Comparison of corneal topography maps obtained using the IOLMaster 700® and the Anterion® in candidates for toric IOL implantation.

OBJECTIVES: To compare central corneal topography (CT) obtained using the IOLMaster 700® biometer to corneal topography obtained using a Swept-Source OCT-based predicated topographer (PT), in candidates for toric intraocular lens (IOL) implantation. METHODS: A retrospective comparative study was conducted in consecutive patients undergoing a routine cataract surgery assessment with significant astigmatism on keratometry. Each patient was examined using both the IOLMaster 700® (Carl Zeiss Meditec, Jena, Germany) and the Anterion® (Heidelberg Engineering, Heidelberg, Germany) for routine preoperative measurements. The corneal axial anterior power map obtained with each device was then anonymized and analysed independently by two ophthalmologists using a reading grid. The reading grid assessed the usual parameters describing astigmatism and evaluated if a toric IOL was indicated or a second topography examination was needed to confirm the indication. RESULTS: In total, 169 eyes of 120 patients were included. The inter-examination agreement for the astigmatism description ranged from 56 to 85% depending on the reader and parameter. The decision to implant a toric IOL based on the axial map was the same in 59-60% of cases depending on the examiner. A second examination was needed in 18-25% and 8-14% of cases after CT and PT, respectively. The IOLMaster 700® central anterior axial map allowed toric IOL implantation in 58-70% of cases with no need for second corneal examination. CONCLUSION: The agreement between the anterior axial maps obtained using both devices was good. However, in about a quarter of the cases, dedicated topography had to be performed to confirm the surgical indication.

Long-term real-life outcomes of the Clareon® hydrophobic intraocular lens: the Clarte study in 191 eyes : 3-years real-life outcomes of the Clareon® intraocular lens.

BACKGROUND: To describe and analyze the real-life refractive, functional and safety outcomes of the Clareon® intraocular lens (IOL) after 3 years. METHODS: Data was collected retrospectively for observational purposes between July 2017 and December 2019 in the ophthalmology department of Desgenettes military hospital in Lyon, France. Eyes that underwent cataract surgery with Claeron® implantation were consecutively included. Patients with a systemic or ocular condition that could affect the visual outcome were excluded. Postoperative corrected (CDVA) and uncorrected (UDVA) distance visual acuities as well as capsule and IOL transparency were assessed at 1 month and 3 years. RESULTS: A total of 326 eyes were analyzed at one month and 191 eyes were reassessed at the 3-year follow-up visit. At 3 years, the mean CDVA was 0.003 LogMAR (95% confidence interval [CI]: -0.003 to -0.01) and the mean UDVA was 0.075 (95% CI: 0.054 to 0.095). Three quarters of the patients had an UDVA ≥ 0.097 logMAR (20/25 Snellen equivalent) and 50% had an UDVA ≥ 0 (20/20). The absence of glistening was reported in 95.3% of cases and 4.7% [9] of patients experienced a clinically significant posterior capsular opacification (PCO) for which Nd:YAG treatment was required. CONCLUSIONS: This real-life study reports high-performance and stable long-term refractive outcomes of the Clareon® IOL with good safety in terms of PCO and glistening.

Long Intervals between Intravitreal Injections Using a Treat-and-Extend Protocol in a Real-Life Context in AMD: The LIRE Study.

INTRODUCTION: The aim of the study was to assess the outcome of long treat-and-extend (TE) anti-VEGF intravitreal injection (IVI) intervals (≥every 12 weeks [Q12W]) in neovascular age-related macular degeneration (nAMD). The aims of this retrospective study were to determine the proportion of nAMD eyes treated ≥ Q12W, to analyze their longitudinal, functional, and anatomical outcomes, and to compare functional and anatomical outcomes between eyes that rapidly versus slowly reached a Q12W regimen and between eyes directly treated with versus initiating lately the TE regimen. METHODS: All patients receiving IVIs for nAMD were screened. The longitudinal, functional, and anatomical characteristics of Q12W-treated eyes were reported at different timepoints. RESULTS: Ninety-one eyes were included (38% of our total nAMD cohort). The mean TE regimen time to reach a Q12W interval was 20.1 ± 16.2 months. During this time, a mean number of 12.1 ± 9.3 IVIs were needed. The mean best-corrected visual acuity was 68 letters at the time of diagnosis and was maintained (p > 0.05). Eyes that rapidly reached a Q12W interval had a shorter follow-up before TE regimen initiation (p = 0.04) and received fewer IVIs (p = 0.02) than eyes that slowly reached a Q12W interval. Eyes directly treated with the TE regimen reached a Q12W interval more rapidly than eyes with late TE initiation. The neovascularization subtype was not a predictor of outcome in TE-treated eyes. CONCLUSION: ≥Q12W eyes represent an important part of the nAMD population in our real-life study. No baseline anatomical characteristics were associated with the outcome under a TE regimen, although early TE regimen initiation allowed extending more rapidly the IVI interval.

