Neuroinflammatory Findings of Corneal Confocal Microscopy in Long COVID-19 Patients, 2 Years after Acute SARS-CoV-2 Infection.

OBJECTIVE: To describe corneal confocal microscopy findings in patients with long COVID-19 with persistent symptoms over 20 months after SARS-CoV-2 infection. DESIGN: A descriptive cross-sectional study that included a total of 88 patients; 60 patients with Long COVID-19 and 28 controls. Long COVID-19 diagnosis was established according to the World Health Organization criteria. Corneal confocal microscopy using a Heidelberg Retina Tomograph II (Heidelberg Engineering, Heidelberg, Germany) was performed to evaluate sub-basal nerve plexus morphology (corneal nerve fiber density, nerve fiber length, nerve branch density, nerve fiber total branch density, nerve fiber area, and nerve fiber width). Dendritic cell density and area, along with microneuromas and other morphological changes of the nerve fibers were recorded. RESULTS: Long COVID-19 patients presented with reduced corneal nerve density and branch density as well as shorter corneal nerves compared to the control group. Additionally, Long COVID-19 patients showed an increased density of dendritic cells also with a greater area than that found in the control group of patients without systemic diseases. Microneuromas were detected in 15% of Long COVID-19 patients. CONCLUSIONS: Long COVID-19 patients exhibited altered corneal nerve parameters and increased DC density over 20 months after acute SARS-CoV-2 infection. These findings are consistent with a neuroinflammatory condition hypothesized to be present in patients with Long COVID-19, highlighting the potential role of corneal confocal microscopy as a promising noninvasive technique for the study of patients with Long COVID-19.

Interdevice agreement in the measurement of physiognomy parameters and frame angles to prescribe progressive addition lenses.

CLINICAL RELEVANCE: Ophthalmic lens adaptation requires accurate measurements of physiognomy parameters and frame angles, with a great impact on subject vision, especially when personalised progressive addition lenses are prescribed. BACKGROUND: The aim of this study is to describe interdevice agreement between different methods and traditional methods (frame ruler). METHODS: The agreement of the interpupillary distance, nasopupillary distance and fitting point height measured with four devices (PD-5, OptiCenter, Visioffice and a frame ruler) and of pantoscopic and frame wrap angles measured with three devices (OptiCenter, Visioffice and Essilor standard ruler) was assessed in 21 healthy volunteers, by a Bland-Altman analysis; mean difference and limits of agreement (LoA) were calculated. RESULTS: Frame ruler nasopupillary distance measurements showed limited agreement with PD-5 [-0.38 ± 1.03 (LoA -2.40 to 1.64) and 0.44 ± 1.02 (LoA -1.72 to 2.61)] and Visioffice [0.62 ± 1.24 (LoA -1.81 to 3.05) and -0.16 ± 1.72 (LoA -3.54 to 3.22)] measurements for the right and left eyes, respectively. Poor agreement was found for interpupillary distances (PD-5 [0.21 ± 1.47 (LoA -2.67 to 3.09)], OptiCenter [-0.05 ± 1.16 (LoA -2.32 to 2.22)] and Visioffice [0.46 ± 1.95 (LoA -3.36 to 4.28)]), fitting point height (OptiCenter [-1.27 ± 2.56 (LoA -6.27 to 3.75) and -0.92 ± 2.77 (LoA -6.35 to 4.51)] and Visioffice [-5.88 ± 6.21 (LoA -18.05 to 6.29) and -5.98 ± 6.12 (LoA -17.98 to 6.02)] for the right and left eyes, respectively) and pantoscopic and frame wrap angles (OptiCenter [-4.13 ± 3.75 (LoA -11.48 to 3.22) and -1.09 ± 0.60 (LoA -2.27 to 0.09)] and Visioffice [-6.18 ± 3.53 (LoA -13.10 to 0.74) and -1.93 ± 3.49 (LoA -8.77 to 4.91)], respectively). CONCLUSIONS: These results suggest that measurements of physiognomy and frame angles are not interchangeable between assessed devices and that these differences could induce lens centration errors with a large impact on progressive addition lens prescriptions.

Corneal Confocal Analysis after Scleral Lens Wear in Keratoconus Patients: A Pilot Study.

