MERCURY-3: a randomized comparison of netarsudil/latanoprost and bimatoprost/timolol in open-angle glaucoma and ocular hypertension.

PURPOSE   : To compare the efficacy and safety of the fixed-dose combination (FDC) of netarsudil 0.02%/latanoprost 0.005% ophthalmic solution (NET/LAT; Roclanda®) with bimatoprost 0.03%/timolol maleate 0.5% (BIM/TIM; Ganfort®) ophthalmic solution in the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS: MERCURY-3 was a 6-month prospective, double-masked, randomized, multicenter, active-controlled, parallel-group, non-inferiority study. Patients (≥ 18 years) with a diagnosis of OAG or OHT in both eyes that was insufficiently controlled with topical medication (IOP ≥ 17 mmHg in ≥ 1 eye and < 28 mmHg in both eyes) were included. Following washout, patients were randomized to once-daily NET/LAT or BIM/TIM for up to 6 months; efficacy was assessed at Week 2, Week 4, and Month 3; safety was evaluated for 6 months. Comparison of NET/LAT relative to BIM/TIM for mean IOP at 08:00, 10:00, and 16:00 h was assessed at Week 2, Week 6, and Month 3. Non-inferiority of NET/LAT to BIM/TIM was defined as a difference of ≤ 1.5 mmHg at all nine time points through Month 3 and ≤ 1.0 mmHg at five or more of nine time points through Month 3. RESULTS: Overall, 430 patients were randomized (NET/LAT, n = 218; BIM/TIM, n = 212), and all received at least one dose of study medication. Efficacy analyses were performed at Month 3 on 388 patients (NET/LAT, n = 184; BIM/TIM, n = 204). NET/LAT demonstrated non-inferiority to BIM/TIM, with a between-treatment difference in IOP of ≤ 1.5 mmHg achieved at all time points and ≤ 1.0 mmHg at the majority of time points (six of nine) through Month 3. Mean diurnal IOP during the study ranged from 15.4 to 15.6 mmHg and 15.2 to 15.6 mmHg in the NET/LAT and BIM/TIM groups respectively, with no between-group statistically significant difference. No significant differences were observed in key secondary endpoints. No serious, treatment-related adverse events (AEs) were observed, and AEs were typically mild/moderate in severity. The most common treatment-related AEs were conjunctival hyperemia (NET/LAT, 30.7%; BIM/TIM, 9.0%) and cornea verticillata (NET/LAT, 11.0%; BIM/TIM, 0%). CONCLUSIONS: Once-daily NET/LAT was non-inferior to BIM/TIM in IOP reduction in OAG and OHT, with AEs consistent with previous findings. NET/LAT offers a compelling alternative FDC treatment option for OAG and OHT.

The Thickness of the Retinal Nerve Fiber Layer (RNFL) as a Biomarker in Uveitis.

AIMS: To study the changes of the retinal nerve fiber layer (RNFL) thickness during and following uveitis flares. METHODS: This was a retrospective study of patients with uveitis diagnosed in the ophthalmology service of Torrevieja hospital. We analyzed RNFL thickness during and after the acute episode. RESULTS: We included 29 patients. Most patients (55.2%) had anterior uveitis; followed by posterior, intermediate and panuveitis. Mean RNFL thickness was significantly higher during the flare (132.17±35.54µm vs 107.66±17.10µm). RNFL thickness had no difference between groups with or without macular edema. CONCLUSIONS: The RNFL thickens during flares in most patients with uveitis. It can be measured by optical coherence tomography in a non-invasive way, representing an objective marker of inflammation. This can favor earlier detection of flares, resolution, and recurrence of uveitis. More studies are needed to determine the evolution of RNFL over time and in different types of uveitis.

Costs and Healthcare Resource Utilization Associated with Posterior Capsule Opacification After Cataract Surgery with Five Different Intraocular Lenses: An Economic Analysis for Spain.

