Corneal transplantation and concomitant SARS-CoV-2 infection: a case report / Transplante de córnea e infecção concomitante por SARS-CoV-2: relato de caso

ABSTRACT This report was aimed at presenting a case of neurotrophic keratitis and concomitant SARS-CoV-2 infection in a patient who has recently undergone a corneal DALK transplant. One month after corneal transplantation with adequate corneal epithelialization, the patient presented neurotrophic keratitis with a torpid course of the corneal transplant coinciding with a SARS-CoV-2 infection, with an excessive host immune response. In addition, the patient presented a re-positivization of nasopharyngeal polymerase chain reaction of SARS-CoV-2 with past disease after starting treatment with autologous serum eye drops. The implications at the ophthalmological level of SARS-CoV-2 infection may be clarified as the time the illness progresses and we learn more about how it acts. In this case, the disparity of signs and symptoms, the antecedent of corneal surgery, and the possibility of a herpetic infection as a cause of the primary leukoma suggested neurotrophic keratitis. Nonetheless, the involvement of systemic SARS-CoV-2 infection in the process, triggering an excessive host immune response at the corneal level with an increase in inflammatory cytokines must be taken into account. No relationship was found between treatment with autologous serum and re-positivization of nasopharyngeal polymerase chain reaction, presenting the patient a favorable response to treatment.

RESUMO O objetivo deste relato foi apresentar um caso de ceratite neurotrófica e infecção concomitante por SARS-CoV-2 em paciente submetido recentemente a transplante de córnea DALK. Um mês após o transplante de córnea com adequada epitelização da córnea, o paciente apresentou ceratite neurotrófica com curso tórpido do transplante de córnea, coincidindo com infecção por SARS-CoV-2, com resposta imune excessiva do hospedeiro. Além disso, o paciente apresentou repositivização da reação em cadeia da polimerase nasofaríngeo de SARS-CoV-2, com doença pregressa após iniciar tratamento com colírio de soro autólogo. As implicações a nível oftalmológico da infecção por SARS-CoV-2, podem ser esclarecidas à medida que a doença progride e aprendemos mais sobre sua forma de atuação. Neste caso, a disparidade de sinais e sintomas, o antecedente de cirurgia de córnea e a possibilidade de infecção herpética como causa do leucoma primário sugeriram ceratite neurotrófica. No entanto, deve-se levar em consideração o envolvimento da infecção sistêmica por SARS-CoV-2 no processo, desencadeando uma resposta imune excessiva do hospedeiro no nível da córnea, com aumento de citocinas inflamatórias. Não foi encontrada relação entre o tratamento com soro autólogo e a repositivização da reação em cadeia da polimerase nasofaríngea, apresentando ao paciente uma resposta favorável ao tratamento.

Ultra-High Resolution Optical Aberrometry in Patients with Keratoconus: A Cross-Sectional Study.

INTRODUCTION: This study performs optical aberration assessment in patients using a novel ultra-high-resolution device. The objective of this study is to analyze optical aberrations, especially the very high order wavefront (more than 10th order of Zernike coefficients), and compare between keratoconus and healthy patients. METHODS: In this cross-sectional study, we analyzed 43 eyes from 25 healthy patients and 43 eyes from 27 patients with keratoconus using corneal tomography and a very high-resolution (8.55 µm) aberrometer prototype (T-eyede) outfitted with a sensor originally developed for use in the field of astrophysics. Corneal aberration values were assessed using an optical model built with Zemax optical software, while ocular aberrations were assessed using T-eyede. In addition, image-processing analysis was performed of the wavefront phase, creating a high-pass filter map. RESULTS: We found lower values for ocular aberrations than corneal aberrations in both groups (p < 0.001). Specifically, we found a reduction in primary astigmatism (0.145 µm) and primary coma (0.017 µm). Also, the keratoconus group showed significantly higher wavefront aberration values compared with controls (p < 0.001). An analysis of the high-pass filter map revealed 2 contrasting results: one smooth or clear, while the other presented a banding pattern. Almost all in the control group (95%) showed the first pattern, while 77% of the keratoconus group showed a banding pattern on the filtered map (chi-squared test, p < 0.001). CONCLUSION: This device provides reliable, precise measurements of ocular aberrations that correlate well with corneal aberrations. Furthermore, the extraordinary high-resolution measurements revealed unprecedented micro changes in the wavefront phase of patients with keratoconus that varied with disease stage. These findings could lead to new screening or follow-up methods.

