Changes in Limbal Optical Coherence Tomography Angiography Outcomes in Patients With Overnight Contact Lens Wear.

OBJECTIVES: To evaluate the perilimbal vasculature of patients who wear contact lenses (CLs) overnight with optical coherence tomography angiography (OCTA) and compare the results with healthy population. METHODS: Forty-two patients were included in this observational study. The OCTA imaging was performed in the temporal quadrant of the perilimbal region using a swept-source optical coherence tomography system (Triton DRI-OCT; Topcon Corporation, Tokyo, Japan). The assessments were made in two depths: starting from the conjunctival epithelium to 200 µm scleral depth and the scleral depth between 200 and 1,000 µm. The vessel density, vessel length density, vessel diameter index, and fractal dimension were the main outcomes and compared between overnight CL users and healthy population. RESULTS: Twenty-two patients who have been using CLs overnight for at least 3 months and 20 healthy individuals were included in the study. The vessel density at the superficial layer was significantly higher in the CL group compared with the control group (P<0.001). Vessel diameter index, vessel length density, and fractal dimension at the superficial layer did not differ between the groups (P>0.05 for all). There was no difference in the vessel density, vessel diameter index, vessel length density, and fractal dimension in the deep layer between the groups (P>0.05 for all). CONCLUSIONS: Patients who use CL overnight exhibit increased vessel density in the superficial layers of the perilimbal region, which may suggest new vessel formation in the conjunctiva. Anterior segment OCTA may be useful to evaluate the initial changes in limbal vasculature in CL users.

Airborne pathogen projection during ophthalmic examination.

PURPOSE: Microscale droplets act as coronaviruses (CoV) carriers in the air when released from an infected person and may infect others during close contact such as ophthalmic examination. The main objective of the present work is to demonstrate how CoV deposited droplets are projected during biomicroscopy and to discuss what kind of precautions should be taken in ophthalmic practice. METHODS: A coupled fluid-structure system comprising smoothed particle hydrodynamics and the finite element method has been built to assess the projection of droplets spreading from an infected person. Different conditions based on the maximum exit flow velocity from the infector's mouth during the ophthalmic examination were modeled. RESULTS: During exhalation, for which the exit flow is ~ 1000 mm/s, the average horizontal distance of the flow front was ~ 200 mm while individual particles can reach up to ~ 500 mm. In case of coughing or sneezing (corresponding to an exit flow of ~ 12,000 mm/s), the average horizontal distance of the flow front was ~ 1300 mm. CONCLUSION: During the ophthalmic examination, the proximity to the patient's nose and mouth was observed to be less than the horizontal distance of flow front particles. Even though mounted breath shields are used, particles flew beyond the shield and contaminate the ophthalmologist. Compared with the current protective breath shields, the use of a larger shield with a minimum radius of 18 cm is needed to decrease viral transmission.

Ocular manifestations of coronavirus disease 2019.

PURPOSE: Coronavirus disease 2019 (COVID-19) is an ongoing global public health problem, and most of the COVID-19 research is focused mainly on the respiratory system because of life-threatening results. However, manifestations in other organs should not be ignored since they can also be a mode of transmission. We sought to describe the ocular manifestations of COVID-19 and investigate the association between ocular involvement and clinical presentation and laboratory outcomes. METHODS: This cross-sectional study was conducted between March 1, 2020, and April 30, 2020. Ninety-three sequentially hospitalized and clinically confirmed COVID-19 patients were included in the study. The systemic and ocular symptoms, clinical findings, and laboratory outcomes were recorded. RESULTS: Of the 93 COVID-19 patients, 54 (58.1%) were male, and 39 (41.9%) were female. Mean age of the patients was 39.4 ± 21.9 (min 7, max 88) years. Twenty patients (n 21.5%) had at least one ocular abnormality. Most common findings included hyperemia (n = 20), epiphora (n = 9), increased secretion (n = 6), chemosis (n = 3), follicular conjunctivitis (n = 2), and episcleritis (n = 2). The most common symptom was photophobia (n 15). Patients with ocular involvement were more likely to have higher neutrophil counts (p = 0.001), and increased CRP (p < 0.001), PCT (p = 0.001), and ESR levels (p < 0.001). Mean lymphocyte count was statistically lower in patients with ocular manifestations (p = 0.001). Mean age and number of patients with fever over 37.3 °C in the ocular involvement group was found to be higher (p < 0.001, p = 0.006, respectively). CONCLUSION: Older age, high fever, increased neutrophil/lymphocyte ratio, and high levels of acute phase reactants seemed to be risk factors for ocular involvement.

