Effects of Modified Haptics on Surgical Outcomes and Rotational Stability of Toric Intraocular Lens Implantation.

PURPOSE: To assess the rotational stability of a new toric intraocular lens (IOL), TECNIS toric II (toric II), which is a modified version of the TECNIS toric IOL (toric I) with frosted haptics (Johnson & Johnson). METHODS: A total of 101 eyes of 101 patients who had been treated with phacoemulsification and toric IOL implantation were included. Before and 1 day, 1 week, and 1 month after surgery, uncorrected (UDVA) and corrected (CDVA) distance visual acuity were measured. Preoperative corneal astigmatism and postoperative manifest refractive astigmatism at 1 day and 1 month were analyzed. At 1 day and 1 month postoperatively, the amount of IOL axis misalignment from the intended orientation, tilt, and decentration were measured using anterior segment optical coherence tomography. RESULTS: Fifty-one eyes received the toric I IOL and 50 eyes received the toric II IOL. Toric I IOLs showed a significantly larger amount of axis misalignment than toric II IOLs at both 1 day (9.6 ± 7.6° vs 5.4 ± 4.8°, P = .003) and 1 month (9.1 ± 7.8° vs. 4.7 ± 4.2°, P = .003) postoperatively.The proportion of eyes with misalignment greater than 10° was significantly larger with toric I than toric II IOLs (P < .001). There were no significant differences between IOLs in the amount of residual astigmatism, UDVA, CDVA, and amount of tilt and decentration at 1 day and 1 month postoperatively. CONCLUSIONS: The TECNIS toric II IOL with frosted haptics has significantly improved rotational stability compared to its previous model. [J Refract Surg. 2022;38(10):648-653.].

Risk factors for failure of resolving optic disc pit maculopathy after primary vitrectomy without laser photocoagulation.

PURPOSE: To determine factors significantly correlated with the failure of macular reattachment by pars plana vitrectomy (PPV) without laser photocoagulation of the optic disc margin to treat optic disc pit (ODP) maculopathy. DESIGN: Retrospective, interventional case series. METHODS: We reviewed the medical records of 35 consecutive patients with ODP maculopathy who underwent PPV without laser photocoagulation. PPV with the creation of a posterior vitreous detachment (PVD) was performed in 34 eyes. An epiretinal membrane and internal limiting membrane present in the other eye with a PVD were removed. Patients were followed for 12-193 months (mean 58 months) after surgery. The main outcome measures were the postoperative rate of retinal reattachment and best-corrected visual acuity. The preoperative clinical characteristics of the successful cases were compared to those of the unsuccessful cases. RESULTS: A complete retinal reattachment was attained in 31 of 35 eyes and it required about one year. The 4 other eyes that did not achieve a macular reattachment after the primary PPV underwent additional therapies. The factors that were significantly associated with a failure of a retinal reattachment after primary PPV were the presence of a retinal detachment connected to the optic disc (P < 0.001) and the presence of preoperative headaches (P = 0.030). CONCLUSIONS: Clinicians should be aware that the presence of a preoperative macular detachment connected to the optic disc margin and preoperative headaches are indicators for an unsuccessful outcome of PPV without laser photocoagulation in eyes with ODP maculopathy.

Rotational stability of modified toric intraocular lens.

We evaluated the rotational stability of a new toric intraocular lens (IOL), HOYA XY-1 toric IOL that is an improved version of HOYA 355 toric IOL, with longer overall length (13.0 mm vs. 12.5 mm), shortened unfolding time, and texture processing of the surface of haptics. Data from 193 eyes of 165 patients (76.4 ± 8.3 years old) with preoperative corneal astigmatism exceeding 0.75 diopters who had undergone phacoemulsification and toric IOL implantation were collected and analyzed. Corneal astigmatism, refractive astigmatism, and uncorrected (UDVA) and corrected distance visual acuity (CDVA) were evaluated before and 1 day, 1 week, and 1 month after surgery. The degree of IOL decentration, IOL tilt, and toric axis misalignment was assessed at 1 day and 1 month postoperatively. Fifty eyes received AcrySof toric IOL, 51 eyes TECNIS toric IOL, 46 eyes HOYA 355 toric IOL, and 46 eyes HOYA XY-1 toric IOL. The amount of axis misalignment from the intended axis was significantly different among IOLs (p = 0.004, one-way ANOVA), and HOYA XY-1 showed significantly less amount of axis misalignment than TECNIS (p = 0.020, Tukey's multiple comparison) and HOYA 355 (p = 0.010). The proportion of eyes that showed axis misalignment <10° at 1 month postoperatively was significantly higher with HOYA XY-1 toric IOL than with other toric IOLs (χ2 test, p = 0.020). HOYA XY-1 toric IOL, the modified version of HOYA 355 toric IOL, showed excellent rotational stability in comparison with other models of toric IOLs.