SIGNIFICANCE: Scleral lenses rely on the scleroconjunctival region without bearing the cornea, which could improve the symptoms and modify the corneal nerve plexus morphology. PURPOSE: This study aimed to evaluate symptoms and changes in corneal nerve plexus morphology and density of Langerhans cells in keratoconus patients with and without intrastromal corneal ring before and after scleral lens wear. METHODS: Sixteen scleral lens wearers with keratoconus were recruited for this short-term experimental pilot study. Subjects were divided into two groups: keratoconus group and intrastromal corneal ring segment group. All subjects were examined in two visits: baseline (before scleral lens wear) and after 6 months of scleral lens wear, after lens removal. The Schirmer I test, the Ocular Surface Disease Index, tear breakup time, and in vivo confocal microscopy were evaluated. RESULTS: The mean age was 42.33 ± 11.27 years. A significant decrease in tear breakup time was found in the total group ( P = .01, Wilcoxon) compared with baseline. Ocular Surface Disease Index score had decreased after 6 months of scleral lens wear in the keratoconus with intrastromal corneal ring segment subgroup ( P = .03, Wilcoxon) and in the total group ( P = .001, Wilcoxon). No statistical changes in nerve density, tortuosity, and ramification were found for either the total group or the subgroup. However, the mean nerve length was higher in all groups, especially in the keratoconus subgroup ( P = .03, Wilcoxon) after 6 months of scleral lens wear. Regarding optical density, the total group showed a significant increase after 6 months of wearing ( P = .02, Wilcoxon). Finally, Langerhans cell density was not statistically different in any group. CONCLUSIONS: These results suggest that scleral lens wearing improves the symptoms and increased the mean length nerves after 6 months of wear use in keratoconus patients.

Is contact lens discomfort related to meibomian gland morphology?

PURPOSE: To examine the relationship between contact lens (CL) discomfort and meibomian gland (MG) morphology assessed by a semi-objective software in subjects without an alteration of MG function (meibum quality and expressibility). METHODS: Nineteen symptomatic (CLDEQ-8 ≥ 12) CL wearers, 19 asymptomatic (CLDEQ-8 < 12) wearers, and 22 non-wearers were recruited. Upper and lower eyelid meibography images were taken and the following parameters were analysed using a semi-objective software in the central 2/3 of each eyelid: number of MG, number of partial MG, percentage of MG loss and percentage of tortuosity. One-way ANOVA or Kruskal-Wallis H test were used for comparisons among groups. The relationships between CLDEQ-8 and MG morphology parameters were analysed using the Spearman correlation coefficient and multivariable linear regression models. RESULTS: No significant differences were found among groups in the MG morphology of the upper or lower eyelids. In all CL wearers, a significant correlation with CLDEQ-8 was found in the upper eyelid for the number of MG (rho = 0.47, p = 0.003). In symptomatic wearers, significant correlations with CLDEQ-8 were found in the lower eyelid for the number of partial MG (rho = 0.49, p = 0.03) and the percentage of partial MG (rho = 0.61, p = 0.005). In all CL wearers, multivariable models were fitted to explain CLDEQ-8 score including the number of MG, the number of partial MG and the percentage of MG loss from the lower eyelid (R2 = 0.19; p = 0.007), and the number of MG from the upper eyelid (R2 = 0.19; p = 0.001). In symptomatic wearers, a model was fitted including the percentage of MG loss from the lower eyelid (R2 = 0.30; p = 0.016). CONCLUSIONS: Alterations of MG morphology, without clinically apparent alteration of MG function, can be involved in causing CL discomfort and influence the degree of symptoms. The differences in findings between eyelids indicate the need to monitor both eyelids, especially the lower one, in CL wearers.

Corneal Confocal Microscopy Findings in Neuro Lyme Disease: A Case Report.

Neuro Lyme disease is caused by several bacteriae of the Borreliaceae family, such as Borrelia Miyamotoi. In late stages of illness, patients with Lyme disease may develop chronic neurologic symptoms such as cognitive disturbances or small fiber peripheral neuropathy. Confocal microscopy is a non-invasive method designed to evaluate the human cornea in vivo. Thus, all the corneal layers, including the cells and the sub-basal nerve plexus, can be easily visualized and analyzed. This is the first report of the morphology of small-fiber peripheral neuropathy analyzed by confocal microscopy in a patient diagnosed of neuro Lyme disease. The decrease in the number of unmyelinated sub-basal nerve fibers with abundant presence of dendritic cells (DC) in comparison with healthy corneas strongly supports the diagnosis of small fiber peripheral neuropathy in a case of neuroborreliosis disease.

