Automated Measurement and Three-Dimensional Fitting of Corneal Ulcerations and Erosions via AI-Based Image Analysis.

PURPOSE: Artificial intelligence (AI)-tools hold great potential to compensate for missing resources in health-care systems but often fail to be implemented in clinical routine. Intriguingly, no-code and low-code technologies allow clinicians to develop Artificial intelligence (AI)-tools without requiring in-depth programming knowledge. Clinician-driven projects allow to adequately identify and address real clinical needs and, therefore, hold superior potential for clinical implementation. In this light, this study aimed for the clinician-driven development of a tool capable of measuring corneal lesions relative to total corneal surface area and eliminating inaccuracies in two-dimensional measurements by three-dimensional fitting of the corneal surface. METHODS: Standard slit-lamp photographs using a blue-light filter after fluorescein instillation taken during clinical routine were used to train a fully convolutional network to automatically detect the corneal white-to-white distance, the total fluorescent area and the total erosive area. Based on these values, the algorithm calculates the affected area relative to total corneal surface area and fits the area on a three-dimensional representation of the corneal surface. RESULTS: The developed algorithm reached dice scores >0.9 for an automated measurement of the relative lesion size. Furthermore, only 25% of conventional manual measurements were within a ± 10% range of the ground truth. CONCLUSIONS: The developed algorithm is capable of reliably providing exact values for corneal lesion sizes. Additionally, three-dimensional modeling of the corneal surface is essential for an accurate measurement of lesion sizes. Besides telemedicine applications, this approach harbors great potential for clinical trials where exact quantitative and observer-independent measurements are essential.

Neuropathic Corneal Pain as Debilitating Manifestation of LONG-COVID.

This report illustrates the case of a female patient suffering from severe ocular discomfort, tinnitus and ageusia, 7 months after a SARS-CoV-2 infection. The medical history implicated a diagnosis of LONG-COVID with ocular pain as the most debilitating symptom. In-vivo confocal microscopy revealed corneal microneuromas with hyperreflectivity and irregular enlargement of nerve endings in both eyes, which led to the diagnosis of neuropathic corneal pain. The aim of this report is to increase awareness that COVID-19 induced neuropathic pain can also occur in the cornea representing the human body's most richly innervated tissue.

The impact of surgeon's experience and sex on the incidence of cystoid macular edema after uneventful cataract surgery.

PURPOSE: To assess the rate of pseudophakic cystoid macular edema (pCME) in uneventful cataract surgery in surgeons in training vs experienced surgeons and to analyze the rate of pCME according to surgeon's sex. METHODS: Medical reports post phacoemulsification between 2010 and 2018 at the Department of Ophthalmology, Medical University of Graz, Austria, were reviewed for pCME. A running lifetime number of preceding cataract surgeries was used to express hands-on experience. A cut-off number of 300 surgeries was defined to distinguish between surgeons in training and experienced surgeons. Outcome parameters were incidence of pCME, patient's sex and age, laterality of eye, coexistence of pseudoexfoliation syndrome (PEX), duration of surgery and surgeon's sex. RESULTS: 25.422 surgeries on 18.266 patients were included. The majority was performed by experienced surgeons (23.139, 91.0%) vs 2.283 (9.0%) by surgeons in training (25 surgeons, 9 (36%) female and 16 (64%) male). pCME occurred in 32 eyes (1.4%) following surgery by surgeons in training and in 152 eyes (0.7%) following surgery by experienced surgeons. Chance for pCME was 1.57 higher in training surgeries (95% CI 1.03-2.41, p = 0.034) and longer duration (OR = 1.04; 95% CI 1.02-1.07, p = 0.001). After excluding the first 100 surgeries for every surgeon in training similar results were observed. No difference in risk for pCME was found between female and male surgeons in both groups (training and experienced surgeons). CONCLUSION: In conclusion, the rate for pCME after uneventful cataract surgery is significantly higher for surgeons in training but steadily decreasing and associated to surgical time. No difference in the risk for pCME was found between female and male surgeons.

Determining the center of a keratoconus: Comparison of different tomographic parameters and impact of disease severity.

