Comparison of adverse events between intravitreal anti-VEGF and laser photocoagulation for treatment-requiring retinopathy of prematurity: a systematic review.

PURPOSE: To synthesize existing evidence on adverse events, complications, and unfavorable outcomes of current treatment modalities for treatment-requiring retinopathy of prematurity (TR-ROP). METHODS: PubMed, Cochrane Central Register of Controlled Trials, Scopus, EMBASE, Trip Database, and the gray literature available were searched. Randomized Clinical Trials and observational studies comparing the adverse events of intravitreal anti-VEGF injections (bevacizumab, ranibizumab, aflibercept, pegaptanib, conbercept) and laser photocoagulation (LPC) as treatment modalities for infants with TR-ROP were included. The main outcomes compared between the two treatment modalities were: 1. Refractive Errors and Biometry Parameters, 2. Adverse events, complications, and unfavorable outcomes, 3. Disease Recurrence/Disease Regression/Need for retreatment, 4. Neurodevelopmental Outcomes. RESULTS: Higher quality studies concluded that LPC leads to greater rates of myopia than intravitreal anti-VEGF treatment while the rate of adverse events and of unfavorable neurodevelopmental outcomes is similar. However, there was controversy among the included studies concerning the rate of ROP recurrence between intravitreal anti-VEGF injections and LPC. CONCLUSION: There is need for future primary studies assessing the adverse events of intravitreal anti-VEGF injections compared with LPC as treatment modalities for infants with TR-ROP.

When should cataract surgeons seek assistance from experienced colleagues?

PURPOSE: To assess which cases should be assorted exclusively to high-volume surgeons and identify when should a cataract surgeon seek assistance from a senior colleague. METHODS: The medical records of 2853 patients with age-related cataract were reviewed. Preoperative risk factors were documented for each case, and they were divided into surgeons who had more (> 400 surgeries/year) or less experience (< 400 surgeries/year). Ophthalmology residents were excluded from this review. The cases that involved posterior capsule rupture, dropped nucleus, zonular dehiscence and anterior capsular tear with or without vitreous loss were defined as "complicated". RESULTS: From the 3247 cataract extraction surgeries that were reviewed, we were unable to identify any statistically significant difference in the complication rates between the two surgeon groups. In the stepwise regression analysis, both groups supported advanced age (> 85) and mature cataracts with up to fourfold odds ratios (OR). Low-volume surgeons had a fivefold OR in the presence of phacodonesis and a fourfold OR in the case of posterior polar cataract. Finally, the low- and high-volume groups had their highest complication rates in the cumulative four and five risk factors, respectively. CONCLUSION: In the presence of advanced age, mature cataracts, phacodonesis and posterior polar cataract, the complication rates appear to be higher for the less experienced surgeons. Meticulous preoperative assessment with detailed documentation of each patient's risk factors can result in fewer complications. The medical complexity of each case can be used as indicator of whether a more experienced surgeon should perform the surgery or not.

Repeatability of corneal pachymetry and epithelial thickness measurements with spectral-domain optical coherence tomography (SD-OCT) and correlation to ocular surface parameters.

PURPOSE: To assess the repeatability of corneal pachymetry and epithelial thickness measurements with spectral-domain optical coherence tomography (SD-OCT) and identify correlations between epithelial thickness and ocular surface parameters. METHODS: Adults who happened to have prolonged computer use were recruited, excluding those with conditions interfering with corneal measurements or tear production. All subjects filled in the ocular surface disease index (OSDI) questionnaire. Three consecutive measurements of central and peripheral corneal and epithelial thickness were performed with SD-OCT (RTVue XR). Schirmer test I and tear film break-up time (TBUT) were performed. Repeatability was evaluated with intraclass correlation coefficient (ICC), coefficient of variation and repeatability limit. Spearman correlation was used for non-parametric variables. RESULTS: 113 eyes of 63 subjects were included in the study. ICC was ≥ 0.989 for all corneal and ≥ 0.944 for all epithelial pachymetry segments. The best repeatability was found centrally and the worst superiorly both for corneal and epithelial measurements. Central epithelial thickness was weakly correlated with Schirmer test I (rho = 0.21), TBUT (rho = 0.02), OSDI symptoms and OSDI score (rho <|0.32|). OSDI symptoms and OSDI score were weakly correlated with Schirmer test I (rho <|0.3|) and TBUT (rho <|0.34|). CONCLUSION: RTVue XR measurements of corneal and epithelial thickness are highly repeatable in all segments. The lack of correlation between epithelial thickness and ocular surface parameters could suggest the assessment of epithelial integrity with reliable methods such as SD-OCT.

