Associations between corneal curvature and other anterior segment biometrics in young myopic adults.

To investigate the associations between corneal curvature (CC) and other anterior segment biometrics in young myopic adults. In this retrospective multi-center study, 7893 young myopic adults were included. CC and other anterior segment biometrics were measured by Scheimpflug imaging (Pentacam). CC was defined as SimK at central 3 mm area, and other anterior segment biometrics included white-to-white corneal diameter (WTW), central corneal thickness (CCT), corneal volume (CV) at 3 mm, 5 mm, and 7 mm area, anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), anterior corneal eccentricity (ACE) and asphericity (ACAP), posterior corneal eccentricity (PCE) and asphericity (PCAP), anterior chamber depth (ACD), and anterior chamber volume (ACV). Univariate regression analyses were used to assess the associations between CC and other anterior segment biometrics, and multivariate regression analyses were further performed to adjusted for age, gender and spherical equivalent. CC was higher in patients of female gender and higher myopia (all P < 0.05). Eyes in higher CC quartiles had lower WTW, thinner CCT, lower CV at 3 mm and 5 mm, lower ACD, and lower ACV (all P < 0.001), but had larger ACA, larger PCA, less PCE and less PCAP (all P < 0.001), compared to eyes in lower CC quartiles. The trends of CV at 7 mm, ACE and ACAP were inconsistent in different CC quartiles. After adjusting for age, gender and spherical equivalent with multivariate linear regression, CC was positively correlated to CV at 7 mm (ßs = 0.069), ACA (ßs = 0.194), PCA (ßs = 0.187), ACE (ßs = 0.072), PCAP (ßs = 0.087), and ACD (ßs = 0.027) (all P < 0.05), but was negatively correlated to WTW (ßs = - 0.432), CCT (ßs = - 0.087), CV-3 mm (ßs = - 0.066), ACAP (ßs = - 0.043), PCE (ßs = - 0.062), and ACV (ßs = - 0.188) (all P < 0.05). CC was associated with most of the other anterior segment biometrics in young myopic adults. These associations are important for better understanding of the interactions between different anterior segment structures in young myopic patients, and are also useful for the exploration of the pathogenesis of myopia.

Preoperative geometric parameters predict the outcome of lamellar keratoscleroplasty in patients with limbal dermoids.

PURPOSE: To find preoperative simple geometric parameters to predict the outcome of lamellar keratoscleroplasty in patients with corneal limbal dermoids. METHODS: We retrospectively analyzed the data of 30 patients with limbal dermoids who underwent lamellar keratoscleroplasty and were followed up for more than 6 months. Seven geometric parameters were used to analyze the relationship with postoperative visual acuity, astigmatism, and scar formation and investigated for their influence on postoperative outcome. These seven parameters included the cornea-invaded area of dermoid, dermoid area, the cornea-invaded length of dermoid, the corneal limbus invaded length of dermoid, dermoid size, bed size, graft size. Furthermore, we divided patients with corneal limbal dermoids into amblyopia group and non-amblyopia group, and analyzed the clinical characteristics of the amblyopia group. RESULTS: The mean age of the patients at surgery was 10.6 ± 5.83 years. The 7 geometric parameters, preoperative and postoperative astigmatism of the amblyopia group were higher than those of the non-amblyopia group (all P < 0.05). Among the geometric parameters analyzed, the r coefficients between the cornea-invaded length of dermoid and postoperative visual acuity and astigmatism were the highest (r = 0.854, r = 0.714). The r coefficient between the corneal limbus invaded length of dermoid and the postoperative scar was the highest (r = 0.375). The r coefficient between age and postoperative steroid-induced high intraocular pressure was the highest (r = - 0.416). In univariate regression analysis, the cornea-invaded length of dermoid was significantly correlated with postoperative visual acuity (ß = 0.270, P < 0.001) and postoperative astigmatism (ß = 1.362, P < 0.001). Among the geometric parameters analyzed, the cornea-invaded length of dermoid had best stratified patients in grouping with or without amblyopia (cutoff > 2.24). CONCLUSION: The cornea-invaded length of dermoid was the most important related factor of postoperative visual acuity, astigmatism, and amblyopia. The corneal limbus invaded length of dermoid was the most important related factor of postoperative scar formation. The geometric parameters and astigmatism in patients with amblyopia were larger than those in patients without amblyopia.