Purpose: There exists remarkable variation in definitions for the location of the center of a keratoconus. The objective of this study was to analyze deviations between locations obtained by different tomographic maps for that purpose. Furthermore, it was investigated whether these deviations are influenced by disease severity. Methods: In 162 eyes with keratoconus, corneal tomographic maps derived by Scheimpflug technology were retrospectively analyzed to determine the cone location with 5 different methods: maximum axial curvature of the front surface (Kmax), maximum tangential curvature of the front surface (tKmax), minimum pachymetry (Pachymin), maximum elevation of the front surface (ELEF), and maximum elevation of the back surface (ELEB). Distances between the locations were calculated and tested for a correlation with keratoconus severity and distance between cone and corneal vertex. Results: Cone locations derived from the curvature maps (Kmax, tKmax) showed the lowest agreement with the locations determined by pachymetry or elevation maps. The largest distances were found between Kmax and Pachymin [Median and Interquartile range: 1.19 mm (0.87, 1.60)], Kmax and ELEB [1.12 mm (0.79, 1.41)], and Kmax and ELEF [0.97 mm (0.64, 1.27)]. Low distances (<0.5 mm) were calculated between ELEB and ELEF, and ELEB and Pachymin. All of the calculated distances between the locations showed a significant negative correlation with keratoconus severity and most of them increased significantly with a more peripheral position of the cone (p < 0.05). Conclusions: There was low consistency between different methods for describing the location of a keratoconus. Curvature-based determinations of the cone center (Kmax, tKmax) showed the highest deviations and should not be used for that purpose. However, the discrepancies between different cone location methods diminished with increasing disease severity and more central position of the cone.

Evaluation of Acanthamoeba keratitis cases in a tertiary medical care centre over 21 years.

To report on Acanthamoeba keratitis cases in a tertiary university eye-hospital in Graz, Austria, over a 21-year period. Retrospective study. Parameters included demographics, diagnostics, clinical courses, medical therapies, surgical interventions, secondary complications, and best spectacle-corrected visual acuity (BSCVA). Patient records for 44 eyes of 42 patients were analysed; 2 bilateral infections. Mean age at presentation was 31 ± 13 (16-65) years; contact lenses were used in 41 of 44 eyes (93.2%). Symptoms at initial presentation were mainly pain (41/43, 95.3%) and photophobia (16/43, 37.2%). Most frequent morphological findings were stromal infiltrates (30/44, 68.2%). Diagnosis was mainly confirmed by smears (40/42, 95.2%) and polymerase chain reaction (8/42, 19%). Antiamoebic treatment comprised biguanides and diamidines. Penetrating keratoplasty was performed in 10/44 (22.7%) eyes. Median time from symptom onset to initial visit was 2 (0-26) weeks; median follow-up was 30 (2-1008) weeks. BSCVA improved in 23/36 (63.9%) eyes, remained unchanged in 6/36 (16.7%) eyes and deteriorated in 7/36 (19.4%) eyes. Acanthamoeba keratitis predominantly occurs in young contact lens wearers. Diagnosis should be considered in patients with pain and stromal infiltrates. In the majority of cases, BSCVA can be improved. Early diagnosis and adequate treatment should be implemented to prevent complications.

Prion Protein on Human Leukocytes Is Reduced in Iron Deficiency - Possible Implications for Age-related Macular Degeneration?

MATERIALS AND METHODS: Patients presenting to the department of ophthalmology of the Medical University of Graz for reasons unrelated to prion diseases were enrolled. Parameters of iron metabolism, including ferritin and soluble transferrin receptor were measured by routine laboratory tests. Serum prion protein was determined by enzyme-linked immunosorbent assay. Surface prion protein on CD14+ monocytes and CD4+ T cells was analyzed by fluorescence activated cell sorting. RESULTS: 95 patients were enrolled. Soluble transferrin receptor correlated significantly with prion protein levels on CD14+POM1+ monocytes (P = .001, r = -0.7) and on CD4+POM1+ T cells (P = .01, r = -0.62). CONCLUSION: Our findings suggest a connection between the physiological function of the prion protein and iron metabolism in humans.

