Comparison of Two Presbyopia-Correcting Trifocal Intraocular Lenses: A Prospective Study.

Objectives: To evaluate the clinical results of a new trifocal intraocular lens (IOL) with sinusoidal design by comparing with a traditional trifocal IOL. Materials and Methods: A total of 79 patients undergoing uneventful microincisional cataract surgery with bilateral implantation of one of two types of trifocal IOLs, the Acriva Trinova IOL (VSY) or Acrysof IQ PanOptix IOL (Alcon), were enrolled in this prospective study. Visual and refractive outcomes, contrast sensitivity (CS), and defocus curve were assessed at 3 months after surgery. Patient satisfaction and incidence of photic phenomena were also evaluated. Results: The number of patients/eyes were 48/96 in the Trinova group and 31/62 in the PanOptix group. There were no significant differences between the groups for monocular and binocular corrected/uncorrected distance or intermediate (at 60 cm) and near visual acuities (VA) postoperatively. The Trinova group had statistically significantly better intermediate VA at 80 cm than the PanOptix group (p<0.05). The CS results of both groups were within the normal limits. In the binocular defocus curve of both IOLs, we observed a peak of good VA at 0.0 diopters defocus and a useful wide range for intermediate distances. The incidence of photic phenomena in the Trinova group was lower at postoperative 1 month (p<0.05) but this difference disappeared at 3 months. A total of 47 patients (97.9%) in the Trinova group and 30 patients (96.7%) in the PanOptix group stated that they would recommend the same IOL. Conclusion: Both trifocal IOLs provide good visual quality outcomes and patient satisfaction.

Effects of chronic smoking on the meibomian glands.

PURPOSE: To evaluate the effects of chronic smoking on tear function tests and meibomian glands. METHODS: This prospective study included 40 volunteers with a long-term (> 5 years) cigarette smoking history (study group) and 43 non-smoking healthy individuals (control group). The symptoms of all the participants were scored using the Ocular Surface Disease Index (OSDI) questionnaire, and a detailed ophthalmological examination was performed including the tear breakup time (TBUT) and Schirmer test (with anaesthesia). The upper and lower lid meibomian glands were evaluated with meibography using the Sirius anterior segment analysis system (Sirius, CSO, Florence, Italy). RESULTS: The groups showed homogenous distribution in respect of age and gender (p > 0.05). The patients in the study group were determined with 22.59 ± 17.25 packet/year cigarette usage. The mean OSDI score was 36.67 ± 21.47 in the study group and 31.65 ± 15.60 in the control group (p = 0.64). The TBUT and Schirmer test values were determined as 9.65 ± 6.14 s and 8.90 ± 4.95 mm, respectively, in the study group and 11.23 ± 5.94 s and 13.08 ± 8.61 mm in the control group (p > 0.05). In the upper lid meibography, loss of 24.68 ± 16.54% was determined in the study group and 17.87 ± 7.06% in the control group (p = 0.01). No statistically significant difference was determined between the groups in respect of the lower lid meibomian gland loss: study group 14.70 ± 8.49% versus control group 12.48 ± 6.44% (p = 0.20). CONCLUSIONS: Smoking results in meibomian gland damage which may be a risk factor for dry eye. In cases of ocular surface disorders related to chronic smoking, meibomian gland damage should be taken into consideration.

Evaluation of choroidal thickness changes after phacoemulsification surgery.

PURPOSE: The aim of the study was to analyze the effects of uneventful phacoemulsification surgery on choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT). METHODS: In this prospective study, 38 eyes of 38 patients having phacoemulsification surgery were included. All patients underwent detailed ophthalmologic examination, including preoperative axial length (AXL) measurement with optical biometry and intraocular pressure (IOP) measurement preoperatively and 1 month postoperatively. The CT was measured perpendicularly at the fovea and 1.5 mm temporal, 3.0 mm temporal, 1.5 mm nasal, and 3.0 mm nasal using SD-OCT preoperatively and 1 month postoperatively. Changes in the CT after surgery and correlation of this change with age, AXL, preoperative IOP, and IOP change were evaluated. RESULTS: There was a statistically significant increase in the CT at all regions evaluated. This increment was more prominent in the nasal and subfoveal regions. The IOP decreased significantly 1 month after surgery (16.14±4.94 mmHg vs 13.91±4.86 mmHg; P<0.001). The change in IOP was correlated with the CT changes at all regions, whereas age, AXL, and preoperative IOP had no significant correlations with the changes in CT. CONCLUSION: Phacoemulsification surgery may cause significant increase in CT, which is correlated with surgery-induced IOP change in the short term. Long-term follow-up of eyes having phacoemulsification surgery may provide further insight into the effects of cataract surgery on the choroid.

Marginal keratitis after intravitreal injection of ranibizumab.

PURPOSE: To report a case of marginal keratitis that developed after intravitreal ranibizumab injection. METHODS: A 56-year-old man with diffuse diabetic macular edema received intravitreal injection of ranibizumab into his right eye. RESULTS: One day after injection, the patient presented with pain, redness, tearing, and discomfort in his right eye. Anterior segment examination of the right eye revealed subconjunctival hemorrhage, 3 corneal subepithelial peripheral infiltrates separated from the limbus by a clear zone, and mild anterior chamber reaction. Examination of the eyelids was remarkable for mild blepharitis. Fungal and bacterial cultures were negative. The condition resolved with topical corticosteroids and antibiotics. CONCLUSIONS: Intravitreal ranibizumab injection may trigger hypersensitivity reaction in the form of marginal keratitis in patients with mild blepharitis.

Repeatability of aberrometric measurements in normal and keratoconus eyes using a new Scheimpflug-Placido topographer.

PURPOSE: To evaluate the repeatability of the anterior and posterior corneal wavefront aberrations using the Sirius Scheimpflug-Placido topographer in normal eyes and keratoconus eyes. SETTING: Bozok University Faculty of Medicine, Yozgat, Turkey. DESIGN: Evaluation of diagnostic test. METHODS: In eyes of healthy subjects and eyes of keratoconus patients, 3 repeated measurements were obtained using the Scheimpflug-Placido topographer. Repeatability of the corneal aberrometric data using a 7th-order Zernike expansion (6.0 mm pupil) and central corneal power (3.0 mm zone) in the anterior and posterior corneal surfaces were analyzed. The within-subject standard deviation (Sw) and the intraclass correlation coefficient (ICC) were calculated. RESULTS: For all modal pairs, the Sw was 0.08 µm or less for anterior and posterior corneal aberrations in both groups. The ICC of the anterior corneal surface ranged from 0.607 (pentafoil) to 0.988 (primary coma) in keratoconus eyes (n = 41) and from 0.568 (quadrifoil) to 0.856 (primary coma) in normal eyes (n = 30). The ICCs for posterior corneal surface aberrometry were 0.656 to 0.873 and 0.592 to 0.824, respectively. For anterior and posterior corneal curvatures, the Sw was 0.12 or lower and the ICC values were more than 0.93 in all cases except the posterior corneal surface reading at the 3.0 mm corneal area in keratoconus eyes (ICC 0.875). CONCLUSIONS: The intraexaminer repeatability of most anterior corneal aberrations with the Scheimpflug-Placido system was moderate to high in normal eyes and keratoconus eyes. The system showed moderate repeatability for the posterior corneal surface. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.