Clinical outcomes after femtosecond laser-assisted implantation of an intrastromal corneal ring segment with a 340-degree arc length in postkeratoplasty patients: 12-month follow-up.

PURPOSE: To assess the clinical outcomes after implantation of a new 340-degree arc length intrastromal corneal ring segment (ICRS) aided by the femtosecond laser in postkeratoplasty patients after a 12-month follow-up. SETTING: Private practice, Brasilia, Brazil. DESIGN: Prospective case series. METHODS: Eyes with previous keratoplasty had ICRS implantation assisted by femtosecond laser. The primary outcome measure was the change in the uncorrected distance visual acuity (UDVA) 12 months postoperatively. The secondary outcome measures were the corrected distance visual acuity (CDVA), refraction, and corneal tomography 1, 3, 6, and 12 months postoperatively. The astigmatism results were analyzed using vector analysis through the double-angle polar plot. RESULTS: Of the 18 patients, 7 (38.9%) were men, and 11 (61.1%) were women. The mean UDVA was 20/250 (1.15 logarithm of the minimum angle of resolution [logMAR]) before implantation and 20/70 (0.54 logMAR) at the last follow-up (P < .001). The mean CDVA improved from 20/35 (0.26 logMAR) to 20/25 (0.10 logMAR) (P < .001). The mean spherical equivalent and astigmatism components were significantly reduced after ICRS implantation. The mean corneal astigmatism decreased from 5.55 ± 2.29 D preoperatively to 3.92 ± 1.82 D postoperatively (P < .001). The CDVA remained the same or improved in 19 of 20 eyes and decreased by 1 line in 1 patient. There were no surgical complications. CONCLUSION: A new ICRS with a 340-degree arc length was effective in treating postkeratoplasty eyes, improving visual acuity and reducing corneal astigmatism.

Spherical aberration and contrast sensitivity in eyes implanted with aspheric and spherical intraocular lenses: a comparative study.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified anterior aspheric surface results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. DESIGN: Prospective, comparative, interventional case series. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified anterior surface (Tecnis Z9001; Advanced Medical Optics, Santa Ana, California, USA; group 1) was compared with biconvex lens with spherical surfaces (ClariFlex; Advanced Medical Optics; group 2). Ocular aberrations for a 5.0-mm pupil and 6.0-mm pupil were measured with Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed up for three months. RESULTS: No statistically significant difference in postoperative uncorrected and best-corrected distance vision acuity after a follow-up of three months existed between the groups. Postoperative contrast sensitivity testing revealed significant differences between the groups under photopic and mesopic conditions. These differences reached statistical significance under photopic conditions at three spatial frequencies and under mesopic conditions at all spatial frequencies. When analyzing higher-order aberrations, the difference between the groups was statistically significant at the 5.00-mm and 6.00-mm pupil diameters, with the group 1 inducing less higher-order aberration and also less spherical aberration compared with group 2. CONCLUSIONS: Results show the Tecnis Z9001 IOL with a modified anterior aspheric surface induced significantly less higher-order aberration and spherical aberration compared with the ClariFlex IOL. Contrast sensitivity revealed better values under photopic and mesopic conditions with the Tecnis Z9001 IOL.

Primary piggyback implantation using the ReSTOR intraocular lens: case series.

PURPOSE: To assess the postoperative outcomes of piggyback implantation using the AcrySof ReSTOR intraocular lens (IOL) (model SA60D3, Alcon Surgical Laboratories). SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Thirteen eyes of 7 patients who had phacoemulsification with piggyback IOL implantation were analyzed prospectively. In all cases, a ReSTOR IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included uncorrected visual acuity (UCVA) at near and distance, best corrected visual acuity (BCVA), and spherical equivalent (SE) before and after surgery. RESULTS: The patients were followed for 12 months. The mean distance UCVA was 0.25 (20/80) preoperatively and 0.88 (20/23) at the last follow-up (1 year), which was significantly better than before surgery (P<.05). The mean SE was +4.25 diopters (D) +/- 1.5 (SD) preoperatively and +0.15 +/- 0.44 D (range -0.50 to +0.75 D) at 1 year, which was significantly better than preoperatively (P<.05). No patient lost lines of BCVA after surgery. At the last follow-up, all eyes had a near UCVA of J1 and none required spectacles for near or distance vision. CONCLUSION: Piggyback implantation using the ReSTOR IOL appeared to be a safe and efficient procedure providing high-quality visual acuity for near and distance vision in selected patients.

Primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens: case series.

