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PURPOSE: Pediatric traumatic retinal detachment (RD) resulting from open globe injuries (OGIs) or closed globe injuries (CGIs) presents unique challenges due to complexity often resulting in lifelong sequelae. This study compares pediatric traumatic RD outcomes and prognostic factors following OGI and CGI. METHODS: A retrospective analysis reviewed 47 cases of pediatric traumatic RD in children (age <18 years), who underwent RD surgery between 2002 and 2021. Among them, 25 cases were caused by CGI and 22 cases by OGI. Demographics, RD characteristics, surgical procedures, and anatomical and functional results were assessed. Predictive factors for visual outcomes were investigated. RESULTS: In the CGI group, mean (±SD) age was 11 years ± 4 years, and 10 years ± 5 years in the OGI group. Closed globe injury traumatic RD had significantly better preoperative (CGI: logarithm of the minimum angle of resolution 1.39 ± 0.19 (mean ± standard error); OGI: logarithm of the minimum angle of resolution 2.12 ± 0.20) and follow-up (CGI: logarithm of the minimum angle of resolution 0.94 ± 0.19; OGI: logarithm of the minimum angle of resolution 1.85 ± 0.20) best-corrected visual acuity (BCVA) ( P < 0.05). Initial BCVA improvement was observed in CGI only. In multivariable analysis, prognostic factors for favorable BCVA outcomes included higher preoperative BCVA, older age, and absence of proliferative vitreoretinopathy ( P < 0.05). CONCLUSION: Visual prognosis for pediatric traumatic RD remains limited, favoring CGI cases compared with OGI. Baseline BCVA emerged as a major determinant of final visual acuity. Tailored management approaches can optimize treatment results.
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Ferimentos Oculares Penetrantes , Descolamento Retiniano , Acuidade Visual , Vitrectomia , Ferimentos não Penetrantes , Humanos , Criança , Descolamento Retiniano/cirurgia , Descolamento Retiniano/etiologia , Descolamento Retiniano/diagnóstico , Estudos Retrospectivos , Masculino , Feminino , Acuidade Visual/fisiologia , Ferimentos Oculares Penetrantes/cirurgia , Ferimentos Oculares Penetrantes/complicações , Ferimentos Oculares Penetrantes/fisiopatologia , Ferimentos Oculares Penetrantes/diagnóstico , Adolescente , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico , Pré-Escolar , Traumatismos Oculares/complicações , Traumatismos Oculares/cirurgia , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/fisiopatologia , Seguimentos , PrognósticoRESUMO
BACKGROUND: To investigate the changes in macular cystic schisis (MCS) and sensitivity during the day in X-linked retinoschisis (XLRS) patients. METHODS: Treatment-naïve patients with genetically verified XLRS underwent best-correlated visual acuity (BCVA) testing with ETDRS charts, spectral domain optical coherence tomography, and microperimetry (MP) twice a day, at 9 a.m. and 4 p.m., to measure changes in central retinal thickness (CRT), macular volume (MV), average threshold (AT), and fixation stability parameters (P1 and P2). RESULTS: At baseline, the BCVA of the 14 eyes of 8 patients amounted 0.73 (± 0.23) LogMAR. Between timepoints, the BCVA increased in 3.21 letters (p = .021), the AV improved in 1.84 dB (p = .03, 9.73%), the CRT decreased in 24.43 µm (p = .007, - 4.05%), and the MV dropped in 0.27 µm3 (p = .016, - 2.68%). P1 and P2 did not variate. The collapse of the MCS led to the reduction of macula thickness. CRT at baseline correlated with the decrease of CRT (Spearman's ρ: - 0.83 [p = .001]). Age and change of BCVA, CRT, and AV did not correlate among one another. Eyes with disrupted ellipsoid zone showed a more prominent change in CRT (p = .050). Photoreceptor outer segment length and integrity of the external limiting membrane and cone outer segment tips were not associated with BCVA, AT, or CRT variation. CONCLUSION: Eyes of treatment-naïve XLRS patients show diurnal macular thickness and function changes. Eyes with pronounced macular thickness show a greater reduction of the MCS. These results should be taken into consideration in upcoming clinical trials in XLRS. TRIAL REGISTRATION NUMBER: Institutional Review Board of the Hamburg Medical Chamber (Ethik-Kommission der Ärztekammer Hamburg): 2020-10,328.