KCTD1 and Scalp-Ear-Nipple ('Finlay-Marks') syndrome may be associated with myopia and Thin basement membrane nephropathy through an effect on the collagen IV α3 and α4 chains.

INTRODUCTION: Scalp-Ear-Nipple syndrome is caused by pathogenic KCTD1 variants and characterised by a scalp defect, prominent ears, and rudimentary breasts. We describe here further clinical associations in the eye and kidney. METHODS: Fifteen affected members from two unrelated families with p.(Ala30Glu) or p.(Pro31Leu) in KCTD1 were examined for ocular and renal abnormalities. The relevant proteins were studied in the eye and kidney, and the mutation consequences determined from mouse knockout models. RESULTS: Five males and 10 females with a median age of 40 years (range 1-70) with pathogenic variants p.(Ala30Glu) (n = 12) or p.(Pro31Leu) (n = 3) in KCTD1 were studied. Of the 6 who underwent detailed ophthalmic examination, 5 (83%) had low myopic astigmatism, the mean spherical equivalent of 10 eyes was 2.38D, and one (17%) had hypermetropic astigmatism. One female had a divergent strabismus.Five individuals had renal cysts (5/15, 33%), with renal biopsy in one demonstrating a thinned glomerular basement membrane identical to that seen in Thin basement membrane nephropathy (AD Alport syndrome).In the eye, KCTD1 and its downstream targets, TFAP2, and the collagen IV α3 and α4 chains localised to the cornea and near the retinal amacrine cells. In the kidney, all these proteins except TFAP2 were expressed in the podocytes and distal tubules. TFAP2B and COL4A4 knockout mice also had kidney cysts, and COL4A3 and COL4A4 knockout mice had myopia. CONCLUSION: Individuals with a pathogenic KCTD1 variant may have low myopic astigmatism and represent a further rare genetic cause for a thinned glomerular basement membrane.

Comparison study between pilocarpine and tropicamide drops on corneal topography and their effect on IL-6 and TNF-α levels in tear.

Corneal stability is essential for contact lenses and refractive surgery. It seems that paralyzing eye drops or expansion of the ciliary muscle affect the radius of curvature and the strength of the cornea, and this effect is to increase the strength of the cornea during muscle spasm and decrease it in the relaxed state of the muscle. On the other hand, different factors (such as contact lens wear, ocular surface disorders, trauma, dry eye, and immunosuppression) could alter the immune defense mechanisms of the outer eye and permit microorganisms to invade the cornea. Therefore, the present study compared Pilocarpine and tropicamide drop on corneal topography and their effect on IL-6 and TNF-α levels in tear. This prospective study was performed on sixty normal and healthy eyes of sixty volunteers with a mean age of 38.19 years and without any ocular pathology. Volunteers were divided into two groups of thirty. In the first group, corneal topography of both eyes was measured before and 30 minutes after instillation of topical tropicamide 1% in only one eye. The other eye was the control eye, and no drop was given. The same routine was performed in the second group, except that subject received one drop of Pilocarpine 2% in one eye. Statistical comparison between groups for the central corneal power, corneal radius, and corneal astigmatism was performed using paired t-test. IL-6 and TNF-α levels in tear were analyzed using two Luminex commercial assays with Bio-Plex 200TM System (Bio-Rad, Hercules, California, USA). In group 1, no significant changes were found in corneal radius, power, and astigmatism. However, in group 2 subjects who received pilocarpine eye drops, the mean corneal radius value decreased significantly by 0.05 mm. The mean corneal power increased by +0.32 D. There was no significant difference change in corneal astigmatism in both groups. Evaluation of IL-6 levels in tears showed a significant difference between the control and treatment groups (P = 0.041). But no significant difference was observed between the Pilocarpine and the Tropicamide groups (P = 0.761). Evaluation of TNF-α level in tears also showed no significant difference between these groups (P = 0.088). Pilocarpine induced ciliary muscle contraction, which may cause pressure on the corneal limbus and scleral spur, resulting in changes in corneal curvature. But tropicamide eye drop did not affect corneal radius and other corneal parameters, and corneal topography can be carried out after the installation of tropicamide eye drop.

