Real world outcomes of the new Tecnis Eyhance IOL.

PURPOSE: To compare the performance of Tecnis Eyhance ICB00 with Tecnis PCB00 IOL for far, intermediate, and near vision, in patients after bilateral cataract surgery. SETTINGS: This study was done at Geneva University Hospitals. DESIGN: This is a retrospective study of 224 eyes that underwent cataract between May 2019 and June 2020. METHODS: Visual acuity was assessed from month 1 to 12 after surgery for distance, intermediate and near visual acuity, by the same optometrist, which was blind regarding the type of IOL. The patients answered to a quality of life questionnaire. Patients were excluded for: monocular surgery, macular disease, other IOL type, or inability to reach 20/20 visual acuity in both eyes without correction. RESULTS: One hundred and fifty-two eyes were excluded. Three groups were then analyzed: PCB00 group (38 eyes), ICB00 group (22 eyes), and mismatch group (12 eyes). Monocular visual acuities (CIVA, UNVA and CNVA, in logMAR) were higher in the ICB00 group than the PCB00 group (respectively 0.3 vs 0.4, p = 0.0033; 0.3 vs 0.4, p = 0.0408; 0.3 vs 0.4, p = 0.0039). Binocular visual acuities, CIVA and CNVA were higher in the ICB00 group than the PCB00 group (0.2 vs 0.4, p = 0.0061; 0.15 vs 0.3, p = 0.018). This mirrored the findings of the quality of life questionnaire. There was no significant difference between PCB00 and mismatch groups. CONCLUSIONS: the Tecnis Eyhance was more effective for intermediate and near vision. The central defocus of the lens might help patients achieve spectacle independence and better quality of life.

Orbital Fractures With Concomitant Ocular Nerve Palsy: An Insidious and Potentially Misleading Association in Surgical Decision-Making.

PURPOSE: Orbital fractures (OFs) are common, but their association with concomitant traumatic ocular nerve palsy (TONP) is exceptional and may potentially cause confusing clinical pictures of oculomotor involvement. The purpose of the present study is to describe a series of patients with OFs and concomitant TONP following facial trauma and to evaluate clinical features, diagnostic pitfalls, and final functional outcome. METHODS: The investigators designed and implemented a retrospective case series and enrolled a sample of patients with OFs and concomitant TONP who had been managed at the University Hospitals of Geneva between 2013 and 2020. The primary outcomes were clinical pitfalls (diagnosis of neurogenic vs restrictive ocular motility pattern at baseline) and final functional outcome (persistent symptomatic diplopia). Other study variables included demographic and injury related parameters. RESULTS: The sample was composed of 10 patients with a mean age of 40.7 ± 12.3 years (range 21 to 53 years) and 80% were men. In all patients, the diagnosis of the neurogenic component accounted for the main diagnostic pitfalls associated to the baseline post-traumatic limitation of ocular motility and diplopia. Six patients (60%) had a full spontaneous recovery of their diplopia. Four patients (40%) had a partial recovery with residual diplopia. Of these 4 patients, 1 patient underwent corrective strabismus surgery, 2 had temporary occlusion of 1 eye, and 1 had Fresnel prisms. At the final follow-up visit none of the patients had persistent symptomatic diplopia. CONCLUSIONS: The present study has shown that OFs with concomitant TONP entail complex ocular motility patterns of neurogenic and/or restrictive origin; the diagnosis of the neurogenic component represents the main clinical pitfall that warrants a careful orthoptic evaluation to ensure the appropriate management; the final outcome was favorable with no persistent symptomatic diplopia in any of the patients.

Long-Term Outcomes of Bacillary Layer Detachment in Neovascular Age-Related Macular Degeneration.

PURPOSE: To evaluate the clinical characteristics, multimodal imaging features, and long-term treatment outcomes of eyes with neovascular age-related macular degeneration (nAMD) and bacillary layer detachment (BALAD) treated with intravitreal anti-VEGF therapy. DESIGN: Retrospective, longitudinal, case series. PARTICIPANTS: Treatment-naive patients with nAMD (n = 30) showing BALAD on OCT and undergoing anti-VEGF therapy. METHODS: Clinical records and multimodal imaging results of up to 4 years after diagnosis were reviewed. MAIN OUTCOME MEASURES: Best-corrected visual acuity (BCVA) values were compared over time. The cumulative risk of and risk factors for subretinal fibrosis were assessed using Cox regression analyses, and adjusted hazard ratio (aHR) was computed. RESULTS: Thirty eyes of 30 patients were included. Macular neovascularization (MNV) subtypes were distributed as follows: type 1, 63%; type 2, 27%; mixed type 1 and 2, 3%; type 3, 3%; aneurysmal type 1, 3%. The BCVA significantly improved after anti-VEGF loading phase (Snellen equivalent, from 20 of 118 to 20 of 71, P = 0.03), but it returned to the baseline levels at 4 years (Snellen equivalent, 20 of 103, P = 0.6). The cumulative risk of subretinal fibrosis was 77% at 4 years. The risk factors associated with subretinal fibrosis included hemorrhagic BALAD (aHR, 2.02; 95% confidence interval [CI] 1.54-3.22; P < 0.01) and the presence of subretinal hyperreflective material (aHR, 1.83; 95% CI 1.35-3.14; P < 0.01). CONCLUSIONS: BALAD was found in association with all types of MNV in patients with nAMD. Long-term observation revealed poor functional outcomes related to the high risk of subretinal fibrosis.

BACILLARY LAYER DETACHMENT: MULTIMODAL IMAGING AND HISTOLOGIC EVIDENCE OF A NOVEL OPTICAL COHERENCE TOMOGRAPHY TERMINOLOGY: Literature Review and Proposed Theory.

PURPOSE: To clarify the histologic basis of bacillary layer detachment (BALAD) through a review of the current literature and an analysis of retinal imaging. METHODS: The literature for previous reports of BALAD were reviewed. An analysis of retinal images was performed to support anatomical conclusions. RESULTS: A total of 164 unique patients with BALAD on optical coherence tomography (OCT) were identified from the published literature. Twenty-two underlying etiologies, all associated with subretinal exudation, were identified. Forty-one different OCT terminologies were found. The defining OCT feature of BALAD was a split at the level of the photoreceptor inner segment myoid creating a distinctive intraretinal cavity. Resolution of BALAD was followed by a rapid restoration of the ellipsoid zone. Histology of age-related macular degeneration eyes suggests that individual photoreceptors can shed inner segments. Furthermore, detachment of the entire layer of inner segments is a common postmortem artifact. It is proposed that BALAD occurs when outwardly directed forces promoting attachment of photoreceptor outer segments to the retinal pigment epithelium exceed the tensile strength of the photoreceptor inner segment myoid. CONCLUSION: This review serves to strengthen the OCT nomenclature "bacillary layer detachment," based on specific reflectance information obtained by OCT and previously published histologic observations.