Prospective Evaluation of the First Mitomycin C Augmented Needle Revision in Patients With Failed Nonpenetrating Deep Sclerectomy.

PRECIS: At 6 months the procedure achieved a 33.89% drop in intraocular pressure (IOP), had an overall success rate of 57.15%, and did not change the best-corrected visual acuity. Achieving <8 mm Hg of IOP the day after the procedure may be a prognostic success indicator. PURPOSE: The purpose of this study was to evaluate the first mitomycin C (MMC)-augmented needle revision in patients with failed nonpenetrating deep sclerectomy (NPDS) and factors associated with its success. MATERIALS AND METHODS: This prospective, nonrandomized comparative trial included 21 consecutive patients (21 eyes) who underwent their first MMC needling revision of failed NPDS blebs. The success was defined as absolute if the IOP decreased >20% from the preoperative value without antiglaucoma treatment and as qualified if that level was achieved with antiglaucoma medications. Preoperative and postoperative factors were evaluated for an association with postoperative success using Kaplan-Meier analysis. RESULTS: A significant reduction in mean IOP from preoperative levels was evident at the end of the follow-up. The overall surgical success rate was 57.15%. On the basis of Kaplan-Meier survival analysis, we found that patients whose IOP on the following day of the procedure was <8 mm Hg had a higher success rate than those whose 1-day postoperative IOP was higher. These patients had a percentage of success of 100%, 84.6%, and 76.9% at 1-, 3-, and 6-month postoperative follow-up, respectively. CONCLUSION: The IOP level on the first postoperative day could be considered a prognostic indicator of success in needling revision performed in failed NPDS.

Role of Tear Osmolarity in Dry Eye Symptoms After Cataract Surgery.

PURPOSE: To analyze changes in tear osmolarity and the Ocular Surface Disease Index (OSDI) in patients after cataract surgery. DESIGN: Prospective, observational cohort study. METHODS: setting: Institutional. PATIENT POPULATION: Fifty-two patients with a unilateral cataract (study eye) scheduled for surgery and good visual function in the fellow (control eye). Patients were excluded who were receiving chronic topical therapy, such as glaucoma medications, or had a history of previous ocular surgery. INTERVENTION: Examinations were performed preoperatively and 1 and 3 months postoperatively. At each visit, complete anterior and posterior segment examinations were performed. MAIN OUTCOME MEASURES: Best-corrected and uncorrected visual acuities, tear osmolarity, and OSDI scores. RESULTS: The mean tear osmolarity values were, respectively, 305.63 ± 15.07, 305.70 ± 16.48, and 303.88 ± 11.75 mOsm/L at baseline and 1 and 3 months postoperatively (P = .067), compared with 309.74 ± 15.92, 306.74 ± 13.22, and 303.19 ± 11.02 mOsm/L at the same times in the unoperated control eyes (P = .064). Patients with normal osmolarity (<312 mOsm/L) and hyperosmolarity values (≥312 mOsm/L) had respective OSDI scores of 22.77 ± 15.73 and 36.02 ± 12.20 at baseline (P = .01), 12.44 ± 12.44 and 14.45 ± 13.45 at 1 month (P = .7), and 10.37 ± 11.11 and 16.48 ± 8.08 at 3 months postoperatively (P = .01). CONCLUSIONS: We did not find differences in tear film osmolarity between the operated eyes and the fellow unoperated control eyes at any time period during the study. Patients with tear osmolarity values of 312 mOsm/L or higher are more likely to have more ocular discomfort postoperatively. Ophthalmologists should consider evaluating tear osmolarity preoperatively, especially in highly demanding patients.

Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes in the Anterior Segment Structures after Deep Sclerotomy Versus Phaco-Deep Sclerotomy with Intraoperative Mitomycin-C and No Implant Use.

This article has been retracted.

Effect of diabetes mellitus on Corvis ST measurement process.

PURPOSE: Diabetes mellitus (DM) affects corneal biomechanical parameters. We compared analyses using ORA (Ocular response analyser) and Corvis ST to determine the influence of disease duration, hyperglycaemia and haemoglobin A1c (HbA1c) levels on these parameters. METHODS: This observational, cross-sectional, observer-masked study assessed one eye of 94 consecutive DM patients and 41 healthy subjects. Two DM groups were analysed: the uncontrolled DM group (n = 54) (HbA1c ≥ 7%) and the controlled DM group (n = 40) (HbA1c < 7%). Central corneal thickness (CCT) was measured by ultrasonic pachymetry and intraocular pressure (IOP) by Goldmann applanation tonometry. ORA and Corvis ST analyses were performed to evaluate the changes. RESULTS: Most of the Corvis ST parameters [Deformation amplitude (DA), A1 and A2 times, A1 velocity] in the uncontrolled DM group eyes were found to be significantly different to controls and controlled DM group eyes (p = 0.005, p = 0.001, p < 0.0001, p = 0.002, respectively). DA on the Corvis ST was correlated with blood glucose concentration (p = 0.004) and HbA1c percentage (p = 0.002). ORA corneal hysteresis was significantly lower in diabetic patients with elevated HbA1c than in control subjects (p = 0.001) and was affected by disease duration (p = 0.037), whereas the corneal resistance factor remained unaltered. CONCLUSIONS: A poor glucose control in DM affects corneal biomechanics measured by ORA and Corvis ST, which may cause high IOP measurements independent of CCT. The measurement of the corneal biomechanics should be taken into consideration in the clinical practice.

