Assessment of the iridocorneal angle pigmentation and structures after the implantation of EVO+ Visian Implantable Collamer Lens.

PURPOSE: To evaluate the effect of EVO+ Visian Implantable Collamer Lens (ICL) implantation on the iridocorneal angle pigmentation and structures. METHODS: Myopic refractive surgery candidates who underwent posterior chamber EVO+ ICL implantation were evaluated preoperatively and 3 and 6 months postoperatively. High-resolution images of the iridocorneal angle (nasal, superior, temporal and inferior quadrants) were acquired during gonioscopy. A masked observer, blinded to study visits and patients' information, evaluated the angle width, apparent iris root insertion, iris configuration, and trabecular meshwork pigmentation according to the Spaeth scale in two different occasions. The intra-rater reliability was estimated using the weighted Gwet's Agreement Coefficient (AC2). Differences between visits were analyzed using the Cochran Q test or the Friedman test. RESULTS: Twenty-one patients (13 females and 8 males) aging 31.3 ± 6.3 years old were recruited. The intra-rater reliability of gonioscopy assessment was excellent for every parameter assessed (AC2 ≥ 0.97). No significant differences were found among the study visits for any quadrant in the angle width (p ≥ 0.74), apparent iris root insertion (p ≥ 0.22), iris configuration (p ≥ 0.21) and trabecular meshwork pigmentation (p ≥ 0.24). Mean pigmentation of trabecular meshwork for the four quadrants did not vary either among visits (p = 0.25). CONCLUSIONS: The EVO+ ICL implantation after uneventful procedures appears not to clinically affect the iridocorneal angle pigmentation and/or structures during a short-medium follow-up using gonioscopy assessment. The intra-rater reliability of glaucoma specialists assessing iridocorneal angle structures using gonioscopy images is very high.

EVO/EVO+ Visian Implantable Collamer Lenses for the correction of myopia and myopia with astigmatism.

INTRODUCTION: Intraocular lens implantation in phakic eyes for the correction of refractive error is currently a widespread procedure. The EVO and EVO+ Visian Implantable Collamer Lenses (ICL) are two of the most prevalent lenses implanted. They incorporate a central orifice to avoid the need for iridotomy. The main difference between both ICL is the higher optical diameter zone provided by the EVO+, allowing a better quality of vision at night. This review aims to provide an overview of the current ICL models available for correcting myopia and myopic astigmatism. AREAS COVERED: During the last decade, more than 100 scientific papers analyzing the performance of EVO and EVO+ lenses have been published. This review describes the objective visual performance achieved with the implantation of central hole ICL lenses and the subjective perception of the patients implanted with these lenses. In addition, the safety and the potential complications associated with undergoing an EVO and EVO+ ICL implantation have been addressed. EXPERT OPINION: Refractive surgeons and candidates to undergo ICL implantation should be aware of the excellent safety and visual outcomes provided by the implantation of central hole ICL lenses. However, future research could address minor issues currently not resolved.

Reliability and agreement of apparent chord mu measurements between static and dynamic evaluations.

PURPOSE: To assess the repeatability and agreement of Cartesian coordinates and the length of apparent chord mu and pupil diameter measurements during static (Galilei G4) and dynamic (Topolyzer Vario) evaluations. SETTING: IOBA-Eye Institute, Valladolid, Spain. DESIGN: Case series. METHODS: 3 consecutive measurements per scenario (Galilei G4 and Topolyzer Vario under low mesopic and photopic conditions) were performed by the same clinician. The intrasession repeatability was assessed using the within-subject SD (Sw), the precision, the coefficient of variation, and the intraclass correlation coefficient (ICC). The agreement was analyzed using repeated-measures analysis of variance and the Bland-Altman method. RESULTS: Thirty-seven healthy participants were recruited. The Sw values for chord mu parameters and pupil diameter ranged from 0.01 to 0.03 and 0.08 to 0.21, respectively. The ICC was ≥0.89 for all parameters. Galilei G4 and Topolyzer Vario under low mesopic and photopic conditions provided significantly different measures of apparent chord mu length (0.23 ± 0.11 mm, 0.30 ± 0.10 mm, and 0.25 ± 0.11 mm, respectively, P ≤ .02), X-coordinate (-0.18 ± 0.12 mm, -0.27 ± 0.11 mm, and -0.21 ± 0.12 mm, respectively, P < .001), and pupil diameter (3.38 ± 0.50 mm, 6.29 ± 0.60 mm, and 3.04 ± 0.41 mm, respectively, P < .001). Y-coordinate values obtained by Galilei G4 and Topolyzer Vario under low mesopic conditions were significantly different (0.06 ± 0.13 mm vs 0.03 ± 0.11 mm, respectively, P = .02), in contrast to Galilei G4 and Topolyzer Vario under photopic conditions (0.05 ± 0.13 mm, P = .82) and both illumination conditions of Topolyzer Vario (P ≥ .23). CONCLUSIONS: Galilei G4 and Topolyzer Vario provide consistent measurements of apparent chord mu Cartesian coordinates and length, as well as pupil diameter; however, the measurements are not interchangeable. Ophthalmic surgeons should consider these findings when planning customized intraocular lens implantation and refractive surgery procedures.