Update on Corneal Confocal Microscopy Imaging.

In vivo corneal confocal microscopy (IVCM) is a non-invasive ophthalmic imaging technique that provides images of the cornea at the cellular level. Despite the uses in ocular surface pathologies, in the last decades IVCM has been used to provide more knowledge in refractive surgery wound healing, in neuropathies diagnosis, etc. The observation of the corneal cells, both normal and inflammatory, and the possibility of quantification of the corneal nerve density with manual or automated tools, makes IVCM have a significant potential to improve the diagnosis and prognosis in several systemic and corneal conditions.

Comparison of physiognomy and frame angle parameters using different devices to prescribe progressive addition lenses.

CLINICAL RELEVANCE: Accurate measurement of several physiognomy parameters (interpupillary, nasopupillary and fitting height distances) and frame angles (pantoscopic and frame wrap angles) is essential for prescribing progressive addition lenses for presbyopic patients. BACKGROUND: Few reports have described the repeatability of different devices commonly used to conduct essential measurements for prescribing progressive addition lenses. METHODS: Interpupillary, nasopupillary (at far and near distances) and fitting point heights were measured three consecutive times in 21 healthy volunteers with four devices (traditional frame ruler, PD-5 interpupilometer, OptiCenter, and VisiOffice). Pantoscopic and wrap frame angles were also measured three times with Essilor standard pantoscopic ruler, Opticenter and VisiOffice. RESULTS: The frame ruler, PD-5 and Opticenter showed better repeatability for interpupillary and nasopupillary distance (co-efficient of variation close to 1%, within-subject standard deviation or Sw < 0.50 mm) measurements at far and near distances than Visioffice (co-efficient of variation > 2%, Sw > 0.50 mm). Fitting point heights measurements showed worse repeatability with all devices (frame ruler: co-efficient of variation close to 5%, Sw = 0.46 mm; Opticenter co-efficient of variation > 5%, Sw > 0.80 mm; Visioffice co-efficient of variation > 10%, Sw > 1.50 mm). Pantoscopic angle measurements showed very low repeatability with the ruler and Opticenter (co-efficient of variation > 25%, Sw > 1.90 mm). The frame wrap angle showed unacceptable repeatability values with the ruler (co-efficient of variation > 10%, Sw = 0.49º) and Visioffice (co-efficient of variation > 60%, Sw > 2.50º), but acceptable repeatability with Opticenter (co-efficient of variation < 1%, Sw = 0.05º). CONCLUSIONS: Interpupillary and nasopupillary distance measurement showed acceptable repeatability with all the assessed methods; however, these measurements alone are no longer sufficient for free-form progressive addition lens prescription, which requires fitting point heights and pantoscopic and frame wrap angle measurement. Such measures display a lack of repeatability that could induce centration errors and could affect vision and/or adaptation of the user.

Ocular Surface Pathology in Patients Suffering from Mercury Intoxication.

