The Influence of Angle Alpha, Angle Kappa, and Optical Aberrations on Visual Outcomes after the Implantation of a High-Addition Trifocal IOL.

The aim of our investigation was to examine the possible correlations between optical aberrations, angle kappa, angle alpha, and visual outcomes following cataract surgery. In total, 56 eyes of 28 patients were implanted with the Liberty 677MY trifocal intraocular lens (IOL). Pre- and postoperative higher-order aberrations, coma, astigmatism, angle alpha, and angle kappa were registered, along with uncorrected and corrected visual acuities at multiple distances. Visual acuity and contrast sensitivity defocus curves were plotted, and the areas under the curve were calculated 1 and 3 months postoperatively. Excellent visual outcomes were found at all distances. Patients reported low levels of dysphotopsia, and 96.4% of patients achieved complete spectacle independence. While angle kappa significantly decreased during cataract surgery (p = 0.0007), angle alpha remained unchanged (p = 0.5158). Angle alpha correlated with postoperative HOAs and had a negative impact on near vision (p = 0.0543). Preoperative corneal HOA and coma had a strong adverse effect on future intermediate and near vision. Residual astigmatism significantly affected postoperative intermediate vision (p = 0.0091). Our results suggest that angle kappa is not an optimal predictive factor for future visual outcomes, while angle alpha and the preoperative screening of optical aberrations might help patient selection prior to multifocal IOL implantation.

Ocular biometry in dense cataracts: Comparison of partial-coherence interferometry, swept-source optical coherence tomography and immersion ultrasound.

PURPOSE: To assess the axial length (AL) measurement failure rate using partial-coherence interferometry (PCI) and swept-source optical coherence tomography (SS-OCT) in dense cataracts. As a secondary outcome, the SS-OCT biometry was compared to immersion ultrasound. METHODS: This is a prospective cross-sectional and comparative study. Seventy eyes from 70 patients with dense cataracts were enrolled in this study. Dense cataract was defined according to the Lens Opacities Classification System III (LOCS III) scores equal to or more than NO4, NC4, C4, and P3. The failure rate of AL measurement was evaluated using PCI and SS-OCT. Anterior chamber depth (ACD), lens thickness (LT), and AL measurements obtained by SS-OCT were compared with IUS. RESULTS: AL measurement failure rate with PCI was 68.57% and 21.43% with SS-OCT (P = 0.007). AL measurement was achieved in 69.23% of NO4, 66.6% of P3, and 15.3% of mixed cataracts using PCI, while SS-OCT was achieved in 100% of NO4, NO5, P3, and P5 and 76.9% of mixed cataracts. Cortical cataracts alone did not influence AL measurement. Biometric data of ACD, LT, and AL were statistically different comparing US and SS-OCT with a good correlation of AL. CONCLUSION: SS-OCT significantly improves the rate of successful AL measurements when compared to PCI in dense cataracts. The LOCS III clinical cut-off for the use of SS-OCT ocular biometry may well be up to P4 and NO5.

Impact of correlation of angle α with ocular biometry variables.

PURPOSE: To analyze the association between angle α and ocular biometry in the general population at a third-level ophthalmology hospital. SETTING: Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P., Mexico City, Mexico. DESIGN: Prospective, cross-sectional study. METHODS: Healthy subjects who attended the hospital for a comprehensive ophthalmological evaluation were examined, and general data were collected. A complete ophthalmological assessment and biomicroscopy evaluation were performed and biometry and clinical data were obtained, including visual acuity, axial length (AL), keratometry (K), white-to-white (WTW) measurement. An OPD-Scan III analyzer was used to assess both the angle α distance and biometry parameters. RESULTS: 74 eyes from the same number of patients were included; 43 (58.10%) were women. A statistically significant inverse correlation was found between the angle α and the AL (r = -0.585; P < .0001) and between the WTW distance and the mean K (r = 0.557; P < .0001). A significant correlation was found between the mean K and the angle α (r = 0.271; P = .019). A significant inverse correlation was observed regarding the WTW distance and angle α (r = -0.359; P = .001). By contrast, a direct correlation was evidenced between the WTW and the AL (r = 0.385; P = .0007). CONCLUSIONS: There was a significant inverse correlation between the AL and the angle α magnitude. Hyperopic patients demonstrated significantly higher angle α values when compared with those of myopic patients. In addition, hyperopic eyes with steeper mean K and lesser WTW distance were associated with an increased angle α.