Inter-eye and postoperative prediction of vault after implantation of EVO + Visian phakic implantable collamer lens.

PURPOSE: To assess whether the postoperative outcomes of the implantation of an EVO + implantable collamer lens (ICL) in one eye can be used as a predictor of the vault of the fellow eye, and to evaluate the vault changes of the implantation in both eyes during the postoperative period. METHODS: A prospective study including 40 eyes of 20 patients with a bilateral EVO + ICL implantation was performed. Subjects were evaluated before the surgery and 1 day, 1 week and 1, 3 and 6 months postoperatively. Central vault was assessed using spectral-domain optical coherence tomography. The inter-eye and follow-up analyses were performed using lineal models and the Bland-Altman method. RESULTS: The vault of the first implanted eye at the 1-day visit highly predicts the vault of the second eye (R2 = .87; P < .001); the mean inter-eye difference was - 0.95 µm, and the superior and inferior limits of agreement were -50.27 µm and 148.37 µm, respectively. This relationship was maintained during the medium-term follow-up, not finding differences in the slopes among visits (P ≥ .09). A progressive decrease of vault was found during the follow-up (P < .001). Larger vault change 6 months after the surgery was associated with higher vault 1 day after the ICL implantation (R2 = .19;P = .005). CONCLUSION: One-day postoperative vault in the first eye can help to predict the optimal ICL sizing in the second eye. Vault tends to decrease during the first 6 months after EVO + ICL implantation. Eyes with higher initial vaults will also show larger reductions during the medium-term follow-up.

EVO+ Implantable Collamer Lens KS-aquaPORT Location, Stability, and Impact on Quality of Vision and Life.

PURPOSE: To determine the longitudinal variation in the KS-aquaPORT central hole location of the phakic EVO+I Implantable Collamer Lens (ICL) (STAAR Surgical) and analyze its influence on visual performance, quality of vision (QoV), and quality of life (QoL). METHODS: A prospective study was performed including 36 patients who had EVO+ ICL implantation. The KS-aquaPORT central hole location (Cartesian and polar coordinates) was determined with respect to the pupil center and visual axis. The effect of time (6-month follow-up) on central hole location was analyzed using linear mixed models. The effect of the KS-aquaPORT location on visual performance, QoV, and QoL parameters was assessed with multivariate regression models. RESULTS: With respect to the visual axis, no significant changes in KS-aquaPORT location were found during follow-up. With respect to the pupil center, the X-coordinate and radius of KS-aquaPORT location showed modest, but significant (P ≤ .05) differences between 1-week and 3-month postoperative visits, and between 1-week and 6-month visits. X-coordinate variation was significant (P = .022) between 1-and 6-month visits. With respect to the visual axis, greater KS-aquaPORT decentration was associated with worse visual acuity (X-coordinate: P = .004; radius: P = .006), and inferior decentration with longer xenon-type glare photostress recovery time (P = .021). With respect to the pupil center, a lower radius was associated with better QoV scores (P ≤ .01) and temporal decentration produced higher ring-shaped dysphotopsia (P = .007). CONCLUSIONS: EVO+ ICL KS-aquaPORT location appears to be clinically stable up to 6 months postoperatively. A central location of the EVO+ ICL KS-aquaPORT hole is preferred because it allows reduced perception of dysphotopic phenomena that can result in better QoV. [J Refract Surg. 2022;38(3):177-183.].