PURPOSE: To report the ocular surface pathology of patients suffering from acute/subacute mercury vapor intoxication. DESIGN: Cross-sectional study. PARTICIPANTS: Male workers intoxicated with inorganic mercury referred for ophthalmic involvement and healthy control subjects. METHODS: The following tests were performed: dry eye (DE)-related symptoms indicated by the ocular surface disease (OSDI) index questionnaire; tear osmolarity; analysis of 23 tear cytokine concentrations and principal component and hierarchical agglomerative cluster analyses; tear break-up time (T-BUT); corneal fluorescein and conjunctival lissamine green staining; tear production by Schirmer and tear lysozyme tests; mechanical and thermal corneal sensitivity (non-contact esthesiometry); and corneal nerve analysis and dendritic cell density by in vivo confocal microscopy (IVCM). RESULTS: Twenty-two out of 29 evaluated patients entered the study. Most had DE-related symptoms (OSDI values > 12), that were severe in 63.6% of them. Tear osmolarity was elevated (>308 mOsms/L) in 83.4% of patients (mean 336.23 (28.71) mOsm/L). Corneal and conjunctival staining were unremarkable. T-BUT was low (<7 s) in 22.7% of patients. Schirmer test and tear lysozyme concentration were low in 13.6% and 27.3% of cases, respectively. Corneal esthesiometry showed patient mechanical (mean 147.81 (53.36) mL/min) and thermal thresholds to heat (+2.35 (+1.10) °C) and cold (-2.57 (-1.24) °C) to be significantly higher than controls. Corneal IVCM revealed lower values for nerve density (6.4 (2.94) n/mm2), nerve branching density (2 (2.50) n/mm2), and dendritic cell density (9.1 (8.84) n/mm2) in patients. Tear levels of IL-12p70, IL-6, RANTES, and VEGF were increased, whereas EGF and IP-10/CXCL10 were decreased compared to controls. Based on cytokine levels, two clusters of patients were identified. Compared to Cluster 1, Cluster 2 patients had significantly increased tear levels of 18 cytokines, decreased tear lysozyme, lower nerve branching density, fewer dendritic cells, and higher urine mercury levels. CONCLUSIONS: Patients suffering from systemic mercury intoxication showed symptoms and signs of ocular surface pathology, mainly by targeting the trigeminal nerve, as shown by alterations in corneal sensitivity and sub-basal nerve morphology.

Effect of Laser-assisted Subepithelial Keratectomy with Mitomycin C on Corneal Optical Density Measured with Confocal Microscopy.

SIGNIFICANCE: The development of confocal microscopy allows one to obtain high-resolution corneal images like its optical density. Some studies have evaluated the optical density with Scheimpflug cameras in the early post-operative period after photorefractive keratectomy, but no studies have evaluated the long-term evolution of optical density after surface ablation when mitomycin C is used. PURPOSE: This work aimed to study the changes in corneal optical density measured with confocal microscopy in eyes treated with laser-assisted subepithelial keratectomy (LASEK) and intraoperative mitomycin C (MMC) to correct myopia. METHODS: A study of 24 consecutive myopic eyes that underwent LASEK with 0.02% MMC and a control group of 24 healthy nontreated eyes was performed. Optical density was measured using the images by the confocal microscopy of the Heidelberg Retina Tomograph II with the Rostock Cornea Module. An analysis of confocal microscopy images was performed using the ImageJ software to obtain the optical density, in gray-scale units (GSU). The optical density of the stromal bed was evaluated 3 months, 15 months, and 3 years after surgery and was compared with the optical density at the equivalent depth of the stroma in controls. RESULTS: The mean values of optical density for the LASEK group were 81.7 ± 9.7, 78.6 ± 11.7, and 73.6 ± 18.7 GSU at 3 months, 15 months, and 3 years, respectively, and it was 61.8 ± 8.2 GSU for the control group. A statistically higher optical density 3 and 15 months after LASEK with MMC was found compared with controls (P < .001). No significant difference was found in optical density at 3 years post-operatively. CONCLUSIONS: Our study suggests that, after LASEK with MMC, the anterior corneal stroma has a higher optical density at 3 and 15 months post-operatively, which gradually returns to normal values 3 years after surgery.

Repeatability and agreement of intraocular pressure measurement among three tonometers.

BACKGROUND: Elevated intraocular pressure (IOP) is one of the causes of irreversible optic nerve head damage and visual field loss. It is often measured with applanation tonometers but the use of rebound tonometry devices has been proposed as an alternative to assess IOP. Rebound tonometers have also been proposed as a method for patients to measure their own intraocular pressure (that is, self-tonometry). The purpose of this study was to determine the intrasession repeatability and the agreement of the IOP measurement with two rebound measuring principle tonometers, ICare ic100 and ICare Home with Perkins tonometer. METHODS: This study involved 27 healthy volunteers (18 to 30 years old). We performed three consecutive IOP measurements with ICare Home, ICare ic100, and Perkins. The means of the three measurements from each device were calculated. Repeatability and agreement were defined according to the British Standards Institute and the International Organization for Standardization. The agreement was assessed using the method described by Bland and Altman, where 95 per cent of the differences or limits of agreement were between 1.96 standard deviations of the mean difference. RESULTS: All tonometers showed close measurements (Perkins 15.34 ± 3.45 mmHg, range 10.00-24.00; ICare ic100 15.40 ± 4.06 mmHg, range 9.67-23.33; and ICare Home 14.22 ± 4.72 mmHg, range 7.33-24.00). The co-efficient of variation (CV) and within-subject standard deviation (Sw) was low for ICare ic100 and Perkins (close to 6.30 per cent and one) with higher values for ICare Home (CV = 9.55% and Sw = 1.33). The intraclass correlation co-efficient showed values higher than 0.96 for all tonometers. The difference between both rebound tonometers was statistically significant (p = 0.03). CONCLUSION: The ICare ic100 tonometer provides repeatable IOP measurements close to the measurements of the Perkins IOP (good agreement); however, ICare Home provides less repeatable values, showing worse agreement with the Perkins tonometer in healthy subjects.