Does the ISNT rule apply to the radial peripapillary capillary vessel density in OCT angiography?

PURPOSE: To investigate the applicability of ISNT (inferior ≥ superior ≥ nasal ≥ temporal), IST (inferior ≥ superior ≥ temporal), and T min (temporal quadrant with the minimum value) rules to the peripapillary nerve fiber layer (NFL) thickness and radial peripapillary capillary (RPC) vessel density (VD) using Optical Coherence Tomography (OCT) and OCT angiography (OCT-A). MATERIALS AND METHODS: This cross-sectional study included 134 eyes of 74 healthy individuals. NFL thickness and RPC VD were measured in all four quadrants using OCT and OCT-A in order to determine the number of eyes that obey the ISNT, IST, and T min rules. RESULTS: Mean age was 48.8 ± 15.5 (range 25-82) years. The ISNT rule was valid in 52 eyes (38.81%) on OCT and only 12 eyes (8.95%) on OCT-A scans. The IST rule was followed by 83 (61.94%) and 37 (27.61%) eyes on OCT and OCT-A scans respectively. The T min rule was valid in 86 eyes (64.18%) in OCT scans and in 26 eyes (19.4%) in OCT-A scans. CONCLUSION: The topography of the RPC network does not obey the ISNT rule in healthy eyes. The ISNT rule and its variants were found to be more relevant in OCT NFL thickness measurements compared to OCT-A RPC VD measurements.

Association of platelet deficiency with severe retinopathy of prematurity: a review.

AIM: The aim of this review was to compile existing evidence on the role of platelets in the development of severe retinopathy of prematurity (ROP), highlight the strengths and weaknesses of the available studies and critically discuss the reported data. METHODS: A comprehensive literature search was conducted on PubMed from January 2000 to January 2022, and the reference lists of the included studies were screened manually. RESULTS: There were 19 primary studies that fulfilled the eligibility criteria. Experimental research indicated lower platelet count in mice oxygen-induced retinopathy model compared with normoxia controls, while platelet transfusions suppressed neovascularisation. The latter finding was not consistently confirmed in clinical research, where a low platelet count, an increased number of thrombopenic episodes and of platelet transfusions have all been implicated in the development of ROP requiring treatment, either type I or aggressive posterior or both. However, existing studies exhibit significant clinical heterogeneity and present methodological limitations that imperil their reliability and validity. CONCLUSION: Platelet deficiency has been associated with severe ROP. However, critical thresholds of platelet parameters are still unrecognised. Future research is required to determine whether platelet parameters can be predictive biomarkers for ROP requiring treatment and at what thresholds.

Improvement in general health after cataract surgery is not limited to vision-specific function.

Cataract surgery is known to have a beneficial impact on quality of life. Recent studies claimed that disease-specific measures of functional impairment are more sensitive to preoperative functional impairment and gains from surgery than are generic measures of general health and quality of life. The purpose of this study is to ascertain whether measures of general health provide additional information on the improvement of patients following cataract surgery over measures of visual function. This is an observational prospective study of a cohort of 150 consecutive patients who underwent phacoemulsification surgery and were evaluated for changes in health-related quality of life with the Medical Outcomes Study Short-Form 36 (SF-36) and improvement in visual-related functioning with the 14-item Visual Function test (VF-14). All of the SF-36 subscales improved post operatively with the magnitude of improvement in VF-14 significantly affecting all subscales except for the Vitality subscale. Treatment effects were significant for the SF-36 subscales 'Role limitations due to physical health', 'Role limitations due to emotional problems', 'Social Functioning' and 'General Health', while taking into account the difference in VF-14 scores pre and postoperatively (p < 0.001). The outcome of phacoemulsification surgery for cataract cannot be completely ascertained solely by the measurement of improvement on tasks related to visual functioning, leaving unaccounted a component related to self-appraisal of ability in everyday and social function, as well as the general feeling of subjective health. The concurrent use of general health measures with visual functioning measures to account for the general improvement on health status following cataract surgery is thus justified.