Risk of Intraocular Lens Opacification After Endothelial Keratoplasty for Different Intraocular Lens Models: A Retrospective Single-Center Cohort Study.

PURPOSE: The aims of this study were to calculate the specific risk of opacification for different intraocular lens (IOL) models and to determine whether differences exist, even between lenses made of similar acrylic materials. METHODS: This is a retrospective cohort study of all patients who underwent endothelial keratoplasty (EK), either after or in conjunction with cataract surgery, from June 2009 to October 2020 at Fundación Jiménez Díaz Hospital. RESULTS: Three hundred seventy-two eyes of 308 patients with a median follow-up of 856 days [interquartile range (IQR): 384-1570] were included, of which 128 IOLs were hydrophobic, 120 hydrophilic, and 124 unknown. 12.9% of IOLs opacified after a median of 466 days (IQR: 255-743). Visual acuity (VA) was significantly lower in the opacified IOL group [0.51 (IQR: 0.36-1.13)] compared with the nonopacified group [0.22 (IQR: 0.11-0.65)] ( P < 0.001). IOL explantation and exchange was performed in 10 eyes, in which VA improved markedly, from 1.75 (IQR: 0.99-3.00) to 0.60 (IQR: 0.36-0.86) ( P = 0.004). IOL material and opacification events were not independent ( P < 0.001). Significant differences were found between the Akreos ADAPT AO and MI60P models and the Asphina 409M model ( P = 0.022). No significant differences were found in the opacification ratio for hydrophilic IOLs in the clinical diagnosis ( P = 0.11), the type of EK ( P = 0.25), the rebubbling rate ( P = 0.44), or the tamponade used ( P = 0.36). CONCLUSIONS: Hydrophilic lenses should be avoided in patients at risk of requiring EK. It is important to know the probability of opacification of each IOL model to balance risk and benefits when planning an EK procedure because not all lenses opacify equally. Opacification is an unwanted event with a negative impact on VA, making IOL explantation and exchange the only viable treatment, although one that is not without risks.

Correction: Assesment of the QuickSee wavefront autorefractor for characterizing refractive errors in school-age children.

[This corrects the article DOI: 10.1371/journal.pone.0240933.].

Optical Evaluation of Intracorneal Ring Segment Surgery in Keratoconus.

Purpose: The purpose of this study was to assess the impact of different intracorneal ring segments (ICRS) combinations on corneal morphology and visual performance on patients with keratoconus. Methods: A total of 124 eyes from 96 patients who underwent ICRS surgery were analyzed and classified into 7 groups based on ICRS disposition and the diameter of the surgical zone (5- and 6-mm). Pre- and postoperative complete ophthalmological examinations were conducted. Corneal geometry, volume, and symmetry were studied. Zernike polynomials were used to build a virtual ray-tracing model to evaluate optical aberrations and the Visual Strehl (VS). Results: ICRS induced significant flattening across the cornea, being more pronounced on the anterior (+0.38 mm, P < 0.001) than on the posterior (+0.15 mm, P < 0.001) corneal radius. Asphericity experienced a larger change for a 6-mm surgical zone diameter (from -1.23 ± 1.1 to -1.86 ± 1.2, P < 0.001) than for a 5-mm zone (from -1.99 ± 1.1 to -2.10 ± 1.5, P = 0.536). Mean astigmatism was reduced by 2.05 D (P < 0.001). Combination four was the most effective in reducing astigmatism. Coma decreased by 30% on average and combination one produced an average reduction by 51% (P < 0.05). Patients experienced significant improvement in visual performance, best corrected visual acuity increased from 0.57 ± 0.21 to 0.69 ± 0.21 and VS changed from 0.049 ± 0.02 to 0.065 ± 0.041. Conclusions: ICRS combinations implanted within 5 mm diameter zone are more effective in flattening the cornea, whereas those implanted on 6 mm diameter are as effective in reducing astigmatism and are a good choice if the asymmetry and the intended flattening are smaller. Combinations with asymmetrical implants are the best option to regularize corneal surface. Translational Relevance: This study uses methods and metrics of optical research applied to daily clinical practice.

