Comparison of the Biometric Characteristics After Long-term Implantation of Iris-fixated Phakic Intraocular Lens in Explanted and Nonexplanted Groups of Eyes.

PURPOSE: To evaluate and compare the biometric characteristics of the anterior chamber of a group of patients with significant endothelial cell loss (ECL) who required phakic intraocular lens (pIOL) explantation and a group of patients who did not fulfill the explantation criteria related to corneal decompensation. DESIGN: Retrospective, consecutive, interventional case series. METHODS: The study included all consecutive patients receiving a pIOL implantation at Oftalmosalud Instituto de Ojos, Lima, Peru, between 2001 and 2012. The explanted group (E group) consisted of eyes in which the pIOLs were explanted due to ECL, and the nonexplanted group (NE group) consisted of eyes randomly selected in which the pIOL was not explanted with a minimum follow-up time of 8 years. Slit-lamp biomicroscopy, visual acuity, refraction, endothelial cell count, and anterior segment optical coherence tomography were assessed at the preoperative evaluation for both groups and before explantation in the E group and 8 years post-implantation in the NE group. RESULTS: pIOLs were implanted in 265 eyes. The annual percentage of ECL was 1.47% and 5.55% in the NE group and E group, respectively (P < .001). The mean minimum endothelial lens distance (ELD) was 1.44 ± 0.22 mm and 1.05 ± 0.23 mm in the NE group and E group, respectively (P < 0.001). The mean time for explantation was 12.58 ± 3.79 years for the E group. Annual ECL could accurately discriminate between the NE group and E group; a cutoff point of 3.5 (%/year) or 86.5 (cells/years) had a 100% sensitivity and specificity. A cutoff of 1.21 mm in the minimum ELD has a 91% sensitivity and 79% specificity to discriminate between the E group and NE group. CONCLUSIONS: pIOL explantation due to ECL occurs in eyes with a significantly postoperative lower minimum ELD. Annual ECL and minimum ELC can effectively discriminate between the E and NE groups.

Interface Fluid Syndrome After Descemet Membrane Endothelial Keratoplasty in Patients With History of LASIK.

PURPOSE: The aim of this study was to evaluate the visual, pachymetric, tomographic, and biomicroscopic findings in a series of cases with laser in situ keratomileusis (LASIK) flap interface fluid syndrome (IFS) after Descemet membrane endothelial keratoplasty (DMEK). METHODS: Six cases were included in this study; all patients had a history of LASIK and underwent DMEK for the treatment of bullous keratopathy. After uneventful surgery, all patients presented with corneal edema and IFS under the LASIK flap, which was demonstrated with anterior segment optical coherence tomography (AS-OCT). Visual acuity, clinical findings, pachymetry, endothelial cell count, and AS-OCT were documented during the management of these cases. RESULTS: IFS appears 2.33 days (±1.03) after DMEK. One case improved with conservative treatment. In 5 cases, the LASIK flap was lifted, the fluid was drained, and the flap was replaced. The mean best-corrected visual acuity after fluid drainage was 0.44 logMAR (range 0.18-1.0) and mean central corneal thickness was 538 µm ± 160. Total resolution of the IFS was achieved at 14.5 days (range 4-30) after DMEK. AS-OCT showed resolution of the flap interface in 5 of 6 cases, while 1 patient required second DMEK due to reaccumulation of the interface fluid. CONCLUSIONS: IFS can occur after DMEK in patients with previous LASIK. AS-OCT is a valuable tool for monitoring these cases preoperatively and postoperatively. Early surgical management is often needed to achieve resolution.

Epithelial downgrowth leading to graft rejection after penetrating keratoplasty.

PURPOSE: To report a case of epithelial downgrowth after penetrating keratoplasty. CASE DESCRIPTION: A 58-year-old man presented with graft rejection in his three-month-old, repeat penetrating keratoplasty. Examination revealed centripetal opacification of the posterior cornea due to deep epithelization. He had new retro-corneal membranes and anterior uveitis. Specular microscopy and anterior segment optical coherence tomography were performed, and a clinical diagnosis of epithelial downgrowth was made. The patient had intracameral injections with 5-fluorouracil (5FU) and achieved resolution of intraocular findings after treatment. CONCLUSIONS: Epithelial downgrowth is an uncommon complication of penetrating keratoplasty. It affects the patients' visual acuity and graft survival. Clinical observation is preferred in severe cases due to the high risk of intraocular damage; intracameral 5FU promises to be a good option in these cases.

Ophthalmological Approach for the Diagnosis of Dry Eye Disease in Patients with Sjögren's Syndrome.