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BACKGROUND: This study was to compare the outcomes of 360° intra-operative laser retinopexy (ILR) and focal laser retinopexy in treating patients with pars plans vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). To identify other potential risk factors for retinal re-detachment after primary PPV. METHODS: This was a retrospective cohort study. Three hundred and forty-four consecutive cases of primary rhegmatogenous retinal detachment treated with PPV were included between July 2013 and July 2018. Clinical characteristics and surgical outcomes were compared between focal laser retinopexy and additional 360° intra-operative laser retinopexy groups. Both univariate and multiple variable analysis were used to identify potential risk factors for retinal re-detachment. RESULTS: Median follow-up was 6.2 months (Q1, Q3:2.0, 17.2). As estimated with survival analysis, the 360º ILR group had the incidence of 9.74% and focal laser 19.54% at 6 months postoperatively. At 12 months postoperatively the difference was 10.78% vs. 25.21%. The difference in survival rates was significant (p = 0.0021). In multivariate Cox regression, the risk factors for retinal re-detachment were without additional 360° ILR, diabetes and macula off before the primary surgery (relatively OR = 0.456, 95%-CI [0.245-0.848], p < 0.05; OR = 2.301, 95% CI [1.130-4.687], p < 0.05; OR = 2.243, 95% CI [1.212-4.149], p < 0.05). CONCLUSION: Additional 360° ILR group had a significantly lower rate of retinal re-detachment when compared with focal laser retinopexy group. Our study also elucidated that diabetes and macular off before the primary surgery might also be the potential risk factors for higher rate of retinal re-detachment outcome. TRIAL REGISTRATION: This was a retrospective cohort study.
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Diabetes Mellitus , Descolamento Retiniano , Perfurações Retinianas , Humanos , Descolamento Retiniano/cirurgia , Vitrectomia/efeitos adversos , Estudos Retrospectivos , Perfurações Retinianas/cirurgia , Lasers , Resultado do Tratamento , Diabetes Mellitus/etiologiaRESUMO
BACKGROUND: Cataract surgery induces corneal endothelial cell loss (ECL). This study investigates the relationship between bottle height (BH) and ECL induced due to irrigation and aspiration (I/A) in cataract surgery and quantifies protective effects of intraoperatively used ophthalmic viscoelastic substances. METHODS: Intermittent I/A without phacoemulsification was performed in porcine eyes for 10 min with varying BHs of 100 cm (BH100), 125 cm (BH125), 150 cm (BH150) or no treatment (control, no I/A). Additionally, in one group a dispersive ophthalmic viscoelastic substance was injected into the anterior eye chamber before treatment with I/A at a BH of 150 cm (BH150 + V). After exposure of the corneal endothelium to I/A, the corneas were prepared to split corneal buttons on day 0 and cultivated for 15 days. Endothelial cell density (ECD) was analyzed blinded on days 1, 8 and 15. RESULTS: Relative ECL significantly correlated with irrigation BH (control (n = 13): -9.69 ± 6.03% (average ± standard deviation); BH100 (n = 12): -9.69 ± 4.81%-p = 1.000; BH125 (n = 14): -19.44 ± 7.30% - p < 0.001; BH150 (n = 13): -21.99 ± 6.70%-p < 0.001). I/A-induced ECL was significantly decreased by the injection of ophthalmic viscoelastic, as BH150 + V (n = 14; -10.92 ± 4.09%-p = 1.000) showed a cell loss comparable to the control group. CONCLUSIONS: ECL is altered by I/A BH and reduced when viscoelastic substances are used.