Long-term changes in straylight induced by corneal refractive therapy: a pilot study.

PURPOSE: To assess long-term intraocular straylight changes induced by corneal refractive therapy (CRT) and to determine whether these changes persist after cessation of CRT lens wear. METHODS: A single-center, prospective, longitudinal study was performed in 22 subjects (group 1) undergoing overnight corneal refractive therapy for 1 year. Ten right eyes of 10 subjects (group 2) with emmetropia served as controls. In each subject, high contrast visual acuity (HCVA), manifest refraction and intraocular straylight were determined at several time points during treatment and 1 month after discontinuing treatment. Straylight was measured using the van den Berg straylight meter (third generation). EDTRS charts (logMAR units) were used to assess HCVA. For both groups, only data for the right eyes were analyzed. RESULTS: Straylight (mean ± standard deviation) significantly fell from baseline (0.98 ± 0.13) to values recorded after 1 month (0.88 ± 0.13, p=0.011), 3 months (0.88 ± 0.13, p=0.004), 6 months (0.88 ± 0.13, p=0.000) and 12 months (0.76 ± 0.12, p=0.003) of treatment. One month after discontinuing CRT lens wear, straylight was still significantly lower than baseline (0.89 ± 0.13, p=0.003). No correlations were observed between intraocular straylight and HCVA. CONCLUSIONS: Good refractive outcomes and reductions in straylight were observed in response to corneal refractive therapy for myopia. The reduction in straylight observed after discontinuing CRT warrents further investigation.

Visante anterior segment optical coherence tomography analysis of morphologic changes after deep sclerectomy with intraoperative mitomycin-C and no implant use.

PURPOSE: To assess long-term intrascleral space maintenance after nonpenetrating deep sclerectomy (NPDS) without implant placement and with application of intraoperative mitomycin-C, using Visante anterior segment optical coherence tomography (AS-OCT). PATIENTS AND METHODS: This cross-sectional, observational, case series study examined 47 eyes from 47 consecutive patients who had undergone NPDS 58.34±23.77 months earlier. All participants underwent a complete ophthalmologic examination. The presence of intrascleral space and its maximum anteroposterior and transverse lengths, maximum height, and volume were evaluated. The thickness of the trabeculo-Descemet membrane, presence and type of any subconjunctival filtering bleb, as well as scleral and suprachoroidal hyporeflectivity were analyzed. Relationships between intraocular pressure (IOP) levels and AS-OCT parameters were established. RESULTS: AS-OCT examinations revealed an open intrascleral space in all cases. The IOP was negatively correlated with the maximum anteroposterior length, maximum height, and volume of intrascleral space. Significant differences in IOP were found between eyes with low-reflective blebs and eyes with other subconjunctival bleb types. The overall surgical success rate was 89.4%. CONCLUSIONS: NPDS without implant placement and with intraoperative mitomycin C application seems to be an effective and well-tolerated method to reduce IOP with long-term effectiveness, casting doubt on the mandatory use of intrascleral implants in nonpenetrating glaucoma surgery.

Anterior segment changes produced in response to long-term overnight orthokeratology.

PURPOSE: To evaluate the effect of overnight orthokeratology (OK) on anterior chamber depth (ACD), posterior radius of corneal curvature (PRCC) and axial length (AL) over one year. METHODS: In this prospective longitudinal study, measurements were made in 34 right eyes of 34 subjects at baseline, 15 days, 1 and 12 months after starting OK treatment. ACD and PRCC measurements were obtained using a Pentacam system and AL was measured using an IOL-Master. ACD and PRCC were measured along the horizontal and vertical meridians at 1 mm intervals. These measurements were expressed as the distance from the center in the nasal (N), temporal (T), superior (S) and inferior (I) directions. RESULTS: A significant reduction in ACD was observed in both meridians during treatment. PRCC flattened significantly in the (T) direction after 15 d (1 mm, p < 0.05), at the corneal center after 15 d (p < 0.01), in the (T) direction after 1 month (1 mm, p < 0.05), in the (S) direction after 12 months (1 mm p < 0.05), in the (N) direction after 12 months (1 mm p < 0.05), in the (N) and (T) directions after 12 months (3 mm, p < 0.05) and in the (T) direction after 12 months (4 mm p < 0.05), at the corneal center after 12 months (p < 0.01). AL was significantly reduced during treatment (p < 0.05). CONCLUSIONS: A long period of OK reduces ACD and AL and changes PRCC.