Impact of Total Corneal Astigmatism Estimated With the Abulafia-Koch Formula Versus Measured With a SS-OCT Biometer on the Refractive Outcomes of a Toric Intraocular Lens in Cataract Surgery.

PURPOSE: To compare the impact of total corneal astigmatism (TCA) estimated with the Abulafia-Koch formula (TCAABU) versus measured by Total Keratometry (TK), swept-source optical coherence tomography (OCT) coupled with telecentric keratometry (TCATK) on the refractive outcomes after cataract surgery with toric intraocular lens (IOL) implantation. METHODS: Two hundred one eyes of 146 patients who underwent cataract surgery with toric IOL implantation (XY1AT; HOYA Corporation) were included in this single-center, retrospective study. For each eye, TCAABU (estimated from the anterior keratometry values measured with the IOLMaster 700 [Carl Zeiss Meditec AG]) and TCATK (measured using TK IOLMaster 700) were entered into the HOYA Toric Calculator. Patients were operated on based on TCAABU. For each eye, centroid and mean absolute error in predicted residual astigmatism (EPA) were calculated according to TCA used (TCAABU or TCATK). The cylinder power and the axis of the posterior chamber IOL were compared. RESULTS: The mean uncorrected distance visual acuity was 0.07 ± 0.12 logMAR, the mean spherical equivalent was 0.11 ± 0.40 D, and mean residual astigmatism was 0.35 ± 0.36 D. Mean centroid EPA was 0.28 D at 132° with TCAABU and 0.35 D at 148° with TCATK (P(x) < .001; P(y) < .01). Mean absolute EPA was 0.46 ± 0.32 D with TCAABU and 0.50 ± 0.37 D with TCATK (P < .01). In the with-the-rule astigmatism subgroup, a deviation from the target of less than 0.50 D was achieved in 68% of eyes with TCAABU versus 50% of eyes with TCATK. The proposed posterior chamber IOL was different depending on the calculation methods used in 86% of cases. CONCLUSIONS: Both calculation methods showed excellent results. However, the predictability error was significantly reduced when TCAABU was used compared to TCATK measured with the IOLMaster 700 in the whole cohort. Finally, TCA was overestimated by TK in the with-the-rule astigmatism subgroup. [J Refract Surg. 2023;39(3):171-179.].

Focal Photocoagulation as an Adjunctive Therapy to Reduce the Burden of Intravitreal Injections in Macula Edema Patients, the LyoMAC2 Study.

AIM: To assess the efficacy of focal photocoagulation of capillary macroaneurysms (CMA) to reduce the burden of intravitreal injections (IVI) in patients with macular edema (ME). MATERIALS AND METHODS: Retrospective multicenter study in patients with diabetic ME or ME secondary to retinal vein occlusion (ME-RVO). CMA associated with ME were selectively photocoagulated. Patients were followed for one year after photocoagulation. RESULTS: 93 eyes of 76 patients were included in this study. At 6 months after the laser (n = 93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 2.52 to 1.52 at 6 months, p < 0.001). The mean BCVA remained stable (0.32 and 0.31 logMAR at baseline and 6 months, p = 0.95). At 12 months (n = 81/93), there was a significant decrease in mean macular thickness (from 354 µm to 314 µm, p < 0.001) and in mean IVI number (from 4.44 to 2.95 at 12 months, p < 0.001), while the mean BCVA remained stable (0.32 and 0.30 logMAR at baseline and 12 months, p = 0.16). CONCLUSION: Focal laser photocoagulation of CMA seems to be effective and safe for reducing the burden of IVI in patients with ME. Their screening during the follow-up should be considered closely.

Use of selective laser trabeculoplasty as an alternative in patients who developed ocular hypertension after intravitreal dexamethasone implants: a series of 35 eyes.