Long-term corneal subbasal nerve plexus regeneration after laser in situ keratomileusis.

PURPOSE: To analyze the recovery of the subbasal nerve plexus in corneas treated with laser in situ keratomileusis (LASIK) at least 10 years prior compared with nonoperated corneas. SETTING: Clínica Novovisión, Madrid, Spain. DESIGN: Prospective nonrandomized observational study. METHODS: Eyes that had LASIK surgery at least 10 years before (LASIK group) were compared with nonoperated healthy eyes (control group). The subbasal nerve plexus morphology (main nerves density, nerve length, nerve branches density, grade of nerve tortuosity, and reflectivity) and the dendritic cell density from the confocal images obtained with the Heidelberg Retina Tomograph II were analyzed. RESULTS: The study comprised 47 eyes (27 eyes in the LASIK group and 20 eyes in the control group). The values were significantly lower in the LASIK group compared with the control group in main nerves density (9.15 nerves/mm2 ± 3.46 [SD] versus 11.75 ± 2.86 nerves/mm2; P = .009) and nerve branches density (2.96 ± 1.99 nerves/mm2 versus 5.35 ± 3.05 nerves/mm2; P = .002). No significant differences were found in nerve length, grade of nerve tortuosity, dendritic cell density, or subbasal nerve plexus reflectivity between the two groups. CONCLUSIONS: The outcomes suggested that the subbasal corneal nerve plexus did not completely recover its preoperative pattern at least 10 years after LASIK. Both main nerves density and nerve branches density continued to be significantly lower compared with virgin corneas after a mean 13-year follow-up, although other parameters of nerve morphology (nerve length, tortuosity, and reflectivity) returned to normal levels.

Binocular and accommodative function in the controlled randomized clinical trial MiSight® Assessment Study Spain (MASS).

PURPOSE: To evaluate the binocular and accommodative function in children wearing dual focus (DF) MiSight® contact lenses (CLs) for myopia control compared with children wearing single-vision (SV) spectacles. METHODS: This was a randomized, controlled clinical trial involving subjects aged 8 to 12, with myopia ranging from - 0.75 to - 4.00D and astigmatism < 1.00D, allocated to MiSight® study CLs group or control group wearing SV. Binocular and accommodative function was determined at baseline, 12-, and 24-month visits, assessed by the following sequence of tests: distance and near horizontal phoria, accommodative convergence/accommodation (AC/A) ratio, stereopsis, accommodative amplitude (AA), and accommodative response (AR) at 33, 25 and 20 cm. RESULTS: Seventy-four children completed the study: 41 in the CL group and 33 in the SV group. CLs group did not show any significant differences in binocular and accommodative measurements throughout the study. In control group, distance and near phoria, stereopsis, AC/A and AR at 20 cm did not show any significant change, but AA, AR at 33 cm and AR at 25 cm were greater at 24-month visit compared with baseline (p < 0.05). CONCLUSIONS: DF lenses do not change the binocular and accommodative function in children wearing dual focus CLs. TRIAL REGISTRATION: NCT01917110.

