Treatment of D alloimmunization in pregnancy with plasmapheresis and intravenous immune globulin: case report.

The prevalence of D alloimmunization occurs between 0.15% and 0.4%. The anti-D can cross the placenta and cause hemolysis and fetal anemia. At present, a Doppler study of the middle cerebral artery allows the monitoring of the degree of fetal anemia. The treatment in cases of moderate to severe anemia in fetuses of less than 34-35 weeks of gestation is intrauterine transfusion via cordocentesis. However, with high titers of anti-D, in the absence of fetal anemia it is possible to modulate the maternal immune response by plasmapheresis and intravenous immunoglobulin administration. We present a case report of an Rh(D) alloimmunized pregnancy treated with plasmapheresis followed by intravenous immunoglobulin administration. We performed a caesarean section at 31 weeks, 5 days of gestation. The hemoglobin at birth was 13.8 g/dl and hematocrit 40.8%. Intrauterine transfusion was not necessary.

Corneal higher order aberrations after LASIK for high myopia with a fast repetition rate excimer laser, optimized ablation profile, and femtosecond laser-assisted flap.

PURPOSE: To evaluate corneal higher order aberrations (HOAs) after LASIK for the correction of high myopia using a new generation of excimer laser (500-Hz repetition rate) and optimized ablation profiles. METHODS: Retrospective consecutive study including 29 eyes from 17 patients (age range: 24 to 61 years) with high levels of myopia (spherical equivalent refraction ≥8.50 diopters). All cases underwent LASIK using the sixth-generation Amaris (SCHWIND eye-tech-solutions) excimer laser and flap creation with the IntraLase (Abbott Medical Optics) femtosecond laser. Postoperative changes in corneal HOAs and corneal asphericity were analyzed during 6-month follow-up. RESULTS: Significant improvement in uncorrected distance visual acuity and spherical equivalent was observed (P<.01). Corrected distance visual acuity did not change after surgery (P=.37). Significant increases in corneal root-mean-square (RMS) HOA, RMS spherical aberration (SA), and RMS coma were observed 6 months after surgery (P<.01). Corneal asphericity for the 4.5-mm (Q45) and 8-mm (Q8) corneal diameter also increased significantly during the postoperative period (P<.01). Significant correlations were found between postoperative RMS HOA and RMS SA and RMS coma (r(2)=0.375, P=0.000 and r(2)=0.596, P=.000, respectively). Linear regression analysis showed a significant relationship between postoperative Q45 and preoperative pachymetry and treatment optical zone (R(2)=0.24, P<.05). A correlation was also found between postoperative Q8 and preoperative sphere and treatment ablation zone (R(2)=0.459, P<.006). CONCLUSIONS: A significant induction of corneal HOAs still exists with the latest generation Schwind excimer laser. Linear regression analysis will help predict postoperative asphericity obtained when using LASIK for the correction of high myopia.

Relationship between patient age and refractive index of the corneal stroma during refractive surgery assisted by femtosecond laser flap creation.

PURPOSE: To measure the refractive index (RI) of the human corneal stroma in vivo using an objective Abbé refractometer (VCH-1) and to determine if RI of the stroma is related to age. METHODS: VCH-1 was used to measure RI at the central anterior stroma immediately after lifting the flap in neophyte patients preselected for laser in situ keratomileusis. Surgical procedures continued as preplanned after measuring the RI, and in binocular cases, measurements were taken from the right eye only. Corneal flaps were created using a femtosecond laser system. RESULTS: Mean RI (±SD, range) and age (±SD, range) values were 1.373 (±0.006, 1.358-1.385) and 36.55 (±12.26, 18-74). A significant linear correlation was found between age and RI. Least squares regression lines equating RI with age (x, years) were of the form: RI = 1.36911 + 0.000096x (r = +0.195; n = 115; P = 0.037). Mean RI (± SD) in the 2 age groups separated by the median age (≤34 and ≥35) were 1.371 (±0.007; n = 57) and 1.374 (±0.005; n = 58). The difference was statistically significant (P = 0.018). CONCLUSIONS: RI of the anterior stroma in vivo tends to be increased in older patients when the corneal flap is created using a femtosecond laser device.

Comparison of a new refractive multifocal intraocular lens with an inferior segmental near add and a diffractive multifocal intraocular lens.