PURPOSE: Steroid-induced ocular hypertension (OHT) occurs in about a third of cases after dexamethasone implant (DEXi) intravitreal injection (IVI), for which treatment discontinuation may be required. The aim of this study was to assess the benefit of selective laser trabeculoplasty (SLT) in patients who developed transient OHT after DEXi injection to prevent subsequent steroid-induced OHT peaks during reinjections. METHODS: A real-life, retrospective, and observational study was conducted to assess the intraocular pressure (IOP) after SLT in steroid responders after DEXi injection (IOP > 21 mmHg). Were analyzed: IOP 1 and 2 months after SLT, maximum IOP (IOPmax) after each new DEXi IVI, and the number of prophylactic hypotensive treatments needed at the time of DEXi reinjections. RESULTS: Thirty-five eyes of 29 patients were included. The mean macular edema follow-up duration was 38.4 ± 28.4 months. SLT was performed after a mean number of 6.3 ± 4.7 DEXi IVIs. After SLT, the IOPmax measured after the first reinjection was lowered by 36.6 ± 14.7% (p < 0.0001). The mean number of hypotensive treatments was 2.1 ± 0.9 before versus 1.5 ± 0.8 after SLT. The post-reinjection lowering in OHT peak was maintained during the subsequent 3 DEXi IVIs: - 29.1 ± 25.5% (p = 0.0009), - 35.8 ± 13.1% (p = 0.0078), and - 45.4 ± 8.6% (p = 0.0312) after the second, third, and fourth DEXi reinjections. SLT allowed continuing injections in 88.6% of patients. CONCLUSION: The use of 180° SLT in this indication could be an effective therapeutic alternative to control steroid-induced OHT and safely continue DEXi injections.

Macular edema in Cogan-Reese syndrome.

PURPOSE: Iridocorneo-endothelial (ICE) syndrome is known as a rare spectrum causing glaucoma, corneal and iris damages. Retinal complications are uncommon. OBSERVATIONS: We report the case of a middle-aged woman suffering from a Cogan-Reese Syndrome (CRS) with refractory ocular hypertension (OHT) who presented a cystoid macular edema (CME) during follow up. CONCLUSIONS AND IMPORTANCE: We suspect the CME to be inflammatory linked to the pathophysiological hypotheses of the CRS. The CME was successfully treated with topical nonsteroidal anti-inflammatory drugs (NSAID). No consensus is available on its duration. A recurrence happened when treatment was stopped, its reintroduction was successful.

Screening of telangiectatic capillaries in chronic macular edema based on multimodal imaging: a study of 101 eyes. LyoMAC1 study.

PURPOSE: To estimate the prevalence of telangiectatic capillaries (TCs) in patients followed for chronic macular edema (CME) (diabetic ME [DME] and ME associated with retinal vein occlusion [RVO]). METHODS: Real-life, prospective, bi-centric cohort study including all consecutive patients followed for a clinically significant CME secondary to diabetic retinopathy or RVO. Inclusion criteria were patients treated with intravitreal injection for their ME for at least 12 months who had to undergo follow-up angiography. Multimodal imaging with color retinophotography, spectral-domain optical coherence tomography (SD-OCT), OCT angiography, and en face OCT was performed in all patients. RESULTS: A total of 101 eyes of 71 patients were included between November 2019 and June 2020. Of the 101 eyes analyzed, indocyanine green angiography found at least one TC in 67 eyes (66.3%). No significant differences were found between the groups with and without TC except for the distribution of DME and RVO (p < 0.008). In 83.6% of eyes with TCs, TCs contributed to the formation of the ME. SD-OCT sensitivity for TC detection was 94%. CONCLUSION: In our study, the estimated prevalence of TCs in CME (DME and ME associated with RVO) was 66.3%, i.e., two-thirds of patients. SD-OCT was an excellent screening examination with a sensitivity of 94%.

Should Artificial Tears Be Used During the Preoperative Assessment of Toric IOLs Before Age-Related Cataract Surgery? The TORIDE Study.

