Results with Posterior Scleral Reinforcement for Progressive Highly Myopic Children in Hungary.

PURPOSE: We have been performing posterior scleral reinforcement in our ophthalmological department since 1992 on progressive highly myopic eyes. Here, we report on our results with this technique in the foregoing 7 years in a retrospective comparative design. METHODS: Thirty-eight eyes of 32 patients, operated according to Snyder-Thompson's method, were enrolled in this study, and a control group of 9 age- and myopia-matched children's 14 eyes was built for comparison. Pre- and postoperative best-corrected visual acuity, subjective refractive error (spherical equivalent of spectacle dioptres), and axial length were recorded. Changes within groups were calculated, as well as baseline parameters and their changes during follow-up, and compared between the groups. Correlation analysis was performed to identify factors that could influence myopia progression. RESULTS: Myopic progression was significantly lower in the operated than in the nonoperated group, both in terms of mean annual axial length as well as refractive error changes (0.21 ± 0.08 mm versus 0.49 ± 0.19 mm and 0.18 ± 0.29 D versus 0.6 ± 0.33 D, respectively). Mean overall visual improvement was more explicit in operated eyes as compared to those left untreated (0.15 ± 0.09 versus 0.01 ± 0.1). No association of any factor with myopia progression could be identified. We encountered no serious or lasting complications. CONCLUSION: In our clinical practice, posterior scleral reinforcement according to Snyder-Thompson proved to be a safely applicable and effective surgical method to stop or significantly retard pathological increases in axial length and dioptres, and thus can help prevent the onset of myopic degenerative lesions, and irreversible visual impairment in the long run.

Refractive prediction of four different intraocular lens calculation formulas compared between new swept source optical coherence tomography and partial coherence interferometry.

PURPOSE: To compare the biometry and prediction of postoperative refractive outcomes of four different formulae (Haigis, SRK/T, Holladay1, Barrett Universal II) obtained by swept-source optical coherence tomography (SS-OCT) biometers and partial coherence interferometry (PCI; IOLMaster ver 5.4). METHODS: We compared the biometric values of SS-OCT (ANTERION, Heidelberg Engineering Inc., Heidelberg, Germany) and PCI (IOLMaster, Carl Zeiss Meditec, Jena, Germany). Predictive errors calculated using four different formulae (Haigis, SRKT, Holladay1, Barrett Universal II) were compared at 1 month after cataract surgery. RESULTS: The mean preoperative axial length (AL) showed no statistically significant difference between SS-OCT and PCI (SS-OCT: 23.78 ± 0.12 mm and PCI: 23.77 ± 0.12 mm). The mean anterior chamber depth (ACD) was 3.30 ± 0.04 mm for SS-OCT and 3.23 ± 0.04 mm for PCI, which was significantly different between the two techniques. The mean corneal curvature also differed significantly between the two techniques. The difference in mean arithmetic prediction error was significant in the Haigis, SRKT, and Holladay1 formulae. The difference in mean absolute prediction error was significant in all four formulae. CONCLUSIONS: SS-OCT and PCI demonstrated good agreement on biometric measurements; however, there were significant differences in some biometric values. These differences in some ocular biometrics can cause a difference in refractive error after cataract surgery. New type SS-OCT was not superior to the IOL power prediction calculated by PCI.

Accuracy of partial coherence interferometry in patients with large inter-eye axial length difference.

BACKGROUND: To determine accuracy of partial coherence interferometry (PCI) in patients with large inter-eye axial eye length (AEL) difference. METHODS: Patients undergoing cataract surgery at two academic medical centers with an inter-eye axial eye length (AEL) difference of > 0.30 mm were identified and were matched to control patients without inter-eye AEL difference > 0.30 mm on the basis of age, sex, and AEL. The expected post-operative refraction for the implanted IOL was calculated using SRK/T, Holladay II, and Hoffer Q formulae. The main outcome measures were the refractive prediction error and the equivalence of the refractive outcomes between the subjects and controls. RESULTS: Review of 2212 eyes from 1617 patients found 131 eyes of 93 patients which met inclusion criteria. These were matched to 131 control eyes of 115 patients. The mean AEL was 24.92 ± 1.50 mm. The mean absolute error (MAE) ranged from 0.47 D to 0.69 D, and was not statistically different between subjects and controls. The refractive prediction error was equivalent between the cases and controls, with no significant difference between the MAE for any formula, nor in the number of cases vs. controls with a refractive prediction error of at least 0.50 D or 1.00 D. CONCLUSIONS: Among eyes in our study population, good-quality PCI data was equally accurate in patients with or without an inter-eye AEL difference > 0.30 mm. Confirmatory AEL measurements using different AEL measuring modalities in patients with a large inter-eye AEL difference may not be necessary.