Un estudio de prevalencia de error de refracción en niños entrecerrados (6-12 años) asistiendo al Hospital Dr. Aso-Eye Shahed / A study of Prevalence of Refractive Error in Squinted children (6-12 years) attending shahed Dr. Aso-Eye Hospital

Determinar la prevalencia del error de refracción (RE) como causa en los ojos en los niños en niños de esta edad (6-12 años) en la ciudad de Sulaimania. El estudio de tasa de prevalencia entre los pacientes que asisten al Shahed Dr. Aso Eye Hospital para el período del 1 de octubre de 2008 al 1 de junio de 2009. Un total de 116 niños (6-12 años) asisten al departamento de entrecerrares durante aproximadamente 8 meses. El estudio incluyó ambos sexos, eran niños de 55 años y niñas 61. Se sometieron a un examen ocular completo. Encontramos que (72) pacientes (62.02 %) tenían un error de refracción, incluyen: 33 pacientes (45.9 %) = hipermetropia (H); 22 pacientes (29.16%) = miopía [m]; 18 pacientes (24.3%) astigmatismo (AST.); 4 mixtos; 6 h-as. y 8 m-as. En conclusiones, la causa más frecuente del entrecerrar de la infancia a este ancho [6-12 años) es el error refractivo, mientras que las otras causas en su conjunto constituyen solo 1/3 de las causas, y el error de refracción más común es la hipermetropía

To determine the prevalence of refractive error (RE) as a cause in squinted in children in this aged (6-12 years) in Sulaimania city. The prevalence rate study among patient attending Shahed Dr. Aso eye hospital for the period from 1st October 2008 - 1st June 2009. A total of 116 children ( 6-12 years) attending squint department for about 8 months. The study included both sexes, were boys 55 and girls 61. Underwent full ocular examination. We found that (72) patients (62.02%) had refractive error, include: 33 patients (45.9 %) = Hypermetropia (H); 22 patients (29.16%) = Myopia [M]; 18 patients (24.3%) Astigmatism (Ast.); 4 mixed; 6 H-Ast. and 8 M-Ast. In conclusions, the most prevalent cause of childhood squint at this aged [6-12 years) is refractive error while the other causes as a whole constitute only 1/3 of the causes, and most common refractive error is hypermetropia

Characteristics of astigmatism before and 1 month after blepharoptosis surgery in patients with acquired ptosis.

In this study, we aimed to evaluate the characteristics of astigmatism preoperatively and 1 month postoperatively in patients with age-related ptosis (AP) and contact lens-related ptosis (CLP), and investigate surgery-induced astigmatism (SIA) using the Jaffe vector analysis and the Cravy method. Consecutive patients who underwent blepharoptosis surgery between January 2019 and December 2019 were included. The patients were divided into AP and CLP groups. Computerized corneal topography was used to assess the magnitude and axis of corneal astigmatism. Astigmatism was classified as with-the-rule (WTR), against-the-rule (ATR), or oblique astigmatism (OA) pre- and postoperatively. SIA was calculated by vector analysis using the Cravy and Jaffe methods. The correlation between SIA and margin reflex distance (MRD) was calculated. One hundred and eight eyes from 58 patients (AP group: 85 eyes from 45 patients, CLP group: 23 eyes from 13 patients) were included. The AP group (73.8±7.6 years) was significantly older than the CLP group (47.7±6.6 years). The MRD increased significantly after treatment in both groups. The proportions of WTR, ATR, and OA were 52%, 22%, and 25%, and 86%, 9%, and 4% in the AP and CLP groups, respectively. A shift in astigmatism type was observed in 41% and 13% of patients in the AP and CLP groups, respectively. The average SIA measured using the Cravy method was 0.11±1.22 D in the AP group and -0.28±1.07 D in the CLP group (WTR astigmatism). The SIA calculated using the Jaffe method was 0.78±0.70 D in the AP group and 0.82±0.88 D in the CLP group. There was no significant correlation between SIA calculated using the Cravy and Jaffe methods and MRD. ATR was most common in age-related ptosis and WTR was most common in contact lens-related ptosis. Upper eyelid re-positioning may affect visual functions due to astigmatic changes in the short term postoperatively.