Mesopic Disability Glare in Stage-Two Dysfunctional Lens Syndrome.

INTRODUCTION: There is a lack of evidence about the exact deterioration of visual function associated with the age-related natural changes in the lens, particularly in intermediate (stage-2) dysfunctional lens syndrome (DLS). Standard photopic visual acuity and contrast sensitivity tests may not show the visual worsening in daily life activities, such as oncoming vehicle headlights at night. The purpose of this study was to analyze visual function under different conditions and glare sources in stage-2 DLS. METHODS: Forty patients over 49 years of age with initial bilateral lens opacification (Lens Opacities Classification System III [LOCS-III] scores up to 3), best-corrected visual acuity of 20/25 or better, and no ocular disease were evaluated. Binocular photopic and mesopic contrast sensitivity (CS) with/without halogen and xenon increasing glare sources were analyzed. Mesopic disability glare (MDG) was calculated as the difference between mesopic CS with/without the glare source. RESULTS: The median logarithmic CS (logCS) values were lower under mesopic conditions (1.05) than under photopic illumination (1.65; P < 0.001). Halogen and xenon glare further decreased mesopic CS (both, median logCS 0.75, P < 0.001). The mean MDG was 0.31 ± 0.10 log units for halogen glare and 0.33 ± 0.09 log units for xenon glare. The mesopic CS and MDG were not associated with any photopic test. The mesopic CS with glare but not photopic CS or mesopic CS was correlated with the LOCS-III scores. The best association was provided by MDG, which showed a pooled correlation with LOCS-III nuclear opalescence (r = 0.411, P < 0.001) and cortical scores (r = 0.226, P = 0.04). CONCLUSION: The mesopic CS under a glare source is an independent early indicator of visual impairment in stage-2 DLS patients, and appears to be substantial. Furthermore, the MDG is more sensitive than photopic and mesopic CS for evaluating patients with initial phacosclerosis. Surgeons should consider this in the decision-making process of the correct timing for lens surgery.

Epithelial cells removed in advanced surface ablation (ASA) surgery can be used as a source of corneal samples to perform in vitro studies.

Human corneal epithelial cells are needed to study corneal pathophysiology in vitro. Due to the limitations of cell lines, the use of primary cells is highly desirable, but the scarcity of human tissues, along with ethical issues, make it difficult to accomplish all required experiments. In advanced surface ablation (ASA), the central corneal epithelium is removed and discarded. We hypothesized that ASA samples could be used to perform in vitro assays. In this study, 29 samples from patients undergoing ASA were recovered in supplemented DMEM/F12 culture medium, RIPA buffer, or RLT lysis buffer. The first aim was to determine whether cells could be maintained in culture. Although with the explant technique, tissue pieces did not attach to the culture surface, after disaggregation, cells showed high viability (90.0 ± 6.0%), attached to plates, and remained viable for up to 14 days. The second aim was to elucidate if ASA samples could be used to study protein or gene expression. Cytokeratin-3, ZO-1, Ki67, and E-cadherin protein expression were confirmed by immunofluorescence. Total protein (485.8 ± 115.8 µg) was isolated from cells in RIPA buffer, and GAPDH was detected by Western blotting, indicating that samples are adequate for protein studies. RNA (9.0 ± 3.6 µg) was isolated from samples in RLT lysis buffer, and GAPDH gene expression was studied by PCR, confirming that samples were also suitable for gene expression studies. These results suggest that samples obtained from corneal surface ablation procedures may constitute a valuable source of human cells to accomplish in vitro studies.

Preliminary Evaluation of the Clinical Benefit of a Novel Visual Rehabilitation Program in Patients Implanted with Trifocal Diffractive Intraocular Lenses: A Blinded Randomized Placebo-Controlled Clinical Trial.