Repeatability, reproducibility, and comparison of ocular biometry using a new optical coherence tomography-based system and another device.

Precise measurement of axial length before cataract surgery is necessary for the proper lens implantation. We included 100 eyes of 56 patients in the study. The mean age was 41 (15-84 years). Measurements of axial length, anterior chamber depth (ACD) carried out with the new Revo NX were compared with those obtained with the IOLMaster 500. Interoperator testing was performed on 56 eyes of 56 participants. To test repeatability, axial length, ACD, central corneal thickness, and lens thickness were used. Inter-operator reproducibility was also assessed. The results were evaluated using Bland-Altman analyses. The mean ACD measured with the IOLMaster and Revo NX was 3.41 and 3.40 mm p = 0.467, respectively. The interclass correlation was excellent at the level of 0.975. ICC for axial length values was 0.999, and the mean was equal to 23.47 for the new device and 23.48 for IOLMaster. ICC for Inter-operator repeatability was higher than 0.99 in all parameters. Revo NX showed a very high level of repeatability with ICC ranging from 0.9929 for central corneal thickness to 0.9997 for axial length. Both devices showed excellent agreement and differences that are insignificant, which suggests that they can be used interchangeably.

Treatment effect of posterior scleral reinforcement on controlling myopia progression: A systematic review and meta-analysis.

BACKGROUND: High myopia is a sight-threatening disease that causes axial length elongation and severe complications. Data on the benefits of posterior scleral reinforcement surgery in myopia control have been conflicting. The purpose of this study was to explore the treatment effect and complications of posterior scleral reinforcement in the treatment of myopia. METHODS: Articles were retrieved for relevant studies from inception to July 24, 2019, by PubMed, EMBASE, and Ovid. Analyses were conducted to compare the treatment effects of controlling spherical equivalent refraction and axial length elongation. The weighted mean difference and Hedges' adjusted g were used to evaluate the treatment effects, with a random-effects model. Heterogeneity was quantified using I2 statistic and explored by subgroup analysis. Publication bias was addressed by funnel plots and Egger's test. RESULTS: A total of 11 articles were included in this meta-analysis. On estimating the treatment effect, the mean differences of myopia progression and axial length changes between surgery and control groups were 0.41 diopters per year (95% CI 0.21 to 0.61; P < .001) and -0.17 mm per year (95% CI -0.22 to -0.11; P < .001). Subgroup analysis showed significant treatment effects of the single wide strip operation. Single-arm meta-analysis showed less annual axial elongation in children subgroup. These results were robust by sensitivity analysis. The incidence of some major complications in the operation group were significantly greater (5.8% vs 2.7% for myopic degeneration; 2.3% vs 1.6% for macular hemorrhage; 0.8% vs 0 for retinal detachment). CONCLUSION: Posterior scleral reinforcement may be an effective surgery on controlling myopia progression by slowing both refraction and axial length change. However, frequent surgical complications should be considered. Further well-designed studies are needed to determine the long-term safety and efficacy.

A negative correlation of axial length with aqueous humor concentration of cytokines in patients with congenital cataracts.

Purpose: To investigate the association between cytokine (and related proteins) concentrations in the aqueous humor (AH) of patients with congenital cataracts and preoperative and postoperative axial length. Methods: Samples from the AH were collected from 25 eyes of 17 patients with congenital cataracts who underwent congenital cataract extraction and intraocular lens implantation. Multiplex enzyme-linked immunosorbent assays (ELISAs) and Luminex xMAP technology were used to assess the concentration of cytokines or chemokines, and acute phase proteins in the AH. Axial lengths were measured before surgery and at 3 months, 6 months, and 1 year after surgery. Results: The mean protein concentrations were determined in the AH of patients with congenital cataracts. The following proteins were assessed: VEGF (9.89 ± 4.94 pg/ml), TNF-α (1.88 ± 0.12 pg/ml), TGF-ß2 (1622.88 ± 762.53 pg/ml), IL-1RA (110.78 ± 141.29 pg/ml), IL-1ß (1.85 ± 0.13 pg/ml), IL-2 (41.96 ± 14.48 pg/ml), IL-4 (9.75 ± 1.32 pg/ml), IL-5 (1.38 ± 0.09 pg/ml), IL-6 (2.31 ± 5.97 pg/ml), IL-10 (1.46 ± 0.47 pg/ml), IL-12p70 (21.50 ± 1.60 pg/ml), IL-15 (2.23 ± 0.18 pg/ml), IL-17A (1.22 ± 0.11 pg/ml), GM-CSF (2.80 ± 0.38 pg/ml), IFN-γ (9.20 ± 0.42 pg/ml), CCL2/MCP-1 (131.45 ± 90.45 pg/ml), CCL3/MIP-1α (87.14±3.83 pg/ml), CCL4/MIP-1ß (66.26 ± 2.22 pg/ml), CXCL10/IP-10 (13.99 ± 39.66 pg/ml), CCL11/eotaxin (27.17 ± 2.00 pg/ml), and PDGF-BB (0.43 ± 0.04 pg/ml). These data suggested a negative correlation between the level of VEGF in the AH and the preoperative axial length (r2 = 0.2615, p<0.01). Similarly, the level of GM-CSF and CCL11/eotaxin in the AH decreased with an increase in axial length (r2 = 0.2456, p = 0.01; r2 = 0.1758, p=0.037). At 1 year post-surgery, a negative correlation was observed between the level of PDGF-BB and the change in the axial length (r2 = 0.2133, p = 0.02). Axial elongation at 1 year post-surgery was 0.24 ± 0.34 mm. The predicted change in axial length at 1 year post-surgery was 1.05 ± 0.83 mm, and the actual axial elongation was statistically significantly smaller than the predicted change in healthy children (paired t test, p<0.01). Conclusions: Increased preoperative axial lengths were negatively correlated with AH levels of VEGF, GM-CSF, and CCL11/eotaxin. The level of PDGF-BB was negatively correlated with the change in axial length 1 year post-surgery. These data suggest that the concentrations of these proteins in the AH may have predictive value for changes in axial length in patients with congenital cataracts, and possibly provide a useful prognostic modality.