Silodosin as a predisposing factor of intraoperative floppy iris syndrome (IFIS): an observational propensity score-matching cohort study.

PURPOSE: To evaluate the correlation between silodosin and intraoperative floppy iris syndrome (IFIS) and compare it with other a1-adrenergic receptor antagonists (a1-ARAs) and other factors predisposing to IFIS. METHODS: From the patients who underwent phacoemulsification between 2014 and 2020, we identified all patients who, during their preoperative assessment, reported an a1-ARAs intake (exposed group). These patients were matched utilizing a propensity score matching analysis with an otherwise homogenous group of patients (control group) based on demographics and systemic/ocular comorbidities. RESULTS: A total of 350 patients were included in each group. In the exposed group, 177 (50.6%) patients were exposed to tamsulosin, 105 (30%) to alfuzosin, 43 (12.2%) to silodosin. Regarding IFIS, it was observed in 21.5% of patients on tamsulosin (38/177), 11.4% on alfuzosin (12/105), 37.2% on silodosin (16/43), and 3.4% in the controlled group (12/350). In a multiple regression model analysis, the only two factors significantly associated with IFIS development were silodosin and tamsulosin yielding an adjusted odds ratio of 8.471 (95%CI 4.005-17.920) and 3.803 (95%CI 2.231-6.485), respectively. CONCLUSION: Silodosin has been demonstrated as a predisposing factor, strongly correlated with IFIS development. These results should increase cataract surgeons' awareness to assess their patients preoperatively for exposure to silodosin carefully and employ the appropriate prophylactic measures to ameliorate the impact of silodosin intake on the surgical outcome.

Reliability of Refraction, Keratometry, and Intraocular Pressure Measurements with an Automated All-in-one Device.

SIGNIFICANCE: This study explores the reliability of TonoRef II (Nidek, Tokyo, Japan), which represents a simple tool to obtain rapid refractometry and tonometry measurements. The present device demonstrates very high repeatability of refraction and intraocular pressure (IOP) readings as compared with subjective measurements and a higher concordance of IOP readings to Goldmann application tonometry (GAT). PURPOSE: This study aimed to evaluate the repeatability of measurements acquired with the Autorefractometer/Keratometer/Tonometer TonoRef II and assess their agreement to subjective measurements and readings of other established devices. METHODS: In a cross-sectional study, 54 eyes of 54 healthy subjects were enrolled. Each subject underwent five measurements with the TonoRef II, three measurements with the Canon RK-F1 Autorefractor Keratometer (Canon Europe NV, Amstelveen, the Netherlands), three IOP measurements with the Canon TX-F Noncontact Tonometer (Canon Inc., Tokyo, Japan), three measurements with GAT, and a thorough subjective refraction. Repeatability coefficient (r), intraclass correlation coefficient (ICC), and Bland-Altman plots were used to evaluate repeatability of readings and agreement to the subjective values. RESULTS: TonoRef II showed high repeatability (ICC >0.9) in all parameters tested (sphere, r = 0.157; cylinder, r = 0.196; IOP, r = 2.653). A strong correlation was found between TonoRef and Canon instruments (P < .001 in all parameters). Mean differences and limits of agreement (mean ± 1.96 standard deviation) were -0.01 ± 0.69 D, -0.11 ± 0.7 D, and 2.1 ± 3.4 mmHg for sphere, cylinder, and IOP, respectively. Both autorefractors achieved a very good to excellent agreement to the values obtained with the subjective refraction for most of the parameters tested, without any significant difference to each other (P > .05). Intraocular pressure measurements of TonoRef II showed higher agreement to the GAT values compared with those obtained with the Canon tonometer (ICC, 0.9114 and 0.7002, respectively; P < .001). CONCLUSIONS: Intraocular pressure and refraction readings acquired with TonoRef II demonstrate very high repeatability and agreement to the subjective measurements. Regarding IOP evaluation, TonoRef II shows higher concordance to GAT compared with another established noncontact tonometer.

Successful Cataract Surgery Leads to an Improvement in Depressive Symptomatology.