Dry eye has two basic subdivisions: aqueous deficient dry eye (ADDE), with SS a major cause; and evaporative dry eye (EDE), due to either intrinsic or extrinsic factors. SS is a chronic inflammatory disorder defined by dysfunction of the exocrine glands leading to dry eye and dry mouth. The objective of this article was to carry out a systematic and critical review of several scientific publications on dry eye disease, with the aim of providing general recommendations to distinguish dry eye and its different variants in patients with SS, during the period 1979 to 2020, using search engines for articles indexed in Scopus, Latindex, Scielo, Clinical Trials, Medline, Embase, and Cochrane, allowing the analysis of 132 articles published in indexed journals on the subject of dry eye disease and SS, evidencing its conceptualization, prevalence, risk factors, etiopathogenesis, clinical manifestations, diagnosis, and treatment.

Astigmatic change as a predictor of intrastromal corneal ring segment late extrusion.

PURPOSE: To evaluate changes in keratoconic corneas implanted with intrastromal corneal ring segments (ICRSs) that have been explanted because of late extrusion of the segment after >2 years. SETTING: Vissum Miranza, Alicante, Spain; OftalmoSalud, Lima, Peru; Minya University Hospital, Egypt. DESIGN: Retrospective multicenter case series. METHODS: 23 keratoconic corneas that were implanted for ≥2 years and explanted because of natural extrusion of the segment. Clinical measures of visual, refractive, topographic, pachymetric, and aberrometric data were analyzed. To perform exploratory factor analysis, the Kaiser-Meyer-Olkin (KMO) test was used to evaluate sampling adequacy. Factor analysis with VARIMAX rotation was used to determine the main factors of the inventory. RESULTS: The mean time interval was 5 years. Topographic findings were reversed nearly to the baseline level after segment explantation (Km: 48.97 ± 3.47 D pre implantation and 47.60 ± 3.67 D after explantation, P =.374). Significant worsened in refractive cylinder was found pre-ICRS extrusion (‒2.54 ± 3.40 D after implantation and ‒3.96 ± 1.72 before extrusion, P < .05). The main factor obtained in the preimplantation moment included keratoconus grade, keratometric readings, and visual acuities. After ICRS implantation, the most strength components were the refractive cylinder, corrected distance visual acuity, and uncorrected distance visual acuity. Corneal aberrations were the main factors in the pre-explantation analysis. CONCLUSIONS: ICRSs were safely extracted, with a reversal of the corneal topographic data to the preoperative level. A significant astigmatic change was shown in patients implanted with ICRSs before late extrusion of the segment, suggesting the role of this parameter as a prognostic factor of extrusion.

Intracorneal Ring Segment Implantation for the Management of Keratoconus in Children.

The short-term safety and efficacy of intracorneal ring segment (ICRS) implantation in keratoconus eyes of children are investigated in this study. A retrospective interventional case series study including a total of 33 keratoconus eyes (age 8 to 17 years) that had undergone ICRS (Keraring segments, Mediphacos) implantation was conducted. Information about visual, refractive, pachymetric, corneal topographic and aberrometric, and corneal endothelial changes during a 3-month follow-up were extracted and analysed. A significant improvement was observed in logMAR corrected distance visual acuity (p = 0.005), combined with a statistically significant reduction in keratometric readings (p < 0.001). A reduction in the magnitude of corneal astigmatism of ≥1 D was observed in 52.8% of eyes. No significant changes were observed in corneal endothelial density (p = 0.317). Significant changes were found in the anterior vertical coma component (p = 0.002) as well as in the spherical aberration of the posterior corneal surface (p = 0.004). Only two relevant complications were described: one corneal microperforation with penetration of the ring segment into the anterior chamber (1 eye, 2.8%), and a case of ring extrusion (1 eye, 2.8%). ICRS implantation in children keratoconus eyes allows a reduction of corneal astigmatism, irregularity, and aberrations, leading to a significant visual improvement.

Femtosecond laser assisted capsulotomy in the treatment of capsule contraction case report.

PURPOSE: To present the surgical value of femtosecond laser capsulotomy in the treatment of capsular contraction. OBSERVATIONS: The clinical case of a 63-year-old male patient with single eye who, two months after cataract surgery without complications, presented a significant dislocation of the secondary intraocular lens due to a capsule contraction and epithelial metaplasia that covered the lens optics and caused low vision. CONCLUSIONS: The femtosecond laser-assisted capsulotomy proved to be effective and safe with minimal traction on the zonule and no IOL damage, in this patient with a follow-up of 29 months.