A new endocapsular open ring for prevention of anterior and posterior capsule opacification.

PURPOSE: The aim of this study is to demonstrate the functionality of a new design of a thick endocapsular open ring for prevention of anterior capsule opacification (ACO) and posterior capsule opacification (PCO). SETTING: The Institute of Vision and Optics, University of Crete and University Hospital of Heraklion, Crete, Greece. DESIGN: Prospective, interventional pilot study. METHODS: Fifteen patients (17 eyes) underwent cataract surgery with phacoemulsification. During surgery, a thick endocapsular open ring (peripheral capsule reconstructor) was inserted into the capsular bag, prior to intraocular lens (IOL) implantation. Six different models of IOL were implanted. Postoperatively, the degree of ACO and PCO was evaluated and described as none, mild, moderate, or severe. RESULTS: The mean follow-up period was 30±8.06 months (range: 12-36 months). At the last follow-up, mild PCO was observed in only three eyes and mild ACO in three patients. The centration of IOLs was good in all but one eye, which had a tilted IOL. CONCLUSION: The results of this pilot study suggest that the implantation of a new design of thick endocapsular open ring is feasible and may contribute to the prevention of PCO and ACO after cataract surgery.

Combined Cataract and Refractive Corneal Inlay Implantation Surgery: Comparison of Three Techniques.

PURPOSE: To compare clinical outcomes of three different techniques of combined cataract and Presbia Flexivue Microlens refractive corneal inlay (Presbia Coöperatief U.A., Amsterdam, Netherlands) implantation surgery for presbyopia compensation over a 12-month follow-up. METHODS: In this comparative pilot study, 15 patients with bilateral cataract were allocated to one of three groups with a different combination of surgical steps (cataract surgery, intrastromal pocket creation, and inlay implantation). In the three-step group, the intracorneal pocket was created in the non-dominant eye, bilateral cataract surgery was performed 3 months later, and the intracorneal inlay was inserted 3 months after that. In the two-step at 3 days group, bilateral cataract surgery was performed 3 days after pocket creation and inlay implantation in the non-dominant eye. In the two-step at 3 months group, the pocket creation and the inlay implantation were performed in the non-dominant eye 3 months after bilateral cataract surgery. Visual, refractive, and contrast sensitivity outcomes were evaluated and compared between the three groups. RESULTS: Twelve months after the inlay implantation, mean monocular uncorrected distance visual acuity was 20/32 in the three-step group, 20/32 in the two-step at 3 days group, and 20/25 in the two-step at 3 months group. Achieved mean monocular uncorrected near visual acuity was similar in the three groups (20/25). The visual and refractive outcomes did not show significant differences between groups. Contrast sensitivity was similar between groups under mesopic and photopic conditions. No intraoperative or postoperative complications were observed. CONCLUSIONS: Clinical outcomes of three different techniques of combined cataract surgery and refractive corneal inlay implantation had no apparent differences between them. The corneal inlay provided excellent near vision acuity, with high patient satisfaction and a high spectacle independence rate after cataract surgery. [J Refract Surg. 2016;32(5):318-325.].

EX-PRESS® Implant Position and Function: Comparative Evaluation with Ultrasound Biomicroscopy and Optical Coherence Tomography.