[SMILE - Small Incision Lenticule Extraction]. / SMILE ­ Small Incision Lenticule Extraction.

Refractive lenticule extraction is a corneal surgical technique that uses a femtosecond laser exclusively to create an intrastromal refractive lenticule for the correction of myopia and myopic astigmatism. In small incision lenticule extraction (SMILE) the generated refractive lenticule is subsequently extracted through a small incision. The reported efficacy, predictability and safety of the flap-less SMILE procedure is similar to those of femtosecond laser in situ keratomileusis (LASIK). Advantages of SMILE over LASIK include less iatrogenic dry eye, fewer induced higher-order aberrations, and potentially less biomechanical weakening of the cornea. However, there is a steeper surgeon learning curve for SMILE as the procedure is technically more challenging than LASIK. Furthermore, the current SMILE laser platform cannot use cyclotorsion control or eye-tracking technology and retreatment options are more complex compared to LASIK. This review looks at patient selection, surgical method, possible complications, retreatment options, and postoperative outcome of the SMILE technique.

[Enhancements after Refractive Corneal Surgery]. / Refraktive Hornhautchirurgie: Nachkorrekturen.

This review article focusses on the management of enhancements after corneal refractive laser surgery. Fundamental issues regarding enhancement embrace identification of the underlying reason for postoperative ametropia, assurance of stability of refraction, type of primary refractive laser treatment and thorough evaluation of the given anatomical parameters of the cornea. With respect to specific inclusion and exclusion criteria, different surgical options for enhancement strategies are displayed with their particular advantages and disadvantages including preoperative planning of the according laser parameters and postoperative patient management.

Characteristics of preoperative and postoperative astigmatism in patients having Descemet membrane endothelial keratoplasty.

PURPOSE: To evaluate the characteristics of preoperative and postoperative astigmatism in patients having Descemet membrane endothelial keratoplasty (DMEK). SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Retrospective case series. METHODS: Measurements were obtained using a Scheimpflug camera (Pentacam AXL) preoperatively and 3 months and 12 months postoperatively. Values of front and back astigmatism and total astigmatism in the central 4.0 mm diameter zone (TCA4) were analyzed. RESULTS: Fifty-three eyes of 45 patients were included. The prevalence of TCA4 above 1.0 diopter (D) was considerably higher (79%) and with-the-rule astigmatism was less frequent in this cohort of European patients with Fuchs endothelial dystrophy (mean age 65 years) than that reported in a meta-analysis of healthy European eyes. The TCA4 values correlated with anterior astigmatism preoperatively and postoperatively (P < .001) and with posterior astigmatism at the 1-year follow-up (P < .01). Although, no correlation was found between the preoperative and 1-year results for anterior astigmatism (P = .12), posterior astigmatism (P = .35), or total corneal astigmatism (P = .47), the difference in vector analysis between the two measurements was only 0.01 at 109 degrees, 0.03 at 98 degrees, and 0.02 at 157 degrees, respectively. However, the greater the difference between the preoperative TCA3 and preoperative TCA5 values, the greater the decrease in corneal astigmatism (P < .001). CONCLUSIONS: The percentage of eyes with corneal astigmatism above 1.0 D was higher preoperatively and postoperatively in patients with Fuchs endothelial dystrophy than in a healthy population. Predicting postoperative astigmatism based on preoperative results is not possible; however, in eyes with a high difference between TCA3 and TCA5, a reduction in corneal astigmatism after DMEK is likely.

Evaluation of keratoconus progression.