PURPOSE: To assess the impact of the use of artificial tears during the preoperative work-up performed before age-related cataract surgery, when a toric intraocular lens (IOL) was indicated. METHODS: This was a monocentric prospective study assessing 73 eyes of 51 patients, included consecutively after a preoperative work-up performed without artificial tears (no artificial tears group), when a toric IOL was indicated. Each included patient underwent a second series of examinations: biometry using the IOLMaster 700 (Carl Zeiss Meditec AG) and topography using the OPD-Scan II (Nidek), 1 minute after artificial tears instillation (artificial tears group; hyaluronate de sodium 0.15%, threalose 3% [Théalose; Théa]). Changes in anterior corneal astigmatism and subsequent changes in toric IOL calculation were analyzed. The error in predicted residual astigmatism was calculated. RESULTS: Anterior corneal astigmatism and total corneal astigmatism measured with the IOLMaster 700 were significantly modified when artificial tears were instilled before the examinations (1.51 ± 0.57 diopters [D], range: 0.75 to -3.55 vs 1.42 ± 0.63 D, range: 0.42 to 3.35 D; P = .043 and 1.59 ± 0.54 D, range: 0.87 to 3.48 vs 1.51 ± 0.59 D, range: 0.56 to 3.27 D, P = .038, respectively). This modification led to a change in IOL cylinder calculation in 43.8% of cases and to a change in implantation axis greater than 10° in 17.7% of cases. These changes were significantly greater in patients with a breakup time (BUT) less than 5 seconds (57.5% and 27.8%, with P = .009 and .029, respectively). In the subgroup of patients with a BUT of less than 5 seconds, the mean absolute error in predicted astigmatism was significantly lower after artificial tears instillation (0.48 ± 0.50 D, range: 0.00 to 2.79 vs 0.37 ± 0.25 D, range: 0.00 to 1.10 D, P = .048). CONCLUSIONS: Dry eye significantly impacted toric IOL calculations and should be taken into account during the preoperative assessments. Using artificial tears reduced the number of refractive errors. [J Refract Surg. 2021;37(11):759-766.].

A prospective multicentre study of intravitreal injections and ocular surface in 219 patients: IVIS study.

PURPOSE: To assess the impact of intravitreal injections (IVTI) on ocular surface of patients treated with multiple injections. METHODS: Prospective, tricentric study conducted in patients treated with unilateral IVTI. An asepsis protocol with povidone-iodine was used for all patients during IVTI. The primary endpoint was the difference between the pre-IVTI Ocular Surface Disease Index (OSDI 1) score and that measured on day one (D1) post-IVTI (OSDI 2). Secondary endpoints were the evaluation of predictive factors for OSDI scores, pain assessment on D1, and the Lacrydiag® analysis of tears from the injected eye versus contralateral eye before IVTI. RESULTS: Two hundred and nineteen patients with a mean age of 75.9 ± 10 years were included. The mean OSDI2-OSDI1 difference was 19.2 ± 20.6 (p < 0.001). The mean noninvasive tear break-up time was 6.41 ± 4.59 seconds in the injected eye versus 7.36 ± 4.36 seconds in the contralateral eye (p < 0.001). In the multivariate analysis, the factors significantly associated with the OSDI 2 score were the OSDI 1 score (p < 0.001), the pain score on D1 (p < 0.001) the number of instilled glaucoma eye drop (p = 0.01) and a centre effect (centres 2 and 3 versus centre 1, p < 0.001). CONCLUSION: Our results confirm the impairment of the ocular surface and quality of life immediately after an IVTI. These results suggest 3 levels of action to improve the immediate tolerance: improving the basal status of the ocular surface, reducing the contact time with povidone-iodine that might be toxic to the surface, and improving immediate post-IVTI treatment.

Impact of measured total keratometry versus anterior keratometry on the refractive outcomes of the AT TORBI 709-MP toric intraocular lens.

PURPOSE: The aim of this study was to compare the visual and refractive outcomes of total keratometry (TK) versus anterior keratometry (AK) measurements of the IOLMaster 700® (Carl Zeiss Meditec AG, Jena, Germany) in surgery for age-related cataract with preexisting corneal astigmatism. METHODS: Monocentric retrospective comparative study. The IOLMaster 700® biometer was used in the 2 groups: in AK mode (AK group) and in TK mode (TK group), for toric IOL (AT TORBI 709 MP) calculation with ZCALC®, Zeiss toric IOL calculator. A 2:1 matching was made between the AK and TK groups. Uncorrected distance visual acuity (UDVA), the correction index and the error in predicted residual astigmatism were analyzed 1 month postoperatively using the vector analysis by the Alpins method. RESULTS: The whole cohort included 405 eyes distributed as follows after 2:1 matching: 158 eyes in the AK group and 79 eyes in the TK group. The mean UDVA was similar in both groups (0.07 ± 0.10 LogMAR; p = 0.587). No significant difference in mean absolute error in predicted residual astigmatism (0.37 ± 0.33 D versus 0.35 ± 0.26 D; p = 0.545) and in mean centroid error in predicted residual astigmatism (0.19 ± 0.49 at 3° and 0.06 ± 0.46 at 0°; p = 0.008 and 0.161 respectively for the x- and y-components) was found between the AK and TK groups. CONCLUSION: TK of the IOLMaster 700® gives excellent refractive and visual outcomes, comparable to those obtained in AK mode, without showing its superiority for corneas with regular astigmatism.