PURPOSE: To compare the visual acuity outcomes and ocular optical performance of eyes implanted with a multifocal refractive intraocular lens (IOL) with an inferior segmental near add or a diffractive multifocal IOL. DESIGN: Prospective, comparative, nonrandomized, consecutive case series. PARTICIPANTS: Eighty-three consecutive eyes of 45 patients (age range, 36-82 years) with cataract were divided into 2 groups: group A, 45 eyes implanted with Lentis Mplus LS-312 (Oculentis GmbH, Berlin, Germany); group B, 38 eyes implanted with diffractive IOL Acri.Lisa 366D (Zeiss, Oberkochen, Germany). METHODS: All patients underwent phacoemulsification followed by IOL implantation in the capsular bag. Distance corrected, intermediate, and near with the distance correction visual acuity outcomes and contrast sensitivity, intraocular aberrations, and defocus curve were evaluated postoperatively during a 3-month follow-up. MAIN OUTCOME MEASURES: Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), corrected distance near and intermediate visual acuity (CDNVA), contrast sensitivity, intraocular aberrations, and defocus curve. RESULTS: A significant improvement in UDVA, CDVA, and UNVA was observed in both groups after surgery (P ≤ 0.04). Significantly better values of UNVA (P<0.01) and CDNVA (P<0.04) were found in group B. In the defocus curve, significantly better visual acuities were present in eyes in group A for intermediate vision levels of defocus (P ≤ 0.04). Significantly higher amounts of postoperative intraocular primary coma and spherical aberrations were found in group A (P<0.01). In addition, significantly better values were observed in photopic contrast sensitivity for high spatial frequencies in group A (P ≤ 0.04). CONCLUSIONS: The Lentis Mplus LS-312 and Acri.Lisa 366D IOLs are able to successfully restore visual function after cataract surgery. The Lentis Mplus LS-312 provided better intermediate vision and contrast sensitivity outcomes than the Acri.Lisa 366D. However, the Acri.Lisa design provided better distance and near visual outcomes and intraocular optical performance parameters.

Femtosecond-assisted keratopigmentation for functional and cosmetic restoration in essential iris atrophy.

UNLABELLED: We describe a new surgical technique of femtosecond-assisted keratopigmentation (KTP) in a 23-year-old woman with severe visual dysfunction secondary to unilateral essential iris atrophy due to the presence of iridocorneal endothelial syndrome in her left eye. The patient presented with complaints of photophobia and monocular diplopia in the affected eye. Femtosecond-assisted KTP surgery was performed in this eye. Following the procedure, the patient reported complete elimination of photophobia and diplopia, with an excellent cosmetic result. Follow-up of 12 months was unremarkable. To our knowledge, this is the first report of a severe visual function disability caused by essential iris atrophy that was corrected by a new KTP technique. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Double-pass system analysis of the visual outcomes and optical performance of an apodized diffractive multifocal intraocular lens.

PURPOSE: To evaluate the postoperative ocular optical quality using a double-pass method and assess visual outcomes in eyes with an apodized multifocal intraocular lens (IOL) and to correlate the findings with IOL power. SETTING: Vissum Corporation, Alicante, Spain. DESIGN: Case series. METHODS: This study evaluated eyes that had cataract surgery with implantation of an AcrySof ReSTOR SN6AD3 multifocal IOL. Near and far visual acuities were measured postoperatively at 1 month and 6 months. Ocular optical quality was assessed at 1 month using a double-pass system (Optical Quality Analysis System), and the point-spread function (PSF) and modulation transfer function (MTF) were characterized. RESULTS: The study included 38 eyes of 19 patients with a mean age of 63.4 years ± 8.4 (SD). The improvements in uncorrected distance visual acuity (from 0.57 ± 0.31 logMAR preoperatively to 0.11 ± 0.13 logMAR 1 month postoperatively and 0.11 ± 0.12 logMAR at 6 months) were statistically significant (P<.00001), as were the improvements in uncorrected near visual acuity (0.76 ± 0.40 logMAR preoperatively to 0.21 ± 0.11 logMAR and 0.12 ± 0.09 logMAR, respectively) (P<.00001). The IOL power correlated significantly with PSF width (r = 0.57, P = .017) and the MTF cutoff frequency (r = -0.36, P = .05). Furthermore, the lower the IOL power, the better the near and distance visual acuities, especially 1 month postoperatively. CONCLUSION: The apodized multifocal IOL restored distance and near visual function, although IOL power was a limiting factor to the final visual outcomes and optical quality.