AIM: To define variables for the evaluation of keratoconus progression and to determine cut-off values. METHODS: In this retrospective cohort study (2010-2016), 265 eyes of 165 patients diagnosed with keratoconus underwent two Scheimpflug measurements (Pentacam) that took place 1 year apart ±3 months. Variables used for keratoconus detection were evaluated for progression and a correlation analysis was performed. By logistic regression analysis, a keratoconus progression index (KPI) was defined. Receiver-operating characteristic curve (ROC) analysis was performed and Youden Index calculated to determine cut-off values. RESULTS: Variables used for keratoconus detection showed a weak correlation with each other (eg, correlation r=0.245 between RPImin and Kmax, p<0.001). Therefore, we used parameters that took several variables into consideration (eg, D-index, index of surface variance, index for height asymmetry, KPI). KPI was defined by logistic regression and consisted of a Pachymin coefficient of -0.78 (p=0.001), a maximum elevation of back surface coefficient of 0.27 and coefficient of corneal curvature at the zone 3 mm away from the thinnest point on the posterior corneal surface of -12.44 (both p<0.001). The two variables with the highest Youden Index in the ROC analysis were D-index and KPI: D-index had a cut-off of 0.4175 (70.6% sensitivity) and Youden Index of 0.606. Cut-off for KPI was -0.78196 (84.7% sensitivity) and a Youden Index of 0.747; both 90% specificity. CONCLUSIONS: Keratoconus progression should be defined by evaluating parameters that consider several corneal changes; we suggest D-index and KPI to detect progression.

Comparison of standard and accelerated corneal cross-linking for the treatment of keratoconus: a meta-analysis.

PURPOSE: To compare results between standard and accelerated corneal collagen cross-linking (CXL) for the treatment of progressive keratoconus. METHODS: We performed literature searches in PubMed, Cochrane Library, Web of Science, ISRCTN registry, ClinicalTrials.gov, and EMBASE for studies comparing conventional Dresden (C-CXL) and accelerated CXL (A-CXL). Outcomes were clinical results and changes in corneal properties. Weighted mean differences were used to evaluate the effects. RESULTS: Here, 22 studies with 1158 eyes (C-CXL: 577 eyes; A-CXL: 581 eyes) were included. At the last follow-up, C-CXL was superior regarding minimum keratometry (p < 0.00001) and demarcation line depth (p < 0.00001), whereas A-CXL should be favoured when considering minimum corneal thickness (p = 0.0005). No differences in uncorrected and corrected distance visual acuity (p = 0.09 and 0.98), spherical equivalent (p = 0.11), spherical and cylindrical error (p = 0.29 and 0.32), maximal and average keratometry (p = 0.05 and 0.65), central corneal thickness (p = 0.15), corneal biomechanical properties (p ≥ 0.21 respectively), time of reepithelialization (p = 0.76), subbasal nerve density (p = 0.69), endothelial cell density (p = 0.30) and morphology (p ≥ 0.40 respectively) were found among both groups. CONCLUSION: Consideration of less corneal thinning favours A-CXL, whereas the deeper demarcation line and greater changes in minimum keratometric values in C-CXL may indicate a higher treatment efficacy. Altogether, C-CXL, as well as A-CXL, provides successful results in the strengthening of corneal tissue.

Impact of a Displaced Corneal Apex in Small Incision Lenticule Extraction.

PURPOSE: To evaluate the possible impact of a displaced corneal apex (point of maximum curvature) on visual results and tomographic parameters after small incision lenticule extraction (SMILE). METHODS: In this retrospective evaluation, eyes with uncomplicated SMILE for myopia correction were classified in two groups based on their preoperative distance between the corneal apex and corneal vertex (corneal intercept with the patient's line of sight) of 1 mm or greater (large A-V distance) or less than 1 mm (small A-V distance). All surgeries were performed during the early learning curve of two surgeons. Visual outcome parameters included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refractive spherical equivalent (MRSE), and refractive astigmatism 3 months postoperatively. Scheimpflug-derived tomographic outcome parameters included mean keratometry value, root mean square higher order aberrations (RMS HOAs), and optical zone decentration. RESULTS: The study comprised 94 eyes of 48 patients: 44 eyes in the large A-V distance group and 50 eyes in the small A-V distance group. Preoperative and postoperative RMS HOAs were significantly higher in the large A-V distance group than in the small A-V distance group (P = .002 and .008, respectively). Postoperative CDVA was significantly better in the small A-V distance group (P = .014). There were no statistically significant differences in postoperative UDVA, MRSE, refractive astigmatism, mean keratometry value, and optical zone decentration. CONCLUSIONS: After SMILE, CDVA was significantly worse in eyes with a preoperatively displaced corneal apex compared to eyes with a more central corneal apex. However, good visual results were achieved in both groups. [J Refract Surg. 2018;34(7):460-465.].