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Extração de Catarata , Catarata , Facoemulsificação , Animais , Suínos , Células Endoteliais , Endotélio Corneano , Contagem de CélulasRESUMO
PURPOSE: The study aims to explore the intereye asymmetry in normal and keratoconic individuals and to evaluate the discriminant power of single and combined asymmetry parameters. METHODS: This is a retrospective designed study including 414 patients who had Pentacam Scheimpflug topographic and tomographic imaging in both eyes: 124 subjects with bilateral normal corneas evaluated for refractive surgery and 290 with keratoconus. All elevation-, pachymetric-, and volumetric-based data (56 parameters) were electronically retrieved and analyzed. Intereye asymmetry was determined by subtracting the lowest value from the highest value for each variable. The degree of asymmetry between each subject's eyes was calculated with intraclass correlation coefficients for all the parameters. Receiver operating characteristic curve was used to determine predictive accuracy and to identify optimal cutoffs of these values and combinations thereof. RESULTS: In the normal/keratoconus subjects the median intereye asymmetries were 0.30/3.45 for K2 (flat) meridian, 0.03/0.25 for BFS front, 1.00/15.00 for elevation back BFS apex, and 7.00/29.00 for pachy min. CONCLUSIONS: In addition to Rabinowitz's Kmax intereye asymmetry we propose pachymetric, elevation-based, and high-order corneal wavefront intereye asymmetry parameters to improve the diagnostic armamentarium of keratoconus.
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Ceratocone , Córnea , Paquimetria Corneana , Topografia da Córnea , Humanos , Curva ROC , Estudos Retrospectivos , TomografiaRESUMO
BACKGROUND: Diffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling. METHODS: This is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE). RESULTS: Mean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 µm with the ERM to 313.70 ± 36.98 µm after PPV. Mean SE after lensectomy was - 0.18 ± 0.38 D, which minimally changed to - 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV. CONCLUSION: PPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.
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Membrana Epirretiniana , Lentes Intraoculares , Facoemulsificação , Membrana Epirretiniana/cirurgia , Humanos , Desenho de Prótese , Estudos Retrospectivos , VitrectomiaRESUMO
PURPOSE: To determine the long-term incidence of pseudophakic retinal detachment (PRD) after phacoemulsification and the weight of the main risk factors in the appearance of such complication in a large sample. To implement a customized formula and a software calculation program able to quantify the risk of suffering PRD applicable to all lens extraction patients. METHODS: Retrospective cumulative risk analysis conducted on 178,515 eyes operated under similar conditions in a group of refractive surgery clinics (Clínica Baviera SL) located in a relatively limited geographical area (Spain). A survival analysis was performed and the data were modelled using the Weibull regression to determine the risk over a period of 16 years and to estimate the association of different risk factors: sex, age, axial length (AXL) of the eye, intraoperative posterior capsule rents (PCR), and YAG laser capsulotomies. The resulting estimates were translated into a predictive equation for hazard rates and survival probabilities. Later, an application was developed to make prediction available for the clinical community in order to estimate the potential risk of any hypothetical case before lens surgery. RESULTS: Globally, 1521 (0.85%) cases of PRD were diagnosed during the period. The risk for PRD was significantly greater in males (5.48 [2.94-10.2]; p < 0.001), in long eyes (1.24 [1.21-1.26]; p < 0.001), and also after posterior capsule rents (13.97 [11.61-16.82]; p < 0.001). Posterior capsule rupture increased the risk of PRD up to fourteen times. CONCLUSIONS: From weaker to stronger impact, age, axial length, sex, and intraoperative posterior capsule rent were significant risk factors for the appearance of PRD after lens extraction.
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Extração de Catarata , Facoemulsificação , Descolamento Retiniano , Seguimentos , Humanos , Masculino , Facoemulsificação/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/epidemiologia , Descolamento Retiniano/etiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: To investigate the refractive results of a LASIK enhancement and its impact on treatment safety, efficacy, predictability and patient reported outcome in eyes after clear lens extraction and diffractive trifocal lens implantation. METHODS: A retrospective cohort multicentre study of Care Vision Refractive Centres in Germany compared two groups of patients. Group 1 consisted of eyes that had non-toric MIOL surgery only, whereas group 2 had a consecutive laser enhancement after 3 months follow-up. Refractive and subjective results of the two groups were compared. Patient reported outcome measurements were assessed by using a 30-item questionnaire with four subscales. (Spectacle Dependence, Eye Comfort, Freedom and Looking/Feeling Well). Refractive results were reported following standard reporting in refractive surgery. RESULTS: 139 eyes of 79 patients were included in which either MIOL surgery or MIOL surgery plus LASIK enhancement had been performed between January and December 2017. UDVA reached 0.1logMAR (0.8; 20/25) in 94% in group 2 and 85% in group 1. Compared to preoperative CDVA no change in Snellen lines of CDVA was shown in 89% in group 1 and in 93% in group 2. Spectacle dependence (P = 0.41), eye comfort (P = 0.15), freedom (P = 0.48) and looking/feeling well (P = 0.45) showed no statistically significant difference between both the groups. CONCLUSIONS: In patients with residual ametropia after MIOL implantation, LASIK provides a reliable, safe and efficient way to achieve the desired refractive outcome and patient satisfaction. We recommend performing Laser enhancement at 3 months after MIOL implantation (Bioptics) in trifocal MIOL patients that benefit from improvement of residual ametropia.