Visual outcomes and management after corneal refractive surgery: A review / Resultados visuales y manejo tras cirugía refractiva corneal: revisión

Corneal refractive surgery procedures are widely performed to permanently correct refractive errors. Overall, refractive surgeries are safe, predictable and present high rates of satisfaction. Nevertheless, the induced epithelial, stromal and nerve damage alters corneal integrity and function, triggering a regenerative response. Complications that arise from corneal wound healing process might directly impact on visual outcomes of keratorefractive procedures. Most of these complications can be prevented or effectively treated with minimal consequences and minor impact on optical quality. Nevertheless, it is crucial to accurately and timely identify these corneal regeneration-related complications for successful counseling and management. Optometrists, as primary eye care providers, play an essential role in detecting anatomic and functional alterations in vision. It is therefore of great interest for optometrists to be familiar with the principal postoperative complications derived from alterations in regenerative process after corneal laser refractive surgeries. This review aims to provide a basis for optometrists to better understand, identify and manage the main wound healing-related complications after refractive surgery

La cirugía refractiva corneal se lleva a cabo a menudo para corregir de manera permanente los errores refractivos. En general, la cirugía refractiva es segura y predecible, y presenta altos índices de satisfacción. Sin embargo, el daño inducido a nivel epitelial, estromal y nervioso altera la integridad y la función de la córnea, y desencadena una respuesta regenerativa. Las complicaciones que surgen del proceso de cicatrización de la herida corneal podrían tener un impacto directo sobre los resultados visuales de los procedimientos queratorefractivos. La mayoría de estas complicaciones pueden prevenirse, o tratarse de manera efectiva con mínimas consecuencias y un menor impacto sobre la calidad óptica. Sin embargo, es esencial identificar de manera precisa y oportuna dichas complicaciones relacionadas con la regeneración de la córnea, en aras de llegar a un asesoramiento y tratamiento satisfactorios. Los optometristas, al ser profesionales sanitarios de atención ocular primaria, juegan un papel esencial a la hora de detectar las alteraciones anatómicas y funcionales de la visión. Por tanto, es muy interesante que los optometristas estén familiarizados con las complicaciones postoperatorias principales derivadas de las alteraciones del proceso regenerativo tras cirugía refractiva corneal láser. Esta revisión tiene como objetivo proporcionar una base a los optometristas para la mejor comprensión, identificación y tratamiento de las principales complicaciones relacionadas con el proceso de cicatrización tras una cirugía refractiva

Reliability of Blotting Techniques to Assess Contact Lens Water Content.

OBJECTIVES: To determine the reliability of wet and modified dry blotting techniques used in the gravimetric method to assess contact lens (CL) water content (WC), the accuracy of both techniques in comparison with the nominal WC, and also their agreement. METHODS: We evaluated hydrated and dry CL mass values and WC using the gravimetric method in 440 daily disposable CLs. Samples assessed corresponded to Dailies Total 1, Dailies AquaComfort Plus, 1-Day Acuvue TruEye, and Biotrue ONEday. Back vertex power ranged from +3.00 diopters (D) to -6.00 D. Within-subject coefficient of variation (CVw) and intraclass correlation coefficients were calculated. Bland-Altman analysis was also performed. RESULTS: The modified dry blotting technique yielded significantly (P≤0.0001) higher hydrated CL mass values. The wet blotting technique provided significantly (P≤0.04) better consistency than the modified dry one. Values of CVw for wet and modified dry blotting techniques ranged from 1.2% to 2.1% and from 3.7% to 5.4%, respectively. As for dry CL mass values, CVw values were not significantly different (P≥0.05) between wet (range: 1.1%-1.9%) and dry (range: 1.0%-5.1%) blotting techniques, except for Dailies AquaComfort Plus (P=0.03). Bland-Altman analysis showed poor agreement between the techniques. The wet blotting technique yielded WC values close (around 1%) to nominal ones, in contrast to modified dry blotting technique (≥2.5%). CONCLUSIONS: The wet blotting technique is not only more reliable than the modified dry one when obtaining hydrated CL mass but also provides more accurate nominal WC measurements. Agreement between the techniques was poor.

A hemispherical contact model for simplifying 3D occlusal surfaces.