Visual results after implantation of a trifocal intraocular lens in high myopes.

PURPOSE: To report visual and refractive outcomes after implantation of a trifocal intraocular lens (IOL) in highly myopic patients. SETTING: Department of Ophthalmology, Goethe University, Frankfurt, Germany. DESIGN: Retrospective case series. METHODS: This study included eyes with previous phacoemulsification and implantation of a trifocal IOL (AT LISA tri 839MP or 939MP) with an IOL power between 0.0 diopter (D) and 10.0 D. Postoperative outcomes at 3 months including uncorrected distance (UDVA), intermediate (UIVA), and near visual acuity (UNVA), corrected distance visual acuity, spherical equivalent, and refractive astigmatism were analyzed. Age-matched eyes after implantation of the same trifocal IOL with higher dioptric power (>10.0 D) served as controls. RESULTS: Thirty-six eyes of 19 patients were included: 18 eyes (10 patients) in the highly myopic group (IOL power 0.0 to 10.0 D) and 18 eyes (9 patients) in the age-matched control group (IOL power >10.0 D). Three months postoperatively, the mean UDVA, UIVA, and UNVA in the highly myopic group were 0.06 logarithm of the minimum angle of resolution (logMAR) ± 0.08 (SD), 0.13 ± 0.09 logMAR, and 0.12 ± 0.07 logMAR, and -0.01 ± 0.10 logMAR, 0.04 ± 0.10 logMAR, and 0.04 ± 0.11 logMAR in the control group, respectively (P = .022, P = .033, P = .053, respectively). CONCLUSION: Implantation of a trifocal IOL in highly myopic eyes with low IOL power (0.0 to 10.0 D) provided satisfactory short-term visual and refractive outcomes; however, results were not as good as those obtained in eyes with higher dioptric IOL power.

Refractive Outcomes After Femtosecond Laser-Assisted Cataract Surgery in Eyes With Anterior Chamber Phakic Intraocular Lenses.

PURPOSE: To report the efficacy, predictability, and safety of femtosecond laser-assisted cataract surgery (FLACS) in eyes with anterior chamber phakic intraocular lenses (IOLs). METHODS: This retrospective case series included eyes with previous implantation of an angle-supported and an iris-fixated phakic IOL for the correction of myopia that underwent a combined procedure of phakic IOL ex-plantation and FLACS with in-the-bag implantation of a posterior chamber IOL. Postoperative corrected distance visual acuity (CDVA), predictability of refractive outcome, and occurrence of intraoperative and postoperative complications were analyzed. RESULTS: Ten eyes of 7 patients with significant cataract were included: 5 eyes with an angle-supported foldable hydrophobic phakic IOL, 4 eyes with an angle-supported polymethylmethacrylate (PMMA) phakic IOL, and 1 eye with an iris-fixated PMMA phakic IOL. Mean follow-up after FLACS was 8.4 ± 5.8 months. Mean interval between phakic IOL implantation and FLACS was 11.9 ± 4.0 years. After the combined procedure of phakic IOL explantation and FLACS, mean manifest refractive spherical equivalent (MRSE) was -0.11 ± 0.49 diopters (D) and MRSE was within ± 0.75 D of target refraction in all eyes. Four eyes received a toric posterior chamber IOL after phacoemulsification. Mean preoperative CDVA of 0.40 ± 0.23 logMAR improved significantly to 0.22 ± 0.11 logMAR postoperatively (P = .027). No intraoperative or postoperative complications occurred. CONCLUSIONS: The results in this series showed that FLACS in eyes with previous implantation of both rigid and foldable anterior chamber phakic IOLs offers good refractive outcomes with a high level of predictability and safety. [J Refract Surg. 2018;34(5):338-342.].

Comparison of Corneal Collagen Cross-Linking Protocols Measured With Scheimpflug Tomography.

