Assessment of precision of astigmatism measurements taken by a sweptsource optical coherence tomography biometer - IOLMaster 700.

Purpose: : To assess the repeatability of ocular measurements, particularly astigmatism, taken using the latest version of an swept-source optical coherence tomography (SS-OCT) device, IOLMaster 700. Methods: This prospective observational study done in a private eye care centre. Study included 213 eyes of 152 patients diagnosed with cataract. Axial length (AL), Anterior corneal astigmatism (ΔK), Total corneal astigmatism (ΔTK), Aqueous depth (AD), Lens thickness (LT), Iris barycentre distance (IBD) and White to white distance (WTW) were analysed; three measurements were taken for each patient in the same sitting by the same examiner in an undilated state using the SS-OCT device. Repeatability was analysed using intraclass coefficient (ICC) and coefficient of variation (CV) measures, and astigmatism values were transformed into vector components (J0/J45) and categorised based on magnitude. Results: Astigmatism vector components (J0/J45) showed poor repeatability (ICC < 0.5 and CV > 0), while iris coordinates (IBD) and astigmatism magnitude had good correlation (ICC > 0.9) but more variations between the readings which was least for magnitude ≥ 1.5D; however, rest of the parameters demonstrated excellent repeatability (ICC > 0.9 with P value < 0.05). Conclusion: IOLMaster 700 demonstrated good reliability for the parameters measured, although, for astigmatism and iris barycentre distance, more number of readings and cross reference with other devices may be required to get clinically accurate results.

Outcomes of bioptics with small-incision lenticule extraction as a sequential treatment after implantable collamer lens for management of extreme myopia.

PURPOSE: To study the safety and efficacy of bioptics using implantable collamer lens (ICL) followed by small-incision lenticule extraction (SMILE) for management of extreme myopia. SETTING: Nethradhama Superspeciality Eye Hospital, Bangalore, India. DESIGN: Retrospective case series. METHODS: Data were analyzed for patients who underwent bioptics using ICL in the first stage and SMILE in the second stage for correction of the residual refractive error. The mean interval between stage 1 and stage 2 correction was 24.2 ± 13.33 days. The mean follow-up after the SMILE procedure was 12.26 ± 1.39 (range 11 to 14) months. RESULTS: Fifteen eyes from 9 patients with mean age 26 ± 4.69 years were included. Preoperatively, the mean SE was -22.89 ± 3.04 diopter (D) (-16.50 to -28.00 D), which decreased to -3.40 ± 1.89 D after ICL and further reduced to -0.48 ± 0.24 D after final correction with SMILE, at the end of the mean follow-up. The mean cylinder reduced from -2.88 ± 1.69 D to -1.93 ± 1.07D post-ICL and to -0.38 ± 0.24 D post-SMILE surgery. The mean corrected distance visual acuity (CDVA) significantly improved from 0.38 ± 0.22 to 0.068 ± 0.09 logMAR after SMILE correction (P = .00). The mean uncorrected distance visual acuity (UDVA) at the end of follow-up was 0.15 ± 0.09 logMAR, with all eyes achieving UDVA of 0.3 logMAR or greater. All eyes had gain in CDVA, with 53% eyes gaining 2 or more lines. No wound-, intraocular pressure-, or ICL-related complications were observed during and after the SMILE surgery. No patient required spectacles, contact lenses, or enhancement for further improvement of vision. CONCLUSIONS: Bioptics with SMILE after ICL implantation might be a valid option for extremely myopic patients, resulting in significant improvements in visual acuity and high patient satisfaction.

Evaluation of Scheimpflug imaging system as an added tool in improving the accuracy of reference marking (as compared to the slit lamp marking system) for toric intraocular lens implantation.

Purpose: To assess the role of Scheimpflug imaging in improving the accuracy of reference marking for toric IOL implantation. Methods: In this prospective, randomized, clinical trial all patients with cataract and pre-existing significant regular corneal astigmatism, who required implantation of a toric IOL were included in the study, and patients with any ocular pathology or abnormality were excluded. Patients were divided into two groups: For one group of patients, Group I (GI), reference marking was finalized using slit lamp only, and for the second group, Group II (GII), after slit lamp marking, the reference marks were checked using Goniometer of Scheimpflug imaging. The primary outcome was to determine the axis of toric intraocular lens (IOL) postoperatively (within 1 hour) and compare it with the desired axis of placement. Results: We found a statistically significant difference in the two groups (P < 0.001) suggesting Group II (4 step technique) is better than Group I (3 step technique). Conclusion: Scheimpflug imaging, an extra step preoperatively, is an effective measure to reduce errors in reference marking and thereby improving the refractive outcome of toric intraocular lens.

A rare case of atypical sympathetic ophthalmia post therapeutic keratoplasty.

INTRODUCTION: Sympathetic ophthalmia (SO) is a rare, bilateral, diffuse granulomatous uveitis that usually occurs after open globe injury or intraocular surgery. METHODS: A patient developed SO following therapeutic penetrating keratoplasty (TPK) with cataract extraction in the exciting eye following fungal keratitis. The sympathizing eye presented with only posterior segment findings (exudative retinal detachment) and responded well with oral corticosteroids. RESULTS: Graft remained clear in the left eye and the right eye; the best-corrected visual acuity (BCVA) improved to 0.2 log MAR. CONCLUSION: SO presenting after TPK for fungal keratitis is a rare occurrence but if detected early can be managed effectively.