Ocular manifestations in classic homocystinuria.

BACKGROUND: Classic homocystinuria (HCU), or cystathionine beta-synthase (CBS) deficiency, is a rare inborn error of methionine metabolism. Main clinical features may include skeletal and vascular manifestations, developmental delay, intellectual disability and eye disorders. MATERIAL AND METHODS: This is an observational and retrospective study aiming at describing eye abnormalities presented by a cohort of late-diagnosed HCU patients. Data regarding ophthalmological evaluation included visual acuity, refraction, biomicroscopy, Perkins tonometry, fundus examination, retinography, biometry, ocular ultrasound, optical coherence tomography, anterior segment photography and topography. RESULTS: Ten patients with HCU (20 eyes) were included. The most frequent findings were ectopia lentis(n = 20) and myopia (n = 9). Biometry, ultrasound, OCT and topography findings were available for four patients. One patient had keratoconus; one had abnormal retinal pigmentation; and two had lens surgery scars with irregular astigmatism. CONCLUSIONS: Eye abnormalities are very frequent in late-diagnosed HCU patients. The presence of ectopia lentis should always raise the diagnostic hypothesis of HCU.

Analysis of astigmatism outcomes after horizontal rectus muscle surgery in patients with intermittent exotropia.

This study examined the factors affecting corneal curvature change after lateral rectus recession and medial rectus resection surgery in patients with intermittent exotropia. This was a retrospective cross-sectional study in intermittent exotropia patients who underwent rectus resection surgery. The study involved 41 male and 42 female patients (mean age: 9.55 ± 5.03 years, range: 3-28 years). Corneal astigmatism analysis was performed using the Galilei G4 Dual Scheimpflug Analyzer. The values of simulated and ray tracing corneal keratometry (K) of astigmatism, including axis changes, were determined preoperatively and at 1 week and 3 months postoperatively. The factors found to affect corneal curvature change were sex, extent of surgery, and axial length. Simulated and ray tracing changes were significant preoperatively and at 1 week and 3 months after rectus resection surgery (p < 0.05); however, there were no differences in astigmatism (D) at any time. The spherical equivalent had a myopic change after rectus resection surgery with cycloplegic refraction, and in ray tracing mode, flat K was decreased at 1 week from baseline and increased 3 months later. Steep, mean K, and axis increased continuously from baseline to 1 week and 3 months. Astigmatism, in contrast, was increased at 1 week, but decreased at 3 months, with no return to baseline. Univariable linear regression analyses showed that the extent of surgery had an effect on flat K change and that sex had an effect on steep K and axis. Additionally, axial length affected steep K and astigmatism, while age had no effect on any variable. Ray tracing values were significantly different from simulated values. In ray tracing mode, rectus resection surgery may result in astigmatism shifted toward with-the-rule, and myopic changes may be caused by differences in thickness and flexibility of the sclera. Notably, age did not affect any variable.

Short and long term outcomes after small-incision lenticule extraction: A tertiary referral centre experience.

PURPOSE: The objective of this study is to evaluate the preoperative and short- and long-term postoperative results in terms of visual acuity, refractive error, and corneal wavefront aberrations in patients with myopia and myopic astigmatism undergoing small incision lenticule extraction (SMILE). METHODS: Seventy-nine eyes of 52 myopes with or without astigmatism (41 right and 38 left) were enrolled in this retrospective study. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and wavefront aberrations. All the measurements before and after SMILE surgery were systematically recorded. RESULTS: Mean preoperative UDVA was 1.19±0.24 logMAR and improved to 0.06±0.17 logMAR at the 3-year postoperative follow-up. At the conclusion of the 3-year follow-up, UDVA was better than or equal to 20/20 and 20/25 in 73% and 84% of eyes, respectively. At 1 month postoperatively, CDVA was 0.05±0.23 logMAR and significantly lower than the preoperative CDVA, 0.02±0.04 log MAR (P>0.05). However, at 1 year and 3 years after surgery, CDVA showed a significant increase compared to preoperative CDVA. At the conclusion of the 3-year follow-up, SE was -0.47 D, and 69.6% and 83.5% of the eyes were within±0.50 D and±1.00 D, respectively, of the intended correction. HOA's, coma, and spherical aberration increased significantly. No significant change in trefoil was detected. CONCLUSION: This study showed that SMILE produces a stable, safe outcome for surgical treatment of myopia and myopic astigmatism.