PURPOSE: To evaluate the effectiveness of corneal collagen cross-linking with Dresden and accelerated protocols to treat keratoconus by Scheimpflug tomography. METHODS: Fifty-eight eyes with manifest keratoconus were measured preoperatively at least twice with the Pentacam. The difference of relevant variables for keratoconus progression (eg, D value, thinnest pachymetry, Kmax) was established. After evident progression, patients underwent corneal cross-linking (29 eyes with the Dresden protocol and 29 eyes with the accelerated protocol). Postoperatively, variables used for defining manifest progression were compared again by measuring the difference between 2 measurements. RESULTS: Preoperatively, the mean D value was 9.6 ± 4.8 for the Dresden cohort and 8.3 ± 5.1 for the accelerated cohort. There was no significant difference between both cohorts in terms of the mean preoperative difference in the D value (0.59 ± 1.7 for the Dresden cohort vs. 0.4 ± 1.49, P = 1). Postoperatively, however, a significant difference (P < 0.01 for the accelerated corhort) was found (Dresden: -0.47 ± 0.88 vs. accelerated: 0.04 ± 0.67). Regression analysis showed that keratoconus progression was significant in both study groups preoperatively (with a significant reduction of corneal thickness and increase in the D value). Postoperative data show an improvement in all observed keratoconus indices in both study groups and stagnation in progression for the accelerated cohort, P = 0.774, for the D value and a regression in manifestation for the Dresden cohort (decrease in the D value, P < 0.01). CONCLUSIONS: Before operative intervention, Scheimpflug imaging showed signs of a progressive disease in all eyes. Both conventional Dresden protocol and accelerated pulsed corneal collagen cross-linking techniques effectively stopped this progression.

Early Tomographic Changes in the Eyes of Patients With Keratoconus.

PURPOSE: To identify tomographic variables best suited for detecting keratoconus before manifestation of ectatic changes and showing disease progression in the early stage. METHODS: Twenty-seven patients with diagnosed unilateral keratoconus were followed up for their fellow eye, which had not yet shown any ectatic changes, to determine initial change indicators toward keratoconus disease. Variables were compared to 50 normal eyes without any known disease. A following receiver operating characteristic (ROC) analysis was performed to reveal the variables best used to discriminate healthy eyes from early ectatic eyes. RESULTS: The calculated mean difference of the cylinder for total corneal refractive power was only 0.07 ± 0.32 diopters (D) (anterior astigmatism = 0.12 ± 0.28 D and posterior astigmatism = 0.02 ± 0.10 D). ROC revealed the index of height decentration with an area under the curve of 0.788 ± 0.054 as the most suitable to differentiate between eyes of healthy patients and the non-ectatic eye of patients with asymmetrical keratoconus, followed by the index of vertical asymmetry of 0.772 ± 0.057 and a keratoconus index of 0.743 ± 0.062. However, with progression of the eyes into early ectactic stages, the ROC showed the highest area under the curve for D-index (0.876 ± 0.039), followed by index of height decentration (0.855 ± 0.046) and index of vertical asymmetry (0.842 ± 0.046). CONCLUSIONS: Early stages of keratoconus are hard to diagnose and best results can be achieved by using index of height decentration and index of vertical asymmetry. As the disease progresses, D-index is better suited to diagnose an ectasia. Astigmatism, keratometry, and pachymetry barely change in the early stages, so these values are not as fitting as corneal elevation parameters for early diagnosis. [J Refract Surg. 2018;34(4):254-259.].

Femtosecond laser-assisted cataract surgery in eyes with foldable anterior or posterior chamber phakic intraocular lenses.

We describe a technique for the application of femtosecond laser-assisted cataract surgery in eyes with cataract and previous implantation of a foldable anterior or posterior chamber phakic intraocular lens (pIOL). In 2 eyes with an anterior chamber pIOL (angle-supported Acrysof Cachet) and 3 eyes with a posterior chamber pIOL (2 eyes with an Implantable Collamer Lens pIOL; 1 eye with a Phakic Refractive Lens), a femtosecond laser was used to create a capsulotomy, perform lens fragmentation, and create corneal incisions with the pIOL in situ. In all cases, the capsulotomy was created successfully. Lens fragmentation was complete in 4 eyes and incomplete in 1 eye, where trapped cavitation bubbles in the space between the posterior chamber pIOL and anterior lens capsule were evident as a result of a shallow vault of the pIOL.