Pinhole amniotic membrane for peripheral corneal defects in patients with a single eye or low vision.

AIMS: To describe the efficacy of a new pinhole amniotic membrane placement technique in cases of peripheral epithelial defects in patients with a single eye or low vision in the contrye. METHODS: This technique is based on a small central hole done with a dermatological 3 to 4 mm punch (according to pupillary diameter in mesoscopic conditions) and a continuous suture in the perilimbal cornea to fix the amniotic membrane. We performed this technique in 6 patients. Patients were followed clinical and photographically. RESULTS: No changes in the visual acuity before and after the surgery were observed. During follow-up, a complete re-epithelialization was observed with no need for reinterventions. CONCLUSIONS: Amniotic membrane transplantation is a very useful option in patients with persistent epithelial defects; however, its use is limited by the subsequent visual acuity. The use of the pinhole amniotic membrane technique allows us to treat peripheral persistent corneal lesions without modifying patients' visual acuity. This new technique may become especially useful in patients with functional single eye of low vision in the contralateral eye.

Assesment of the QuickSee wavefront autorefractor for characterizing refractive errors in school-age children.

PURPOSE: To assess the performance of an open-view binocular handheld aberrometer (QuickSee) for diagnosing refractive errors in children. METHODS: 123 school-age children (9.9 ± 3.3 years) with moderate refractive error underwent autorefraction (AR) with a standard desktop device and subjective refraction (SR), with or without cycloplegia to determine their eyeglass prescription. Measurements with QuickSee (QS) were taken in 62 of these patients without cycloplegia (NC), and in 61 under cycloplegia (C). Differences in refraction values (AR vs SR vs QS) as well as the visual acuity (VA) achieved by the patients with each method (QS vs SR) were used to evaluate the performance of the device in measuring refractive error. RESULTS: The spherical equivalent refraction obtained by QS agreed within 0.5 D of the SR in 71% (NC) and 70% (C) of the cases. Agreement between the desktop autorefractor and SR for the same threshold was of 61% (NC) and 77% (C). VA resulting from QS refractions was equal to or better than that achieved by SR procedure in 77% (NC) and 74% (C) of the patients. Average improvement in VA with the QS refractions was of 8.6 and 13.4 optotypes for the NC and C groups respectively, while the SR procedure provided average improvements of 8.9 (NC) and 14.8 (C) optotypes. CONCLUSIONS: The high level of agreement between QuickSee and subjective refraction together with the VA improvement achieved in both study groups using QuickSee refractions suggest that the device is a useful autorefraction tool for school-age children.

Interaction of Monochromatic and Chromatic Aberrations in Pseudophakic Patients.

PURPOSE: To measure monochromatic aberrations at various wavelengths in eyes implanted with the Clareon monofocal aspheric intraocular lens (IOL) (Alcon Laboratories, Inc., Fort Worth, TX). The authors estimated longitudinal chromatic aberration (LCA), modulation transfer functions (MTFs), and the impact of interactions between chromatic and monochromatic aberrations on retinal image quality. METHODS: Ten patients (age: 68.4 ± 3.21 years) were measured in two experiments: (1) Hartmann-Shack wave aberrations at five visible wavelengths (480 to 700 nm) and (2) best subjective focus at each wavelength. Objective and psychophysical LCAs were obtained from the Zernike defocus and psychophysical best focus, respectively. MTFs were calculated for the closest wavelengths to the peak sensitivity of the three cone classes (S [480 nm], M [555 nm], and L [564 nm]) using the measured aberrations and chromatic difference of focus. The degradation produced by LCA was estimated as the visual Strehl ratio for green divided by the visual Strehl ratio for blue and red. RESULTS: The root mean square for higher order aberrations (HOAs) ranged from 0.0622 to 0.2084 µm (700 nm, 4.3-mm pupil). Monochromatic visual Strehl ratio was above 0.35 in all patients. LCA was 1.23 ± 0.05 diopters (D) (psychophysical) and 0.90 ± 0.11 D (objective). Visual Strehl ratio decreased by a factor ranging from 1.38 to 3.82 on chromatic defocus from green to blue. There was a significant correlation between native visual Strehl ratio and the degradation produced by LCA (ie, visual Strehl555/visual Strehl480). CONCLUSIONS: The Clareon IOL compensates for spherical aberration, with postoperative wave aberrations dominated by astigmatism and other HOAs, being highly subject-dependent. The impact of LCA in blue is largely dependent on the magnitude of monochromatic aberrations. [J Refract Surg. 2020;36(4):230-238.].

