Impact of a Displaced Corneal Apex in Small Incision Lenticule Extraction.

PURPOSE: To evaluate the possible impact of a displaced corneal apex (point of maximum curvature) on visual results and tomographic parameters after small incision lenticule extraction (SMILE). METHODS: In this retrospective evaluation, eyes with uncomplicated SMILE for myopia correction were classified in two groups based on their preoperative distance between the corneal apex and corneal vertex (corneal intercept with the patient's line of sight) of 1 mm or greater (large A-V distance) or less than 1 mm (small A-V distance). All surgeries were performed during the early learning curve of two surgeons. Visual outcome parameters included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refractive spherical equivalent (MRSE), and refractive astigmatism 3 months postoperatively. Scheimpflug-derived tomographic outcome parameters included mean keratometry value, root mean square higher order aberrations (RMS HOAs), and optical zone decentration. RESULTS: The study comprised 94 eyes of 48 patients: 44 eyes in the large A-V distance group and 50 eyes in the small A-V distance group. Preoperative and postoperative RMS HOAs were significantly higher in the large A-V distance group than in the small A-V distance group (P = .002 and .008, respectively). Postoperative CDVA was significantly better in the small A-V distance group (P = .014). There were no statistically significant differences in postoperative UDVA, MRSE, refractive astigmatism, mean keratometry value, and optical zone decentration. CONCLUSIONS: After SMILE, CDVA was significantly worse in eyes with a preoperatively displaced corneal apex compared to eyes with a more central corneal apex. However, good visual results were achieved in both groups. [J Refract Surg. 2018;34(7):460-465.].

Depth of focus after implantation of spherical or aspheric intraocular lenses in hyperopic and emmetropic patients.

PURPOSE: To evaluate whether hyperopic patients with short axial length and high dioptric intraocular lens (IOL) power can achieve a higher depth of focus after implantation of a monofocal spherical or aspheric IOL than emmetropic patients. SETTING: Department of Ophthalmology, Medical University Graz, Graz, Austria. DESIGN: Prospective case series. METHODS: Patients presenting for cataract surgery were divided by calculated IOL power into a hyperopic (≥22.0 diopters [D]) or emmetropic (18.0 to 21.5 D) groups and received an aspheric (Tecnis ZA9003) or a spherical IOL (Sensar AR40e). Postoperative measurements included corrected (CDVA) and uncorrected (UDVA) distance visual acuities, distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuities, root-mean-square values of corneal and total eye higher-order aberrations and spherical aberrations, and photopic and mesopic contrast sensitivity. RESULTS: Sixty-two eyes of 62 patients were enrolled in this study, 34 eyes (15 hyperopic, 19 emmetropic) in the aspheric IOL group and 28 eyes (14 hyperopic, 14 emmetropic) in the spherical IOL group. The UDVA, CDVA, and contrast sensitivity did not differ significantly between the 2 IOL groups, whereas the DCIVA and DCNVA were significantly better in the spherical IOL group (P = .004 and P = .001, respectively). No significant differences were found in DCIVA and DCNVA between hyperopic patients and emmetropic patients with aspheric or spherical IOLs. CONCLUSIONS: Implantation of a monofocal spherical IOL resulted in an increased depth of focus without significant degradation of distance visual acuity or contrast sensitivity. There were no differences in the depth of focus between hyperopic eyes and emmetropic eyes.

Pupil ovalization after phakic intraocular lens implantation is associated with sectorial iris hypoperfusion.

OBJECTIVE: To investigate iris perfusion in patients with and without pupil ovalization after phakic intraocular lens implantation. METHODS: Comparative retrospective randomized case series of 6 participants, each with a regular pupil, and 6 participants with pupil ovalization after phakic intraocular lens implantation for high myopia were included in the study. Indocyanine green angiography was performed between 20 and 40 months (mean +/- SD, 26 +/- 6.1 months) after lens implantation. RESULTS: Iris perfusion defects were found in 5 of 6 patients with pupil ovalization. No perfusion deficits were noted in patients with round pupils. CONCLUSION: Iris ovalization after phakic intraocular lens implantation may be associated with a lack of iris perfusion and with secondary ischemia. Patients with these lenses and pupil ovalization should be followed regularly.

Retropupillary Fixation of Iris-Claw Intraocular Lens for Aphakic Eyes in Children.

PURPOSE: To report outcome, complications and safety of retropupillary fixated iris-claw intraocular lenses in a pediatric population. DESIGN: Retrospective study. PATIENTS AND METHODS: Ten consecutive pediatric patients (15 eyes) underwent placement of retropupillary fixated iris-claw intraocular lenses between October 2007 and July 2013 at the Department of Ophthalmology, Medical University Graz and General Hospital Klagenfurt, Austria. Postoperative visual acuity and complications were analyzed. RESULTS: Median final best-corrected visual acuity improved by 0.12 logMAR from preoperative baseline. Mean postoperative spherical equivalent was -0.05 ± 1.76 D. No serious complications were observed intra- or postoperatively during the entire follow-up period of up to 40 months. One patient experienced a haptic disenclavation with IOL subluxation immediately after a car accident. CONCLUSION: Our study demonstrates that iris-claw intraocular lens implantation behind the iris is safe in children with lack of capsular support and yields excellent visual outcome with low complication rate.