LONG-TERM INCIDENCE AND RISK FACTORS OF OCULAR HYPERTENSION FOLLOWING DEXAMETHASONE-IMPLANT INJECTIONS: THE SAFODEX-2 STUDY.

PURPOSE: To analyze the incidence, risk factors, and time to onset of ocular hypertension (OHT) after intravitreal injections (IVI) of dexamethasone implant and to evaluate the long-term cumulative probability of intraocular pressure elevation. METHODS: Eyes of patients having received at least one dexamethasone implant IVI between October 2010 and February 2015 were included in the present study. Ocular hypertension was defined as intraocular pressure > 25 mmHg and/or an increase of 10 mmHg over the follow-up period compared with baseline intraocular pressure. RESULTS: Four hundred ninety-four eyes were studied in 410 patients. For a total of 1,371 IVI, the incidence of OHT was 32.6% in the study eyes with a mean follow-up period of 30 months (3-62.5) and a median follow-up of 29 months. Pressure-lowering treatment was introduced for 36.9% of eyes. Topical treatment alone was sufficient to manage OHT in 97%. Young age, male sex, uveitis and retinal vein occlusion, and glaucoma treated with a double- or triple-combination topical pressure-lowering medication were found to be risk factors for OHT. The incidence of OHT did not change with an increase in the number of IVI, and there was no cumulative effect, defining by an increase of the incidence of OHT in patients after repeated IVI (P = 0.248). CONCLUSION: This study confirmed that OHT is of moderate incidence, transient, controlled by topical treatment and provides data on the long-term cumulative probability of intraocular pressure elevation in a large cohort of eyes treated with dexamethasone implant IVI. Repeat injections of dexamethasone implant neither increase nor decrease the risk of OHT.

Contribution of swept-source OCT-angiography in analysis of choroidal osteoma and its quiescent neovascular complications: A case study.

Purpose: Choroidal osteoma (CO) is a rare benign tumor of the choroid. Improvements in Optical Coherence Tomography (OCT) technologies, notably swept-source (SS), enables a better visualization of the choroid with deeper signal penetration in the tissues. Observation: We describe SS-OCT and OCT-angiography findings in a 30-year-old patient with CO. The best visualization of the choroid allows even more precise analysis beyond the identification of classical structures of trabecular bone and denser cortical bone. OCT-Angiography show in this case a quiescent choroidal neovascularization without exudation on B-scan OCT. Conclusions and importance: SS-OCT and OCT-angiography allow a nearly histological description of choroidal osteoma. Patient consent: Written consent to publish this case has not been obtained. This report does not contain any personal identifying information.

Increased choroidal thickness: a new indicator for monitoring diabetic macular oedema recurrence.

PURPOSE: The aim of this study was to determine whether choroidal thickness (CT) increases at the time of exudative recurrence in diabetic patients with unilateral diabetic macular oedema (DME) treated with intravitreal injections of anti-VEGF or dexamethasone. METHODS: A real-life, prospective, two-centre study was conducted over a 9-month period investigating diabetic patients presenting with unilateral DME treated with anti-VEGF or dexamethasone intravitreal injections, and CT was measured manually, using the enhanced depth imaging module of the spectral domain optical coherence tomography. Choroidal thickness (CT) was measured in the morning, in both the affected and healthy eye of each patient at two timepoints: when the macula was 'dry' (T0) and at the time of exudative recurrence (T1). RESULTS: A total of 51 patients with unilateral DME were included. Mean CT in the affected eye was significantly thicker at the time of exudative recurrence (210.8 ± 44.1 µm at T0 versus 238.0 ± 49.0 µm at T1, p < 0.001). There was no significant variation in CT in the fellow eye (214.4 ± 52.3 µm at T0 versus 218.9 ± 53.4 µm at T1, p = 0.53). The type of intravitreal injection, the number of injections and the CT at T0 had no influence on the change in CT. CONCLUSION: This study found that CT increased significantly in the affected eye at the time of recurrence of DME treated with anti-VEGF or dexamethasone injections. Choroidal thickness (CT) could constitute an interesting new indicator for monitoring patients with DME.