Diagnostic Sensitivity of Different Reference Bodies When Using Scheimpflug Tomography in a Myopic Population with Keratoconus.

PURPOSE: To establish which reference body offers the greatest sensitivity in keratoconus (KC) diagnosis, obtain normative data for the myopic population with toric ellipsoid reference bodies, and determine the cutoff points for a population with KC. METHODS: A retrospective, observational study of the entire Scheimpflug tomographer database of the Fundación Jiménez Díaz in Madrid was conducted to identify a normal myopic and a KC myopic population. Three different reference bodies were tested on all patients: best fit sphere (BFS), best fit toric ellipsoid with fixed eccentricity (BFTEFE), and best fit toric ellipsoid (BFTE). Anterior and posterior elevation measurements at the apex and thinnest point were recorded, as well as the root mean square of posterior elevations (RMS-P). Normative data were extracted, and receiver operating characteristic (ROC) curves were generated to obtain cutoff points between the normal and KC population. RESULTS: A total of 301 eyes were included, comprising 219 normal myopic and 82 myopic KC eyes. BFS and BFTEFE produced the best results when measuring posterior elevation at the thinnest point. BFTE had better sensitivity with the RMS-P. From all measurements, best sensitivity (100%) was achieved with a cutoff point of 8 µm of posterior elevation at the thinnest point using the BFTEFE. BFTE was found to hide the cone in certain patients. CONCLUSIONS: Posterior elevation measured at the thinnest point with a BFTEFE is the best-performing parameter and, therefore, is recommended to discriminate between normal and KC patients within a myopic population.

Comparison of visual quality and subjective outcomes among 3 trifocal intraocular lenses and 1 bifocal intraocular lens.

PURPOSE: To compare visual quality and subjective outcomes between 3 trifocal intraocular lenses (IOLs) and 1 bifocal IOL. SETTING: Clínica Oftalmológica Martínez de Carneros, Madrid, Spain. DESIGN: Prospective case series. METHODS: This study comprised patients having bilateral phacoemulsification and implantation of an AcrySof IQ PanOptix, AT LISA tri 839MP, FineVision, or Tecnis ZLB00 IOL. Postoperative evaluation included logarithm of the minimum angle of resolution (logMAR) uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and distance-corrected near visual acuity (DCNVA); reading speed; through-focus logMAR visual acuity at 100%, 50%, and 12% contrast; and contrast sensitivity function (CSF) under photopic and mesopic conditions. Subjective outcomes were assessed using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). RESULTS: The study enrolled 160 patients, 40 in each group. Six months postoperatively, there were no statistically significant between-group differences in the spherical equivalent, UDVA, CDVA, DCNVA, reading performance, or CSF under photopic and mesopic conditions. The defocus curves at 100%, 50%, and 15% of contrast showed that trifocal IOLs, especially the AcrySof PanOptix, had better intermediate performance than the bifocal IOL and comparable outcomes at far and near distances. There were no statistically significant differences in the postoperative NEI VFQ-25 questionnaire scores between the 4 IOL groups. CONCLUSION: The trifocal IOLs provided better intermediate distance vision than the bifocal IOL without compromising distance or near vision.

Estimation of intraocular lens position from full crystalline lens geometry: towards a new generation of intraocular lens power calculation formulas.