STATEMENT OF PROBLEM: Currently, dental articulators can recreate mandibular movements and occlusal contacts. However, whether virtual articulators can also provide information about occluding dental surfaces, functional movements, and the mandibular condyles is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the occluding surfaces on dental casts obtained from a patient and approximate them to a hemispherical contact model. Both models were tested by digitizing the Dentatus ARL dental articulator. MATERIAL AND METHODS: A combination of photogrammetry and structure from motion methods were used to scan a Dentatus ARL articulator and representative dental casts. Using computer-aided engineering and finite element analysis, contact points and action vectors to the forces on occluding surfaces and condyles were obtained for cast and hemispherical models. This experiment was performed using centric occlusion and 3 different condylar inclinations. The Kruskal-Wallis 1-way analysis of variance on ranks test was used to allow all pairwise comparisons between condylar inclination and mechanical action vector values in each location (α=.05). RESULTS: Action vectors from the cast model and each location of the hemispherical model were calculated to show the mechanical consequences and the similarity among models. Overall, no significant differences were observed for action vectors (A20 versus A40 versus A60) at each location (dental cast/hemisphere, right condylar, and left condylar) in the analysis of dental casts and the hemisphere model (.382≤P≤.999). CONCLUSIONS: This study provided graphical information that may assist the dental professional in determining which occlusal contacts should be modified to attain condylar and balanced centric occlusion.

Visual outcomes and management after corneal refractive surgery: A review.

Corneal refractive surgery procedures are widely performed to permanently correct refractive errors. Overall, refractive surgeries are safe, predictable and present high rates of satisfaction. Nevertheless, the induced epithelial, stromal and nerve damage alters corneal integrity and function, triggering a regenerative response. Complications that arise from corneal wound healing process might directly impact on visual outcomes of keratorefractive procedures. Most of these complications can be prevented or effectively treated with minimal consequences and minor impact on optical quality. Nevertheless, it is crucial to accurately and timely identify these corneal regeneration-related complications for successful counseling and management. Optometrists, as primary eye care providers, play an essential role in detecting anatomic and functional alterations in vision. It is therefore of great interest for optometrists to be familiar with the principal postoperative complications derived from alterations in regenerative process after corneal laser refractive surgeries. This review aims to provide a basis for optometrists to better understand, identify and manage the main wound healing-related complications after refractive surgery.

Are Contact Lens Discomfort or Soft Contact Lens Material Properties Associated with Alterations in the Corneal Sub-Basal Nerve Plexus?

PURPOSE: To study whether contact lens (CL) discomfort and some properties of soft CL materials are associated with alterations in the nerve fibers morphology and density of dendritic cells of the corneal sub-basal nerve plexus. MATERIALS AND METHODS: Forty soft CL wearers and 20 non-CL wearers were included. The Contact Lens Dry Eye Questionnaire-short form was administered to divide CL wearers based on their symptoms (20 symptomatic and 20 asymptomatic CL wearers were included). The CL material properties considered were the CL material type (16 hydrogel and 24 silicone hydrogel CL wearers were included), water content, oxygen transmissibility, and modulus of elasticity. Confocal microscopy was performed, and the number and density of corneal nerves, density of nerve branches, grade of nerve tortuosity, and density of dendritic cells were analyzed. The effects of CL discomfort and CL material properties on the confocal microscopy parameters were analyzed. RESULTS: No significant differences were found among symptomatic and asymptomatic CL wearers and non-CL wearers in any of the confocal microscopy parameters evaluated. The density of dendritic cells was higher in the hydrogel CL wearers compared to the silicone hydrogel CL wearers and non-CL wearers (p = 0.002). The density of dendritic cells tended to be higher as the oxygen transmissibility decreased (ß = -0.40, p = 0.07). CONCLUSIONS: CL discomfort appears not to be associated with alterations in the corneal sub-basal nerve plexus. Hydrogel CL wear might be involved in the recruitment of dendritic cells into the cornea, being a possible origin its lower oxygen permeability compared to silicone hydrogel materials. Future studies are required to confirm these results.

Comparison of keratocyte density after femtosecond laser vs mechanical microkeratome from 3 months up to 5 years after LASIK.

