Implantation of a Small Aperture Intraocular Lens in Eyes with Irregular Corneas and Higher Order Aberrations.

Purpose: Corneal irregularities can lead to high order aberrations (HOAs) and may influence the outcomes in terms of intraocular lens (IOL) selection and visual acuity assessment. The aim of this study was to evaluate the visual acuity and satisfaction after IC-8 implants in patients characterized by corneal irregularities and HOAs who could not undergo refractive surgery due to the poor residual thickness of the cornea or other conditions such as astigmatism secondary to previous radial keratotomy. Methods: This descriptive, retrospective cohort study was conducted on nine eyes in six patients affected by corneal irregularities and HOAs who had undergone IC-8 IOL implantation. The primary endpoint was the best-corrected visual acuity (BCVA), the subjective visual function, and the visual field. Results: Nine eyes of six patients (three bilateral implantation) were enrolled. For each patient, BCVA, vision, and lifestyle quality were evaluated. In all patients, we noticed an improvement in all parameters without visual field defects. Conclusion: Our work encourages the use of the IC8 lens to improve visual acuity in patients with irregular corneas and HOAs who cannot be treated with customized refractive surgery. Patients experience a subjective improvement of their quality of vision and also more self-confidence in their daily life. IC-8 lenses do not interfere with the visualization of retinal fundus and there is no impairment of the visual field detected by patients.

A singular case of iatrogenic gas-filled double anterior chamber after DALK.

AIM: To present a case of double anterior chamber after DALK and its surgical management. CASE DESCRIPTION: A 67-year-old healthy woman underwent deep anterior lamellar keratoplasty (DALK) in her right eye for keratoconus with the big-bubble technique. About 7 days after surgery a partial detachment of the Descemet membrane from the posterior corneal stroma was revealed using AS-OCT (double anterior chamber appearance). In spite of two injections in the anterior chamber of air and gas on the 7th and 9th post-operative days respectively, the double anterior chamber still persisted. Furthermore, both air and gas passed through the little perforation of the host Descemet membrane-endothelium complex and enlarged the space between the stroma and Descemet membrane. About 10 weeks after DALK, a spontaneous resolution of the double anterior chamber was observed. CONCLUSION: This case suggests that an injection of air or gas into the anterior chamber, to deal with a Descemet membrane detachment following perforation during DALK procedure, can enlarge the double anterior chamber by increasing the space between stroma and Descemet membrane. These cases can be managed with a "wait and see" strategy for a spontaneous resolution to Descemet membrane detachment.

Corneal Graft Rejection after Yellow Fever Vaccine: A Case Report.

PURPOSE: To report an unusual case of corneal graft rejection after yellow fever vaccine. METHODS: Case report. RESULTS: We have described the case of a 48-year-old man who developed a corneal graft rejection in the left eye 3 weeks after a yellow fever vaccination. The ophthalmic examination of the left eye revealed conjunctival hyperemia, corneal graft edema with Descemet folds, and fine keratic precipitates. No abnormalities were found in the right eye. The episode of graft rejection fully recovered after a short course of systemic and topical steroid treatment. CONCLUSIONS: This is the first case report of corneal transplant rejection temporally associated with yellow fever vaccination. Although the yellow fever vaccine is a very safe and efficacious vaccine, the occurrence of vaccine-related rejection may be more frequent than reported. Both patients and ophthalmologists should be aware of possible vaccine-related complications which may be potentially sight-threatening.

Patient and surgeon comfort in vitreoretinal surgery performed with Sub-Tenon's Anaesthesia.

Background. Since Stevens first introduced Sub-Tenon's anaesthesia into cataract surgery it has shown itself to be a safe, simple, and efficient technique. The advantages of this type of block are comparable to those of sharp needle anaesthesia and complications are minimal. Several studies have found that the anaesthesia provided by Sub-Tenon's capsule injection is as good as or better for cataract surgery than that achieved by retrobulbar injection, but the efficacy of Sub-Tenon's block in vitreoretinal surgery is less well established. Methods. We performed 50 vitreoretinal procedures; 50 eyes received a Sub-Tenon's injection of a 5 ml mixture (50:50) of lidocaine and ropivacaine, plus 15 IU mL-1 of Hyaluronidase. Results. In 45 cases, only one injection was needed to achieve sufficient anaesthesia and akinesia; in 5 cases a second injection was performed five minutes after the first. Mean surgical time was 45.7 minutes. After surgery, each patient was asked to indicate his value on the VAS pain scale. Mean VAS degree was 2.4. In 7 cases, VAS was > 3 and the pain was successfully managed with the administration of paracetamol in the postoperative period. No light perception was detected at the end of surgery in 33 patients. All cases with 2 injections had no light perception at the end of surgery. Anaesthesia lasted throughout the surgery in all cases. The surgeon performed all surgery comfortably and with no difficulty. Conclusions. According to our experience and to a growing body of evidence, Sub-Tenon's anaesthesia appears to be a safe, simple, versatile, and effective technique and should be considered as a real alternative method of anaesthesia in vitreoretinal surgery.

Protecting the Ocular Surface in Cataract Surgery: The Efficacy of the Perioperative Use of a Hydroxypropyl Guar and Hyaluronic Acid Ophthalmic Solution.

PURPOSE: To evaluate the effects of a hydroxypropyl guar (HPG) and hyaluronic acid (HA) ophthalmic solution in terms of post-cataract surgery dry-eye disease (DED) prevention. PATIENTS AND METHODS: In this retrospective study, the data of 419 patients not previously affected by DED, who had undergone unilateral cataract surgery in 17 Italian centers with different perioperative lubricating regimens, were retrospectively reviewed. Patients who had instilled HPG/HA solution 3 times/day in the preoperative week and for two postoperative months were included in group A; group B only instilled HPG/HA for two postoperative months; group C did not instill any perioperative artificial tears. All patients followed the same antibiotic and anti-inflammatory postoperative topical regimen. The scores of SPEED (Standard Patient Evaluation of Eye Dryness) questionnaire, tear break-up time (BUT) and corneal fluorescein staining (CFS, Oxford scale), performed at the preoperative visit and at one, four and eight postoperative weeks, were evaluated. RESULTS: In groups A and B, the SPEED scores were significantly lower than group C in the whole postoperative period. In group A, the SPEED scores were significantly lower than group B 1 and 4 weeks after surgery (p<0.001 and p=0.021). In group C, 25% of patients reported symptom scores corresponding to mild-moderate dry eye 4 and 8 weeks after surgery. The fluorescein tear BUT in groups A and B was significantly higher than group C in the whole postoperative period (p<0.001). In group A, BUT was significantly higher than group B 4 weeks after surgery (p=0.016). More patients showed no corneal fluorescein staining (CFS grade=0) in groups A and B than group C at all the postoperative visits. CONCLUSION: The hydroxypropyl guar and hyaluronic acid ophthalmic solution was effective at reducing post-cataract surgery ocular discomfort and tear instability, particularly if also administered in the preoperative period.