PURPOSE: To assess the postoperative outcomes of primary piggyback implantation using the Tecnis ZM900 multifocal intraocular lens (IOL) (Advanced Medical Optics). SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Patients who had phacoemulsification with primary piggyback IOL implantation were analyzed prospectively. In all cases, a Tecnis ZM900 multifocal IOL was implanted in the capsular bag and a second silicone IOL was implanted in the ciliary sulcus. Information collected included near and distance uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and the spherical equivalent (SE) before and after the surgery. RESULTS: Twenty eyes of 12 patients were included in the study. They were followed for 6 months. The mean preoperative distance UCVA was 20/400. At the last follow-up (6 months), the mean distance UCVA was 20/29, significantly better than before referral (P<.001). The mean preoperative SE was +6.35 diopters (D) +/- 2.25 (SD). Six months after surgery, the mean SE was -0.25 +/- 0.40 D (range -1.00 to +0.50 D), significantly better than before referral (P<.001). No patient lost lines of BCVA after surgery. At the last follow-up, 90% of the eyes achieved a near UCVA of J1 and 83.3% of patients were spectacle independent for near and distance vision. A second refractive procedure was performed in 2 eyes. CONCLUSIONS: Primary piggyback implantation using the Tecnis ZM900 multifocal IOL was a simple, safe, and accurate option for patients with high hyperopia who wanted to reduce their dependency on spectacles.

Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study.

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified posterior aspherical surface (AcrySof IQ, Alcon Surgical Laboratories) results in reduced ocular aberrations (spherical aberration) and improved contrast sensitivity after cataract surgery. SETTING: Brasilia Ophthalmologic Hospital, Brasilia, and Sao Geraldo Eye Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified posterior surface (AcrySof IQ) was compared with a biconvex IOL with spherical surfaces (AcrySof Natural, Alcon). Ocular aberrations with a 5.0 mm and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed for 3 months. RESULTS: There were no statistically significant differences between eyes in postoperative uncorrected and best corrected distance visual acuities after a follow-up of 1 month and 3 months. Postoperatively, there was a statistically significant between-group difference in contrast sensitivity under photopic conditions without glare at 18 cycles per degree (cpd) (P = .04) and under mesopic conditions without glare at all spatial frequencies (3 cpd, 6 cpd, 12 cpd, and 18 cpd; P = .03, P = .009, P = .003, and P = .003, respectively) and with glare at 3 cpd and 6 cpd (P = .001 and P = .02, respectively). The difference in higher-order aberration (HOA) values between groups was statistically significant with a 5.0 mm and 6.0 mm pupil, with the AcrySof IQ IOL inducing less HOA than the AcrySof Natural IOL. Eyes with an AcrySof IQ IOL also had statistically significant less spherical aberration than eyes with an AcrySof Natural IOL with both pupil diameters (P<.001). CONCLUSIONS: The AcrySof IQ IOL with a modified posterior surface induced significantly less HOA and spherical aberration than the AcrySof Natural IOL. Contrast sensitivity was better under mesopic conditions with the AcrySof IQ IOL.

Diamond burr treatment of poor vision from anterior basement membrane dystrophy.

PURPOSE: To determine the outcome of patients with decreased vision associated with anterior basement membrane dystrophy (ABMD) managed with diamond burr (DB) polishing. DESIGN: Retrospective nonrandomized case series. METHODS: A chart review of all patients with ABMD who underwent epithelial debridement and DB polishing to treat visual disturbances resulting from corneal epithelial irregularity was performed. RESULTS: Ten patients' charts were analyzed. The mean age was 57.4 years. DB treatment was performed in 13 eyes. The average preoperative BCVA was 0.40 (20/50). At the last follow-up (mean 21.8 months) the average visual acuity of these patients was 0.88 (20/23), significantly better than pre-operative readings (P < .001). There was no recurrence of dystrophic changes in the treatment zone seen with the slit lamp during the follow-up period. CONCLUSIONS: In this study, DB polishing was shown to be an effective and safe treatment for decreased vision caused by to ABMD over an average follow-up of 21.8 months.

Management of pellucid marginal corneal degeneration.

PURPOSE: This study was designed to determine how patients with pellucid marginal corneal degeneration (PMCD) are managed in a tertiary corneal practice. METHODS: A retrospective chart review of 45 patients with PMCD from a corneal referral practice was performed. Information collected from the medical records included demographic data, best-corrected visual acuity, videokeratography, contact lens use, and surgical procedures. RESULTS: Forty-five patients (85 eyes; 30 males, 15 females) with PMCD were included in this study. They were followed-up for an average of 4.7 years (standard deviation (SD), +/-8.7). Seventy-five eyes (88.2%) were managed nonsurgically with spectacles in 31 eyes (36.4%) or contact lenses in 44 eyes (51.8%). Contact lens management was initially attempted in 51 eyes (60%); however, 7 eyes failed contact lenses. Visual acuity of 0.5 (20/40) or better was noted in 34 eyes (75.5%) after contact lens fit. Ten eyes (11.8%) underwent penetrating keratoplasty with an average postoperative follow-up of 9 years (SD, +/-8.2; 1.5-20.5). Clear grafts were present in all 10 eyes at the end of the study (average, 9 years; SD, +/-82). CONCLUSIONS: Nonsurgical management of PMCD continues to play a predominant role in the management of this disorder. Poor best-corrected visual acuity at presentation of 0.2 (20/100) or worse and long follow-up (8 years or more) were significantly associated with surgery.