Idiopathic polypoidal choroidal vasculopathy in Caucasians: The POLYON real-life study in 50 naive patients.

OBJECTIVES: Polypoidal choroidal vasculopathy is a common disease in Asia, but it has been less described in the Caucasian population. The aim of this real-life observational study was to describe the diagnostic and therapeutic practices as well as the prognosis in this population. METHOD: Fifty Caucasian patients with polypoidal choroidal vasculopathy were included in this study. All patients underwent angiography to confirm the diagnosis. Patients were divided into two treatment groups: patients of group 1 only received anti-vascular endothelial growth factor injections and those of group 2 required photodynamic therapy rescue in addition to intravitreal injections in case of suboptimal (anatomically or functionally) response. Clinical (visual acuity, fundus examination), paraclinical (retinal pigment epithelium detachment height and central retinal thickness on optical coherence tomography), and therapeutic (number of intravitreal injections) criteria were analyzed after 24 months. RESULTS: Patient mean age was 73.9 ± 9.1 years, and half of the patients had age-related macular degeneration. In the whole cohort, the initial visual acuity was equivalent to the final visual acuity (59.9 ± 24.0 letters vs 62.5 ± 21.1 letters, p = 0.259). In group 1, the final visual acuity was significantly increased (from 56.9 ± 24.7 letters to 63.4 ± 21.6 letters, p = 0.016), while in group 2, it remained stable (from 61.7 ± 23.4 letters to 61.0 ± 21.4 letters, p = 0.249). The number of intravitreal injections was similar between both groups. CONCLUSION: In a Caucasian population, polypoidal choroidal vasculopathy seems to have a later onset. A non-standardized management allows stabilizing the functional prognosis. Patients requiring photodynamic therapy rescue have a poorer prognosis.

Comparison of two biometers: A swept-source optical coherence tomography and an optical low-coherence reflectometry biometer.

PURPOSE: The technological improvements in optical biometers have made cataract surgery evolve to the level of refractive surgery. This study assessed the correlation and agreement between a biometer using swept-source optical coherence tomography technology (IOLMaster 700; Carl Zeiss Meditec, Jena, Germany) and a biometer using optical low-coherence reflectometry (Lenstar; Haag Streit, Koeniz, Switzerland). PROCEDURES: Optical biometric measurements were taken with the IOLMaster 700 and the Lenstar on 129 eyes of 129 patients referred for cataract surgery. We compared biometric data (axial length, mean keratometry, central pachymetry, anterior chamber depth, lens thickness, and horizontal white-to-white measurement) and the emmetropic intraocular lens power calculated with SRK/T and Haigis formulas. Correlation and agreement for these parameters were evaluated. RESULTS: Only anterior chamber depth measurements (3.05 ± 0.07 vs 3.07 ± 0.07, p < 0.001) and the white-to-white measurement (11.97 ± 0.07 vs 12.06 ± 0.07, p < 0.001) differed significantly between the machines. Correlations and agreements were excellent, with perfect agreement for axial length measurement (r = 1, intraclass correlation coefficient = 1). Emmetropic intraocular lens power did not differ between devices with SRK/T formula (20.94 ± 0.51 vs 20.92 ± 0.50, p = 0.51). With Haigis formula, there was a statistically significant difference (21.04 ± 0.52 vs 20.84 ± 0.52, p < 0.001). CONCLUSION: This study suggests that there is a very high correlation and agreement for the biometric measurements and calculation of intraocular lens implant power with the SRK/T formula.

EVALUATION OF OBSTRUCTIVE SLEEP APNEA SYNDROME AS A RISK FACTOR FOR DIABETIC MACULAR EDEMA IN PATIENTS WITH TYPE II DIABETES.