Purpose: To estimate the economic impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy and its related complications for five different intraocular lenses (IOLs) from the payer and hospital perspectives in Spain. Materials and Methods: The three-year incidence rates of Nd:YAG laser capsulotomy after cataract surgery with five different single-piece acrylic monofocal IOLs (AcrySof IOLs, AJL LLASY60, IOL Tech Stabibag, Medicontur Bi-flex, Zeiss Asphina) for 8293 patients were derived from odds ratios of multivariate analysis adjusted for age, gender, and diabetic retinopathy. A cost-consequence model for a hypothetical cohort of 2000 eyes was then developed to quantify the potential impact of Nd:YAG capsulotomy in terms of costs and time for each of the included IOLs, from the payer and hospital perspectives. Results: The adjusted three-year Nd:YAG laser capsulotomy incidence was 5.0% (95% CI 3.9 to 6.1) for AcrySof and ranged from 26.0% to 44.0% for the other four IOLs. The average costs of Nd:YAG treatment and related complications were €261.90 for payers and €19.99 for hospitals. The average time needed for Nd:YAG treatment and related complications was 32.82 minutes. Model estimates based on 2000 hypothetical cataract surgeries showed that AcrySof IOLs could lead to cost savings between €110,259.90 and €205,591.50 for payers. For hospitals, time, and cost savings with AcrySof ranged from 230.29 hours and €8415.79 compared to Zeiss Asphina to 429.40 hours and €15,692.15 compared to AJL LLASY60 IOLs. Conclusion: Post cataract surgery, AcrySof IOLs were associated with a significantly lower incidence of Nd:YAG treatment and its subsequent complications compared to other IOLs. Our analysis shows that IOL choice is an important factor that can reduce the burden for patients, payers, and hospitals.

Nd:YAG capsulotomy incidence associated with five different single-piece monofocal intraocular lenses: a 3-year Spanish real-world evidence study of 8293 eyes.

OBJECTIVES: To investigate the associations between different single-piece monofocal intraocular lenses (IOLs) and neodymium-doped yttrium aluminum garnet laser (Nd:YAG) capsulotomy incidence 3 years after cataract surgery in a Spanish cohort. METHODS: This is a longitudinal retrospective cohort study. Data were extracted from the electronic medical records of two large regional hospitals in Spain. Patients aged ≥65 years receiving cataract surgery with placement of five different IOLs and with ≥6 months of baseline data were included. We report the Nd:YAG capsulotomy incidence 3 years post cataract surgery, and the survival plot over the 3 years of follow-up time. The associated adjusted (age, gender, and diabetic retinopathy) multivariate analysis with odds ratios (ORs) and 95% CIs is also presented. RESULTS: The cohort (53% female, mean age 75 ± 5.9 years) included 14,519 eyes (Alcon AcrySof = 2968, AJL LLASY60 = 1776, Medicontur Bi-flex = 5176, Zeiss Asphina = 4478, and IOL Tech Stabibag = 121). Of these, 8293 were retained until 3-year follow-up. At 3 years after cataract surgery, the Nd:YAG capsulotomy incidence was 5% for Alcon AcrySof, while it ranged from 21.2% to 31.1% for the other IOLs (p < 0.0001 for each comparison). The odds for Nd:YAG capsulotomy were significantly higher (p < 0.0001) for other IOLs compared with those of Alcon AcrySof (ORs = 8.85, 5.86, 5.74, 5.21 for AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag, and Zeiss Asphina, respectively). CONCLUSIONS: The lower Nd:YAG capsulotomy rates for Alcon AcrySof IOLs compared to the other IOLs support the importance of lens choice in reducing patient burden and treatment costs.

Long-Term Clinically Significant Posterior Capsular Opacification Development Pattern in Eyes Implanted with an Aspheric Monofocal Intraocular Lens with a Square Optic Edge.

PURPOSE: To analyse the posterior capsular opacification (PCO) development pattern in the long term in eyes implanted with a monofocal intraocular lens (IOL) with a square edge all around the optic. METHODS: Longitudinal retrospective study is data analyzed from a total of 7059 eyes from 4764 patients (mean age: 75.8 years) undergoing cataract surgery with implantation of an aspheric monofocal IOL (Bi-Flex HL 677AB/677P, Medicontur, Budapest, Hungary). These data were retrospectively collected using the electronic medical record of the hospitals involved. Nd : YAG capsulotomy rates were calculated per year during a follow-up of more than 10 years. The Kaplan-Meier analysis was used to establish the transparent capsule survival rate. RESULTS: The Nd : YAG capsulotomy rate increased from 1.1% at 1 year postoperatively to 17.2% at 5 years after surgery. No significant differences were found between eyes with and without capsulotomy in terms of age (p = 0.202), gender (p = 0.061), type of anaesthesia used (p = 0.128), and presence of conditions such as hard cataract (p = 0.111) or pseudoexfoliation (p = 0.137). IOL power was significantly lower in those eyes of patients requiring Nd : YAG capsulotomy during the follow-up (p < 0.001). Significantly more eyes implanted with the preloaded model of the IOL required capsulotomy (p < 0.001). Mean survival time and rate were 9.38 years and 85.9%, respectively. CONCLUSIONS: Most eyes undergoing cataract with implantation of the Bi-Flex IOL do not develop a clinically significant PCO requiring Nd : YAG capsulotomy in the long term. IOL material and design may be the main factors accounting for this finding.

