Two-Year Changes in Corneal Spherical Aberration After Laser-Assisted In Situ Keratomileusis and Photorefractive Keratectomy in Regular and Wavefront-Guided Ablations.

INTRODUCTION: The aim of this study was to analyze the changes in corneal spherical aberration following regular ablation (RA) and wavefront-guided (WFG) ablations in photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK). METHODS: A retrospective analysis was performed on the eyes that underwent femtosecond LASIK or PRK between January 2016 and December 2018. Changes in the corneal spherical aberration were measured preoperatively and postoperatively with a high-resolution Scheimpflug camera system, and they were correlated with the attempted correction and all other tomography parameters. RESULTS: Of the 3826 eyes that were reviewed, 484 eyes met the inclusion criteria and were enrolled in the study. Seventy-four eyes underwent PRK and 410 eyes underwent LASIK. The LASIK and PRK subgroups were similar in terms of the general demographics, preoperative higher-order aberrations, and manifest spherical equivalent. The changes in spherical aberration were significantly correlated with the attempted correction in both LASIK (y = -0.35x and R2 = 0.42 for myopic WFG; y = -0.18x and R2 = 0.19 for myopic RA; y = -0.44x and R2 = 0.49 for hyperopic WFG; y = -0.53x and R2 = 0.69 for hyperopic RA) and PRK (y = -0.20x and R2 = 0.25 for myopic WFG; y = -0.37x and R2 = 0.44 for myopic RA). No other preoperative parameters except corneal asphericity, axial length, and anterior chamber depth were significantly correlated with the changes in the spherical aberration. CONCLUSIONS: LASIK correction had a higher induction of spherical aberration compared with that of PRK, and the beneficial effect of the WFG treatment on spherical aberration was mainly visible in the PRK-treated eyes.

A Novel Device to Exploit the Smartphone Camera for Fundus Photography.

Purpose. To construct an inexpensive, convenient, and portable attachment for smartphones for the acquisition of still and live retinal images. Methods. A small optical device based on the principle of direct ophthalmoscopy was designed to be magnetically attached to a smartphone. Representative images of normal and pathological fundi were taken with the device. Results. A field-of-view up to ~20° was captured at a clinical resolution for each fundus image. The cross-polarization technique adopted in the optical design dramatically diminished corneal Purkinje reflections, making it possible to screen patients even through undilated pupils. Light emission proved to be well within safety limits. Conclusions. This optical attachment is a promising, inexpensive, and valuable alternative to the direct ophthalmoscope, potentially eliminating problems of poor exam skills and inexperienced observer bias. Its portability, together with the wireless connectivity of smartphones, presents a promising platform for screening and telemedicine in nonhospital settings. Translational Relevance. Smartphones have the potential to acquire retinal imaging for a portable ophthalmoscopy.

TREATMENT OF EXUDATIVE AGE-RELATED MACULAR DEGENERATION WITH RANIBIZUMAB COMBINED WITH KETOROLAC EYEDROPS OR PHOTODYNAMIC THERAPY.

PURPOSE: To evaluate whether ketorolac eyedrops plus intravitreal ranibizumab (IVR) or verteporfin photodynamic therapy plus IVR provides additional benefit over IVR monotherapy for treatment of choroidal neovascularization in age-related macular degeneration. METHODS: This was a prospective, randomized, pilot study in 75 patients with naive choroidal neovascularization. Patients were randomized 1:1:1 into 3 groups: ranibizumab monotherapy (RM), ranibizumab plus ketorolac, or ranibizumab plus loading-phase reduced-fluence verteporfin photodynamic therapy (RV) groups. RESULTS: At 12 months, all groups showed significant improvement in both best-corrected visual acuity and central retinal thickness. The mean best-corrected visual acuity change from baseline to 12 months was -0.14 ± 0.52 logMAR (20/73 ± 20/29), -0.25 ± 0.60 logMAR (20/46 ± 20/27), and -0.10 ± 0.30 (20/97 ± 20/40) logMAR in RM, ranibizumab plus ketorolac, and RV groups, respectively. The mean central retinal thickness change from baseline to 12 months was -125 ± 15 µm, -141 ± 21 µm, and -130 ± 15 µm in RM, ranibizumab plus ketorolac, and RV groups, respectively. Both ranibizumab plus ketorolac and RV groups required fewer IVR treatments than RM. CONCLUSION: Compared with RM and ranibizumab plus verteporfin photodynamic therapy, the combination of 0.45% ketorolac eyedrops 3 times a day and ranibizumab in patients with choroidal neovascularization provided superior best-corrected visual acuity and central retinal thickness outcomes. Both combination regimens required fewer IVR injections than RM during the 12-month follow-up period.

Comparison of smartphone ophthalmoscopy with slit-lamp biomicroscopy for grading diabetic retinopathy.