PURPOSE: To evaluate the association between obstructive sleep apnea and diabetic macular edema (DME) in patients with Type II diabetes, using the apnea-hypopnea index and other nocturnal hypoxemia parameters. METHODS: This cross-sectional, case-control study included 99 patients with Type II diabetes: the first group included patients with DME (DME+ group) and the second patients without DME (DME- group). Polysomnography was performed in all patients. The two groups were compared, and the risk factors were studied using logistic regression. RESULTS: The DME+ group comprised 38 patients, and the DME- group comprised 61 patients, aged a mean 68.8 years and 66.3 years (P = 0.27), respectively; mean body mass index was 29.7 and 30.9 (P = 0.16), respectively. The mean apnea-hypopnea index was significantly higher in the DME+ group (43.95 [13.5-87.3]) than in the DME- group (35.18 [3.55-90.7]) (P = 0.034). Patients with DME had more severe obstructive sleep apnea (apnea-hypopnea index >30) than the others: 71% versus 50.8% (P = 0.049). Cumulative time of SPO2 below 90% (CT90%) was independently associated with DME after adjusting for confounding factors, whereas there was no difference between the oxygen desaturation index and minimum O2 saturation. CONCLUSION: Severe obstructive sleep apnea (apnea-hypopnea index >30) and parameters of nocturnal hypoxemia (cumulative time of SPO2 below 90%) are associated with DME.

Increased choroidal thickness: a new feature to monitor age-related macular degeneration recurrence.

PURPOSE: The main objective of this study was to assess choroidal thickness (CT) changes during an exudative recurrence of age-related macular degeneration (AMD). METHODS: A real-life prospective non-interventional 9-month study was conducted in two centers in consecutive patients with exudative AMD between November 2016 and July 2017. CT was measured manually in both eyes based on enhanced-depth imaging spectral-domain optical coherence tomography at different follow-up visits scheduled in the morning. RESULTS: A total of 134 patients were included. Ninety-five patients presented at least one episode, defined by a follow-up visit under controlled condition (dry retina) followed by a visit for exudative recurrence. A total of 119 episodes were analyzed. The mean CT change in the treated eye was + 8.45 ± 13.52 µm (p < 0.001) and + 5.62 ± 14.77 µm (p = 0.009) respectively in the subfoveal area and nasal area. No significant change in CT was observed in the fellow eye. No significant association between CT changes and treatment, number of intravitreal injections, and blood pressure was observed. CONCLUSION: CT increased in case of exudative recurrence of neovascular AMD. The increase was mild but significant. Thus, CT could be used as a monitoring criterion, like the central retinal thickness, in AMD management.

Retinal vein occlusion and obstructive sleep apnea: a series of 114 patients.

PURPOSE: Evaluate the prevalence of obstructive sleep apnea (OSA) in patients with retinal vein occlusion (RVO). METHODS: A prospective and controlled study including 114 patients from January to September 2016, who were divided into two groups: 69 patients with RVO (RVO+) and 45 controls (RVO-), matched for age, sex and disease. All the patients completed a simple questionnaire and the Epworth Sleepiness Scale and underwent a RUSleeping® (portable monitoring device and then continuously monitored the subject's respiration to detect respiratory events). In addition, all patients with RVO were administered OSA screening with a polysomnography (PSG) during an overnight stay in the hospital, which was analysed by a single sleep apnea specialist. RESULTS: Sleep apnea was suspected in 73.9% in the RVO group and 63% in the control group based on the simple questionnaire; 22% in the RVO group and 4.3% in the control group according to the Epworth Sleepiness Scale; 82.6% in the RVO group and 55.6% in the control group (p = 0.005) according to RUSleeping® . Multivariate logistic regression analysis (based on RUsleeping® ) confirmed that RVO was associated with OSA (adjusted odds ratio, 5.65, [1.60-19.92], p = 0.007). All patients in the RVO group were confirmed by PSG, and finally, 91.5% were diagnosed with moderate-to-severe OSA. Among the RVO+ patients, the mean apnea-hypopnoea index (AHI) was 42.2 events per hour (7.7-96.5). OSA was moderate in 22% patients and severe in 69.5% patients. There was no significant relationship between RVO severity and the PSG data variables. CONCLUSION: The systematic screening of OSA with the gold standard PSG found a high prevalence of OSA in patients with RVO. The OSA is probably a risk factor associated with RVO. Polysomnography remains the gold standard method; nevertheless, the RUsleeping® RTS portable monitoring device can assess the presence and severity of sleep apnea with a low failure rate and a single use, prior to PSG, which is less available in clinical practice. Further studies with larger samples are needed to clarify the association.