Intrusion of an encircling buckle after retinal detachment surgery.

PURPOSE: To report a patient with intrusion of the encircling buckle late postoperatively after surgical treatment of a rhegmatogenous retinal detachment. DESIGN: Interventional case report. METHODS: We performed an encircling buckle procedure on a 77-year- old woman with a rhegmatogenous retinal detachment. Four years after the operation, the encircling buckle intruded into the vitreous cavity. RESULTS: After 3 months of diagnosis of the intrusion, the retina was detached totally. CONCLUSIONS: Intrusion of the encircling buckle without any additional segmental buckling element is a very rare late complication of retinal detachment surgery.

Phototherapeutic keratectomy with an epithelial flap for recurrent erosion syndrome.

Phototherapeutic keratectomy (PTK) is an acceptable technique to treat recurrent erosion syndrome. Its disadvantage is postoperative pain. We present a modified technique to reduce the immediate pain from removal of the epithelium after PTK. Nine patients with recurrent erosion syndrome had PTK with epithelial reflap (similar to laser-assisted subepithelial keratectomy) and contact lens application. The follow-up was 6 months. No patient reported severe postoperative pain. Three of 9 patients reported mild pain during the first 24 hours postoperatively. The best spectacle-corrected visual acuity was 0.40 to 0.63 logMAR on the first postoperative day and 0.80 to 1.00 logMAR after a week. No patient developed recurrent erosion.

Pupillary block after phakic anterior chamber intraocular lens implantation.

A 49-year-old patient developed pupillary block glaucoma with an intraocular pressure (IOP) of 29 mm hg after implantation of a phakic intraocular lens (IOL) (NuVita, Bausch & Lomb) in the left eye. the anterior chamber deepened again, and the iop decreased to 16 mm hg after a neodymium: YAG iridotomy. Pupillary block glaucoma may occur after phakic IOL implantation without iridotomy, and we advocate that routine iridotomy be performed during phakic IOL surgeries.

Early changes in corneal sensation, ocular surface integrity, and tear-film function after laser-assisted subepithelial keratectomy.

PURPOSE: To investigate the changes in corneal sensation, ocular surface integrity, and tear-film function after laser-assisted subepithelial keratectomy (LASEK). SETTING: Department of Ophthalmology, University of Graz, Graz, Austria. METHODS: Laser-assisted subepithelial keratectomy was performed in 21 consecutive patients (37 myopic eyes). The patients were observed for subjective complaints of dry eye, corneal sensation, tear-film breakup time (BUT), Schirmer test without local anesthesia, and fluorescein and lissamin-green staining preoperatively and 1 week and 1, 3, and 6 months postoperatively. RESULTS: The subjective score for dry-eye symptoms was not statistically significantly higher after the procedure. Corneal sensation was reduced up to 1 month after LASEK (P<.05). There were obvious decreases in BUT at 1 week and 1 month (P<.01) and no significant changes in Schirmer test results. In fluorescein staining of the cornea, dots were more concentrated at 1 week (P<.05). In lissamin-green staining, no significant changes were found at any follow-up examination. CONCLUSIONS: Laser-assisted subepithelial keratectomy induced a short-term reduction in corneal sensation and affected the ocular surface and tear film slightly. Epithelial flap repositioning in LASEK may have a positive influence on tear-film and ocular-surface factors.

Long-term follow-up with I-CARE phakic IOLs.

AIM: To evaluate visual quality and postoperative results as well adverse events in myopic patients undergoing I-CARE anterior-chamber angle-supported phakic intraocular lens (IOL) implantation. DESIGN: A retrospective, non-randomised, case series. PARTICIPANTS: Data on 29 eyes (16 patients) receiving I-CARE phakic IOL for high myopia (-11.66±3.3) were analysed. METHODS: The IOLs were implanted between 2003 and 2006 at the Department of Ophthalmology, Medical University, Graz, Austria. The mean follow-up was 51.7±16 months (17-78 months). MAIN OUTCOME MEASURES: The authors measured uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); patients underwent slit-lamp examination, corneal topography, Scheimpflug imaging and measurement of endothelial cells (EC). RESULTS: The mean UCVA and BCSVA were 0.63 and 0.94 decimal after 1 year. Endothelial cell loss was the most serious adverse event observed. The mean EC loss was 2%, 9%, 17%, 21%, 33% and 47% after 1 year (n=17), 2 years (n=20), 3 years (n=17), 4 years (n=17), 5 years (n=12) and 6 years (n=3), respectively. Eight IOL explantations were made due to severe EC loss 3-6 years after implantation. Other serious complications included one patient with Urrets-Zavalia Syndrome (one eye). CONCLUSION: Implantation of the I-CARE phakic-IOL is not a safe method for the correction of high myopia due to serious endothelial cell loss that might occur in a high number of patients. Patients with these IOLs should be followed up at least every 6 months, and the IOL should be explanted, once the EC count drops to less than 2000 cells/mm(2).