Influence of Angle κ and Higher-Order Aberrations on Visual Quality Employing Two Diffractive Trifocal IOLs.

Prospective, randomized, comparative, and controlled study to estimate the association between angle κ distance and higher-order aberrations (HOAs) with postoperative visual acuity after presbyopia-correcting IOL implantation. Forty-three eyes from 43 patients were included and randomly assigned in two groups for either AT LISA tri 839MP or Acrysof IQ PanOptix IOL implantation. The OPD-Scan III analyzer was utilized to assess the angle κ distance and higher-order aberration (HOAs). Twenty-three eyes were in the Acrysof IQ PanOptix group and 20 patients in the AT LISA tri 839MP group. The uncorrected distance visual acuity (UDVA) for the PanOptix group was 0.092 ± 0.10, whereas for AT LISA tri was 0.050 ± 0.06 (P=0.229). The uncorrected intermediate visual acuity (UIVA) for the PanOptix group was 0.173 ± 0.18, whereas for AT LISA tri, it was 0.182 ± 0.11 (P=0.669). Uncorrected near visual acuity (UNVA) was 0.068 ± 0.04 and 0.085 ± 0.07, respectively (P=0.221). Also, correlation coefficient between HOAs and the Strehl ratio for each group were -0.768 (P < 0.0001) and -0.863 (P=0.0001). Patients implanted with both trifocal IOLs showed excellent postoperative visual performance at all distances at the six-month follow-up visit. No association was found between angle κ distance and postoperative visual acuity regardless of the angle κ magnitude or the two trifocal IOLs inner optical diameter. Also, internal aberrations demonstrated a significant inverse correlation with the Strehl ratio for both trifocal IOLs.

Femtosecond laser-assisted cataract surgery in pediatric patients.

Pediatric cataract surgery poses a significant challenge for the cataract surgeon, in part because an elastic anterior capsule can make capsulorhexis difficult. With the use of femtosecond laser-assisted cataract surgery (FLACS), however, the continuous curvilinear capsulorhexis can be made with predictable size, circular shape, centration, and accuracy. In addition, topical anesthesia can be used for the FLACS docking procedure in cooperative children above 6 years of age, using transparent adhesive polyurethane film segments.

Comparison of biometric measurements obtained by the Verion Image-Guided System versus the auto-refracto-keratometer.

PURPOSE: To compare the biometric measurements obtained from the Verion Image-Guided System to those obtained by auto-refracto-keratometer in normal eyes. METHODS: This is a prospective, observational, comparative study conducted at the Asociación para Evitar la Ceguera en México I.A.P., Mexico. Three sets of keratometry measurements were obtained using the image-guided system to assess the coefficient of variation, the within-subject standard deviation and intraclass correlation coefficient (ICC). A paired Student t test was used to assess statistical significance between the Verion and the auto-refracto-keratometer. A Pearson's correlation coefficient (r) was obtained for all measurements, and the level of agreement was verified using Bland-Altman plots. RESULTS: The right eyes of 73 patients were evaluated by each platform. The Verion coefficient of variation was 0.3% for the flat and steep keratometry, with the ICC being greater than 0.9 for all parameters measured. Paired t test showed statistically significant differences between groups (P = 0.0001). A good correlation was evidenced for keratometry values between platforms (r = 0.903, P = 0.0001 for K1, and r = 0.890, P = 0.0001). Bland-Altman plots showed a wide data spread for all variables. CONCLUSION: The image-guided system provided highly repeatable corneal power and keratometry measurements. However, significant differences were evidenced between the two platforms, and although values were highly correlated, they showed a wide data spread for all analysed variables; therefore, their interchangeable use for biometry assessment is not advisable.