The authors of this study evaluated the potential benefit on visual performance of a novel 3 week visual rehabilitation program based on the use of Gabor patches in patients undergoing bilateral cataract surgery with the implantation of two models of trifocal diffractive intraocular lens (IOL). A total of 30 patients were randomly assigned to two groups: a study group (15 patients) that used a videogame based on Gabor patches and a placebo group (15 patients) that used a videogame without specific stimuli for improving visual performance. No statistically significant differences between groups were found in distance, intermediate, and near post-training visual acuity (p ≥ 0.15). Significantly better distance contrast sensitivity (CS) was found for the spatial frequencies of 6 (p = 0.02) and 12 cpd (p = 0.01) in the study group. Likewise, significantly better values of near CS were found in the study group compared to the placebo group for the spatial frequency of 1.5 cpd (p = 0.02). In conclusion, a 3 week visual rehabilitation program based on the use of Gabor patches in the immediate postoperative period after the bilateral implantation of trifocal diffractive IOLs seems to be beneficial for improving both distance and near visual performance achieved with the implant.

Effect of the EVO+ Visian Phakic Implantable Collamer Lens on Visual Performance and Quality of Vision and Life.

PURPOSE: To assess the effect of EVO+ (V5) Visian implantable collamer lens implantation on mesopic visual performance, quality of vision (QoV), and quality of life (QoL). DESIGN: Prospective interventional case series. METHODS: Thirty-six eyes of 36 participants who underwent EVO+ implantation for myopia were evaluated preoperatively and at postoperative visits at 1 week and 1, 3, and 6 months. Visual acuity (VA) and mesopic contrast sensitivity (CS) with and without halogen- and xenon-type glare sources were evaluated at each visit. Subjective QoV was assessed with the QoV questionnaire and QoL assessed with the Quality of Life Impact of Refractive Correction (QIRC) questionnaire at each visit. Ring-shaped dysphotopsia was also assessed at each postoperative visit. Linear, cumulative link and logit mixed models were fitted to analyze the effect of the EVO+. RESULTS: Following EVO+ implantation, VA significantly (P ≤ .012) improved at the 4 postoperative visits. Mesopic CS progressively improved at 1, 3, and 6 months postoperatively (P ≤ .012). Halogen glare CS decreased at 1 week and halogen and xenon glare CS improved at 6 months (P ≤ .016). Photostress recovery time after halogen glare improved at 3 and 6 months (P ≤ .004). QoV scores improved at 1 week and 3 and 6 months (P ≤ .001). QIRC scores improved postoperatively (P < .001). Ring-shaped dysphotopsia decreased at 3 and 6 months (P ≤ .007). CONCLUSIONS: EVO+ implantation provides good mesopic visual performance, QoV, and QoL during up to 6 months follow-up. Some activities performed under mesopic conditions with glare sources may be affected during the first postoperative week. Ring-shaped dysphotopsia is negligibly bothersome 6 months after surgery.

Evaluation of Potential Pain Biomarkers in Saliva and Pain Perception After Corneal Advanced Surface Ablation Surgery.

PURPOSE: To evaluate the evolution of a set of proposed pain biomarkers in the saliva of subjects following Advanced Surface Ablation (ASA), in order to determine their validity as objective pain measures. METHODS: A multicenter, prospective, and descriptive study was carried out to assess the variations between biomarkers and perceived pain. The Inclusion criteria were healthy subjects who underwent a bilateral, alcohol-assisted surface ablation with epithelial removal (ASA). Pain intensity before and after surgery was assessed by Visual Analog Scale (VAS) and the Numeric Pain Rating Scale (NPRS). Cortisol, sAA, sIgA, testosterone, and sTNFαRII were assayed at four-time points (V0, baseline; V1, pre-surgery; V2, 1 hr post-surgery, and V3, 72 hrs post-surgery). Comorbidities and Hospital Anxiety and Depression (HADS) questionnaires were administrated before and at 6 hrs after the surgery. All patients were treated with cold patches, topical steroids, topical cold antibiotics, and benzodiazepines after ASA surgery. A descriptive analysis of biomarkers and pain intensity evolution and the agreement between biomarkers and pain was performed. RESULTS: Concentration of sIgA and sTNFαRII post-surgery was significantly higher at each visit compared to baseline (p-value: 0.053, p-value: <0.001, respectively). Relations between VAS scale score and putative biomarker variations were not statistically significant except for the sIgA but only at visit 0 (p-value: 0.024). The HADS questionnaire showed anxiety scores between 0 and 7 in all patients before and at 6 hrs after surgery. CONCLUSION: In this study, sIgA and sTNFαRII are the two potential biomarkers that present correlation with the VAS and these salivary substances showed acceptable levels of reproducibility in healthy subjects.