INTRODUCTION: Cataract is the most common reversible cause of blindness worldwide, and the associated vision impairment has been associated with an adverse impact on health-related quality of life and mental health in particular. However, findings from studies on the mental health improvement of patients after cataract surgery remain inconclusive. The objective of this study is to ascertain whether the outcome on best-corrected visual acuity (BCVA) following cataract surgery is associated with depressive symptomatology. METHODS: This is an observational prospective study of a cohort of 150 consecutive patients who underwent phacoemulsification surgery and who were evaluated for changes in depressive symptomatology with Beck's Depression Inventory-II (BDI-II). RESULTS: The difference in BDI-II scores pre- and postoperatively correlated with the difference in BCVA pre- and postoperatively (p < 0.001). A paired-samples t test revealed a statistically significant difference in the preoperative and postoperative BDI-II scores (p < 0.001). A related-samples Wilcoxon signed-rank test revealed a statistically significant improvement of depression status among the patients (p = 0.004). A stepwise regression analysis concluded that the only statistically significant predictor in assessing the difference in total BDI-II score before and after the operation was the respective difference in visual acuity. DISCUSSION/CONCLUSION: The success of phacoemulsification surgery for cataract as evaluated with the change in BCVA is related to the rate of improvement in depressive symptomatology.

Lens Epithelial Surface Disorders in Exfoliation Syndrome: A Scanning and Transmission Electron Microscopy Study.

BACKGROUND: Hydrodissection was recently reported to occur more easily in patients with exfoliation syndrome (XFS). Transmission electron microscopy (TEM) studies have already revealed alterations of the lens epithelial cells (LECs) and their apical membrane towards the lens fibers. OBJECTIVE: The aim of this work was to examine the three-dimensional appearance of the lens epithelium in patients with XFS. METHODS: Fourteen patients with senile cataract, 7 of whom had XFS, were included. Anterior lens capsules (aLCs) were obtained with continuous curvilinear capsulorrhexis (CCC) during phacoemulsification and were examined with scanning electron microscopy (SEM) and TEM. RESULTS: Exfoliation samples exhibited an overall more irregular apical surface of the lens epithelium compared to control aLCs. The height of LECs varied extensively. On the apical surface of LECs, amorphous, crystalline-like, or microgranular extracellular material and membranous, oval-shaped structures were documented with SEM. All findings were connected to corresponding observations with TEM and were not correlated to the type of cataract. CONCLUSIONS: In XFS patients, the lens epithelial surface exhibited a highly irregular margin, with extracellular material covering the apical membrane of LECs. We suggest that XFS probably causes both epithelial and lens fiber degeneration which, during CCC and mechanical extraction of the aLC from the lens cortex, result in diverse alterations.

Iridocorneal angle assessment in children with spontaneously regressed retinopathy of prematurity.

PURPOSE: To assess anterior segment anatomic parameters in school-aged children with spontaneously regressed retinopathy of prematurity (sr-ROP) and in children born preterm without ROP history (preT). METHODS: sr-ROP and preT children were compared with healthy, born at term children (control group). Biometric characteristics were measured with the IOLMaster. Iridocorneal angle structure was evaluated using Visante AS-OCT, and angle opening distance, trabecular iris space area and scleral spur angle were calculated. Best-corrected visual acuity (BCVA) was measured with the ETDRS chart. RESULTS: We examined 22 eyes of 11 children with sr-ROP, 26 eyes of 13 preT children and 24 eyes of 12 healthy controls, with a median age of 8 years. sr-ROP children exhibited worse mean BCVA and reduced AL compared to controls (p = 0.001 and p = 0.007, respectively). A narrower iridocorneal angle was found in sr-ROP compared to the preT and the control groups. Preterm children were found to have similar anterior chamber angle metrics compared to the full-term control group. CONCLUSION: In this study, school-aged children with a history of sr-ROP had narrower angles compared to preterm- and term-born children. AS-OCT demonstrated structural differences of the iridocorneal angle in sr-ROP, possibly reflecting a mild developmental arrest of the anterior segment.

Macular sequelae in vasoproliferative tumors: results of surgical approach.