Comprehensive evaluation of total corneal refractive power by ray tracing in predicting corneal power in eyes after small incision lenticule extraction.

PURPOSE: To assess the prediction accuracy of four variations of total corneal refractive power (TCRP) by the ray tracing method in determining corneal power in eyes after myopic small incision lenticule extraction (SMILE). METHODS: Forty eyes of forty patients who had undergone myopic SMILE were enrolled in this prospective study. Manifest refraction and Pentacam HR were performed preoperatively and three months or more postoperatively. Mean keratometry (Km), true net power (TNP), equivalent keratometry readings (EKR) and 4 subtypes of TCRP (pupil centered or apex centered within a ring or a zone)-TCRPpupil,ring, TCRPpupil,zone, TCRPapex,ring and TCRPapex,zone-were recorded and compared to the theoretical postoperative keratometry value using the clinical history method (CHM). RESULTS: The only keratometric values that showed no statistically significant differences from the CHM were 4.0 mm and 4.5 mm EKR, 6.0 mm TCRPpupil,zone and TCRPapex,zone. Pearson's correlation test revealed that 4.0 mm TCRPpupil,zone exhibited the highest correlation coefficient (r = 0.974) followed by TCRPapex,zone 4.0 mm (0.972) and EKR 4.5 mm (0.970). The 95% limits of agreement (LOA) of the 4.0 mm EKR and CHM, the 4.5 mm EKR and CHM, the 6.0 mm TCRPpupil,zone and CHM, the 6.0 mm TCRPapex,zone and CHM were (-1.27 to 1.22 D), (-1.04 to 0.98 D), (-1.39 to 1.08 D) and (-1.38 to 0.96 D), respectively, while the modified 4.0 mm TCRPpupil,zone (TCRPpuil,zone + 0.70 D) and TCRPapex,zone (TCRPapex,zone+0.70 D) yielded the narrowest 95% LOA of (-0.96 to 0.95 D) and (-0.96D, 1.05 D). CONCLUSIONS: Total corneal refractive power using the ray tracing method could predict corrected corneal power derived from the CHM in eyes following SMILE surgery after simple modification.

Corneal Tomography Changes and Refractive Outcomes After Descemet Stripping Without Endothelial Keratoplasty.

PURPOSE: To investigate corneal tomography changes and refractive outcomes after Descemetorhexis without endothelial keratoplasty (DWEK). METHODS: Retrospective chart review of 25 eyes from 16 patients with Fuchs corneal endothelial dystrophy that underwent successful DWEK combined with cataract surgery. RESULTS: There was no significant change in anterior corneal curvature on tomography maps. However, all tomography maps demonstrated an increase in central posterior float and all but one demonstrated a decrease in pachymetry after DWEK. Only 7 of 25 eyes had increased irregular astigmatism on tomography after DWEK, of which 57% had preexisting irregular astigmatism before the procedure. The mean difference between the targeted and outcome refraction was +0.65 diopters (D) at the time of corneal clearance, but this improved to +0.38 D 1 month after corneal clearance. Postoperative refraction was within 1 D of target refraction for 92% of cases (23 eyes) but within 0.5 D of target refraction for only 48% of cases (12 eyes). The differences between expected and actual refractive outcomes were correlated with change in posterior corneal curvature and pachymetry. CONCLUSIONS: DWEK induces an increased central posterior float localized to the site of Descemet membrane stripping, confirming the need for centralized stripping. Irregular astigmatism can occur after DWEK but is typically minimal and occurs more commonly in the setting of preoperative irregular astigmatism. DWEK induces about a 0.5 D hyperopic shift, which should be considered when determining intraocular lens power with simultaneous surgery.