In a cataract surgery, the opacified crystalline lens is replaced by an artificial intraocular lens (IOL). To optimize the visual quality after surgery, the intraocular lens to be implanted must be selected preoperatively for every individual patient. Different generations of formulas have been proposed for selecting the intraocular lens dioptric power as a function of its estimated postoperative position. However, very few formulas include crystalline lens information, in most cases only one-dimensional. The present study proposes a new formula to preoperatively estimate the postoperative IOL position (ELP) based on information of the 3-dimensional full shape of the crystalline lens, obtained from quantitative eye anterior segment optical coherence tomography imaging. Real patients were measured before and after cataract surgery (IOL implantation). The IOL position and the postoperative refraction estimation errors were calculated by subtracting the preoperative estimations from the actual values measured after surgery. The proposed ELP formula produced lower estimation errors for both parameters -ELP and refraction- than the predictions obtained with standard state-of-the-art methods, and opens new avenues to the development of new generation IOL power calculation formulas that improve refractive and visual outcomes.

Evaluation of the True Wavefront Aberrations in Eyes Implanted With a Rotationally Asymmetric Multifocal Intraocular Lens.

PURPOSE: Standard evaluation of aberrations from wavefront slope measurements in patients implanted with a rotationally asymmetric multifocal intraocular lens (IOL), the Lentis Mplus (Oculentis GmbH, Berlin, Germany), results in large magnitude primary vertical coma, which is attributed to the intrinsic IOL design. The new proposed method analyzes aberrometry data, allowing disentangling the IOL power pupillary distribution from the true higher order aberrations of the eye. METHODS: The new method of wavefront reconstruction uses retinal spots obtained at both the near and far foci. The method was tested using ray tracing optical simulations in a computer eye model virtually implanted with the Lentis Mplus IOL, with a generic cornea or with anterior segment geometry obtained from custom quantitative spectral-domain optical coherence tomography in a real patient. The method was applied to laser ray tracing aberrometry data at near and far fixation obtained in a patient implanted with the Lentis Mplus IOL. RESULTS: Higher order aberrations evaluated from simulated and real retinal spot diagrams following the new reconstruction approach matched the nominal aberrations (approximately 98%). Previously reported primary vertical coma in patients implanted with this IOL lost significance with the application of the proposed reconstruction. CONCLUSIONS: Custom analysis of ray tracing-based retinal spot diagrams allowed decoupling of the true higher order aberrations of the patient's eye from the power pupillary distribution of a rotationally asymmetric multifocal IOL, therefore providing the appropriate phase map to accurately evaluate through-focus optical quality. [J Refract Surg. 2017;33(4):257-265.].

Weighing of risk factors for penetrating keratoplasty graft failure: application of Risk Score System.

AIM: To analyze the relationship between the score obtained in the Risk Score System (RSS) proposed by Hicks et al with penetrating keratoplasty (PKP) graft failure at 1y postoperatively and among each factor in the RSS with the risk of PKP graft failure using univariate and multivariate analysis. METHODS: The retrospective cohort study had 152 PKPs from 152 patients. Eighteen cases were excluded from our study due to primary failure (10 cases), incomplete medical notes (5 cases) and follow-up less than 1y (3 cases). We included 134 PKPs from 134 patients stratified by preoperative risk score. Spearman coefficient was calculated for the relationship between the score obtained and risk of failure at 1y. Univariate and multivariate analysis were calculated for the impact of every single risk factor included in the RSS over graft failure at 1y. RESULTS: Spearman coefficient showed statistically significant correlation between the score in the RSS and graft failure (P<0.05). Multivariate logistic regression analysis showed no statistically significant relationship (P>0.05) between diagnosis and lens status with graft failure. The relationship between the other risk factors studied and graft failure was significant (P<0.05), although the results for previous grafts and graft failure was unreliable. None of our patients had previous blood transfusion, thus, it had no impact. CONCLUSION: After the application of multivariate analysis techniques, some risk factors do not show the expected impact over graft failure at 1y.

Safety and Efficacy Clinical Trials for SYL1001, a Novel Short Interfering RNA for the Treatment of Dry Eye Disease.