Recovery evaluation of induced changes in higher order aberrations from the anterior surface of the cornea for different pupil sizes after cessation of corneal refractive therapy.

PURPOSE: To assess corneal aberration changes induced by corneal refractive therapy (CRT) for different pupil sizes and to examine the recovery after cessation of contact lens wear. METHODS: A single-center, prospective, and longitudinal study was performed. Thirty-four subjects who underwent CRT for 1 year were included. High-contrast corrected distance visual acuity (CDVA), manifest refraction, and corneal topography were determined during the treatment and 1 month after the discontinuation of the treatment. Corneal aberrations were calculated using the Vol-CT 6.89 software. Corneal spherical aberration, Z(4,0), and root mean square values (RMS) for coma-like, trefoil, tetrafoil, and higher order aberrations (HOAs) were estimated for different pupil sizes (3-, 4-, 5-, 6-, and 7-mm diameters). Early Treatment Diabetic Retinopathy Study charts were used to measure CDVA. RESULTS: The CRT treatment induced a statistically significant increase of all aberrations studied for all pupil diameters. RMS values for coma-like, trefoil, and tetrafoil aberrations and HOAs after cessation of contact lens wear were not statistically significantly different for any of the different pupil diameters studied at baseline. However, Z(4,0) significantly increased from baseline to 1 month after discontinuation of the CRT lens wear for 5-, 6-, and 7-mm diameter pupils. CONCLUSIONS: Our results suggest that CRT is a treatment completely reversible at 1 month after cessation of contact lens wear in terms of CDVA, refractive error, and RMS of coma-like aberrations and HOAs for all pupil sizes. However, for spherical aberration, 1 month is not enough to recover to the baseline level.

Long-term changes in corneal morphology induced by overnight orthokeratology.

PURPOSE: To assess long-term morphological and biometric corneal changes produced by overnight orthokeratology and to examine their recovery after cessation of contact lens wear. METHODS: Prospective, single-center, longitudinal trial. Fifteen right eyes with low to moderate myopia underwent overnight orthokeratology for 1 year. The central cornea was examined using a confocal microscope and changes determined in visual acuity, refractive error and corneal topography. Cell counts were performed using both the confocal microscope's software and the image analysis software of the USA Health Institute. All measurements were made during orthokeratology treatment and 1 month after discontinuing treatment. RESULTS: No significant changes in endothelial cell density were observed over time but polymegethism increased significantly and baseline values were not recovered (p < 0.01). Stromal cell density remained unchanged though numbers of activated keratocytes increased during the study and returned to baseline when lens wear ceased. Basal epithelium cell densities significantly fell (p < 0.01) and epithelial wing and superficial cells showed enhanced visibility (p < 0.05). Superficial cells increased in height and width; this width increase being significant after 1 year of orthokeratology (p < 0.01). All epithelial cell changes returned to baseline. Corneal thickness, Bowman layer thickness, subbasal plexus thickness and epithelial thickness were reduced in the central cornea but the stroma was thickened. Of these changes, the decrease in epithelium thickness reached statistical significance (p < 0.01) and baseline values were not recovered. CONCLUSION: Overnight orthokeratology induces structural and optical changes particularly in the central corneal epithelium during myopia treatment. If confirmed, the irreversible changes detected indicate a need for further investigation.

Short-term effects of overnight orthokeratology on corneal cell morphology and corneal thickness.

PURPOSE: To examine the morphological and biometric corneal changes produced over periods of 15 days and 1 month after overnight orthokeratology (OK). METHODS: Prospective, single-center, longitudinal trial. Twenty-seven right eyes of 27 subjects (group 1) with low to moderate myopia wore OK lenses for 1 month. Ten right eyes of 10 subjects (group 2) with emmetropia to low myopia who did not wear any type of contact lens served as controls. Corneal morphometric measurements were obtained in vivo using a confocal microscope to examine the central and midperipheral cornea. Thickness measurements in the peripheral cornea were obtained by optical coherence tomography. Changes in visual acuity, refractive error, and corneal topography were also analyzed. RESULTS: No significant changes in either endothelial cell or stromal cell density were observed after 1 month of OK. Basal epithelial cells were, however, significantly reduced (P < 0.01), and epithelial wing and superficial cells showed enhanced visibility (P < 0.05). Superficial cells increased in height and width, the width increase after 1 month being significant (P < 0.01). Epithelial thickness was significantly reduced in the central cornea and 2 mm around the center. Corneal pachymetry increased significantly in the band from 5 to 10 mm from the corneal apex (P < 0.01). CONCLUSIONS: OK lenses for myopia induce significant structural and optical changes particularly in the central epithelium after 15 days or 1 month of wear. The central corneal epithelium responds to OK wear by undergoing significant epithelial cell shape and size alterations with no effects, however, on the cells of the corneal endothelium or the corneal stroma. Peripheral corneal thickness increased with respect to baseline values. These findings suggest that the corneal epithelium is the principal structure affected by the mechanical forces exerted by the OK lenses.