Changes in the size of the foveal avascular zone after vitrectomy with internal limiting membrane peeling for a macular hole.

PURPOSE: To determine the size of the foveal avascular zone (FAZ) before and after vitrectomy for a macular hole (MH). STUDY DESIGN: Retrospective case series study. METHODS: Twenty-five eyes of 25 patients with a unilateral MH that had undergone vitrectomy with internal limiting membrane peeling were studied. The unaffected 17 fellow eyes were studied in the same way. En face images of the parafoveal region were obtained by optical coherence tomography angiography, and the images were used to measure the FAZ before and 1 month after the vitrectomy. The relationships between the different FAZ sizes and the ocular parameters were determined by Pearson product moment correlation analysis. RESULTS: Compared with the preoperative superficial FAZ (sFAZ), the postoperative sFAZ was significantly reduced (P < 0.001). The postoperative sFAZ was significantly smaller than that of the fellow eye (P < 0.001). The size of the postoperative sFAZ was significantly correlated with that of the preoperative sFAZ, the postoperative foveal thickness (FT), and the sFAZ of the fellow eyes (r = 0.520, P = 0.008; r = -0.515, P = 0.012; and r = 0.702, P = 0.002, respectively). The size of the postoperative deep FAZ (dFAZ) was significantly correlated with the postoperative FT and the dFAZ of the fellow eyes (r = -0.441, P = 0.035; and r = 0.499, P = 0.049, respectively). However, no significant correlation was found between the size of the postoperative FAZ and the size of the preoperative MH. CONCLUSIONS: MH closure leads to a significant decrease in the size of the FAZ symmetrical to the size of the fellow eye. The size of the postoperative FAZ is influenced by the postoperative FT independently of the size of the MH.

DURATION OF PRONE POSITIONING AFTER MACULAR HOLE SURGERY DETERMINED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To compare the closure rate of macular hole closure and duration of the prone positioning after macular hole (MH) surgery with two protocols for halting the prone positioning. METHODS: The authors studied 129 eyes of 125 consecutive patients with MH who had undergone vitrectomy. In 60 eyes of 59 patients, the prone positioning was halted after detecting an MH closure in the swept-source optical coherence tomographic images (SS group). In 69 eyes of 66 patients, the prone position was halted by the surgeon's decision (conventional group). The MH closure rate and duration of the prone positioning were compared. RESULTS: Clear images of the MH were recorded in the SS group on postoperative Day 1 in 58 eyes (97%). In the SS group, MH closure was detected on postoperative Day 1 in 47 eyes (78%) and Day 2 in 4 eyes (7%). The MH was closed in 58 eyes (97%) in the SS group and 69 eyes (100%) in the conventional group (P = 0.21). None of the eyes had a reopening of the MH. The duration of prone positioning in the SS group was 1.8 ± 2.5 days, which was significantly shorter than that in the conventional group at 8.4 ± 4.2 days (P < 0.0001). CONCLUSION: The SS-OCT protocol can significantly decrease the duration of the prone positioning without a reopening of the MH.

Preserved retinal sensitivity in spatial correspondence to an intrachoroidal cavitation area with full thickness retinal defect: a case report.

BACKGROUND: Intrachoroidal cavitation (ICC) in the temporal peripapillary area is a relatively frequent finding in high myopia. However, ICC associated with a full thickness retinal defect rarely observed. We report an unusual case of ICC combined with a full thickness retinal defect in the papillo-macular bundle, in which the spatially corresponding visual field sensitivity was preserved. CASE PRESENTATION: A high myopic and pseudophakic left eye of a 79-year-old Japanese woman was evaluated with swept source optical coherence tomography (SS-OCT) and Humphrey 30-2 visual field testing for moderate glaucoma. The best-corrected visual acuity was 20/20, the axial length was 28.77 mm, the mean deviation -8.94 dB, and the intraocular pressure was 15 mmHg without medication. The horizontal SS-OCT scans showed a wide ICC with a full thickness retinal defect in the papillo-macular area at the outer border of the myopic peripapillary beta zone atrophy. The retina was herniated into the ICC area. While no sensitivity loss was seen in the central visual field corresponding to the full thickness retinal defect, a glaucomatous visual field deterioration spatially corresponding to the glaucomatous disc damage was present. The preserved retinal sensitivity spatially corresponding to the full thickness retinal defect was confirmed with microperimetry. CONCLUSIONS: Our case suggests that retina herniated in peripapillary ICC temporal to the disc may preserve some function despite the presence of a retinal defect.