Clinical and tear cytokine profiles after advanced surface ablation refractive surgery: A six-month follow-up.

Neuropathic dry eye is one of the most frequently seen complications after corneal refractive surgery, however, its incidence decreases in a significant manner along the first six months postoperative, reaching between 10 and 45% incidence. However, little is known on the inflammatory status of the ocular surface during this recovery process. We aim to analyze the clinical and tear molecule concentration changes along six months after advanced surface ablation for myopia correction, in a prospective study including 18 eyes of 18 subjects who bilaterally underwent advanced surface ablation corneal refractive surgery. Clinical variables (uncorrected distance visual acuity, symptoms, conjunctival hyperemia, tear osmolarity, tear stability, corneal fluorescein staining, conjunctival lissamine staining, Schirmer test, and corneal esthesiometry) and a panel of 23 pro and anti-inflammatory cytokines/chemokines concentration in tears preoperatively and at 1, 3 and 6 months postoperatively were evaluated. We found that uncorrected distance visual acuity improved significantly from baseline at 1-month visit, symptoms improved and tear osmolarity decreased significantly from baseline at 3-month visit and there was a decrease in mechanical corneal threshold between 1-month and 3- and 6-month visits. Regarding tear molecules, IL-4, IL-5, IL-6, IL-13, IL-17A, and IFN-γ tear levels were significantly increased at all the three visits, compared to preoperative levels at V0; IL-2 and VEGF were also significantly increased at 1-month and 6-month visits, but not at 3-month visit, whereas IL-9 IL-10 and IL-12 were only significantly increased at 6-month visit. Although we found that there is a recovery in clinical variables at 6 months postoperatively (i.e. neuropathic dry eye was not developed in the sample), ocular surface homeostasis is not completely restored, as it can be seen by the changes in concentration of some pro and anti-inflammatory molecules measured in tears.

Short-term changes in ocular surface signs and symptoms after phacoemulsification.

PURPOSE: The aim of this study is to evaluate the incidence, natural course, and distribution pattern of superficial punctate keratopathy and describe the changes in signs and symptoms of dry eye after cataract surgery. SETTING: The setting of this study is University Hospital Rio Hortega and Instituto Universitario de Oftalmobiología Aplicada, Valladolid, Spain. DESIGN: This is a prospective interventional study. MATERIALS AND METHODS: In total, 55 eyes of 55 different patients with no history of dry eye underwent standard phacoemulsification through a 2.75-mm-wide corneal incision. We measured tear break-up time, Schirmer test I, and tear meniscus height, and recorded the Ocular Surface Disease Index score, fluorescein staining patterns, and photo documentation of the ocular surface before and 1 day, 1 week, and 1 month postoperatively. Patients were divided into two groups (with and without superficial punctate keratopathy development, 1 day postoperatively). RESULTS: Patients (mean age: 75.75 ± 7.27 years) showed an incidence of 76.3% of superficial punctate keratopathy at 24 h. Location predominated in the center of the cornea until a week (32.7%) and then began to prevail in the inferior quadrant (21.8%) at 1 month. All dry eye tests were significantly worse after surgery. Ocular Surface Disease Index increased from 10.98 ± 5.05 to 15.87 ± 6.57 at 24 h (p < .001), to 12.80 ± 5.77 at 7 days (p < .001), and to 11.09 ± 4.63 at 1 month (p = .90). Fluorescein staining patterns got worse 24 h postoperatively with a score of 2.12 using the National Eye Institute/Industry-recommended guidelines staining grid. Average break-up time values were significantly lower at 1 day (6.61 ± 2.68),1 week (6.98 ± 2.79), and 1 month (7.05 ± 2.86) postoperatively than preoperatively (8.78 ± 2.97) (p < .001). The mean postoperative first month Schirmer test I value (8.32 ± 3.58) was significantly lower than preoperative value (9.05 ± 3.63) (p < .001). CONCLUSION: Phacoemulsification tends to induce short-term transitory ocular surface impairment manifesting as both signs and symptoms. Superficial punctate keratopathy distribution has a characteristic pattern evolution according to the postoperative time. Those patients with altered preoperative values are more likely to develop ocular surface disease and for longer time.