PURPOSE: This study evaluated the feasibility of anterior segment optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) for the imaging of EX-PRESS(®) implant. MATERIALS AND METHODS: This nonrandomized comparative case series was performed at the Department of Ophthalmology of the University Hospital of Heraklion, Crete, Greece. The Ellex Eye Cubed (40 MHz) UBM and the Zeiss Visante OCT systems were used. The filtering bleb morphology (BL), aqueous outflow (AS), and tube position (TB) were evaluated by two independent observers using a quality scale of 1 (worst) to 4 (best). Data were also collected on corneal and iris clearance from the tip of the tube (CC and IC, respectively). Data from both the devices were statistically analyzed. P < 0.05 was considered as statistically significant. RESULTS: Ten eyes of 10 patients (6 males) with EX-PRESS(®) implant were examined. TB, AS, and BL scores using UBM were 2.40 ± 0.39, 3.45 ± 0.72, and 2.45 ± 0.64, respectively. TB, AS, and BL scores for OCT were 3.35 ± 0.41, 1.55 ± 0.43, and 2.55 ± 0.55, respectively. AS was significantly higher with UBM whereas the opposite was true for TB. Differences in BL between OCT and UBM were not statistically significant (P > 0.05). CONCLUSION: Imaging of the EX-PRESS(®) implant is feasible with both UBM and OCT. Both modalities allow visualization of the position of the implant tube in relation to the iris or cornea and delineate the internal structure of the filtering bleb.

Transient anisocoria after corneal collagen cross-linking.

Purpose. To report a case with transient anisocoria after corneal collagen cross-linking (CXL). Methods. Case report. Results. A 24-year-old male underwent corneal collagen cross-linking (CXL) in his right eye for keratoconus. At the end of the procedure, the pupil of the treated eye was irregular and dilated, while the pupil of the fellow eye was round, regular, and reactive (anisocoria). The following day, pupils were round, regular, and reactive in both eyes. Conclusion. Anisocoria may be a transient and innocuous complication after CXL. A possible cause for this complication might be the anesthetic drops used before and during the surgical procedure or/and the ultraviolet A irradiation during the treatment.

Corneal collagen crosslinking failure in a patient with floppy eyelid syndrome.

UNLABELLED: A 30-year-old man with bilateral floppy eyelid syndrome (more prominent in the left eye) and progressive keratoconus had corneal collagen crosslinking (CXL) in both eyes. No intraoperative or early postoperative complications were found. Topographic examination after CXL revealed a continuous increase in the keratometric values in the left eye in which the floppy eyelid syndrome was more prominent, indicating keratoconus progression (CXL failure). The fellow eye with the less prominent floppy eyelid syndrome remained stable during the follow-up period. Floppy eyelid syndrome could be a risk factor for CXL failure. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Refractive corneal inlay for near vision improvement after cataract surgery.

UNLABELLED: We present the case of a patient who had refractive corneal inlay implantation for near vision improvement after bilateral cataract surgery. The patient had a history of bilateral cataract, and a 2-step procedure was suggested to improve her near and distance visual acuities. The first step was bilateral cataract extraction with a power target of plano intraocular lens implantation. Six months later, a refractive corneal inlay, Presbia Microlens, was implanted in the nondominant eye in the intracorneal pocket made with the femtosecond laser. No intraoperative or postoperative complications occurred. The bilateral uncorrected near visual acuity improved from less than Jaeger (J)6 to J1 and remained stable during the 2-year follow-up. The refractive corneal inlay is a safe, simple, and efficient method for improving near visual acuity in patients after cataract surgery. FINANCIAL DISCLOSURE: Dr. Pallikaris is the chair of the medical advisory board of Presbia Coöperatief U.A. No other author has a financial or proprietary interest in any material or method mentioned.

Anterior chamber angle evaluation with ultrasound biomicroscopy and optical coherence tomography in eyes implanted with a Crystalens.

This study employs optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) imaging as well as optical aberrometry to examine correlations between the anterior chamber angle aperture and visual acuity for near vision as well as coma along the horizontal and vertical axes in eyes implanted with an accommodative intraocular lens (Crystalens). A retrospective comparative consecutive case series of 22 eyes of 11 patients (5 males) uneventfully implanted with a Crystalens. Eyes with signs of posterior capsular opacification were excluded. All eyes were examined with 40 MHz UBM (Ellex Eyecubed) and spectral-domain OCT (Zeiss Visante). The angle aperture along the horizontal and vertical meridians was recorded based on the software of the systems. The coma root mean square (RMS) scores for the horizontal and vertical meridians were also recorded with the iTrace aberrometer. The anterior chamber angle was significantly wider along the horizontal axis compared with the vertical axis by UBM (46.37° and 44.20°, respectively) and by OCT (46.79° and 43.58°, respectively) (p = 0.02 in both cases, paired-samples t test). The correlations between the logMAR-converted Jaeger near vision score and the horizontal or vertical angle apertures was not statistically significant. Horizontal coma RMS was significantly inversely correlated with the horizontal angle aperture (r = -0.45, p = 0.03 and r = -0.39, p = 0.04 by OCT and UBM, respectively). Measurement of the horizontal angle aperture by the modalities used may represent an anatomical and clinical predictor of the optical aberrations induced by the Crystalens.