Purpose: To evaluate the efficacy and safety of SYL1001, a short interfering (si) RNA targeting the transient receptor potential cation channel subfamily V member 1 (TRPV1), for the treatment of dry eye disease (DED). Methods: This study combines a phase I and two phase II clinical trials to test different doses of SYL1001 in a total of 156 healthy subjects and patients with DED. After 10 days of treatment, the primary efficacy endpoints were the effect on (1) the scoring in the Visual Analogue Scale (VAS) and Ocular Surface Disease Index (OSDI) questionnaires, and (2) ocular tolerance evaluated by corneal fluorescein staining and conjunctival hyperemia. Secondary endpoints included the assessment of systemic and local tolerance. Results: Topical administration of SYL1001 1.125% once daily produced a significant decrease in VAS scores compared with placebo from day 4 until the end of treatment (change from baseline at day 10: -1.73 ± 0.32 vs. -0.91 ± 0.34; P = 0.013). For all treatments, OSDI scores were significantly reduced compared to their respective baseline values (P < 0.01), although no significant changes were detected between groups. Conjunctival hyperemia (quantified as normal or abnormal) significantly improved after instillation of SYL1001 1.125% compared with placebo (50% vs. 20%; P < 0.05). Excellent tolerability was reported, with no differences in the rates of occurrence of adverse events between groups. Conclusion: These trials achieved their primary endpoints of identifying the most effective dose of SYL1001 (1.125%). SYL1001 showed a large safety margin and may provide novel therapeutic opportunity for the relief of dry eye. (ClinicalTrials.gov numbers, NCT01438281, NCT01776658, and NCT02455999.).

Activation of Rac1 and RhoA Preserve Corneal Endothelial Barrier Function.

PURPOSE: The corneal endothelium is responsible for the correct hydration of the corneal stroma. Corneal endothelial cells have a low proliferative capacity, so preserving their barrier function under suboptimal conditions that cause osmotic imbalance, such as those arising from corneal pathologies, age, cryopreservation, and transplantation, is essential for maintaining corneal transparency. We have investigated the signaling induced by hyperosmotic shock that reversibly disrupts corneal endothelial barriers in human endothelial cells and in murine corneas. METHODS: Endothelial barrier properties were analyzed in vitro by electric cell substrate impedance sensing (ECIS) and confocal microscopy of the human endothelial cell line B4G12-HCEC, and, ex vivo, by confocal microscopy and stimulated emission-depletion (STED) super-resolution microscopy of murine corneas. Cell signaling in response to hyperosmotic stress, induced with an excess of sodium chloride, was investigated in B4G12-HCECs. Rho GTPase activity was detected by pulldown assays with recombinant GST proteins fused to the Rho binding domains of Rho effectors. RESULTS: Hyperosmotic stress increased actin polymerization and activated the Rho GTPases Rac1 and RhoA, but not Cdc42. Rac1- and RhoA-mediated pathway inhibition had a minor effect on barrier disruption but partially delayed barrier reformation after stress withdrawal. In contrast, Rac1 and RhoA activation enhanced constitutive endothelial barrier function and accelerated barrier repair. CONCLUSIONS: Our results indicate that Rac1 and RhoA activation do not mediate stress-induced cell contraction but are endothelial responses that act to restore and maintain barrier homeostasis. Therefore, pharmacological activation of these two GTPases could be a therapeutic strategy for preserving corneal endothelial barrier function.

A human cellular system for analyzing signaling during corneal endothelial barrier dysfunction.

Correct corneal endothelial barrier function is essential for maintaining corneal transparency. However, research on cell signaling pathways mediating corneal endothelial barrier dysfunction has progressed more slowly than that involving other cellular barriers because of the lack of human corneal endothelial cell models. Here we have optimized the culture of the human corneal endothelial cell (HCEC) line B4G12 as a model for studying paracellular permeability. We show that B4G12-HCECs form confluent monolayers with stable cell-cell junctions when cultured on plastic, but not glass, surfaces precoated with various extracellular matrix components. Cell morphometry and measuring intercellular spaces and transendothelial electric resistance indicate that B4G12-HCECs form optimal monolayers on collagen and fibronectin. Based on the use of specific inhibitors, it has been proposed that the Rho-regulated kinases, ROCK-I and ROCK-II, mediate actomyosin-induced contraction in corneal endothelial cell barriers. ROCKs are effectors of RhoA, RhoB and RhoC. We show that the GTPase RhoA and its effector ROCK-II are predominantly expressed in B4G12-HCECs and primary human corneal endothelial cells. The activation of Rho GTPases during acute barrier disruption has not been investigated in corneal endothelial cells. RhoA, but not other related GTPases that are highly expressed in B4G12-HCECs, such as Rac1 and Cdc42, is transiently activated during barrier disruption in response to the inflammatory mediator thrombin. Pharmacological inhibition of RhoA and ROCK reduces B4G12-HCEC acute contraction. We propose that exploiting B4G12-HCECs is a useful experimental strategy for gaining further insight into the signaling pathways involved in human corneal endothelial barrier function.