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Lasers de Excimer/uso terapêutico , Implante de Lente Intraocular , Lentes Intraoculares Multifocais , Facoemulsificação , Pseudofacia/fisiopatologia , Refração Ocular/fisiologia , Acuidade Visual/fisiologia , Adulto , Feminino , Humanos , Hiperopia/fisiopatologia , Hiperopia/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Masculino , Pessoa de Meia-Idade , Miopia/fisiopatologia , Miopia/cirurgia , Satisfação do Paciente , Erros de Refração/fisiopatologia , Estudos Retrospectivos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Bibliometric science employs statistical and quantitative analyses to analyse the scholarly impact and characteristics of publications within a research field. The present study was initiated to analyse and quantify the 100 most often cited papers in glaucoma research. MATERIALS AND METHODS: The databases of the Institute for Scientific Information were utilised for the identification of articles published from 1900 to December 2016. All glaucoma articles were identified that had been published in 109 relevant journals and which had been cited at least 200 times. The top 100 articles were selected for further analysis of authorship, source journal, number of citations, citation rate, geographic origin, article type, and level of evidence. RESULTS: The publication dates of the 100 most often cited articles ranged from 1966 to 2011, with the greatest number of articles published in the 1990s. Citations per article ranged from 258 to 1908. All articles were published in 18 of the 109 journals. The leading countries of origin were the U.âS.âA., followed by the U.âK. The study focussed on two main clinical articles (diagnostics; epidemiology) and basic research articles. The number of citations per article was greatest for articles published in the 2000s. Most articles provided level III evidence, followed by levels I and II. CONCLUSION: The majority of the most cited articles were published in three of the top-ranked journals. Most clinical articles dealt with epidemiology and diagnostics. Individuals who authored multiple articles in the list often focussed on one of these two areas. Most studies were conducted in the U.âS.âA. and presented level III clinical outcomes. This indicates that even studies with small case series or cohort studies can attract attention.
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Bibliometria , Glaucoma , Bases de Dados Factuais , HumanosRESUMO
PURPOSE: To evaluate corneal deformation to an air puff as a new noninvasive tool to document disease status in Marfan syndrome (MFS) METHODS: Prospective observational cohort study. We included patients diagnosed with MFS who had their routine cardiovascular follow-up and applied the revised Ghent nosology to define two subgroups according to a high (≥ 7) and a low (< 7 points) systemic score. Dynamic Scheimpflug-based biomechanical analyses (CorvisST® [CST; Oculus GmbH]) were performed. The main outcome measure was the displacement of the corneal apex as given by the parameters highest concavity (HC; in ms), peak distance (PD; in mm), and highest concavity deformation amplitude (DA; mm). RESULTS: Forty-three eyes of 43 individuals (19 female, 24 male; mean age 42.0 ± 12.0 years, range 18-67 years) diagnosed with MFS were included. Applying the Ghent criteria, 21 patients had an advanced systemic score of ≥ 7, and 22 had score points < 7. There were no differences in age or sex between both groups. In contrast, HC was faster (P = 0.004), and PD (P < 0.001) was longer in those individuals with systemic score ≥ 7; maximum DA did not result in a statistically significant difference between the groups (P = 0.250). CONCLUSIONS: In vivo noninvasive biomechanical analyses with CST offer a new, non-invasive method to identify pathologic corneal deformation responses in adults with MFS. In the future, corneal deformation to an air puff could thus assist early identification of patients with high Ghent score as an adjunct to existing diagnostic tests.