Depth of focus after implantation of spherical or aspheric intraocular lenses in hyperopic and emmetropic patients.

PURPOSE: To evaluate whether hyperopic patients with short axial length and high dioptric intraocular lens (IOL) power can achieve a higher depth of focus after implantation of a monofocal spherical or aspheric IOL than emmetropic patients. SETTING: Department of Ophthalmology, Medical University Graz, Graz, Austria. DESIGN: Prospective case series. METHODS: Patients presenting for cataract surgery were divided by calculated IOL power into a hyperopic (≥22.0 diopters [D]) or emmetropic (18.0 to 21.5 D) groups and received an aspheric (Tecnis ZA9003) or a spherical IOL (Sensar AR40e). Postoperative measurements included corrected (CDVA) and uncorrected (UDVA) distance visual acuities, distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuities, root-mean-square values of corneal and total eye higher-order aberrations and spherical aberrations, and photopic and mesopic contrast sensitivity. RESULTS: Sixty-two eyes of 62 patients were enrolled in this study, 34 eyes (15 hyperopic, 19 emmetropic) in the aspheric IOL group and 28 eyes (14 hyperopic, 14 emmetropic) in the spherical IOL group. The UDVA, CDVA, and contrast sensitivity did not differ significantly between the 2 IOL groups, whereas the DCIVA and DCNVA were significantly better in the spherical IOL group (P = .004 and P = .001, respectively). No significant differences were found in DCIVA and DCNVA between hyperopic patients and emmetropic patients with aspheric or spherical IOLs. CONCLUSIONS: Implantation of a monofocal spherical IOL resulted in an increased depth of focus without significant degradation of distance visual acuity or contrast sensitivity. There were no differences in the depth of focus between hyperopic eyes and emmetropic eyes.

Vitreous hyper-reflective dots in pseudophakic cystoid macular edema assessed with optical coherence tomography.

PURPOSE: This study compares the presence of vitreous hyper-reflective dots (VHDs) detected with optical coherence tomography (OCT) between eyes with pseudophakic cystoid macular edema (CME) and those with no CME after cataract surgery. In addition, we evaluated the impact of VHDs on the responsiveness of pseudophakic CME to cortisone treatment. SETTING: Department of Ophthalmology, Medical University of Graz, Austria. DESIGN: Retrospective, monocenter case-controlled study. METHODS: Inclusion criteria for the study group and the control group were CME and no CME within 12 weeks following uneventful phacoemulsification in otherwise healthy eyes, respectively. VHDs (number and size) and the macular thickness were assessed with OCT. Furthermore, the number of peribulbar or intravitreal steroid injections was assessed. RESULTS: A total of 284 eyes from 267 patients were analyzed, among which 119 met the inclusion criteria for the study (n = 63) and the control group (n = 56). VHDs were observed in 54 (85.7%) study eyes and 21 (37.5%, p = 0.013) control eyes. The number of VHDs was 3.9±3.4 in the study group and 0.7±1 in the control group (p<0.001). The size of the VHDs was 33.5±9.1 µm and 36.6±17.9 µm in the study and control groups, respectively (p = 0.978). Overall, the number of VHDs correlated with central subfield thickness (r = 0.584, p<0.001), cube volume (r = 0.525, p<0.001), and postoperative best-corrected visual acuity (BCVA) (r = -0.563, p<0.001). The number of VHDs did not correlate with the frequency of peribulbar or intravitreal steroid injections. CONCLUSION: VHDs occurred more often in eyes with CME than in eyes without CME following cataract surgery. In addition, the number of VHDs had an impact on the extent of macular thickening and subsequently postoperative BCVA. No correlation was found between the number of VHDs and the frequency of required peribulbar or intravitreal steroid injections.