High-cylinder acrylic toric intraocular lenses: a case series of eyes with cataracts and large amounts of corneal astigmatism.

PURPOSE: To examine the stability and efficacy of high-cylinder power AcrySof toric intraocular lenses (IOLs), models SN60T6, SN60T7, SN60T8, and SN60T9 (Alcon Laboratories Inc). METHODS: Eligible eyes had cataract and symmetric corneal astigmatism > 2.25 diopters (D). Outcomes included monocular uncorrected distance visual acuity (UDVA), manifest refraction, and assessment of IOL axis. RESULTS: Nineteen eyes from 14 patients had preoperative corneal astigmatism of 4.00 ± 1.10 D. Postoperatively, residual refractive cylinder was 0.55 ± 0.60 D at 3 months. Uncorrected distance visual acuity was 1.3 ± 0.5 logMAR preoperatively and improved to 0.11 ± 0.09 logMAR 3 months postoperatively (P<.0001). All IOLs were stable within 5°. CONCLUSIONS: The IOLs were stable and effective in correcting high amounts of preexisting astigmatism at the time of cataract surgery.

Secondary Bilateral Angle Closure Glaucoma due to Topiramate.

We examined a 39-year-old female with severe headache and blurred vision. She was on topiramate, 50 mg once a day for one week because of migraine. Periorbital edema, chemosis, myopia, high intraocular pressures, and shallow anterior chambers were present at the initial examination. Iridocorneal angles were closed, ultrasound showed choroidal effusions. We stopped topiramate and started antiglaucoma treatment. After one week the intraocular pressure was 10 mm Hg in both eyes without treatment. A new ultrasound showed no choroidal effusions. Topiramate has been associated with acute secondary angle closure glaucoma as an idiosyncratic reaction to the drug. Physicians prescribing topiramate need to alert patients of this potential sight-threatening idiosyncratic reaction.

Inhibition of surgically induced miosis and prevention of postoperative macular edema with nepafenac.

OBJECTIVE: To evaluate the effectiveness of prophylactic administration of nepafenac 0.1% in maintaining mydriasis and in preventing postoperative macular edema following cataract surgery. METHODS: This was a prospective, randomized, single-masked comparative study in 60 patients undergoing phacoemulsification cataract surgery. Patients were randomized to either the nepafenac or the control group. Nepafenac was administered 3 times daily 1 day before surgery and continued for 6 weeks. The control group received tobramycin-dexamethasone treatment only. Trans-operative mydriasis was measured before surgery, after nuclear emulsification, following cortex aspiration, and at the conclusion of surgery. Macular optical coherence tomography determined central foveal thickness (FT) and total macular volume (TMV) before surgery and at 2 and 6 weeks after surgery. All patients received tobramycin-dexamethasone for 2 weeks after surgery. RESULTS: The difference in mean pupil size, at the end of surgery, between the control group (6.84 +/- 0.93 mm) and the nepafenac group (7.91 +/- 0.74 mm) was statistically significant (p < 0.001). There were no significant differences in FT values between the two groups at any time point; however, TMV at 2 and at 6 weeks was statistically significantly different (p < 0.001), with higher TMV in the control group. CONCLUSION: Prophylactic use of nepafenac was effective in reducing macular edema after cataract surgery and in maintaining trans-operative mydriasis.

Posterior capsule opacification and neovascularization treated with intravitreal bevacizumab and Nd:YAG capsulotomy.

We reported a 75-year-old diabetic man, who developed opacification and neovascularization of the posterior capsule after extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient was treated with two injections of 2.5 mg of intravitreal bevacizumab. The treatment produced an important regression of the posterior capsular new vessels, allowing us to perform a successful Nd:YAG capsulotomy, clearing the visual axis and improving the visualization of the posterior pole. Even though, best corrected visual acuity was 20/200 due to diabetic macular edema.