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Córnea/fisiopatologia , Doenças da Córnea/fisiopatologia , Pressão Intraocular/fisiologia , Síndrome de Marfan/complicações , Adolescente , Adulto , Idoso , Córnea/patologia , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Topografia da Córnea , Elasticidade , Feminino , Seguimentos , Humanos , Masculino , Síndrome de Marfan/fisiopatologia , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
The purpose of this study was to analyze ocular residual astigmatism (ORA) before and after implantation of two different optical types of non-toric multifocal intraocular lenses (MIOL) in pre-cataract patients. This retrospective cohort study analyzed 72 eyes from 72 consecutive patients after MIOL surgery . To investigate magnitude and axis of astigmatic changes, the concepts of true corneal astigmatism and Alpins vector method were applied. There were no statistically significant between-group differences prior to surgery. The mean refractive surgically induced astigmatism (RSIA) (P = 0.063) and the topographic SIA (TSIA) (P = 0.828) did not differ significantly between the lenses, and the summated vector mean for ORA was reduced in terms of magnitude by approximately 0.30 Diopter. ORA in pseudophakic eyes mainly results from the posterior corneal surface and less from IOL tilting, postoperative posterior capsule shrinkage, or secondary cataract.
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Câmara Anterior/cirurgia , Astigmatismo/diagnóstico , Catarata/complicações , Córnea/diagnóstico por imagem , Lentes Intraoculares , Pseudofacia/cirurgia , Refração Ocular/fisiologia , Adulto , Idoso , Astigmatismo/fisiopatologia , Topografia da Córnea , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Acuidade VisualRESUMO
PURPOSE: This study was initiated to introduce the term non-corneal ocular residual astigmatism (N-CORA) as a new parameter in astigmatic change analysis after implantation of two different types of non-toric, multifocal intraocular lenses (MIOL). METHODS: Seventy-two eyes from 72 consecutive patients after MIOL surgery were studied in terms of a retrospective, cross-sectional data analysis. Two types of spherical MIOL were used. Surgical technique in all patients was a 2.4-mm incision phacoemulsification, performed by one surgeon. To investigate the magnitude and axis of astigmatic changes, the true corneal astigmatism and Alpins vector method were applied. RESULTS: There were no statistically significant between-group differences related to the preoperative refraction or ocular residual astigmatism (ORA). After surgery, the mean refractive surgically induced astigmatism (RSIA) and the topographic SIA (TSIA) did not differ significantly between the lenses. The magnitude and orientation of ORA and N-CORA changed after surgery. CONCLUSIONS: There are no statistically significant differences in postoperative ORA in magnitude or axis when implanting different types of MIOL. The similarity of N-CORA between both MIOL types shows that both diffractive and refractive asymmetric MIOLs with plate haptics have the same pseudolentogenic astigmatic effect which could be presented in terms of the newly introduced parameter N-CORA.
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Astigmatismo/cirurgia , Córnea/patologia , Lentes Intraoculares , Facoemulsificação/efeitos adversos , Segmento Posterior do Olho/cirurgia , Refração Ocular/fisiologia , Adulto , Idoso , Astigmatismo/diagnóstico , Astigmatismo/fisiopatologia , Córnea/cirurgia , Topografia da Córnea , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Desenho de Prótese , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Previous studies have suggested that, to improve refractive predictability in hyperopic LASIK treatments, preoperative cycloplegic or manifest refraction, or a combination of both, could be used in the laser nomogram. We set out to investigate (1) the prevalence of a high difference between manifest and cycloplegic spherical equivalent in hyperopic eyes preoperatively, and (2) the related predictability of postoperative keratometry. METHODS: Retrospective cross-sectional data analysis of consecutive treated 186 eyes from 186 consecutive hyperopic patients (mean age 42 [±12] years) were analyzed. Excimer ablation for all eyes was performed using a mechanical microkeratome (SBK, Moria, France) and an Allegretto excimer laser platform. Two groups were defined according to the difference between manifest and cycloplegic spherical equivalent which was defined as ≥1.00 diopter (D); the data was analyzed according to refractive outcome in terms of refractive predictability, efficacy, and safety. RESULTS: In 24 eyes (13 %), a preoperative difference of ≥1.00D between manifest spherical equivalent and cycloplegic spherical equivalent (= MCD) occurred. With increasing preoperative MCD, the postoperative achieved spherical equivalent showed hyperopic regression after 3 months. There was no statistically significant effect of age (accommodation) or optical zone size on the achieved spherical equivalent. CONCLUSIONS: A difference of ≥1.00D occurs in about 13 % of hyperopia cases. We suggest that hyperopic correction should be based on the manifest spherical equivalent in eyes with preoperative MCD <1.00D. If the preoperative MCD is ≥1.00D, treatment may produce manifest undercorrection, and therefore we advise that the patient should be warrned about lower predictability, and suggest basing conclusions on the arithmetic mean calculated from the preoperative manifest and cycloplegic spheres.