A Multicenter Study on Early Outcomes of Small-Incision Lenticule Extraction for Myopia.

This study was aimed to investigate the early clinical outcomes of small-incision lenticule extraction (SMILE) to correct both myopia and myopic astigmatism at major clinical centers in Japan. This case series consisted of two hundred fifty-two eyes of 130 consecutive patients who underwent SMILE surgery (29.5 ± 6.3 years, mean age ± standard deviation), with spherical equivalents of -4.33 ± 1.61 D. We determined the safety, efficacy, predictability, stability, and adverse events of this procedure. Corrected distance visual acuity significantly improved, from -0.18 ± 0.04 preoperatively to -0.19 ± 0.07 logMAR postoperatively (paired t-test, p < 0.001). Uncorrected distance visual acuity also significantly improved, from 1.05 ± 0.26 preoperatively to -0.15 ± 0.11 logMAR postoperatively (p < 0.001). 88% and 98% of eyes were within ± 0.5 and 1.0 D of the targeted correction, respectively. Changes in manifest spherical equivalent from 1 week postoperatively were 0.02 ± 0.35 D (p = 0.127). No vision-threatening complications were observed in any of the cases. SMILE performed well in the correction of myopic refractive errors, and we experienced no severe complications in this series, indicating its feasibility as a surgical option for the treatment of these eyes.

Posterior keratoconus and iris atrophy: a fortuitous association? / Ceratocone posterior e atrofia de iris: uma associação incidental?

ABSTRACT The authors describe an unusual association between posterior keratoconus and iris atrophy, confirmed by a complete ocular evaluation, scheimpflug imaging and pachymetric curve. A hypothesis for concomitant findings is discussed.

RESUMO Os autores descrevem a rara associação entre ceratocone posterior e atrofia de íris, confirmada por avaliação oftalmológica completa, imagens de scheimpflug e curva paquimétrica. Sugere-se uma hipótese que explique a concomitância de ambas as alterações.

An approach for simulating the fitting of rigid gas-permeable contact lenses using 3D printing technology.

OBJECTIVE: To introduce a new approach to simulatethe fitting process of rigid gas-permeable (RGP) contact lenses using 3D printing technology. METHODS: A hemispherical or parabolic 3D model was created using 3D Builder or Tinkercad software. The horizontal and vertical diameters and the hemispherical or ellipsoid height were adjusted to simulate different morphologies of the corneal anterior surface. After exporting the file in stereo lithography (STL) format, a solid model was printed using a 3D printer and was used to simulate RGP contact lens fitting. RESULTS: Limited by the precision of the entry-level 3D printer which was used in this study, the print-outs of the corneal models were crude, but the models were tested for their ability to simulate common corneal morphologies with no corneal astigmatism and different axial corneal astigmatism. Compared with some built-in simulation programs for corneal topography, the solid models generated by 3D printing could well simulate the positioning of the lens under the influence of gravity and the eyelid, as well as lens eccentricity or the bubbles under lenses caused by an improper wearing method. CONCLUSION: 3D printing technology can be well applied in the simulation of RGP contact lens fitting, which may become a new teaching method in optometry.

Penetrating Keratoplasty Using the Femtosecond Laser: A Comparison of Postoperative Visual Acuity and Astigmatism by Suture Pattern.

