Visual and refractive outcomes and glistenings occurrence after implantation of 2 hydrophobic acrylic aspheric monofocal IOLs.

PURPOSE: To compare the Clareon IOL with the Tecnis PCB00 IOL in terms of visual performance, refractive outcomes, glistenings occurrence, and quality-of-life outcomes. SETTING: Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. DESIGN: Single-center, single-masked, prospective, randomized controlled trial. METHODS: One hundred thirty-nine patients with bilateral cataracts were randomized to receive the Clareon (C IOL) or Tecnis (T IOL) IOL. Visual acuity, refraction, central corneal thickness (CCT), endothelial cell loss, contrast sensitivity, mesopic gap acuity, evaluation of glistenings, and rates of perioperative and postoperative complications were recorded. Quality-of-life outcomes were measured with the EuroQOL-5 dimensions questionnaire and the patient-reported outcome measures (PROMs) questionnaire. Optimized A-constants were available for the T IOL but not for the C IOL. RESULTS: Seventy-one patients (140 eyes) received the C IOLs and 68 patients (134 eyes) received the T IOLs. Data were analyzed for the first implanted eye. At 12 months, mean uncorrected distance visual acuity (logarithm of the minimum angle of resolution) was 0.02 ± 0.10 and 0.01 ± 0.08 (mean ± SD; P = .49; 95% CI, -0.02 to 0.04) in the C IOL and T IOL groups, respectively. Corrected distance visual acuity was -0.02 ± 0.09 and -0.03 ± 0.06, respectively (P = .45; 95% CI, -0.02 to 0.04). The increase in CCT was 14 ± 19 and 16 ± 28 µm, respectively (P = .63; 95% CI, -10.16 to 6.16). Mean absolute refraction spherical equivalent error from target refraction was 0.41 ± 0.28 for the C IOL and 0.25 ± 0.2 for the T IOL groups (P = .002; 95% CI, 0.08 to 0.24). Glistenings were minimal (median grade 0), with no difference in grades between groups (P = .2). PROMs improved postoperatively and were similar in both groups. CONCLUSIONS: There were no differences in visual outcomes between the Clareon IOL and Tecnis PCB00 IOL. Glistenings were rarely observed in either IOL with no difference in grades. There was no difference in perioperative or postoperative complications. Surgeon optimization of the A-constant for the Clareon IOL is recommended.

Comparison of Epithelium-Off Versus Transepithelial Corneal Collagen Cross-Linking for Keratoconus: A Systematic Review and Meta-Analysis.

PURPOSE: To systematically compare standard epithelium-off corneal collagen cross-linking (SCXL) and transepithelial corneal collagen cross-linking (TECXL) for treating keratoconus. METHODS: PubMed, EMBASE, the Cochrane Library, the US trial registry (ClinicalTrials.gov), VIP Database, Wanfang Databse, and China National Knowledge Infrastructure searches up to February 2017 were conducted. Primary outcomes were changes at 1 year in uncorrected distance visual acuity, maximum keratometry (Kmax), and mean keratometry (mean K). Secondary outcomes were changes at 1 year in corrected distance visual acuity, mean refractive spherical equivalent, central corneal thickness, endothelial cell density, and the occurrence of adverse events. RESULTS: Eight studies with a total of 455 eyes were included. For primary outcomes, SCXL showed a greater reduction in mean K [standardized mean difference (SMD) 0.28; 95% confidence interval (CI), 0.03-0.53; P = 0.03] compared with TECXL. Subgroup analysis indicated that SCXL had a comparable effect on reducing mean K with TECXL protocols using chemical enhancers (SMD 0.05; 95% CI, -0.36 to 0.45; P = 0.82) but a greater reduction in mean K compared with TECXL with current iontophoretic protocols (SMD 0.43; 95% CI, 0.10-0.75; P = 0.01). For the other outcomes, there were no statistically significant differences. CONCLUSIONS: With the exception of less reduction in mean K with current iontophoretic protocols, analysis of the limited number of comparative studies available seems to demonstrate that SCXL and TECXL have a comparable effect on visual, refractive, pachymetric, and endothelial parameters at 1 year after surgery. Further follow-up is required to determine whether these techniques are comparable in the long-term.

Late Stromal Rejection in Deep Anterior Lamellar Keratoplasty: A Case Series.

PURPOSE: To report a series of 4 cases (3 patients) with late stromal graft rejection 32 to 46 months after an uneventful deep anterior lamellar keratoplasty (DALK). METHODS: Three patients (4 eyes), who had undergone an uneventful DALK for keratoconus (3 eyes) and infectious keratitis (1 eye) 32 to 46 months previously presented with a history of ocular discomfort and redness, with reduced visual acuity in 3 eyes. In all cases, all sutures had been removed at least 18 months previously. On examination, there was superficial and in 2 eyes deep neovascularization. In 2 eyes, the vessels extended within the interface between the donor and host corneas. The stroma of the donor cornea adjacent to the areas of vascularization was edematous. A diagnosis of stromal graft rejection was made, and the patients were administered intensive topical corticosteroids. RESULTS: All eyes responded well to treatment, becoming more comfortable, with decreasing redness, reversal of corneal edema, and return of prerejection best corrected visual acuity with up to 18 months follow-up. The patients continued to receive tapering dosage of topical corticosteroid for 12 months. In 1 eye topical steroids were reintroduced at 13 months because of a further rejection episode. CONCLUSIONS: These cases of late stromal rejection after DALK provide clinical evidence that donor keratocytes may persist in such lamellar grafts for extended periods and that patients should be warned that rejection may occur years after surgery.