externo canaloplasty performed with a tensioning suture (suture group) and without a tensioning suture (no-suture group) in mild to severe glaucoma patients with high myopia. Twenty-three eyes received canaloplasty as a standalone procedure, 5 in combination with phacoemulsification. Primary efficacy endpoints included intraocular pressure (IOP) and the number of glaucoma medications. Safety was assessed based on reported complications and adverse events. RESULTS: Twenty-nine eyes of 29 patients with a mean age of 61.2 ± 12.3 years; 19 eyes in the no-suture group and 10 eyes in the suture group. All eyes demonstrated a significant reduction in IOP 24 months postoperatively, from 21.9 ± 7.22 to 15.4 ± 4.86 mmHg in the suture group and from 23.8 ± 7.58 to 19.7 ± 3.68 mmHg in the no-suture group. The mean number of anti-glaucoma medications reduced from 3.1 ± 0.6 to 0.4 ± 0.7 in the suture group and 3.3 ± 0.9 to and 0.2 ± 0.6 in the no-suture group at 24 months. IOP was not significantly different at baseline between the 2 groups, but it was statistically different at 12 and 24 months. There was no statistically significant difference in the number of medications between the groups at baseline, 12 and 24 months. No serious complications were reported. CONCLUSION: Ab-externo canaloplasty performed either with or without a tensioning suture demonstrated good effectiveness in highly myopic eyes with a significant reduction in IOP and number of anti-glaucoma medications. The suture group achieved a lower postoperative IOP. However, the no-suture modification provides a similar reduction in medications with reduced tissue handling.

Impact of femtosecond laser-assisted in situ keratomileusis on retinal ganglion cell function.

PURPOSE: To analyse the effect of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) on the electrical response of retinal ganglion cells using pattern electroretinography (pERG). METHODS: This was a longitudinal, prospective, observational pilot study. We included consecutive myopic patients who underwent FS-LASIK to correct up to 6 dioptres of myopia and up to 2 dioptres of astigmatism. Patients with excessive blinking or tearing and those with Snellen uncorrected visual acuity less than 0.9 dec on postop day 1 were excluded. Diopsys NOVA® (Diopsys Inc., NJ) pERG records, using high- and low-contrast patterns, were obtained 16 h and 1 month after FS-LASIK was performed. Magnitude (µV), Magnitude D (µV), Magnitude D/Magnitude ratio and signal-to-noise ratio (dB) were analysed. Wilcoxon test for nonparametric paired data was employed. RESULTS: pERG data from 24 eyes were analysed from 24 patients who underwent FS-LASIK. Mean age was 35.79 ± 9.86 years. Mean preoperative refraction was -2.69 ± 7.6 D (spherical) and -0.38 ± 0.40 D (cylinder). Mean surgical time was 56.88 ± 7.6 s. No statistically significant differences were obtained for any of the studied parameters when comparing 16 h with 1 month after FS-LASIK, with the exception of Magnitude with low contrast, which increased from 1.21 ± 0.2 to 1.39 ± 0.29 µV at 16 h and 1 month postoperatively, respectively (p = 0.03). CONCLUSIONS: FS-LASIK seems to induce a mild and transitory defect in retinal ganglion cell function. Only a mild decrease was detected in the magnitude value for low-contrast stimuli when pERG was performed 16 h postoperatively, and it returned to normal 1 month after surgery.

Measurement of the Intraocular Pressure Elevation During Laser-Assisted In Situ Keratomileusis Flap Creation Using a Femtosecond Laser Platform.

Purpose: The purpose of this study was to measure the intraocular pressure (IOP) elevation during laser assisted in situ keratomileusis (LASIK) flap creation using the WaveLight FS200 femtosecond (FS) laser platform. Methods: We conducted an ex vivo experimental study in an animal model. The WaveLight FS200 FS laser platform was used to perform the corneal LASIK flap in freshly enucleated porcine eyes. We measured the changes in IOP from the application of the suction ring (suctioning phase) through the creation of the lamellar corneal flap (cutting phase). The IOP was recorded using a manometric technique with direct cannulation to the anterior chamber. Results: Nine freshly enucleated porcine eyes were included in the study. The mean baseline IOP before the procedure was 20.33 ± 5.9 mm Hg. The mean IOP increase over baseline IOP was 32.33 ± 11.3 mm Hg at the suctioning phase, and 38.22 ± 11.3 mm Hg at the cutting phase. The total surgical time needed to complete the procedure was 29.5 ± 4.4 seconds. Conclusions: The WaveLight FS200 FS laser platform produces a low to moderate increase in IOP during LASIK flap creation. Translational Relevance: The WaveLight FS200 is a safe FS laser platform because it induces a low to moderate IOP increase during LASIK flap creation.

Thinner retinal nerve fibre layer in healthy myopic eyes with thinner central corneal thickness.