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Córnea/cirurgia , Hiperopia/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Midriáticos/farmacologia , Cuidados Pré-Operatórios/métodos , Refração Ocular/efeitos dos fármacos , Acuidade Visual , Adolescente , Adulto , Estudos Transversais , Feminino , Seguimentos , Humanos , Hiperopia/diagnóstico , Hiperopia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: This study examined the refractive and visual outcome of wavefront-optimized laser in situ keratomileusis (LASIK) in eyes with low myopia and compound myopic astigmatism ≤ 0.75 diopter (D). METHODS: 153 eyes from 153 consecutive myopic patients (74 male, 79 female; mean age at surgery 40.4 ± 10.4 years) who had a preoperative refractive cylinder ≤ 0.75 D and a manifest sphere between -0.25 D and -2.75 D, and who had completed 4-month follow-up. Three subgroups defined by the magnitude of preoperative manifest refractive cylinder (0.25, 0.50, and 0.75 D) were formed. Manifest refraction, uncorrected and corrected visual acuity were assessed pre- and postoperatively. The astigmatic changes achieved were determined using the Alpins vector analysis. RESULTS: After 4 months (120.0 ± 27.6 days) of follow-up, a mean uncorrected distant visual acuity of 0.07 ± 0.11 logMAR and a mean manifest refraction spherical equivalent of -0.06 ± 0.56 D were found. There was no statistically significant difference in efficacy and safety between the preoperative cylinder groups. Astigmatic overcorrection for preoperative cylinder of ≤ 0.50 D was suggested by the correction index, the magnitude of error, the index of success, and the flattening index. CONCLUSIONS: Low myopic eyes with a preoperative cylinder of ≤ 0.50 D were significantly overcorrected with regard to cylinder correction when combined with low myopic LASIK. Accordingly, we are cautious in recommending full astigmatic correction for eyes with low myopia and manifest cylinder of ≤ 0.50 D.
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Astigmatismo/cirurgia , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia/cirurgia , Adulto , Astigmatismo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/fisiopatologia , Refração Ocular/fisiologia , Estudos Retrospectivos , Acuidade Visual/fisiologiaRESUMO
Laser in situ keratomileusis (LASIK) is one of the dominant procedures for the surgical correction of refractive errors. Meteorotropic reaction has been described regarding the field of ophthalmology. This study was thus initiated to assess the impact of air pressure and wind speed on the refractive and visual outcome of LASIK in myopic eyes. Our study comprised 1,052 eyes of 1,052 consecutive myopic patients (419 males, 633 females; mean age at surgery 35.0 ± 9.0 years) with mean preoperative refractive spherical equivalent (SE) of -3.88 ± 1.85 diopters (D). Two subgroups were defined, which had undergone surgery either during meteorological winter or summer. Manifest refraction, uncorrected and corrected visual acuity were assessed pre- and post-operatively. We applied robust regression analysis with efficiency index (EI), safety index, and postoperative SE (D) as dependent variables. At the 1-month (33.0 ± 5.0 days) follow-up, the mean postoperative SE was -0.18 ± 0.44 D. Bivariate comparisons showed that statistically significant better EI was related to days with low to moderate air-pressure. This was confirmed by robust regression analysis. Moderate to high wind speed was related to more appropriate postoperative SE. No change by more than one line on logMar scale was obtained. Although being statistically significant, there is no clinically relevant difference in outcome of LASIK, which demonstrates its highly standardized quality. Prospective, longitudinal studies are warranted to address meteorotropic reactions through evaluating individual risk profiles.