Comparison of two swept-source optical coherence tomography biometers and a partial coherence interferometer.

PURPOSE: To compare biometry and prediction of postoperative refractive outcomes obtained by two swept-source optical coherence tomography (SS-OCT) biometers (IOLMaster 700 and Argos), and a partial coherence interferometry (IOLMaster ver 5.4). METHODS: Biometric values were measured using two SS-OCT and PCI device and evaluated against one another. Predictive errors were compared at one month after cataract surgery. RESULTS: One hundred forty six eyes were considered. Axial length (AXL) measurements were not successful in 3 eyes measured by IOLMaster 700 and Argos devices, and in 17 eyes measured by IOLMaster ver. 5.4 devices. AXL as measured by Argos showed a tendency to be shorter in long eyes with AXL more than 26.0 mm (p < .001) and to be longer in short eyes with AXL less than 22.5 mm (p = .005). Anterior chamber depth as measured by IOLMaster ver. 5.4 was longer than that measured by the other two SS-OCT devices (vs. IOLMaster 700: p = .003; vs. Argos: p = .006). White-to-white diameter measured using Argos was significantly different measurements obtained using two IOLMaster (p < .001, respectively). The mean absolute postoperative prediction errors were 0.41 ± 0.31 diopters (D), 0.42 ± 0.32 D, and 0.35 ± 0.30 D for IOLMaster ver. 5.4, IOLMaster 700, and Argos, respectively. CONCLUSION: The ocular biometric measurements using three devices showed high agreement. AXL measured by Argos showed a significant difference compared with the measurements from two IOLMaster. ACD was highly correlated between two SS-OCT devices except IOLMaster ver 5.4. LT and CCT values between IOLMaster 700 and Argos were different significantly. SS-OCT devices demonstrated a superior ability to successfully perform measurements compared with PCI device.

Predictive factors associated with axial length growth and myopia progression in orthokeratology.

PURPOSE: To investigate the factors affecting axial length (AXL) growth and myopia progression in orthokeratology. METHODS: This prospective, observational study enrolled 28 new orthokeratology lens wearers from a contact lens clinic between March 2016 and March 2017. Among them, 32 eyes of 17 wearers who completed one year of follow-up were finally analyzed. All participants underwent central (C) and peripheral (nasal 30° [N30] and temporal 30° [T30]) AXL measurements as well as central and peripheral refraction, ocular aberrations, and corneal topography at baseline and every posttreatment visit. A generalized estimating equation (GEE) was used to assess the associations between AXL change and all independent variables in both eyes. RESULTS: The mean central AXL was 24.21 ± 0.60 mm and the mean baseline central spherical equivalent refractive error (SER) was -2.43 ± 0.97 diopters (D). Among all parameters that were significantly associated with AXL change in univariable GEE analyses, the baseline difference in AXL between C and N30 (ß = -0.213, p < 0.001), baseline SER (ß = -0.040, p < 0.033), posttreatment coma (ß = -0.291, p < 0.031), third-order higher-order aberrations (HOAs) (ß = -0.482, p < 0.001), and changes in second-order aberrations (ß = 0.025, p = 0.027) at one year of follow-up were identified as significant factors in multivariable GEE analysis. CONCLUSIONS: The inhibition of AXL elongation and myopia progression in orthokeratology lens wear is significantly associated with the peripheral myopization and asymmetric optical changes mostly induced by third-order HOAs.

