Efficacy of toric intraocular lens and prevention of axis misalignment by optic capture in pediatric cataract surgery.

PURPOSE: To compare the outcomes of intraocular lens (IOL) implantation using toric (T)-IOL and nontoric (N)-IOL in pediatric cataract patients with astigmatism and to examine the effect of optic capture (OC) on the axis misalignment (AM) of the T-IOLs. SETTING: Department of Ophthalmology, Kindai University Hospital, Osaka, Japan. DESIGN: Interventional, comparative case study. METHODS: Consecutive pediatric patients implanted with T-IOLs or N-IOLs were retrospectively reviewed. In the T-IOL group, the preoperative and postoperative corrected distance visual acuity (CDVA) and AM were compared in patients with and without OC. RESULTS: The T-IOL group included 14 eyes of 11 patients, whereas the N-IOL group included 22 eyes of 15 patients. One year postoperatively, the mean ocular cylinder (1.38 ± 0.80 diopters [D]) was significantly smaller than the mean corneal cylinder (3.33 ± 1.24 D) in the T-IOL group (P = .00012, Wilcoxon signed-rank test). The mean preoperative and 1-year postoperative CDVA (logMAR) were 0.57 and 0.003 (T-IOL) and 0.71 and 0.09 (N-IOL), respectively. The AM at 1 week and 1 year postoperatively was 2.6 ± 3.7 degrees and 4.4 ± 3.1 degrees for the OC group, and 13.3 ± 8.8 degrees and 18.5 ± 14.8 degrees, for the non-OC group, respectively. The AM was significantly smaller in the OC group than that in the non-OC group (P = .009, Mann-Whitney U test) at postoperative 1 week. CONCLUSIONS: T-IOL implantation is effective in correcting astigmatism in pediatric cataract patients with astigmatism, and the OC technique is likely to achieve lower AM of the T-IOL.

Incidence and Factors of Postoperative Lens Opacity after Lens-Sparing Vitrectomy for Retinopathy of Prematurity.

PURPOSE: To determine the incidence and factors associated with lens opacity after lens-sparing vitrectomy (LSV) for retinopathy of prematurity (ROP). DESIGN: Retrospective, comparative case series. PARTICIPANTS: Among the 141 eyes of 94 patients who underwent LSV for ROP between 2006 and 2019, 108 eyes of 71 patients with a minimum follow-up of 12 months after LSV were investigated. METHODS: Data were collected from patients' charts, including gender, gestational age at birth, birth weight, stage of ROP, postmenstrual age (PMA) at LSV, surgical procedure, preoperative injection of anti-vascular endothelial growth factor (VEGF) agents, subsequent retinal surgeries, and lensectomy during follow-up. MAIN OUTCOME MEASURES: Lens status at last visit, incidence and timing of lensectomy, and risk factors for lens opacity requiring lensectomy. RESULTS: Stages of ROP at LSV were 4A, 4B, and 5 in 92 eyes, 13 eyes, and 3 eyes, respectively. The median PMA at LSV was 40.6 weeks. Thirty-two eyes received anti-VEGF therapy before LSV. Lens opacity was found in 17 eyes (15.7%), of which 10 eyes (9.3%) underwent lensectomy. The period between LSV and lensectomy ranged from 21 days to 131.9 months (median, 21.1 months). Eleven other eyes (10.2%) underwent lensectomy as part of a reoperation for worsening of ROP. A total of 80 eyes (74.1%) preserved clear lenses at the latest follow-up examination after surgery (median, 6.8 years; range, 1-14 years). The Kaplan-Meier estimate showed that the proportion of patients with phakia at 5 and 10 years was 92.4% and 89.0%, respectively. Multivariate Cox regression analysis revealed that eyes with the use of tamponade at LSV (P = 0.005; odds ratio [OR], 25.68; 95% confidence interval [CI], 4.187-157.5) and young PMA at LSV (P = 0.033; OR, 1.047; 95% CI, 1.012-1.099) were associated significantly with lens opacity requiring lensectomy. However, anti-VEGF therapy was not associated with lens opacity requiring lensectomy. CONCLUSIONS: Nearly 10% of eyes required lensectomy because of lens opacity after LSV for ROP. The development of lens opacity requiring lensectomy seems to be associated with the use of tamponade and young PMA at LSV.

Quantification of Eccentric Fixation Using Spectral-Domain Optical Coherence Tomography.

PURPOSE: This study aimed to evaluate the utility of optical coherence tomography (OCT) in the quantification of eccentric fixation in amblyopic patients. MATERIAL AND METHODS: In this study, 14 amblyopic patients and 10 healthy volunteers were enrolled. Under non-mydriatic conditions, fixation tests were performed directly using a fixation ophthalmoscope and indirectly using spectral-domain OCT. For evaluations using OCT, the distance between the fovea and the fixation point, which was determined by a cross-sectional image, was measured. RESULTS: On evaluations of healthy volunteers by OCT, the mean distance between the fixation point and the fovea was 80.4 ± 37.7 µm for the dominant eyes and 63.7 ± 36.4 µm for non-dominant eyes (p = 0.41). In amblyopic patients, on evaluation by OCT, the mean distance between the fixation point and the fovea was 193.8 ± 188.3 µm in amblyopic eyes and 83.5 ± 39.3 µm in paired fellow eyes (p = 0.02). Although OCT could detect eccentric fixation points in all the affected eyes of amblyopic patients, fixation ophthalmoscope was unable to quantify them in 2 of 14 affected eyes. CONCLUSIONS: Compared with a fixation ophthalmoscope, our method using OCT seems to be superior both in quantification and detection of eccentric fixation in amblyopic patients, without the need for mydriasis.

Intraoperative optical coherence tomography (RESCAN® 700) for detecting iris incarceration and iridocorneal adhesion during keratoplasty.

There is no report focusing on the visualization of the iris incarceration or the iridocorneal adhesion during keratoplasty by use of microscope-integrated intraoperative optical coherence tomography (MIOCT). The purpose of this study is to report the usefulness of MIOCT for detecting iris incarceration and iridocorneal adhesions during penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK). MIOCT system was applied both in a patient who underwent PK for corneal leukoma and in a patient who underwent DALK for keratoconus. During the surgeries, we obtained cross-sectional images around the host-graft interface by operating the foot switch of microscope without discontinuing the surgical procedure. Intraoperative MIOCT findings and postoperative outcomes were examined. An iris incarceration at the host-graft interface was visualized during surgery after corneal suture in PK, which allowed surgeons to return the iris to its original position instantly. In DALK, misdirected air into the posterior chamber could also be seen at the end of the DALK. This iridocorneal adhesion was resolved by fluid injection through paracentesis. Secondary glaucoma and graft rejection have not occurred postoperatively in both cases. The MIOCT system provides advantages such as prevention of secondary glaucoma and rejection following PK and DALK.