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Pressão do Ar , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia/cirurgia , Estações do Ano , Vento , Adulto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Miopia/fisiopatologia , Refração Ocular/fisiologia , Análise de Regressão , Acuidade Visual/fisiologiaRESUMO
The purpose of this retrospective pseudonymised data analysis was to determine whether the patient's age has an influence on the safety, efficacy, and prediction accuracy of laser in situ keratomileusis (LASIK) treatment of myopic and hyperopic eyes. This study was performed at CARE Vision GmbH (Düsseldorf, Germany) and included two patient cohorts: an older group with patients > 55 years old and a younger group with patients 30-40 years old. Each patient had a single LASIK treatment. The safety, efficacy, and prediction accuracy of the refractive results were analysed. In total, 682 patients were analysed, with 341 patients in each patient group (one eye per patient). There were 570 myopic eyes and 112 hyperopic eyes. In myopic eyes, the efficacy was significantly influenced by the patient's age but only in myopic eyes (myopic: p ≤ 0.05; hyperopic: p = 0.085), while safety was not significantly influenced by the patient's age in hyperopic or myopic eyes (p = 0.204). We found that LASIK treatment at an older age (> 55 years) resulted in almost the same safety outcomes as a LASIK treatment at a younger age (30-40 years) but with a lower efficacy; the efficacy correlated with the patient's age. If the patient was hyperopic, their age did not influence safety or efficacy.
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Hiperopia , Ceratomileuse Assistida por Excimer Laser In Situ , Miopia , Humanos , Adulto , Pessoa de Meia-Idade , Estudos Retrospectivos , Olho , LasersRESUMO
Background: This pilot study aimed to evaluate the Retinal Function Imager (RFI) for visualizing retinal vasculature and assessment of blood flow characteristics in patients with retinal vasculitis. The RFI is a non-invasive imaging device measuring the blood flow velocity (BFV) in secondary and tertiary retinal vessels using hemoglobin as an intrinsic motion-contrast agent. Methods: To test the feasibility of the RFI for patients with retinal vasculitis, capillary perfusion maps (nCPMs) were generated from 15 eyes of eight patients (five females; mean age: 49 ± 12 years) with a mean uveitis duration of 74 ± 85 months. Five of these patients had birdshot chorioretinopathy, and three had primarily non-occlusive venous retinal vasculitis of unknown origin. To reflect that the BFV may be more reduced in patients with prolonged disease, patients were classified into a short-term (uveitis duration: 8-15 months) and a long-term uveitis group (uveitis duration: 60-264 months). Data were compared with healthy controls (16 eyes of 11 patients; mean age 45 ± 12 years; 8 females). Results: The mean BFV in the controls was 3.79 ± 0.50 mm/s in the retinal arteries and 2.35 ± 0.44 mm/s in the retinal veins, which was significantly higher compared to the retinal vasculitis group. Patients revealed an arterial BFV of 2.75 ± 0.74 mm/s (p < 0.001) and a venous BFV of 1.75 ± 0.51 mm/s (p = 0.016). In the short-term group, a trend towards a decreased venular and arteriolar BFV was seen, while a significant reduction was observed in the long-term group. The patients' microvasculature anatomy revealed by the nCPMs appeared unevenly distributed and a lower number of blood vessels were seen, along with a lower degree of complexity of their branching patterns, when compared with controls. Conclusions: This study demonstrated a reduction in venular and arteriolar BFVs in patients with retinal vasculitis. BFV alterations were already observed in early disease stages and became more pronounced in progressed disease. Additionally, we showed that retinal microvasculature changes may be observed by nCPMs. Retinal imaging with the RFI may serve as a diagnostic and quantifying tool in retinal vasculitis.