Clinical outcomes and optical performance of four differentmultifocal intraocular lenses.

BACKGROUND/AIM: The purpose of the present study was to evaluate clinical outcomes and optical performance of 4 different multifocal intraocular lenses (IOLs). MATERIALS AND METHODS: Ninety eyes of 51 patients who received Reviol MFM 611, Reviol MFM 625, Acri.LISA, and ReSTOR SN6AD3 multifocal IOLs after cataract surgery were retrospectively evaluated. The patients were similar in terms of age, sex, cataract hardness and axial length. The mean outcome measures were uncorrected and corrected distance visual acuity (UDVA, CDVA), distance-corrected intermediate and near visual acuity (DCIVA, DCNVA), intra or postoperative complications, and contrast sensitivity (CS) results under mesopic conditions. The mean follow up period was 10.5 months (range: 6-12 months). RESULTS: All cases were within ± 0.75 D of emmetropia. Postoperative increase in UDVA and DCNVA was statistically significant in all groups. The Acri.LISA group showed slightly lower DCIVA compared with the other IOLs. CS was clinically similar between the groups. None of the patients developed any early or late postoperative complication or neuroadaptation problem, which necessitated explantation of the lens. CONCLUSION: All four multifocal lens designs provided satisfactory visual functions and CS results in patients who fulfilled the criteria for multifocal lens implantation.

Comparison of tear osmolarity and ocular comfort between daily disposable contact lenses: hilafilcon B hydrogel versus narafilcon A silicone hydrogel.

The aim of this study was to evaluate tear osmolarity and ocular comfort with two different types of hydrogel daily disposable lenses. The right eyes of 15 first-time contact lens users were included in this prospective study. All eyes wore hilafilcon B silicone hydrogel contact lenses for 8 h (group 1). After 1 week without contact lenses, all eyes wore narafilcon A silicone hydrogel contact lenses for 8 h (group 2). Tear osmolarity measurement was performed before and after 4 and 8 h of each contact lens wear. Ocular comfort was assessed after 4 and 8 h of each contact lens wear. In group 1, the mean baseline, 4- and 8-h tear osmolarity values were 293 ± 10.57, 303.00 ± 10.5 mOsm/L (p = 0.023), and 295.0 ± 1.4 mOsm/L (p > 0.05), respectively. In group 2, the mean baseline, 4- and 8-h tear osmolarity values were 294 ± 13.65, 300.9 ± 11.3 mOsm/L (p = 0.007), and 298.80 ± 7.2 mOsm/L (p > 0.05), respectively. In group 1, the mean comfort score was 7.20 ± 0.45 and 8.60 ± 0.45 at 4 and 8 h, respectively (p = 0.038). In group 2, the mean comfort score significantly decreased from 9.80 ± 0.45 to 7.80 ± 0.84 at 4 h (p = 0.039). Both hydrogel and silicone hydrogel daily disposable contact lenses elevated tear osmolarity during 8 h of contact lens wear. The increase in tear osmolarity with both contact lenses was below the cut-off value for dry eye and was not associated with ocular comfort.

Comparison of clinical outcomes with 2 small-incision diffractive multifocal intraocular lenses.