Inyección intraocular accidental de corticoesteroides. Presentación de un caso / Accidental intraocular injection of corticosteroids. Case Report

Los corticoesteroides son comúnmente utilizados en el tratamiento de enfermedades inflamatorias oculares, ya que su concentración a nivel del segmento posterior del ojo es adecuada y se evitan los efectos colaterales de la administración sistémica. Sin embargo la técnica no es inocua y pueden presentarse complicaciones, como perforación del globo ocular con la subsecuente administración del medicamento en la cavidad vítrea o espacio subretiniano. En este artículo, los autores presentan el caso de un paciente en que ocurrió accidentalmente perforación ocular, su diagnóstico, evolución y manejo.

Lesiones quísticas de órbita: imagen ecográfica / Orbital cystic lesions: ecographic image

Existen varios tipos de lesiones quísticas de la órbita, las cuales presentan características ecográficas comunes como forma redonda u oval, superficie bien delimitada de bordes definidos, y ausencia de vascularidad interna. Dichas lesiones son habitualmente fáciles de diferenciar de los tumores sólidos.

Resultados y complicaciones de implantes de lentes intraoculares secundarios / Results and complications of secundary intraocular lens implatation

Los implantes secundarios de lentes intraoculares son importantes para pacientes en los que al realizar cirugía de catarata no se colocó un lente intraocular de primera intención, con la subsecuente dificultad para adaptarse a un lente de contacto y más aún cuando el ojo contralateral es fáquico o pseudofaco. Nosotros revisamos retrospectivamente expedientes del Hospital "Dr. Luis Sánchez Bulnes" de la Asociación Para Evitar la Ceguera, de pacientes que fueron sometidos a cirugía de implante secundario de lentes intraoculares de cámara anterior o posterior en un periodo entre 1989 y 1996, para valorar su capacidad visual final y conocer las posibles complicaciones que existen en estos pacientes. Se describe el tipo de cirugía inicial, el estado en que se encontraba el ojo en el momento del implante secundario, el número de pacientes que estaban rehabilitados visualmente y algunas otras variables clínico-epidemiológicas.

Amiloidosis de la glándula lagrimal. Reporte de un caso / Lacrimal gland amyloidosis. Case report

La amiloidosis representa un espectro de alteraciones que afecta a órganos y sistemas; la fisiopatología involucra una vía metabólica común que resulta en un depósito de proteínas en los tejidos o en múltiple órganos y sistemas. Se presenta el caso de un paciente femenino con una masa blanda en reborde orbitario superior izquierdo, bien delimitada, móvil, con diagnóstico clínico de dacrioadenitis. Se inició tratamiento con prednisolona y sulfas en gotas y ungüento, además de antibiótico por vía oral, sin mostrar cambios en la evolución clínica. Se realizó estudio de ultrasonido ocular y orbitario AO con un equipo Biovisión B-scan-S, observando la presencia de una masa sólida, bien definida, localizada a la glándula lagrimal y con extensión a la porción superior de órbita izquierda. El modo A estandarizado reveló una estructura interna regular y alta reflectividad. El estudio histopatológico reportó una tinción positiva al Rojo Congo y birrefringencia a la luz polarizada con diagnóstico de amiloidosis de la glándula lagrimal. Aunque la amiloidosis de la glándula lagrimal es rara, el estudio de ultrasonido es un método útil en el diagnóstico, aun sin signos clínicos de amiloidosis

Ultrasonido biomicroscópico. Hallazgos en queratomileusis miópica (Lasik) / Ultrasonic biomicroscopic findings in miopic keratomileusis (Lasik)

En la actualidad una de las cirugías más populares para miopía alta es el procedimiento de Lasik, en la cual, la capa de Bowman es preservada. Nosotros estudiamos 9 ojos de 8 pacientes con ultrasonido biomicroscópico a quienes se les realizó la técnica de Lasik. Todos los pacientes fueron mayores de 20 años de edad, con un equivalente esférico promedio de -9.69 dioptrías. A la exploración con ultrasonido biomicroscópico las características de la córnea fueron similares tanto en el examen pre y postoperatorio, el grosor corneal promedio preoperatorio fue de 562 micras y en el post operatorio de 470 micras, la profundidad de la cámara anterior no presentó cambios significativos. La profundiad de la ablación promedio calculada en el preoperatorio fue de 90 micras y en post operatorio fue de 74 micras