BACKGROUND: To compare keratocyte density after mechanical microkeratome LASIK (MK-LASIK) and femtosecond-laser assisted LASIK (FS-LASIK). METHODS: We performed a prospective study of myopic patients that underwent MK-LASIK or FS-LASIK. We measured keratocyte density 3 and 15 months, and 3-5 years after the surgery using confocal microscopy, and compared them with healthy, non-operated corneas. RESULTS: Thirty-one eyes were included in the FS-LASIK group, 30 in the MK-LASIK group and 28 in the control group. Three months postoperatively, there was an increase in the keratocyte population of the whole cornea, mainly due to the mid and posterior stromal layers, in both treatment groups. It was also increased in the stromal bed after MK-LASIK, but not after FS-LASIK. In both groups, this was followed by a normalisation and stabilisation of cell density in those deeper layers 15 months after the surgery. Keratocyte density in the flap and stromal bed was decreased 15 months after FS- and MK-LASIK compared to 3 months postoperatively and compared to controls. It seemed to remain stable thereafter. In spite of this decrease, the average cell density throughout the cornea was not decreased compared to controls at any time point. CONCLUSION: We found a reorganization of keratocytes density after LASIK, with an initial increase, followed by a decrease in the stromal flap and stromal bed 15 months postoperatively, and stable from then onwards, but still maintaining normal average densities in the total cornea. There were no differences between MK- and FS-LASIK.

Keratocyte density 3 months, 15 months, and 3 years after corneal surface ablation with mitomycin C.

PURPOSE: To study the effects of surface ablation with mitomycin C (MMC) on keratocyte population. DESIGN: Prospective, nonrandomized, interventional, comparative case series. METHODS: Thirty two eyes treated with surface ablation with 0.02% MMC were compared with nontreated eyes at Vissum Santa Hortensia, Madrid, Spain. Keratocyte density was measured with the Heidelberg Retina Tomograph II (Rostock Cornea Module) 3, 15, and 36 to 42 months after the surgery in the anterior, mid, and posterior stroma, and compared with control eyes. RESULTS: Three months postoperatively, we found a lower stromal bed density compared to controls (16 993 ± 8001 vs 29 660 ± 5904 cells/mm(3), P = .0001), while there was a significantly higher cell density in the mid (30 783 ± 9300 vs 18 505 ± 1996 cells/mm(3), P = .0001) and deep stroma (30 268 ± 8321 vs 18 438 ± 2139 cells/mm(3), P = .0001). Three years after the surgery, the cellularity in the stromal bed had not significantly changed from the 3-month follow-up, but the density in the mid (18 889 ± 3474 cells/mm(3)) and posterior stroma (18 992 ± 3402 cells/mm(3)) had decreased to show no difference from controls. The mean cell density between the anterior, mid, and posterior stroma was not significantly different from controls 15 months and 3 years after the surgery. CONCLUSION: Our study suggests that there is a reorganization of the stromal cell population soon after surface ablation with MMC, with a decrease in the stromal bed compensated initially with an increase in the mid and posterior stroma. Corneal cellularity tends to normalize over time, and 3 years postoperatively the mean cell density throughout the cornea seems to maintain normal values.

Keratocyte density after laser-assisted subepithelial keratectomy with mitomycin C.

PURPOSE: To study the effects of laser-assisted subepithelial keratectomy (LASEK) with mitomycin C (MMC) on the keratocyte population. DESIGN: Prospective, nonrandomized, interventional, comparative case series. METHODS: Fifty-six eyes treated at Vissum Santa Hortensia, Madrid, Spain, were included in the study. We compared 28 eyes treated with LASEK with intraoperative 0.02% MMC versus 28 non-treated eyes. Keratocyte density was measured 3 months after the surgery in the anterior, mid, and posterior stroma and was compared with the corresponding layers in the control eyes. The anterior layer in the LASEK group was compared with 2 layers in the control group: the most anterior stromal layer and the 80 µm-deep layer, because that was the mean ablation depth performed in eyes that underwent LASEK. RESULTS: We found a statistically significantly lower keratocyte population in the most anterior stromal layer after LASEK with MMC compared with both the most anterior stromal layer and the 80 µm-deep layer in controls. On the contrary, the treated group showed a significantly higher keratocyte density in both the mid stroma and the deep stroma. The comparison between the average densities through the entire cornea showed a significantly higher keratocyte population in the LASEK with MMC group. CONCLUSIONS: LASEK with MMC seems to cause a decrease in the anterior stromal cells 3 months after the surgery compared with nonoperated corneas. There seems to be a compensating proliferation of keratocytes in the deeper corneal layers, suggesting that the ability of keratocytes to repopulate the cornea is maintained after the surgical procedure.