PURPOSE: To assess the accuracy and reliability of smartphone ophthalmoscopy, we compared the ability of a smartphone ophthalmoscope with that of a slit-lamp biomicroscope to grade diabetic retinopathy (DR) in patients with diabetes mellitus (DM). DESIGN: Clinical-based, prospective, comparative instrument study. METHODS: This comparative clinical study was performed in 120 outpatients (240 eyes) with type 1 or type 2 DM. After pupil dilation, the patients underwent smartphone ophthalmoscopy with the D-Eye device, followed by dilated retinal slit-lamp examination, to grade DR according to a 5-step scale. RESULTS: Overall exact agreement between the 2 methods was observed in 204 of 240 eyes (85%) (simple κ = 0.78; CI 0.71-0.84) and agreement within 1 step was observed in 232 eyes (96.7%). Compared to biomicroscopy, the sensitivity and specificity of smartphone ophthalmoscopy for the detection of clinically significant macular edema were 81% and 98%, respectively. Smartphone ophthalmoscopy and biomicroscopy could not be used to examine the fundus and grade DR in 9 eyes (3.75%) and 4 eyes (1.7%), respectively, because of cataract and/or small pupil diameter. CONCLUSION: Smartphone ophthalmoscopy showed considerable agreement with dilated retinal biomicroscopy for the grading of DR. The portability, affordability, and connectivity of a smartphone ophthalmoscope make smartphone ophthalmoscopy a promising technique for community screening programs.

Topical nonsteroidal anti-inflammatory drugs for macular edema.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are nowadays widely used in ophthalmology to reduce eye inflammation, pain, and cystoid macular edema associated with cataract surgery. Recently, new topical NSAIDs have been approved for topical ophthalmic use, allowing for greater drug penetration into the vitreous. Hence, new therapeutic effects can be achieved, such as reduction of exudation secondary to age-related macular degeneration or diabetic maculopathy. We provide an updated review on the clinical use of NSAIDs for retinal diseases, with a focus on the potential future applications.

A randomised controlled trial of ranibizumab with and without ketorolac eyedrops for exudative age-related macular degeneration.

AIMS: To evaluate whether ketorolac eyedrops and ranibizumab intravitreal injections would provide additional benefit over ranibizumab alone in the treatment of choroidal neovascularisation (CNV). METHODS: This was a pilot study of eyes with new-onset CNV. A total of 56 patients were enrolled consecutively and randomised in a 1:1 ratio to receive combination treatment with intravitreal ranibizumab and topical ketorolac (group 1) or ranibizumab alone (group 2). All patients received monthly 0.5-mg ranibizumab intravitreal injections for 3 months, after which monthly injections were administered in accordance with the standard of care. Group 1 patients also self-administered one drop of ketorolac three times a day for 6 months. All patients were followed up for 6 months. RESULTS: At 6 months, both groups showed a significant improvement in best-corrected visual acuity (both, p<0.001). The two treatments did not show significant differences in terms of the number of ranibizumab injections required. However, the mean 6-month change in central macular thickness (CMT) in the combination group was -124 µm (-29.7%; p<0.001), while in the ranibizumab-only group, the change was -86.9 µm (-19.5%; p=0.001); thus, the combination treatment resulted in a greater reduction (p=0.003). The combination treatment had no adverse effects. CONCLUSIONS: This pilot study is the first to prospectively investigate the efficacy and safety of a combination of 0.45% ketorolac eyedrops three times a day and intravitreal ranibizumab injections in patients with CNV, and suggests that topical ketorolac supplements the activity of intravitreal ranibizumab in reducing CMT in CNV.

Recurrent central serous chorioretinopathy after peripheral retinal laser photocoagulation: a case report.

PURPOSE: To report a case of recurrent central serous chorioretinopathy (CSC) after performing peripheral laser photocoagulation for retinal degenerations. METHODS: A 44-year-old woman with ocular history of CSC presented to the emergency room of our department complaining of heavy photopsia due to retinal tuft and lattice degenerations, and underwent laser photocoagulation to prevent retinal detachment. RESULTS: Two days after laser treatment, the visual acuity dropped, and optical coherence tomography scan showed the onset of CSC. The serous detachment completely resolved in 20 days with no therapy. A new CSC episode occurred in the same eye after another analogous laser treatment and, similarly, quickly resolved spontaneously. CONCLUSIONS: We reviewed the literature and discuss the possibility that laser-induced inflammation could rouse an inflammatory cascade mediated by proinflammatory cytokines and PAI-1, leading to the exacerbation of retinal serous detachment in susceptible patients.

Correlation between visual acuity and OCT-measured retinal nerve fiber layer thickness in a family with ADOA and an OPA1 mutation.

PURPOSE: To assess the association between retinal nerve fiber layer (RNFL) thickness and visual acuity in a family from Siracusa (Sicily) with autosomal dominant optic atrophy (ADOA) due to a heterozygous c.869G>A OPA1 mutation. METHODS: Affected family members underwent complete neuro-ophthalmological evaluation, including visual acuity testing, colour vision testing, tonometry, visual field testing, colour fundus photography, pattern visual-evoked potential (PVEP) testing, and pattern electroretinography (PERG). Patients and age-matched control subjects were scanned by spectral-domain optical coherence tomography (SD-OCT) to assess circumpapillary RNFL thickness. RESULTS: All patients showed the characteristic optic disc pallor and central scotomas in the visual field. PVEP testing and PERG also showed alterations consistent with ADOA. The average circumpapillary RNFL thickness was thinner in ADOA patients than in control subjects (60.87 ± 6.58µm and 108.13 ± 6.53µm, respectively; p = 0.0001). The visual acuity in patients with ADOA correlated significantly with the circumpapillary average RNFL thickness (r = -0.845, p = 0.008). CONCLUSIONS: OCT-measured peripapillary RNFL thickness is reduced in ADOA patients compared with healthy subjects and correlates significantly with visual acuity in patients with ADOA. The photoreceptor layers are morphologically unaffected.