PURPOSE: To compare the effect of 3 common suturing techniques on eyes that received femtosecond laser-enabled penetrating keratoplasty (FLEK) with a zig-zag configuration at the Gavin Herbert Eye Institute, University of California- Irvine, California. METHODS: This is a retrospective chart review of a series of 319 eyes of 286 patients who underwent FLEK with a zig-zag configuration. One hundred fifty-seven eyes had running sutures, 136 eyes had simple interrupted sutures, and 26 eyes had combined sutures (single running and simple interrupted). The main outcome measures were uncorrected distance visual acuity, best spectacle-corrected visual acuity (BSCVA), and topographic astigmatism (TCyl). These parameters were recorded for the first year of follow-up regardless of suture removal status and also after full suture removal. RESULTS: At 3 months, the BSCVA of the running, interrupted, and combined suture groups was 0.22 (±0.2), 0.41 (±0.3), and 0.29 (±0.1), respectively (P < 0.01). The mean TCyl of the running, interrupted, and combined groups at 3 months was 3.95 (±2.7), 6.41 (±4.4), and 5.44 (±3.3) D, respectively (P < 0.01) All sutures were removed in 190 of 319 eyes, and at the last recorded visit, the mean BSCVA was 0.18 (±0.2), 0.34 (±0.2), and 0.19 (±0.2) logarithm of the minimum angle of resolution in the running, interrupted, and combined groups, respectively (P < 0.01) and mean TCyl was 4.51 (±2.8), 5.62 (±3.7), and 4.57 (±2.9) D, respectively (P = 0.11). CONCLUSIONS: Better visual acuity after full suture removal was observed in the running suture group; however, the subgroups of patients with keratoconus were similar after all sutures were removed.

[Assessment of astigmatism associated with the iris-fixated ARTISAN aphakia implant: Anterior fixation versus posterior fixation, study of postoperative follow-up at one year]. / Évaluation de l'astigmatisme associé à l'implant ARTISAN Aphakia fixé à l'iris en face antérieure versus face postérieure : étude du suivi postopératoire sur un an.

PURPOSE: The goal of our retrospective, single-center study of a case series was to compare the total, corneal, and internal astigmatism, and the visual acuity at one year after combined or stand-alone surgery consisting of iris fixation of an iris-claw intraocular lens (ARTISAN aphakia) in aphakic patients, according to whether the lens was fixated to the anterior (n=21) or posterior (n=51) surface of the iris. RESULTS: We did not find a significant difference between these two types of fixation for any of the studied variables. The surgically induced astigmatism was 1.67 D at 176° in group A versus 1.19 D at 11° in group P. CONCLUSION: Although this surgery creates additional corneal astigmatism, it has not been proven that it differs depending on the type of fixation of the iris-claw. If we adhere to the notion that the posterior fixated iris-claw decreases the risk of endothelial decompensation in case the implant becomes disenclavated, then reverse iris fixation of the iris-claw makes sense.

Essential role of ultraviolet radiation in the decrease of corneal endothelial cell density caused by pterygium.

PURPOSE: To investigate the essential role of ultraviolet (UV) radiation in the decrease of corneal endothelial cell density (ECD) caused by pterygium. METHODS: In this retrospective controlled study, 76 consecutive patients with unilateral primary pterygium were enrolled from January 2016 to August 2016. The Central corneal ECD was measured in both eyes. Divide the subjects into two subgroups according to the UV exposure time, and the difference of corneal ECD between both eyes was analyzed using independent samples t-test. The relationship between the percentage of difference of corneal ECD and the disease duration, the percentage of pterygium to the cornea and the astigmatism value were analyzed. RESULTS: For subjects with longer UV exposure, the average of ECD in pterygium group and control group were, respectively, 2264.83 ± 349.78 cells/mm2 and 2477.16 ± 300.36 cells/mm2 (P = 0.004). For subjects with short UV exposure, the average of ECD in pterygium group and control group were, respectively, 2596.46 ± 373.24 cells/mm2 and 2690.66 ± 321.34 cells/mm2 (P = 0.262). The decrease of corneal ECD was positively correlated with the period of the disease (P = 0.035). There was no statistical correlation between a decrease in the corneal ECD and the percentage of pterygium to cornea (R = -0.055, P = 0.635) and the astigmatism value in the pterygium eye (R = -0.135, P = 0.246). CONCLUSIONS: UV radiation exposure played a significant role in the effect of pterygium decreasing the corneal ECD.

Evaluation of corneal topographic changes and surgically induced astigmatism after transconjunctival 27-gauge microincision vitrectomy surgery.