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BACKGROUND: To investigate the presence of silicone oil (SO)-emulsification on the anterior iris surface with anterior segment optical coherence tomography (AS-OCT). METHODS: In this single-center cross-sectional study, vitrectomized eyes with SO tamponade that underwent AS-OCT imaging and gonioscopy examination during the postoperative follow-up visits, were reviewed. RESULTS: 45 eyes of 42 consecutive patients were included. In 35.6% of the eyes (n = 16) emulsified SO droplets were detected in the anterior chamber (AC) angle by gonioscopy and in 55.6% (n = 25) on the anterior iris surface by AS-OCT imaging. The presence of SO emulsifications in the AC-angle correlated with the presence of SO emulsifications on the anterior iris surface (OR = 13.4, 95% CI [2.179-82.130]; p = 0.005). The accuracy of the AS-OCT predicting the presence of SO in the AC-angle was 71.0% and the sensitivity was 87.5%. No significant association between SO droplets in the AC and other clinical parameters including endotamponade-duration or type of silicone oil were found. The presence of emulsified SO droplets on the anterior iris surface detected by AS-OCT was significantly correlated to postoperative IOP rise (p = 0.027). CONCLUSION: AS-OCT is a suitable method for the detection of SO on the anterior iris surface. SO droplets on the iris surface correlate with elevated postoperative IOP and with the presence of SO in the AC detected by gonioscopy, therefore AS-OCT might be used as a screening method for the detection of SO migration into the AC. TRIAL REGISTRATION NUMBER: Institutional Review Board of the Hamburg Medical Chamber (Ethik-Kommission der Ärztekammer Hamburg): 2023-300372-WF.
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BACKGROUND: To evaluate accuracy of WASCA wavefront aberrometry (WA) refraction in comparison to manifest refraction (MR) in an older population awaiting cataract surgery. METHODS: Prospectively, refractive errors of 130 eyes were determined by WA and MR. Mean age was 65.9 (SD 11.81), corrected distance visual acuity (CDVA) averaged 0.20 logMar (SD 0.57), mean manifest sphere was 0.23 dioptres (D, SD 3.39) and manifest astigmatism amounted to -1.25 D (SD 1.21). For further analysis, refractive values were transformed into power vector components: spherical equivalent (SE), Jackson cross cylinder at 0° and 45° (J0 and J45). The 'limits of agreement' approach, regression analysis, correlation analysis, and ANOVA were applied and additionally compared to 28 healthy eyes (mean VA -0.1 logMAR) of a group of young subjects (mean age 33.9). RESULTS: SE measures in myopia correlated highly between WA and MR (r = 0.917, p < .001). In hyperopia this correlation was moderately high (r = 0.800, p < .001). For all subjects, correlations between WA and MR for J0 and J45 were r = 0.742 (p < .001) and r = 0.760 (p < .001) respectively. WA measurements revealed larger agreement ranges with increasing myopia and astigmatism. Controlled for possible confounding variables of age, VA, and refractive state, no statistically significant effects were found. Across nearly all conditions, WA measured significantly higher myopic and astigmatic values than MR. Most effects were replicated in the reference group. CONCLUSIONS: WA refraction can provide valuable information in previously under-researched conditions such as reduced VA (cataract-related), advanced age, and hyperopia. However, loss of optical media transparency will inherently reduce accuracy of WA. Further studies are needed to define cut-off values for automated wavefront quality grading and intra-operative application of WA in refractive surgery.
Assuntos
Aberrometria/normas , Catarata/fisiopatologia , Refração Ocular/fisiologia , Erros de Refração/fisiopatologia , Transtornos da Visão/fisiopatologia , Acuidade Visual/fisiologia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
PURPOSE: To study the influence of angle kappa (κ) on visual acuity after implantation of a multifocal intraocular lens (MIOL) and consecutive "touch-up" corneal refractive surgery with Laser-in-situ-Keratomileusis (LASIK). METHODS: This retrospective multicenter study included patients who underwent MIOL surgery and consecutive LASIK (= Bioptics) in the period from 2016 to 2020 at Care Vision Refractive Centers in Germany. Our study was approved by the local ethics committee at the University in Duesseldorf (approval date: 23.04.2021) and conducted according to the tenets of the Declaration of Helsinki and Good Clinical Practices Guidelines. The pre- and post-operative κ of 548 eyes were measured using a Scheimpflug-based imaging system. Corrected distance visual acuity (CDVA) and the safety index (SI) were analyzed in relation with κ. For a more detailed analysis, the cohort was divided into pre-operative hyperopic and myopic patients to show group-specific differences. RESULTS: There was a significant decrease (p<0.001) in the magnitude of κ after MIOL implantation and Bioptics. However, there was almost no significant correlation of κ on CDVA and SI, pre- and postoperatively. CONCLUSION: A large κ is not a significant risk factor for poor visual acuity. Therefore, it is not a suitable clinical predictor of postoperative outcomes after a Bioptic procedure.