Effect of central hole location in phakic intraocular lenses on visual function under progressive headlight glare sources.

PURPOSE: To analyze the effect of the central hole location in the V4c implantable collamer lens (ICL) on the quality of vision, including progressive headlight glare simulation and quality of life. SETTING: IOBA-Eye Institute, Valladolid, Spain. DESIGN: Case series. METHODS: The central hole location was determined by slitlamp and dual Scheimpflug imaging for 6 months or more postoperatively. The visual acuity, mesopic contrast sensitivity, halogen glare contrast sensitivity, xenon glare contrast sensitivity, photostress recovery time after glare, de Boer scale, and Quality of Life Impact of Refractive Correction (QIRC) questionnaire results were evaluated. Multiple regression models were used to analyze the effect of the central hole location on parameters using the pupil center and visual axis as references based on Cartesian and polar coordinates. RESULTS: The safety index was 1.13 and the efficacy index, 1.12. Under all testing circumstances, central hole decentration did not affect the visual acuity or contrast sensitivity. With the visual axis as a reference, worse QIRC values were associated with greater upward central hole displacement (P = .03) and a lower polar angle value (P = .008); also, halogen glare discomfort was greater with a higher radius (P = .04). Using the pupil center as a reference, greater nasal central hole decentration was associated with longer xenon glare photostress recovery time (P = .002). CONCLUSIONS: Implantation of the ICL with a central hole yielded excellent visual outcomes, even under increasing glare sources, regardless of the hole's location. However, hole decentration might affect patient-perceived quality of life, bothersome halogen glare, and longer xenon glare photostress recovery time. Such complaints after the early postoperative period might be managed with discrete ICL centration if the central hole is decentered upward or nasally.

Pain perception description after advanced surface ablation.

PURPOSE: The objective of this study was to characterize the evolution of ocular pain after advanced surface ablation (ASA) to improve strategies in postoperative pain management. METHODS: This was a multicenter, prospective, descriptive, cohort study. The inclusion criteria were healthy individuals ≥18 years old receiving bilateral alcohol-assisted surface ablation with epithelial removal. Pain intensity was evaluated with the visual analog scale (VAS) and the numeric pain rating scale before and after surgery. Comorbidities (photophobia, burning, tearing, and foreign body sensation) and Hospital Anxiety and Depression (HAD) questionnaire were evaluated before and at 6 hours after surgery. Postoperative treatments included cold patch, topical cold antibiotics, topical steroids, and benzodiazepines. RESULTS: Thirty-two consecutive patients having similar profiles of postoperative pain evolution were included. At 0.5 hour after ASA, the pain score by VAS was 37±20 mm, and the maximum pain, 61±31 mm, occurred at 24 hours. Afterward, it decreased progressively until 72 hours after surgery (19±20 mm). Most patients (81%) scored >60 mm, and 44% required rescue medication. Among the comorbidities, all patients had photophobia and 84% had burning sensation. At 6 hours, the HAD score was 5.4±3.9, within the range of values considered as normal. CONCLUSION: Postoperative acute ocular pain after ASA showed a characteristic evolution over time. Recognition of the pattern could be important for improving the acceptance of ASA and for improving strategies in pain management in the postoperative period.

Comparison of specular microscopy and ultrasound pachymetry before and after cataract surgery.

PURPOSE: To compare specular microscopy (Topcon SP-3000P, Topcon Corporation, Tokyo, Japan) and ultrasound (US) technology when evaluating central corneal thickness (CCT) prior to and after phacoemulsification. METHODS: Corneal edema was assessed in phacoemulsification patients due to senile cataract by measuring CCT preoperatively and 1 day, 1 month, and 3 months postoperatively. Bland-Altman analysis was performed to assess interchangeability between pachymetry techniques for each visit. Repeated measures analysis of variance was performed to evaluate variation in CCT agreement depending on the degree of corneal edema. RESULTS: One hundred and eighteen patients aged 73.9 ± 10.1 years were recruited. Topcon SP-3000P provided significant (p < 0.0001) lower CCT values than US with and without induced corneal edema. Mean differences between CCT techniques for baseline, 1 day, 1 month and 3 months after cataract surgery were -28.9 ± 22.6, -30.5 ± 41.4, -32.3 ± 16.2 and -33.0 ± 16.9 µm, respectively. The systematic bias observed was not significantly different among the 4 visits (p = 0.59). The estimated limits of agreement (based on 1.96 standard deviation) were substantial, being 90.5, 165.8, 64.9 and 67.5 um at baseline, 1 day and 1 and 3 months. CONCLUSIONS: Topcon SP-3000P provides similar systematic bias in comparison with US technique for CCT measurements regardless of the degree of corneal edema after phacoemulsification, which should be reduced after applying a constant calibration adjustment of ∼30 µm. However, interchangeability between techniques may be still limited by the notable random measurement error.