PURPOSE: To evaluate the corneal topographic changes and postvitrectomy astigmatism after 27-gauge (g) microincision vitrectomy surgery (MIVS) by using Pentacam HR-Scheimpflug imaging system. METHODS: This prospective descriptive study included 30 eyes of 30 patients who underwent 27-g MIVS. All eyes underwent a Pentacam HR examination preoperatively and on the first week, first month and third month postoperatively. The power of the corneal astigmatism, mean keratometry (K m), K 1 and K 2 values and corneal asphericity (Q value) values for the both front and back surfaces of the cornea, index of surface variance (ISV), index of vertical asymmetry (IVA), index of height asymmetry (IHA), index of height decentration (IHD) and higher-order aberrations including coma, trefoil, spherical aberration, higher-order root-mean-square and total RMS were recorded. Additionally, the mean induced astigmatism was estimated by vector analysis. RESULTS: No statistically significant changes were observed in the mean power of corneal astigmatism, mean keratometry, K 1 and K 2 values, corneal asphericity values, ISV, IVA, IHA, IHD and higher-order aberrations on the first week, first month and third month after the operation. The mean surgically induced astigmatism was calculated as 0.23 ± 0.11 D on the first week, 0.19 ± 0.10 D on the first month and 0.19 ± 0.08 D on the third month postoperatively. CONCLUSION: Minor corneal surface and induced astigmatic changes are expected to result in rapid visual rehabilitation after pars plana vitrectomy with the 27-g MIVS system.

In Vivo and Ex Vivo Evaluation of Inflammation and Apoptosis Induced after SMILE Procedures for Different Refractive Error Range.

PURPOSE: To detect corneal inflammation and apoptosis induced after small incision lenticule extraction (SMILE) at different refractive corrections for moderate to high values of myopia. METHODS: Fifty patients (50 eyes) suffering from medium to high myopia (spherical equivalent refraction from -3.75 to -10.00 diopters (D) with refractive astigmatism under -0.75 D) underwent SMILE in order to correct myopic error. In vivo evaluation was done by corneal confocal microscopy (IVCM) and ex vivo by immunohistochemistry. After surgery, all corneal lenticules were checked for regularity, entirety, and fixed in formalin for immunohistochemistry evaluation of apoptosis (TUNEL) and inflammation (CD11b) levels. Postoperative assessments took place during the first week and the first and third months after surgery. Patients returned for IVCM examination for analysis of the corneal stromal femtosecond laser treatment interfaces reflectivity. RESULTS: No correlation was observed between treated myopic refractive error and number of CD11b+ and TUNEL+ cell in all analyzed extracted lenticules. IVCM at 1 week and 1 month of follow-up showed numerous reflective particles at the laser treatment interface with a moderate light scattering. In semi-quantitative analysis of reflectivity intensity at the laser interfaces, a statistical difference was evident only between 1 week and 1 month (p = 0.0213). CONCLUSIONS: SMILE, as an innovative all-femto surgical procedure, results in a reduced tissue inflammation and apoptosis levels with a minimum tissue response, in terms of interface reflectivity, and there are no statistically significant differences among variable treated refractive error range.

Distribution of Anterior Chamber Angle Width and Correlation With Age, Refraction, and Anterior Chamber Depth-The Gutenberg Health Study.

PURPOSE: Scheimpflug imaging allows quantitative analysis of the width of the anterior chamber angle. We report the population-based distribution of the anterior chamber angle width using this noncontact imaging technique and investigate associated factors. METHODS: A population-based cross-sectional study was carried out in Germany. A comprehensive ophthalmologic examination including refraction, biometry, and Scheimpflug imaging was performed. Automated measurement of the anterior chamber angle was performed in each anterior chamber quadrant. Exclusion criteria were previous ocular surgery or inadequate image quality. Association analyses were carried out to determine independently associated systemic and ocular factors for anterior chamber angle width using a generalized estimating equation model. RESULTS: A total of 3014 subjects (48% female) with a mean age of 58.6 ± 10.4 years were included in this study. The mean anterior chamber angle width was 32.6° ± 5.5°. Statistical analysis revealed an independent association between a smaller anterior chamber angle and female sex, higher age, and more hyperopic refraction. When including biometric parameters, shallow anterior chamber depth, shorter axial length, higher central corneal thickness, and lower corneal power were independently associated with a narrower mean anterior chamber angle width. CONCLUSIONS: These parameters are considered risk factors for angle-closure glaucoma.