PURPOSE: Thinner central corneal thickness (CCT) is a risk factor for conversion from ocular hypertension to glaucoma and for disease progression. However, little is known about the relationship between CCT and characteristics of the optic nerve and the retinal nerve fibre layer (RNFL) in non-glaucomatous eyes. Because myopic eyes may pose diagnostic challenges when assessed for glaucoma, characterising the relationship between CCT and RNFL in these eyes is clinically relevant. Our aim was to investigate the relationship between CCT and RNFL thickness in non-glaucomatous eyes with small/moderate myopia. METHODS: This was a single-centre, observational, prospective, assessor-masked study. Consecutive eligible patients (myopia ≤ - 6.0 dioptres, astigmatism ≤ 2.0 dioptres) without other ocular or neurodegenerative diseases were included. Based on their CCT, the participants were allocated to group 1 (CCT > 555 µm) or group 2 (CCT < 555 µm). Peripapillary RNFL measurements were performed by a masked observer using the Spectralis OCT platform. RESULTS: Sixty eyes were included in group 1 and 63 in group 2. The CCT in the two groups was significantly different (584.27 ± 22.8 µm vs 522.23 ± 20.03 µm, p = 0.0001). There were no other significant differences in the groups in terms of age, refraction, or intraocular pressure. The peripapillary RNFL thickness was higher (all p < 0.005) in group 1 at several sectors: superior-temporal, inferior-temporal, inferior-nasal, and average. A significant positive correlation between CCT and average RNFL thickness was found for the whole population (r = 0.31, p = 0.0001). CONCLUSION: Otherwise, healthy myopes with thinner CCT have thinner RNFL compared with participants of similar age and refraction with thicker CCT.

Retinal nerve fiber layer thickness after laser-assisted subepithelial keratomileusis and femtosecond LASIK: a prospective observational cohort study.

PURPOSE: Based on the assumption that high levels of intraocular pressure (IOP) during femtosecond laser-assisted in situ keratomileusis (FS-LASIK) may compromise the retinal nerve fiber layer (RNFL), newer femtosecond platforms that operate without causing significant IOP elevation have been developed in recent years. However, this assumption has not been adequately tested. The aim of the current study was to evaluate possible changes in RFNL thickness in nonglaucomatous myopic patients undergoing FS-LASIK using the 60 KHz IntraLase® device that significantly elevates the IOP for an appreciable period of time vs an advanced surface ablation technique (laser-assisted subepithelial keratomileusis, LASEK) that does not induce any IOP elevation. METHODS: This was a prospective, observational, controlled cohort study. One randomly selected eye of 114 consecutive eligible patients was analyzed. Inclusion criteria were myopia up to -6.00 diopters and astigmatism up to -2.00 diopters. As clinically indicated, 50 patients underwent LASEK and 64 underwent FS-LASIK. The RNFL thickness was determined with a spectral-domain optical coherence tomography device preoperatively and 3 months postoperatively by the same masked observer. RESULTS: There was no significant difference in preoperative refractive error, age, or sex between the groups. Preoperatively, central corneal thickness was significantly lower in the LASEK group (529.1±36.1 vs 562.4±31.6 µm, P=0.001). For the LASEK group, there was no significant difference between preoperative and postoperative RNFL thickness in the studied sectors (superior-temporal, temporal, inferior-temporal, average). For the FS-LASIK group, compared to preoperative RNFL measures, statistically significant thicker postoperative values were found for the average RNFL (mean difference: 0.67 µm, 0.7% increase, P=0.008) and the inferior-temporal sector (mean difference: 0.92 µm, 0.6% increase, P=0.02). CONCLUSION: LASIK with a femtosecond platform that induces high intraoperative IOP did not cause RNFL thinning. The observed differences between preoperative and postoperative values are below the axial resolution limit of optical coherence tomography devices.

Pupillary Abnormalities in Descemet Membrane Endothelial Keratoplasty After Nearly Full Tamponade.

PURPOSE: To describe the incidence, risk factors, and management of pupillary abnormalities after anterior chamber (AC) full air or gas tamponade in Descemet membrane endothelial keratoplasty (DMEK) without pupillary block. METHODS: In this retrospective case series, clinical records of 25 patients (32 eyes) who underwent DMEK were reviewed for pupillary abnormalities and iris morphology. All patients had nearly full intracameral tamponade with air or 20% SF6 at the end of surgery without default air release postoperatively. RESULTS: Pupillary abnormalities ranging from mild ovalization to mid-mydriasis were seen in 56% of the cases. These abnormalities were not related to morphometric changes in the iris volume, or in the iris dilator or iris sphincter muscle, but were probably due to posterior synechiae. Combining DMEK and cataract surgery increases by 5-fold the odds of developing this complication. Surgical revision of the posterior surface of the iris and synechiolysis reversed these pupillary abnormalities. CONCLUSIONS: Nonischemic pupillary abnormalities can be seen in patients with DMEK using a nearly full air/gas tamponade in the AC after surgery despite patent iridectomy especially when combined with cataract surgery. Ensuring complete mydriasis in the immediate postoperative period and a free-floating bubble in the AC above the inferior pupillary margin may reduce its incidence.