Modified Posterior Scleral Reinforcement as a Treatment for High Myopia in Children and Its Therapeutic Effect.

PURPOSE: To investigate the safety and therapeutic effect of a modified posterior scleral reinforcement (PSR) in treating high myopia. METHODS: A total of 85 highly myopic eyes in 47 children (6.3±3.6 years of age, range from 3 years to 15 years) who underwent this modified PSR were included in this study. Axial length, refractive error, best-corrected visual acuity (BCVA), macular scans, and adverse events were recorded before the operation (as a baseline) and in postoperative reviews taken yearly for 5 years. RESULTS: This was a 5-year research: 50% of the children (20 children, 40 eyes) participated in the 6-month review, 41% of the children (17 children, 33 eyes) participated in the 1-year review, 26% of the children (11 children, 21 eyes) participated in the 2-year review, 16% of the children (7 children, 13 eyes) participated in the 3-year review, 13% of the children (5.3 children, 11 eyes) participated in the 4-year review, and 8% of the children (3.3 children, 7 eyes) participated in the 5-year review. Compared with the baseline, axial elongation was significantly changed (P<0.05) over the 5-year period in all of the children: 6-month (P=0.003), 1-year (P=0), 2-year (P=0), 3-year (P=0), 4-year (P=0), and 5-year (P=0). The axial length was extended. No significant difference was found in refractive error between measurements taken at baseline and at the 5-year postoperative visit in all of the children: 6-month (P=0.51), 1-year (P=0.50), 2-year (P=0.46), 3-year (P=0.56), 4-year (P=0.30), and 5-year (P=0.16). There were significant differences in BCVA between measurements taken at baseline and at the postoperative 5-year visit in all the children: 6-month (P=0), 1-year (P=0), 2-year (P=0), 3-year (P=0), 4-year (P=0), and 5-year (P=0). BCVA improved in 71 eyes (83.52%), remained stable in 14 eyes (16.47%), and declined in none of the children. No serious adverse events occurred before the operation and during the 5-year follow-up period. CONCLUSION: This modified PSR could be a therapeutic treatment for high myopia.

Implantation of the Argus II Retinal Prosthesis in an Eye With Short Axial Length.

The authors describe the implantation of the Argus II Retinal Prosthesis System (Argus II) (Second Sight Medical Products, Sylmar, CA) into a short axial length (AL) eye. The authors' main modification is the use of endocyclophotocoagulation (endo-CPC) to the ciliary processes in the area that the cable enters through the sclerotomy. This case describes the surgical technique necessary for successful implantation of the Argus II into a short AL eye. The use of endo-PC prevents chafing to the ciliary processes, does not affect postoperative intraocular pressure, and facilitates direct visualization of the structures during the surgery, preventing damage during implantation.

[Cataract surgery in nanophthalmic eyes]. / Phakoemulsifikation bei nanophthalmischen Augen.

PURPOSE: The aim of this study was to determine the prevalence of nanophthalmos among cataract patients and to evaluate intraoperative and postoperative complications in nanophthalmic eyes. PATIENTS AND METHODS: Medical and operating records of all 3287 patients who had undergone clear cornea phacoemulsification cataract surgery with foldable acrylic IOL implantation during a period of two years (January 2009 to December 2010) were retrospectively reviewed. Nanophthalmos was diagnosed according to a shorter axial length than 20 mm, a shallow anterior chamber, hyperopia and scleral thickness greater than 1.7 mm as determined by echography. Before surgery all patients received an intravenous 20 % mannitol solution. RESULTS: From 3287 eyes, six eyes of four patients were identified as nanophthalmic with an axial length below 20 mm and a scleral thickness greater than 1.7 mm. The prevalence of nanophthalmos was 0.18 %. The average hyperopia was + 7.87 D (+ 6.0 to + 9.50). The mean axial length was 19.58 mm (18.94 to 20.00). The mean biometry calculation was 33.16 D (31.5 to 36.0). In all cases no complications were observed during the surgery. In two eyes a mild iritis was observed one day after surgery. During a follow-up of 3 months no further complications occurred. CONCLUSIONS: Surgical manipulation in a narrow and crowded anterior chamber in nanophthalmic eyes with increased vitreous pressure is always a challenge and must be performed by an experienced surgeon. Preoperative examination of scleral thickness and preoperative administration of hyper-osmotic solution for reduction of vitreous pressure are very important to prevent unexpected complications. There was no need for a prophylactic surgical procedure in our patients.