Lensectomy after radial keratotomy: 1-year follow-up.

PURPOSE: To report visual and refractive results in radial keratotomy (RK) patients that underwent a cataract surgery with a monofocal intraocular lens (IOL) implantation with 1 year of follow-up. METHODS: Twenty-eight eyes of 15 patients with cataract and the previous RK were included. All eyes underwent phacoemulsification and monofocal IOL implantation. IOL power calculation was done using the Double-K formula of Aramberri. The preoperative versus postoperative corrected distance visual acuity (CDVA) and the uncorrected distance visual acuity (UDVA) values were used to assess the efficacy and safety of the surgery; meanwhile, the achieved versus the expected refractive outcomes postoperatively were used to assess the predictability. RESULTS: Phacoemulsification and IOL implantation was performed successfully in all eyes, and no intra- and postoperative problems occurred. The mean logMAR UDVA significantly improved from 0.7 ± 0.3 to 0.4 ± 0.2 at 6 months, and 0.3 ± 0.2 at 12 months postoperatively. By the end of the follow-up period, about 60% of the eyes achieved 20/25 or better CDVA, 25% of the eyes gained three or more lines of visual acuity, and two eyes had lost one or more lines of visual acuity. The mean spherical equivalent improved from - 1 ± 6.00 to - 0.75 ± 1.1 D by the end of the follow-up, and about 60% of the eyes were within ± 1 D at 12 months after the surgery. No intra- and postoperative problems occurred. CONCLUSIONS: Pseudophakic monofocal IOL implantation offers good visual acuity recovery and acceptable refractive correction in RK patients after 1-year follow-up.

Refractive correction with multifocal intraocular lenses after radial keratotomy.

PURPOSE: To assess visual and refractive results of multifocal intraocular lens (IOLs) implantation for refractive correction after radial keratotomy (RK). METHODS: In a retrospective non-comparative interventional case series, we analyzed the outcomes of multifocal IOL implantation performed in the context of cataract or refractive lens exchange surgery following RK. A total of 17 eyes from nine patients were included in the study. IOL power calculation was done using the Double-K formula. Refractive error was used to assess predictability, and distance-corrected visual acuity (DCVA) and uncorrected distance visual acuity (UDVA) values were used to assess the surgical procedure's efficacy and safety. Distance-corrected near visual acuity (DCNVA) was also determined. RESULTS: Phacoemulsification and multifocal IOL implantation was successful in all cases, with neither complications nor adverse events. At 6 months postoperatively, monocular UDVA, DCVA, and DCNVA were 0.51 ± 0.39, 0.20 ± 0.30, and 0.11 ± 0.11, respectively (logMAR scale). More specifically, 35.29% of the eyes had DCVA ≥20/20 and 52.94% showed DCVA ≥20/25. Regarding pre- vs. post-operative changes, 52.94% had lost one line of DCVA, 23.53% showed no changes, 11.76% had gained one line of DCVA, 5.88% had gained two lines, and 5.88% had gained three or more lines. The efficacy and safety indexes were 0.56 and 0.98, respectively. As for near vision surgical outcomes, 29.41% of the eyes had DCNVA ≥20/20 and 64.71% had DCNVA ≥20/25. As for surgical accuracy, 29% of the eyes were within ±0.50 D of the target refraction, whereas 65% were within ±1.00 D. CONCLUSIONS: Multifocal IOL implantation following radial keratotomy (RK) does not result in good distance visual performance, at least after 6 months of follow-up. Thus, this surgical approach has to be considered with only limited expectations.

Implantation of Implantable Collamer Lenses After Radial Keratotomy.

PURPOSE: To assess the predictability, efficacy, and safety of posterior chamber phakic implantable collamer lens (ICL) implantation after radial keratotomy. METHODS: In a retrospective non-comparative interventional case series, outcomes in 6 consecutive eyes of 4 patients with residual refraction after radial keratotomy were analyzed after the implantation of ICLs. All of the lenses were implanted to correct the residual refractive error, ranging from -12.00 to +3.50 diopters (D) for sphere and from -0.75 to -3.75 D for cylinder. RESULTS: The mean uncorrected distance visual acuity after ICL implantation was 0.31 ± 0.36 logMAR and the corrected distance visual acuity was 0.12 ± 0.10 logMAR. The mean efficacy index was 0.86. No eyes lost lines of visual acuity, two eyes did not change after surgery, two eyes gained one line, and two eyes gained two lines. The mean safety index was 1.17. No intraoperative complications were found and ICL explantation or repositioning was not required during the follow-up. No cases of cataract, pigment dispersion glaucoma, pupillary block, or other vision-threatening complications were found. CONCLUSIONS: ICL implantation may be considered a reasonable surgical procedure for correcting residual refractive errors after radial keratotomy. [J Refract Surg. 2017;33(6):395-398.].

Adjunctive globe magnetic resonance imaging in the diagnosis of posterior scleritis.

OBJECTIVE: To report 4 cases of posterior scleritis with unusually unremarkable ultrasonography findings in which diagnosis was based on magnetic resonance imaging (MRI) examination. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Four patients. METHODS: Patients suffering from suspected posterior scleritis and previously misdiagnosed with a range of conditions after an unremarkable B-scan ultrasonography. A new and thorough review of systems, including MRI examination of the eye/orbit, was carried out. RESULTS: All included patients were diagnosed with posterior scleritis based on MRI findings. Systemic treatment with immunosuppressors (2 patients), antibiotics (1 patient), or no treatment (1 patient) got their inflammatory condition under control. CONCLUSIONS: MRI may play a potential role in the diagnosis of posterior scleritis particularly in those clinically suspicious cases with nondefinitive ultrasonography. Further studies on this matter are warranted.