PURPOSE: To evaluate and compare the clinical results of 2 diffractive multifocal small-incision intraocular lenses (IOLs) implanted after biaxial microincision cataract surgery (MICS). SETTING: Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey. DESIGN: Comparative case series. METHODS: Eyes that had biaxial MICS with implantation of an Acri.Lisa 366D IOL (Group 1) or Acriva Reviol MFM 611 IOL (Group 2) were followed for at least 6 months postoperatively. Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuities; corrected distance visual acuity; distance-corrected intermediate and near visual acuities; and contrast sensitivity measurements with and without glare were determined. Early and late complications and subjective complaints were recorded and evaluated. RESULTS: The study enrolled 60 eyes of 32 patients. The preoperative and intraoperative data were comparable in the 2 IOL groups. There were no statistically significant postoperative differences in the mean spherical equivalent (Group 1, -0.30 diopter (D) ± 0.30 [SD]; Group 2, -0.26 ± 0.28 D; P=.584), mean UDVA (0.80 ± 0.14 and 0.86 ± 0.17, respectively; P=.158), and mean Jaeger UNVA (1.46 ± 0.73 and J 1.23 ± 0.50, respectively; P=.155). However, there was a significant difference in mean Jaeger UIVA (3.06 ± 0.90 and 2.23 ± 0.72, respectively; P=.000). Mesopic contrast sensitivity and the incidence of complications and dysphotopsia symptoms were not significantly different between the 2 IOL groups. CONCLUSIONS: Both IOLs provided excellent distance and near visual acuity and contrast sensitivity. The Group 2 IOL gave better intermediate distance results.

Spontaneous dislocation of posterior chamber intraocular lenses (PC IOLs) in patients with retinitis pigmentosa - Case series.

PURPOSE: To report the outcomes of intraocular lens (IOL) dislocation management in 6 cases with Retinitis Pigmentosa (RP). SETTING: Private practice, Los Angeles, USA. DESIGN: Retrospective interventional case series. METHODS: The medical reports of six eyes of four RP patients with capsule bag fixated posterior chamber IOL dislocation were retrospectively reviewed. Pre-operative data included demographics, systemic or ocular disorders, history of trauma, previous intraocular surgery and pre-operative visual acuity. Outcome measures included the type of surgery, surgical complications, elevation of intraocular pressure (IOP), ocular inflammation, cystoid macular edema (CME) and IOL dislocation at 3 months or greater post-operatively. RESULTS: The medical records of six eyes of four patients operated on between December 2009 and May 2011 were evaluated. In four cases, dislocated PC IOL implants were sutured to the sclera. In two eyes of one patient anterior chamber IOLs (AC IOLs) were implanted after PC IOLs were explanted. One eye developed CME during the follow-up period. Despite modest tilt in one case and modest decentration in another, stability and centration of the IOLs was excellent during the follow-up period. No eyes had intraocular inflammation requiring long term medical treatment, new onset glaucoma or retinal detachment. Mean follow-up time was 6.9 months (range 3-20). CONCLUSIONS: Cataract surgeons should be aware of the increased risk for decentration and malposition of PC IOLs in patients with RP. Satisfactory results can be achieved by fixation of the PC IOL or AC IOL implantation.

Tear meniscus analysis with Fourier-domain optical coherence tomography in keratoconus.

PURPOSE: To measure the lower tear meniscus dynamics with Fourier domain-optical coherence tomography (FD-OCT) in keratoconus patients without dry eye findings to evaluate the effects of the corneal ectasia on lower tear meniscus parameters, and to determine the most affected meniscus variable from the corneal ectasia in keratoconus. METHODS: Prospective, clinical study. Forty-one eyes of 25 keratoconus patients without dry eye and 40 eyes of 20 healthy subjects were included. The lower tear meniscus analysis with FD-OCT, and corneal topography, keratometry, and pachymetry measurements were performed in all eyes. The main outcomes, including the lower tear meniscus height (TMH), depth (TMD), area (TMA), and angle between cornea and the tear meniscus (α-angle), were assessed. The results were compared between the patients and the control subjects. RESULTS: The average keratometric power was 53.94 ± 5.76 D (between 44.46 to 63.75 D) in keratoconic eyes. It was 43 ± 0.8 D (between 40.50 to 45.94 D) in the controls. The average TMH, TMD, and TMA values did not show any statistically significant difference between the patients and the controls (p = 0.39, p = 0.824, p = 0.516, respectively). However, the average value of the α-angle was significantly higher in keratoconic eyes when compared to controls (p = 0.031). It was positively correlated with the keratometric power (r = 0.577, p = 0.001). CONCLUSIONS: The TMH, TMD, and TMA did not show any change with the corneal protrusion; however, the α-angle had positive correlation with the keratometric power in keratoconic eyes.