PURPOSE: The purpose of this study is to report the clinical manifestations and treatment outcomes in three patients diagnosed with vasoproliferative tumors (VPTs). METHODS: A retrospective, single-center case series was conducted, and retinal findings from three cases were documented by clinical examination and multimodal imaging. RESULTS: Three patients presented with an elevated, yellow-white retinal lesion located at the peripheral retina and extensive retinal exudation. All three patients were closely monitored, and tumor-associated features included lipid exudates, cystoid macular edema (CMO), pre-retinal fibrosis and epi-retinal membrane (ERM). Clinical management relied on observation, cryotherapy, laser photocoagulation, intravitreal steroids and anti-vascular endothelial growth factor (anti-VEGF) treatment. Despite different clinical courses, two patients underwent vitreo-retinal surgery to address VPT-related complications of macular hole and vitreo-macular traction, whereas a patient underwent phacoemulsification to treat steroid-induced cataract. CONCLUSION: VPTs are uncommon benign vascular tumors and usually located at the infero-temporal peripheral retina. Close observation and early diagnosis of VPTs are of great importance in preventing vision-threatening complications and ensuring the best final visual outcome. The optimal treatment has yet to be defined due to lack of multi-center clinical studies. Despite the availability of less invasive therapeutic interventions, however, our case series show that pars plana vitrectomy is sometimes the most appropriate choice to restore visual acuity.

Safety of air tamponade versus corneal hydration for sealing clear corneal incisions in cataract surgery.

PURPOSE: To compare safety of wound hydration to anterior chamber air tamponade for securing watertight closure of clear corneal incisions, during uneventful cataract surgery. METHODS: Prospective, comparative case-control series. Patients undergoing phacoemulsification were assigned to receive either anterior chamber air bubble (Group A) or intrastromal wound hydration with balanced salt solution (Group B) at the end of the procedure. Two high-volume surgeons operated equal number of cases in each group employing identical surgical technique, except for corneal side incision management. Patients were assessed pre- and postoperatively at day 1, day 4, day 9, and day 30 after surgery. RESULTS: One hundred eyes of 100 patients were enrolled, of which 2 were lost to follow-up. The two groups were comparable in terms of preoperative risk factor assessment, baseline central corneal thickness (CCT), preoperative endothelial cell density, as well as cumulative dissipated energy and duration of phacoemulsification (p > 0.05). Mean CCT and best-corrected visual acuity were better in Group B on the first postoperative day, but did not differ between the two groups at all other timepoints. Surgically induced astigmatism was comparable in the two groups (p > 0.05). Endothelial cell density loss at 1 month postoperatively was greater in Group A (34.06%) compared to Group B (16.45%). CONCLUSIONS: Wound sealing with intrastromal hydration proved to be safer than air tamponade in terms of preserving endothelial cell density and function.

Comorbidity of Keratoconus and Fuchs' Corneal Endothelial Dystrophy: A Review of the Literature.

INTRODUCTION: Comorbidity of keratoconus (KC) and Fuchs' corneal endothelial dystrophy (FD) has been sporadically reported in the literature since the early nineties. This review summarizes findings from the related literature while examining the possibilities related to the concurrent development of these disorders and the clinical significance for the clinician. METHODS: NLM/PubMed, Ovid, Google Scholar, Cornea, and Cochrane database were reviewed for research papers presenting cases of comorbid KC and FD published between January 1990 and July 2019. RESULTS: Fifteen papers which presented 69 cases were included in the study. Most cases were women (56.5%), involvement was bilateral (59.4%), and the age range was wide (15-82 years) with a normal distribution. Incidence is expected to be approximately 1 per 100,000. FD is the most frequent comorbid corneal dystrophy diagnosed in KC patients. There are 4 distinct possibilities for the cooccurrence of KC and FD, the most likely being that of chance. CONCLUSION: The overall incidence of these disorders found in combination is very low and, in absence of other conclusively proven hypotheses, most likely attributable to chance. The treatment plan should be tailored to the needs of the individual patient, since the diagnosis can be made in any stage of life and could be part of a more complex presentation that includes another pathology of the cornea or senile cataract. The inclusion of preoperative topography and specular microscopy as routine in cataract preoperative assessment would protect against any postoperative complications in these patients.

Ease of Hydrodissection during Phacoemulsification: A Comparison between Patients with and Those without Exfoliation Syndrome.