Benefits of omega-3 fatty acid dietary supplementation on health-related quality of life in patients with meibomian gland dysfunction.

BACKGROUND: We assessed the impact of a dietary supplement based on the combination of omega-3 essential fatty acids and antioxidants on health-related quality of life in patients with meibomian gland dysfunction (MGD). METHODS: Patients of either sex (aged 18-85 years) diagnosed with MGD according to criteria identified at a 2011 International Workshop on Meibomian Gland Dysfunction participated in this randomized, double-masked, placebo-controlled study. Group A patients (controls) received an oral placebo supplement and group B patients received the oral study supplement (Brudysec(®) 1.5 g; Brudy Laboratories, Barcelona, Spain). At baseline and at 3-month follow-up, the patients completed the 36-Item Short Form Health Survey questionnaire using a Spanish validated version. The Physical (PCS) and Mental (MCS) Component Summary scores were the main outcome variables. RESULTS: A total of 61 patients completed the study (group A, n=31; group B, n=30). There were no significant differences in PCS and MCS scores at baseline between the two study groups, but after 3 months of treatment, significantly higher mean PCS and MSC scores were observed in patients treated with the active omega-3 dietary supplement as compared with controls (mean [standard deviation] PCS score 53.33±5.57 versus 47.46±7.31, P=0.008; mean MCS score 54.60±5.64 versus 47.80±8.45, P=0.0005). Moreover, mean differences between values at 3 months as compared with baseline were statistically significant for patients in group B (PCS score 7.14±5.81, 95% confidence interval 4.97-9.31, P=0.000; MCS score 5.96±7.64, 95% confidence interval 3.10-8.81, P=0.0002), whereas mean differences in patients assigned to group A were not statistically significant. CONCLUSION: Dietary supplementation with a combination of omega-3 essential fatty acids and antioxidants had a significant beneficial effect on HRQoL (health-related quality of life) in patients with MGD.

Description of a new family with cryopyrin-associated periodic syndrome: risk of visual loss in patients bearing the R260W mutation.

OBJECTIVE: The aim of this study was to describe a family with cryopyrin-associated periodic syndrome (CAPS) in which the disease was unveiled after the ophthalmologic evaluation. METHODS: Family and personal histories from each of the patients were recorded. Each underwent a full ophthalmological examination along with the physical examination. The mutational analysis of the NLRP3 gene was performed by means of direct sequencing. RESULTS: The proband was admitted during an episode of unilateral anterior uveitis. She had a history of recurrent red eye and had been suffering episodes of skin rash and arthralgia induced by cold since childhood. At examination, she showed a reticulated corneal mid-stroma. Her mother and her younger sister also suffered from relapsing episodes of skin rash and fever triggered by cold as well as flares of red eye. They had developed premature hearing loss. In both cases, opacities in the corneal mid-stroma were evidenced with a slit lamp. The genetic analysis detected the heterozygous germline p.R260W mutation in the NLRP3 gene in the three women, confirming the diagnosis of CAPS. Treatment with anakinra resulted in complete remission of flares. CONCLUSION: In this family, a structural NLRP3 mutation was associated with classic MuckleWells features of different degrees of severity. Interstitial keratitis with corneal opacification, usually ascribed to neonatal-onset multisystem inflammatory disease, was found. We underscore that ocular involvement in MuckleWells syndrome should be carefully assessed, since it can lead to visual impairment.

Aberrometry in patients implanted with accommodative intraocular lenses.