Anterior segment optical coherence tomography evaluation and comparison of main clear corneal incisions in microcoaxial and biaxial cataract surgery.

PURPOSE: To use Fourier-domain anterior segment optical coherence tomography (AS-OCT)) to evaluate the main clear corneal incisions (CCIs) in microcoaxial and biaxial cataract surgery, the effects of incision enlargement, and the probable reasons for problematic healing. SETTING: Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey. DESIGN: Cohort study. METHODS: Eyes that had microcoaxial cataract surgery through a 1.8 mm CCI or biaxial cataract surgery through a 1.2 to 1.4 mm trapezoidal CCI were divided into 2 equal subgroups based on incision enlargement. All surgeries were completed by stromal hydration. Incisions were evaluated 1, 8, and 30 days postoperatively. RESULTS: The CCIs in the microcoaxial group were longer, thinner, and more slanted than those in the biaxial group, with no statistical difference. The microcoaxial incisions had significantly more arcuate configuration at 1 day (P=.003); however, the configuration became linear in the following days in both groups. The endothelial gap rates were less and Descemet membrane detachment rates greater than reported in the literature. In eyes with enlarged CCIs, the endothelial gap rate was higher in the microcoaxial group and the Descemet membrane detachment rate was higher in the biaxial group (both P=.05). At 1 day, the intraocular pressure (IOP) was significantly lower in Descemet membrane detachment and endothelial gap cases (P=.006 and P<.001, respectively). CONCLUSIONS: Although closure was reliable in both groups, the microcoaxial group had slightly fewer undesirable effects on the incision site. Low postoperative IOP seemed to be a significant factor in problematic healing.

Aspheric microincision intraocular lens implantation with biaxial microincision cataract surgery: efficacy and reliability.

PURPOSE: To evaluate the efficacy and reliability of a microincision intraocular lens (IOL) and its use in biaxial microincision cataract surgery (MICS). SETTING: Atatürk Training and Research Hospital, Ankara, Turkey. DESIGN: Prospective clinical study. METHODS: A microincision IOL (Akreos MI60) was implanted after cataract extraction by the biaxial MICS technique. Over a postoperative follow-up of 12 months or more, visual acuity, contrast sensitivity, surgically induced astigmatism (SIA), corneal and ocular aberrations, and early and late complications were recorded. RESULTS: The IOLs were implanted in the capsular bag in all 100 eyes. The mean final incision size was 1.82 mm ± 0.09 (SD). Postoperatively, the mean corrected distance visual acuity was 0.06 ± 0.10 logMAR; the mean spherical equivalent, -0.48 ± 0.91 diopter (D); and the mean calculated SIA, 0.20 ± 0.22 D. Contrast sensitivity with and without glare was within normal limits. There was no statistically significant difference in the root mean square of total corneal aberrations between preoperatively and postoperatively. Ocular wavefront analysis 3 months postoperatively showed mean values of 0.15 ± 0.2 µm for spherical aberration, 0.38 ± 0.16 µm for higher-order aberrations, 0.18 ± 0.14 µm for coma, and 0.14 ± 0.08 µm for trefoil. The 4 cases (4.0%) of membranous anterior chamber reaction resolved with treatment. None of the 20 eyes (20.0%) with posterior capsule opacification required neodymium:YAG capsulotomy. All IOLs remained well centered. CONCLUSION: The aspheric microincision IOL was safely implanted through a 1.8 mm or smaller incision during biaxial MICS and gave good postoperative outcomes.