[Efficacy of Ultra-wide Angle Fundus Imaging without Dilated Pupils in Annual Health Check-up Examination].

PURPOSE: To evaluate efficacy of ultra-wide angle fundus imaging without mydriasis for health screening. METHOD: The judgment rate and the detection rate of ocular diseases in 1160 eyes of 580 patients (Optos group) who underwent ophthalmic screening with Optos 200Tx ultra-wide field scanning laser ophthalmoscope without mydriasis from May 2013 to April 2014 were compared with those of 774 eyes of 387 patients who underwent ophthalmic screening with mydriasis (Mydriasis group). RESULTS: The judgment could be made in 1156 eyes (99.7%) in the Optos group except for 4 eyes because of severe cataracts in 3 eyes and a corneal inlay to correct presbyopia in one eye. The judgment could be made in all eyes in the Mydriasis group. Peripheral retinal lesions could be detected in the Optos group including 2 eyes with retinal breaks, but the detection rate of peripheral retinal lesions including chorioretinal atrophy and retinal detachment was significantly higher in the Mydriasis group. CONCLUSION: Optos wide-angle fundus imaging can detect peripheral retinal lesion even without mydriasis and can be considered useful for health screening because of its convenience.

Efficacy of higher cutting rates during microincision vitrectomy for proliferative diabetic retinopathy.

PURPOSE: To compare the outcomes of 25-G vitrectomy using a vitreous cutter with a higher cutting rate to that of conventional 25-G vitrectomy with a lower cutting rate on eyes with severe proliferative diabetic retinopathy (PDR). METHODS: The medical records of 393 eyes of 326 patients with severe PDR were reviewed. A higher cutting rate dual-pneumatic 25-G vitrectomy probe (5,000 cuts/min, Constellation) was used on 219 eyes (group C) and a conventional 25-G pneumatic vitrectomy probe with lower cutting rate was used on 174 eyes (2,500 or 1,500 cuts/min, Acurrus) (group A). The visual and anatomical outcomes and the incidences of intraoperative and postoperative complications were compared. RESULTS: The incidence of combined cataract surgery was significantly higher in group C (p<0.001). The number of eyes in which scissors were used was significantly lower in group C (p<0.001), and the use of perfluorocarbon liquid was higher in group C (p = 0.015). The incidence of intraoperative iatrogenic tears, postoperative retinal detachments, and neovascular glaucoma was not significantly different between the 2 groups, but the incidence of postoperative vitreous hemorrhage was significantly lower in group C eyes (p<0.001). Preoperative and postoperative vision were not significantly different between the 2 groups. CONCLUSIONS: The higher vitreous cutting rates during 25-G vitrectomy make it easier to dissect fibrovascular membranes with only the vitreous cutter, and achieved equivalent anatomical and visual outcomes after 25-G vitrectomy for PDR.

Ability to determine postoperative status of macular hole in gas-filled eyes by spectral-domain optical coherence tomography.

BACKGROUND: To determine whether the status of a macular hole can be determined by spectral-domain optical coherence tomography in gas-filled eyes. DESIGN: Prospective study, university hospital setting. PARTICIPANTS: Twenty-six eyes with a macular hole, seven eyes with a macular hole retinal detachment and four eyes with a macular hole and myopic traction maculopathy underwent vitreous surgery. METHODS: The macular area was examined by spectral-domain optical coherence tomography (OCT-4000) on postoperative days 1, 3, 7 and 30. MAIN OUTCOME MEASURES: Detection of macular hole closure. RESULTS: The status of macular hole was able to be assessed in 24 eyes (92%) on postoperative day 1 and 23 were closed. The condition of the macular hole could not be determined in the other two eyes with a lower volume of gas (≤60%). The macular hole of seven eyes could be seen only when the patients looked upward or downward (P = 0.009). The 11 eyes with a macular hole retinal detachment or a myopic traction maculopathy had a posterior staphyloma, and the macular hole was visible in four eyes on day 1 (P = 0.001). When a closure of the macular hole was detected on day 1, the macular hole remained closed in all of these eyes on day 30. CONCLUSIONS: The status of a macular hole can be determined by spectral-domain optical coherence tomography on postoperative day 1 even in gas-filled eyes. The visibility depends on the volume of intravitreal gas and the absence of a posterior staphyloma.