Ocular copper deposition associated with monoclonal gammopathy of undetermined significance: case report.

To report a case of ocular copper deposition in both eyes at the level of Descemet's membrane associated with a monoclonal gammopathy of undetermined significance (MGUS). A 49-year-old white woman had golden-brown metallic dust-like deposits on Descemet's membrane of both eyes. A systemic examination revealed an elevated serum copper, normal serum ceruloplasmin and a normal level of total protein. Serum protein electrophoresis demonstrated a single peak (M-spike) in the gamma region (M-protein in serum = 11 g/l). Flow cytometric analysis of the marrow aspirate identified a monoclonal plasma cell population that represents approximately 2% of the total marrow cells consistent with the diagnosis of monoclonal gammopathy of undetermined significance. Copper deposits at the level of Descemet's membrane may be a finding in a patient with monoclonal gammopathy of undetermined significance.

Ferrara intracorneal ring implantation and cataract surgery for the correction of pellucid marginal corneal degeneration.

We report a case of Ferrara intracorneal ring (Mediphacos) implantation and cataract surgery for the correction of pellucid marginal corneal degeneration. Preoperatively, the patient's uncorrected visual acuity (UCVA) was 0.05 in the right eye and 0.10 in the left eye. The best spectacle-corrected visual acuity (BSCVA) was 0.50 with -2.00 -11.25 x 80 in the right eye and 0.60 with -2.00 -5.50 x 95 in the left eye. One month postoperatively, the UCVA was 0.50 in the right eye and 0.30 in the left eye. The BSCVA was 0.80 with -1.00 in the right eye and 0.60 with -0.75 -1.25 x 160 in the left eye. Ferrara intrastromal rings and cataract surgery resulted in a more regular corneal shape with a reduction in astigmatism for good visual recovery.

Inadvertent implantation of a reversed-optic Tecnis ZM900 multifocal intraocular lens: case report.

A 51-year-old woman with age-related cataract had an uneventful phacoemulsification and a Tecnis ZM900 multifocal intraocular lens (IOL) implantation in both eyes. During IOL implantation in the left eye, the optic was unintentionally reversed in the bag and left that way. The refraction surprise was not significant and six months postoperatively the corrected distance visual acuity in both eyes was 20/20 and neither complained of visual discomfort. In conclusion, we found that a reversed-optic Tecnis multifocal IOL in the present case resulted in good final visual acuity without significant differences in aberrations compared to the other eye, and a conservative management can be taken as a safe option.

Visual Performance of Tecnis ZM900 Diffractive Multifocal IOL after 2500 Implants: A 3-Year Followup.

Purpose. To evaluate visual performance for near, intermediate, and distant vision; complaints of photic phenomena, and patient satisfaction with the new diffractive multifocal IOL used in eyes which underwent phacoemulsification. Methods. Two thousand and five hundred consecutive eyes undergoing Tecnis ZM900 multifocal IOL implantation were included in this retrospective analysis. The minimum followup of 3 months was required after the surgery. Patients were assessed for uncorrected near visual acuity (UNVA) at a fixed distance (33 cm), uncorrected intermediate visual acuity (UIVA) at 60 cm, and uncorrected distance visual acuity (UDVA). Using a subjective questionnaire, patients satisfaction, their independence from using glasses, and the perception of glare and halo phenomena were also evaluated at the last follow-up. Results. Two thousand and five hundred eyes of 1558 patients underwent cataract surgery and Tecnis ZM900 multifocal IOL implantation. Four hundred and eighty seven patients (31.3%) were men, and 1071 (68.7%) were women. The mean age of the patients was 66.17 years. A UDVA of 20/30 or better was achieved by 85% of eyes. A UNVA of J1 was achieved by 93.7% of eyes and that of J2 or better was achieved by 98%. A UIVA of J4 or better was achieved by 65% and J5 or better was achived by more than 82.8% of the eyes in the study. Glare and halos were reported as severe by only 6.1% and 2.12% of patients, respectively. Ninety seven percent reported complete spectacle independence and 88% stated that they are totally satisfied with their quality of vision and would choose to have the same lens implanted again after the first implant. Five percent of the eyes in the study needed a second procedure (enhancement) to achieve a better visual result. No patient underwent lens exchange. Conclusion. Excellent near, intermediate, and distant vision was observed in patients implanted with the Tecnis ZM900 diffractive multifocal IOL. Spectacle independence and a minimum occurrence of photic phenomena make this IOL an excellent option in patients with cataract.