BACKGROUND: Exfoliation syndrome (XFS), which is associated with increased surgical complications during phacoemulsification, has a relatively high incidence in Greece. Multiannual surgical experience in XFS patients has led to the clinical observation that hydrodissection occurs more easily in XFS patients. OBJECTIVE: To compare the ease of hydrodissection between cataract patients with and those without XFS. METHODS: One hundred and fifteen patients with senile cataract were included in the study. Forty-two of them had XFS. All patients underwent uneventful phacoemulsification by the same surgeon. For hydrodissection, three 1-mL insulin syringes were filled with 0.5 mL balanced salt solution (BSS). Sequentially, each one was quickly and continuously injected underneath the 3, 6, and 9 o'clock positions of the anterior lens capsule. If lens mobilization was achieved with this procedure, hydrodissection was characterized as "easy." RESULTS: The two groups were matched for age, gender, the biomicroscopic type of cataract, and the presence of diabetes mellitus. Glaucoma occurred more often among the XFS patients (p = 0.002). In 39 of the 42 exfoliation patients (92.8%), "easy" hydrodissection was recorded. In the control group, the corresponding number was 47 out of 73 (64.3%). The two groups differed significantly (p = 0.001). CONCLUSIONS: Hydrodissection was more easily performed on the XFS patients than on the controls. This finding could be related to the extensive ultrastructural subepithelial alterations of the anterior lens capsule in XFS, as recently described in electron microscopy studies. We suggest that less BSS can be used for hydrodissection in XFS patients during phacoemulsification.

A comparative study of depressive symptomatology among cataract and age-related macular degeneration patients with impaired vision.

Vision impairment remains an important cause of disability with the leading being age-related cataract (ARC) and age-related macular degeneration (ARMD) with depression symptoms often reported in vision impairment. This is a cross-sectional survey of two groups of fifty patients with ARC and ARMD and no prior psychiatric history on depressive symptomatology. Results indicate that ARMD patients scored higher on the BDI-II than ARC patients, in line with their poorer prognosis. Female patients with ARMD, living alone, with a higher number of other comorbid health issues, are more likely to have more depressive symptomatology. ARMD patients scored higher in the items related to pessimism for the future, feelings of past failure and feelings of self-dislike. There is a need for liaison psychiatry services to be readily available in patients with suspected ARC and ARMD coming forward with substantial vision loss. ARMD patients in particular tend to be more pessimistic and blame themselves for the progression of their disease. This should be taken into consideration with patient education on the causes of the disease and more effort should be undertaken to instill hope. The impact of vision loss on psychic status is related to disease prognosis and not only current state.

Alternative mydriasis techniques for retinopathy of prematurity screening.

PURPOSE: There is a large variation in mydriatic regimens used in screening for retinopathy in preterm infants. Except for the standard instillation of mydriatic drops in their commercial formulation, other techniques for pupil dilation have also been described. This study aimed to review all techniques that have been used for mydriasis in retinopathy of prematurity eye examination (ROPEE) screening. METHODS: A comprehensive literature search was performed in PubMed, Cochrane library, Trip database, and Scopus, using the key words: "mydriasis", "techniques", "mydriatics", "dilating drops", "retinopathy of prematurity", "ROP", "phenylephrine", "cyclopentolate", "tropicamide", "smaller mydriatic drops", "reduction in drop size" to February 2019. RESULTS: Five primary studies were included, assessing the techniques of microdrops, lower conjunctival fornix (LCF) packing and Mydriasert® ophthalmic insert. Reported efficacy was similar to commercial eyedrops instillation. Microdrops appeared to have a superior safety profile. LCF packing and Mydriasert lead to increased blood pressure, without serious complications, necessitating further safety studies. CONCLUSIONS: Of all alternative mydriasis techniques for ROPEE screening that have been described, microdrops appear to be the safest yet still effective technique in the fragile population of premature infants in risk of ROP.

Safety and efficacy of hypertonic saline solution (5%) versus placebo in the treatment of postoperative corneal edema after uneventful phacoemulsification: a randomized double-blind study.