PURPOSE: To evaluate the objective accommodative response, change of aberrations, and depth of focus in eyes implanted with the Crystalens accommodative intraocular lens (IOL) at different accommodative demands. DESIGN: Prospective, observational study. METHODS: Eleven cataract patients (22 eyes) who underwent implantation of a Crystalens accommodative IOL, and control groups of 9 normal subjects (17 eyes) and 17 pseudophakic patients (17 eyes) implanted with monofocal IOLs were evaluated. A custom-developed laser ray tracing aberrometer was used to measure the optical aberrations. The monochromatic wave aberrations were described using a sixth-order Zernike polynomial expansion. Measurements were obtained under dilated and natural viewing conditions (for accommodative efforts ranging from 0 to 2.5 diopters [D]). The accommodative response was obtained by analyzing changes in paraxial defocus (associated to changes in defocus) and by evaluating the differences in the effective defocus (associated with defocus, spherical aberrations, and pupil diameter) with the accommodative demand. Depth of focus was estimated from through-focus objective optical quality. RESULTS: Wave aberration measurements were highly reproducible. Vertical trefoil (Z3(-3)) was the predominant higher-order aberration in the Crystalens group and significantly higher (P < .0001) than in the young group, but similar to the monofocal IOL group. The coma root mean square also was higher (P < .005) in the Crystalens group than in the young group. On average, the defocus term (Z2(0)), astigmatism, or higher-order aberrations did not change systematically with accommodative demand in Crystalens eyes. As found for paraxial defocus, the effective defocus in Crystalens eyes did not show significant differences between conditions: 0.34 ± 0.48 D (far), 0.32 ± 0.50 D (intermediate), and 0.34 ± 0.44 D (near). Depth of focus was statistically significantly higher in the Crystalens eyes than in the control groups. CONCLUSIONS: The accommodative response of eyes implanted with the Crystalens accommodative IOLs, measured objectively using laser ray tracing aberrometry, was lower than 0.4 D in all eyes. Several subjects showed changes in astigmatism, spherical aberration, trefoil, and coma with accommodation, which must arise from geometrical and alignment changes in the lens with accommodative demand. Pseudoaccommodation from increased depth of focus may contribute to near vision functionality in Crystalens-implanted patients.

Ocular and optical coherence tomography-based corneal aberrometry in keratoconic eyes treated by intracorneal ring segments.

PURPOSE: To analyze corneal and total aberrations using custom-developed anterior segment spectral optical coherence tomography (OCT) and laser ray tracing in keratoconic eyes implanted with intracorneal ring segments (ICRS). DESIGN: Evaluation of technology. Prospective study. Case series. METHODS: Nineteen keratoconic eyes were measured before and after ICRS surgery. Anterior and posterior corneal topographic and pachymetric maps were obtained pre- and postoperatively from 3-dimensional OCT images of the anterior segment, following automatic image analysis and distortion correction. The pupil center coordinates were used as reference for estimation of corneal aberrations. Corneal aberrations were estimated by computational ray tracing on the anterior and posterior corneal surfaces. Total aberrations were measured using a custom-developed laser ray tracing aberrometer. Corneal and total aberrations were compared in 8 eyes pre- and postoperatively for 4-mm pupils. RESULTS: Total and corneal aberrations were highly correlated. Average root mean square of corneal and total high-order aberrations (HOAs) were 0.78 ± 0.35 µm and 0.57 ± 0.39 µm preoperatively, and 0.88 ± 0.36 µm and 0.53 ± 0.24 µm postoperatively (4-mm pupils). The anterior corneal surface aberrations were partially compensated by the posterior corneal surface aberrations (by 8.3% preoperatively and 4.1% postoperatively). Astigmatism was 2.03 ± 1.11 µm preoperatively and 1.60 ± 0.94 µm postoperatively. The dominant HOA aberrations both pre- and postoperatively were vertical coma (Z3(-1)), vertical trefoil (Z3(-3)), and secondary astigmatism (Z4(4)). ICRS decreased corneal astigmatism by 27% and corneal coma by 5%, but on average, the overall amount of HOA did not decrease significantly with ICRS treatment. CONCLUSIONS: OCT is a reproducible technique to evaluate corneal aberrations. OCT-based corneal aberrations and ocular aberrations show a high correspondence in keratoconic patients before and after ICRS implantation. ICRS produced a decrease in astigmatism, but on average did not produce a consistent decrease of HOAs.