Reliability of Potential Pain Biomarkers in the Saliva of Healthy Subjects: Inter-Individual Differences and Intersession Variability.

AIM: Salivary cortisol, α-amylase (sAA), secretory IgA (sIgA), testosterone, and soluble fraction of receptor II of TNFα (sTNFαRII) could serve as objective pain measures, but the normal variability of these potential biomarkers is unknown. PATIENTS & METHODS: Saliva was collected with the passive secretion method from 34, pain-free subjects in two single samples at least 24 hours apart. Biomarker variation and intersession reliability were assessed with the intraclass correlation coefficient (ICC). Also, we calculated the within-subject standard deviation (Sw) and the reproducibility (2.77 × Sw) of intersession measures. RESULTS: Salivary cortisol, sAA, sIgA, testosterone, and sTNFαRII yielded the following ICCs: 0.53, 0.003, 0.88, 0.42 and 0.83, respectively. We found no statistically significant systematic differences between sessions in any biomarker except for testosterone, which showed a decrease on the second day (p<0.001). The reproducibility for salivary cortisol, sAA, sIgA, testosterone, and sTNFαRII were 0.46 ng/ml, 12.88 U/ml, 11.7 µg/ml, 14.54 pg/ml and 18.29 pg/ml, respectively. Cortisol, testosterone and TNFαRII measurement variability showed a positive correlation with the magnitude (p<0.002), but no relationship was found for sAA and sIgA. CONCLUSIONS: Salivary sIgA and sTNFαRII show a remarkable good reproducibility and, therefore, could be useful as pain biomarkers. When using the passive secretion method, intersession variations in salivary sIgA of more than 11.7 µg/ml may reflect true biomarker change. In the case of sTNFαRII this will depend of the magnitude. The estimates herein provided should help investigators and clinicians differentiate actual biomarker modification from measurement variability.

Consistency of corneal sublayer thickness measurements using Fourier-domain optical coherence tomography after phacoemulsification.

PURPOSE: To assess the reliability of corneal epithelial thickness (CET), nonepithelial central corneal thickness (NECCT), and central corneal thickness (CCT) measurements using Cirrus high-definition optical coherence tomography (HD-OCT) in patients who did and did not undergo cataract surgery. METHODS: Forty patients who underwent uneventful phacoemulsification and 40 healthy participants were recruited to evaluate the intraobserver repeatability and interobserver reproducibility of CET, NECCT, and CCT measurements using Cirrus HD-OCT. To analyze repeatability, one examiner obtained 5 consecutive scans in each participant; for interobserver reproducibility, another examiner randomly obtained another scan. Within-subject standard deviation, coefficient of variation (CV), limits of agreement, and intraclass correlation coefficient (ICC) data were obtained. RESULTS: For intraobserver repeatability, the intrasession CV (CVw) and ICC values of the CET in the operated and nonoperated groups were 3.7% and 0.80 and 3.8% and 0.73, respectively; for NECCT, 0.7% and 0.98 and 0.8% and 0.97; and for CCT, 0.6% and 0.99 and 0.7% and 0.98. For interobserver reproducibility, the CVw and ICC values for the CET in the operated and nonoperated groups were 2.6% and 0.82 and 2.3% and 0.62, respectively; for NECCT, 0.7% and 0.98 and 0.5% and 0.98; and for CCT, 0.5% and 0.99 and 0.4% and 0.99. CONCLUSIONS: The corneal sublayer thickness can be measured reliably using Cirrus HD-OCT in patients who underwent cataract surgery and elderly participants; however, the CET consistency is poorer than the NECCT. Corneal epithelial thickness modifications exceeding 4% reflect true thickness changes instead of random error variations using HD-OCT.