PURPOSE: To evaluate safety and efficacy of hypertonic saline solution administration after uneventful cataract surgery. DESIGN: Prospective double-blind randomized study METHODS: In total, 183 eyes of 183 patients undergoing phacoemulsification were randomly allocated into two equal groups. Treatment group (TG) subjects received single-dose hypertonic (NaCl 5%) solution 4 times daily for 14 days, while placebo group (PG) received single dose of normal saline solution (0.9%) at the same frequency in addition to ordinary postoperative treatment. All patients underwent assessment of central corneal thickness (CCT), endothelial cell density (ECD), best-corrected visual acuity (BCVA), clinical staging of postoperative corneal edema and questionnaire regarding the procedure success and impact on patient's life. Measurements were taken at baseline and 1, 4, 9 and 30 days following surgery. RESULTS: CCT increased by 134.67 ± 94.51 µm (25.1 ± 19.4%) on postoperative day 1, without any difference between study groups (p = 0.58). Corneal edema showed a significant recession in TG compared to PG on day 4, in terms of both pachymetry (10.73% vs 7.39%, p = 0.004), BCVA (BCVATG = 0.64 ± 0.24 [logMARTG = 0.25 ± 0.3], BCVAPG = 0.56 ± 0.23 [logMARPG = 0.33 ± 0.3], p = 0.04) and clinical staging (p = 0.02). Similar results were recorded on postoperative day 9 in subjects demonstrating marked corneal edema on the first postoperative day. Endothelial cell loss showed no statistically significant difference between study groups (p = 0.48). No adverse events were recorded in relation to treatment. More patients in the TG (92.4% vs 57.1% in the PG) reported a subjectively clear vision 1 week postoperatively (p = 0.04). CONCLUSION: The use of 5% hypertonic saline solution is found to be a safe and effective adjunct in the management of postoperative corneal edema after uneventful phacoemulsification, achieving rapid corneal clearance and expediting a good visual outcome, especially in cases with marked postoperative edema.

Retinopathy of prematurity occurrence and evaluation of screening policy in a large tertiary Greek cohort.

PURPOSE: To assess the frequency of retinopathy of prematurity (ROP) and evaluate the appropriateness of screening guidelines in a tertiary hospital in Thessaloniki, Greece. METHODS: Retrospective review of consecutive infants admitted to the IInd Department of the Neonatal Care Unit of Aristotle University in the period April 2004-2015. ROP screening took place according to the Royal College of Paediatrics and Child Health and Royal College of Ophthalmologists (UK) guidelines [i.e. gestational age < 32 weeks and/or birth weight < 1501 g)], plus a few additional cases due to comorbidity. RESULTS: 1178 out of the 8782 admitted infants underwent ROP screening. ROP was detected in 232 (19.7%) infants of whom 87 developed severe form of the disease (i.e. ≥ stage 3). Treatment was required in 30 (2.5%) infants, all of whom fulfilled the screening criteria. Two of the 206 infants who were additionally screened due to comorbidity developed severe ROP which regressed spontaneously. Disease regression was achieved in 27/29 (93%) treated infants who survived. CONCLUSIONS: The frequency of ROP observed in this cohort was as low as that reported in other developed countries. The currently used screening criteria permitted identification of all infants who were at risk and, therefore, need not be changed.

Is conversion of decimal visual acuity measurements to logMAR values reliable?

PURPOSE: To assess if conversion of decimal visual acuity (VA) to logMAR is reliable for clinical and research purposes. METHODS: Right eye VA of 74 consecutive patients was measured with 5 min interval, using (a) the ETDRS chart (VAlog), (b) a decimal chart at 6 m (VA6m), and (c) a decimal chart at 4 m (VA4m). VA was the smallest line whereby four of five optotypes were correctly identified. Decimal scores were converted to logMAR using the formula logMAR = -log(decimal acuity). The agreement between VAlog, VA4m, and VA6m was assessed by the Bland-Altman method. RESULTS: Linear regression analysis of the difference between VAlog and VA6m or VA4m showed a significant slope (p = 0.001), with greater disagreement at higher VA values, i.e., poorer acuity. There was considerable lack of agreement, with discrepancies of up to 0.2 logMAR when VA was measured around 0.5 logMAR. CONCLUSION: Converting decimal VA to logMAR produces overestimation of its true value, especially in lower acuities.