Thin-flap laser in situ keratomileusis with femtosecond-laser technology.

PURPOSE: To evaluate the results of thin-flap laser in situ keratomileusis (LASIK) using a femtosecond-laser platform for flap creation. SETTING: Institute of Vision and Optics, Faculty of Medicine, University of Crete, Heraklion, Greece. DESIGN: Prospective interventional case series. METHODS: Patients had LASIK with the FS200 femtosecond laser for flap creation and the Allegretto Wave Eye-Q excimer laser. Flap thickness was set at 105 µm. All eyes were examined 1 month postoperatively. Flap thickness was assessed with anterior segment optical coherence tomography using the manual flap tool at 5 locations on a horizontal B scan. RESULTS: This study comprised 50 eyes of 25 patients (mean age 28 years ±5.72 [SD]); 42 eyes completed 6 months of follow-up. Preoperatively, the mean sphere was -3.61 ± 1.87 diopters (D) and the mean cylinder, -1.08 ± 1.23 D. Six months postoperatively, no eye lost lines of corrected distance visual acuity (CDVA), 29% gained 1 line, and 7% gained 2 lines. The mean spherical equivalent was -0.03 ± 0.42 D (range -0.88 to +0.88 D); 86% had an uncorrected distance visual acuity of 20/20 or better. The mean central flap thickness at 1 month was 102.98 ± 6.33 µm (range 91 to 114 µm). There were no intraoperative or postoperative complications. CONCLUSIONS: No significant complications occurred after treatment with this new femtosecond-laser platform in thin-flap LASIK. Clinical (visual and refractive) results were satisfactory in terms of safety, predictability, and stability.

Evaluation of the corneal collagen cross-linking demarcation line profile using anterior segment optical coherence tomography.

PURPOSE: To evaluate the depth of the stromal demarcation line after corneal collagen cross-linking (CXL) using anterior segment optical coherence tomography. METHODS: In this prospective, interventional case series, 23 patients (27 eyes) with progressive keratoconus were enrolled. All patients underwent uneventful CXL treatment. Corneal stromal demarcation line depth was measured centrally, 3 mm temporally, and 3 mm nasally by 2 independent observers using anterior segment optical coherence tomography at 1 month postoperatively in all patients. RESULTS: Mean depth of the corneal stromal demarcation line measured by the first observer was 310.67 ± 31.04 µm (range, 258-364 µm) centrally, 212.07 ± 24.5 µm (range, 178-279 µm) nasally, and 218.04 ± 21.91 µm (range, 191-261 µm) temporally. Mean depth of the corneal stromal demarcation line measured by the second observer was 308.78 ± 29 µm (range, 262-381 µm) centrally, 211.04 ± 23.93 µm (range, 180-277 µm) nasally, and 217.22 ± 25.51 µm (range, 179-271 µm) temporally. There was a statistically significant difference (P < 0.001) between central and both nasal and temporal depths of the corneal stromal demarcation line (paired samples t test) for both observers. There was no statistically significant difference between nasal and temporal corneal stromal demarcation line depths (paired samples t test, P > 0.05) for each observer. CONCLUSIONS: Mean depth of the corneal stromal demarcation line after CXL treatment is greater centrally in comparison with nasal and temporal depths.