Multifocal intraocular lens optic anteriorization capture to correct residual refractive error.

PURPOSE: To evaluate the efficacy and safety of capturing the intraocular lens (IOL) optic through the anterior capsulorhexis opening in eyes with multifocal IOLs and a residual refractive error. SETTING: Hospital Oftalmológico de Brasília, Brasília, Brazil. METHODS: Eyes with previous cataract surgery and Tecnis ZM900 multifocal IOL implantation were prospectively analyzed. After at least 1 month, patients had second surgery in which the IOL optic was captured through the anterior capsulorhexis opening to correct the residual refractive error. Preoperative and postoperative examinations at 1 day and 3 months included spherical equivalent (SE); uncorrected distance (UDVA), near (UNVA), and intermediate (UIVA) visual acuities; and corrected distance visual acuity (CDVA). RESULTS: The study included 16 eyes of 14 patients. The mean UDVA was 0.32 logMAR preoperatively and 0.10 logMAR after anterior optic capture and the mean SE, +1.09 diopters (D) and +0.26 D, respectively; both improvements were statistically significant (P<.001). The change in CDVA and UNVA from before anterior optic capture to the last follow-up was not statistically significant. The UIVA was significantly worse postoperatively (P = .011). No eye lost lines of CDVA. One eye (6.25%) developed glaucoma postoperatively. At the last follow-up, 13 patients (92.85%) were spectacle-independent for near and distance vision. CONCLUSION: Early outcomes indicate that anterior optic capture is a safe, accurate procedure in eyes with multifocal IOLs and a mild hyperopic residual refractive error postoperatively.

Inadvertent implantation of a reversed-optic Tecnis ZM900 multifocal intraocular lens: case report / Implante invertido da lente intraocular Tecnis ZM900 multifocal: relato de caso

A 51-year-old woman with age-related cataract had an uneventful phacoemulsification and a Tecnis ZM900 multifocal intraocular lens (IOL) implantation in both eyes. During IOL implantation in the left eye, the optic was unintentionally reversed in the bag and left that way. The refraction surprise was not significant and six months postoperatively the corrected distance visual acuity in both eyes was 20/20 and neither complained of visual discomfort. In conclusion, we found that a reversed-optic Tecnis multifocal IOL in the present case resulted in good final visual acuity without significant differences in aberrations compared to the other eye, and a conservative management can be taken as a safe option.

Paciente de 51 anos, sexo feminino, apresentando catarata foi submetida a cirurgia de facoemulsificação com implante de lente intraocular (LIO) multifocal Tecnis ZM900 em ambos os olhos (AO). Durante a implantação da LIO no olho esquerdo, a lente foi inadvertidamente implantada invertida e deixada dessa maneira. Seis meses pós-operatório a surpresa refracional não se mostrou significativa e a acuidade visual corrigida era de 20/20 em AO, sem nenhuma queixa de desconforto visual. Em conclusão, no presente caso, o implante de uma LIO Tecnis multifocal invertida resultou em boa acuidade visual final e sem diferenças significativas na aberrometria em comparação ao olho contralateral, tendo sido possível conduzir o caso de maneira conservadora.

Asymptomatic intracranial gumma in a patient with syphilitic uveitis and human immunodeficiency virus infection.

The case is described of a 51-y-old man with uveitis as the first clinical manifestation of syphilis and in whom laboratory work-up disclosed human immunodeficiency virus infection and asymptomatic brain gummata. The case illustrates the need for a comprehensive work-up in previously asymptomatic patients with uveitis.

Ocular copper deposition associated with monoclonal gammopathy of undetermined significance: case report

Relatar um caso de depósito corneano de cobre em ambos os olhos a nível da membrana de Descemet associado a gamopatia monoclonal de significância indeterminada (GMSI). Paciente feminina, 49 anos, leucodérmica, apresentando depósito corneano de aspecto marrom-ouro a nível da membrana de Descemet em ambos os olhos. Exame sistêmico revelou cobre sérico elevado, ceruloplasmina sérica normal, e proteína total normal. Eletroforese de proteínas séricas demonstrou um pico único na região gama (proteína M = 11 g/l). Análise citométrica de aspirado medular evidenciou uma população de células plasmáticas monoclonais de aproximadamente 2% do total de células medulares consistente com o diagnóstico de gamopatia monoclonal de significância indeterminada. Depósitos de cobre a nível da membrana de Descemet podem ser encontrados em pacientes com gamopatia monoclonal de significância indeterminada.