Early Changes in Corneal Epithelial Thickness after Cataract Surgery--Pilot Study.

PURPOSE: To assess early variations in central and paracentral corneal epithelial and non-epithelial thicknesses after uneventful clear corneal incision phacoemulsification. MATERIALS AND METHODS: Twenty patients with a senile cataract underwent coaxial phacoemulsification through a 2.75-mm-wide corneal incision created at 180° in a prospective cohort pilot study. Corneal sublayer thickness measurements were obtained with Fourier-domain optical coherence tomography (FD-OCT, Cirrus HD-OCT, Carl Zeiss Meditec, Inc., Dublin, CA) before and after 1 week and 1 month postoperatively. Central measurements were performed in the middle of the FD-OCT scan and in the 3-mm corneal diameter (paracentral 180° and 0° locations). Epithelial, non-epithelial and total corneal pachymetry were measured at the central and paracentral locations. RESULTS: No significant changes in epithelial thickness were seen 1 week postoperatively. However, 1 month postoperatively, the central, 180°, and 0° paracentral epithelial thicknesses (52.7 ± 3.8, 53.1 ± 5.4, and 52.7 ± 5.3 µm, respectively) decreased significantly (p < 0.01) compared to preoperatively (57.2 ± 4.8, 58.0 ± 5.7, 56.6 ± 5.3 µm, respectively). The 1-week central, 180°, and 0° paracentral non-epithelial corneal thicknesses (515.5 ± 39.6, 534.3 ± 45.6, and 521.3 ± 36.9 µm) were significantly (p < 0.01) higher than preoperatively (486.2 ± 34.7, 498.2 ± 33.8, 497.5 ± 32.3 µm, respectively). The non-epithelial corneal thickness increase was significantly (p = 0.02) greater after 1 week in the central (29.3 ± 17.2 µm) and the 180° paracentral (36.1 ± 28.7 µm) locations than at the 0° paracentral location (23.8 ± 16.5 µm). CONCLUSIONS: Immediate postoperative corneal edema following phacoemulsification irregularly affects the cornea at the sublayer level. The initial central and paracentral non-epithelial thickening is compensated by subsequent central and paracentral epithelial thinning. These initial changes occurred more markedly closest to the main incision over the entrance pupil, which may have visual implications.

Ocular pain and discomfort after advanced surface ablation: an ignored complaint.

PURPOSE: Laser vision correction is one of the most commonly performed elective surgical procedures in ophthalmology. Generally, discomfort besides pain (photophobia, burning sensation, tearing, and foreign body sensation) after these procedures is not taken into consideration in the clinical practice. The objective is to provide data on these symptoms and their relevance after advanced surface ablation (ASA). METHODS: Single-center survey study based on a structured questionnaire relative to the patients' perceived symptoms after ASA. Inclusion criteria were: ≥18 years old, no ocular disease, with myopia (0.75 to 9 D) or hyperopia (0.25 to 5 D) with or without astigmatism, receiving ASA on at least one eye. All procedures were performed by the same surgeon. A descriptive analysis was performed. RESULTS: Seventy-three consecutive patients (34 men and 39 women) were included in the study. The median (range) of age was 33 (19-64) years. Sixty-nine patients had surgery done on both eyes. Postoperative pain was the most frequent comorbidity (97% [95% confidence interval {CI}: 90-100]) with a median (range) of intensity (verbal numerical rating scale) score of 7 (2-10). Photophobia: 85% (95% CI: 75-92); burning sensation: 62% (95% CI: 50-73); tearing: 59% (95% CI: 47-70); and foreign body sensation: 48% (95% CI: 36-60) were also prevalent postoperative symptoms. Pain during ASA was reported for 44% (95% CI: 32-56) of patients. CONCLUSION: Comorbidities such as pain, photophobia, burning sensation, tearing, and foreign body sensation are prevalent after ASA procedure. Postoperative pain should be taken into consideration due to its prevalence and intensity. A new and more efficient postoperative analgesic protocol should be established.