Supraciliary versus intrascleral implantation with hema implant (Esnoper V-2000) in deep sclerectomy: a multicenter randomized controlled trial.

PURPOSE: To compare the supraciliary versus intrascleral implantation of the hema implant (Esnoper V-2000) in terms of the efficacy and safety in nonpenetrating deep sclerectomy (NPDS). PATIENTS AND METHODS: Prospective, randomized, unmasked, competitive and multicenter clinical trial. Eighty-three eyes from 83 patients suffering from open-angle glaucoma (40 males, 43 females) were enrolled and followed up for 12 months. Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), perimetry (mean defect, MD and Visual Field Index, VFI), pachymetry, number of antiglaucoma medications and analysis of blebs according Moorfields Bleb Grading. RESULTS: The IOP was significantly reduced in both groups from 23.74 ± 6.9 mmHg (implant sutured to the sclera, group 1) and 23.46 ± 6.47 mmHg (implant placed in the suprachoroidal space, group 2) to 15.43 ± 4.27 mmHg (p < 0.001) and 14.62 ± 3.64 mmHg (p < 0.001), respectively. There were no statistically significant differences in mean IOP values between the groups a year after the surgery (p = 0.581). BCVA did not show statistical differences in comparison with baseline (p = 0.09, group 1; p = 0.42, group 2). The mean number of antiglaucoma medications was reduced in both groups from 2.58 ± 0.04 and 2.68 ± 0.02 before the surgery to 0.32 ± 0.76 and 0.24 ± 0.66 after surgery. CONCLUSION: Nonpenetrating deep sclerectomy using hema implant (Esnoper V-2000) is safe and effective regardless of the positioning of the implant. We achieved IOP decrease and reduction in antiglaucoma medications during the first year after surgery without significant differences between both techniques.

Optical Coherence Tomography in Children With Microtropia.

PURPOSE: To assess whether optical coherence tomography (OCT) could be useful for detecting and documenting fixation in patients with microtropia. METHODS: Retinal fixation observation was performed using spectral-domain OCT on amblyopic children with microtropia. The position between the retinal fixation point and the anatomical fovea was measured, in microns, using the system software tools. Only patients with a high level of cooperation, OCT scan quality signal of 7 or better, and visual acuity of 0.70 logarithm of the minimum angle of resolution (logMAR) or worse in the amblyopic eye were included. RESULTS: A total of 25 patients were included: 15 with microtropia (study group) and 10 without tropia and with foveal fixation and stereopsis (control group). In the study group, microtropia was previously diagnosed in 67% of cases through the cover test, and was predominantly in the left eye (73%). The average visual acuity of the sound eye was 0.03 decimal and 0.18 logMAR in the amblyopic eye. The microtropia was 3.73 ± 3.34 prism diopters and eccentric fixation (387 ± 199 µm) with OCT was observed in all cases except one. Eccentricity was predominantly in the superonasal quadrant (57%). Both eyes in the control group and the contralateral eyes of the study group showed foveal fixation. CONCLUSIONS: OCT can play an important role in the diagnosis and measurement of eccentric fixation in eyes with microtropia, providing high sensitivity. [J Pediatr Ophthalmol Strabismus. 2018;55(3):171-177.].

Prospective Evaluation of Two iStent® Trabecular Stents, One iStent Supra® Suprachoroidal Stent, and Postoperative Prostaglandin in Refractory Glaucoma: 4-year Outcomes.

INTRODUCTION: This study evaluates long-term outcomes of two trabecular micro-bypass stents, one suprachoroidal stent, and postoperative prostaglandin in eyes with refractory open angle glaucoma (OAG). METHODS: Prospective ongoing 5-year study of 80 eligible subjects (70 with 4-year follow-up) with OAG and IOP ≥ 18 mmHg after prior trabeculectomy and while taking 1-3 glaucoma medications. Subjects received two iStent® trabecular micro-bypass stents, one iStent Supra® suprachoroidal stent, and postoperative travoprost. Postoperative IOP was measured with medication and annually following medication washouts. Performance was measured by the proportion of eyes with ≥ 20% IOP reduction on one medication (the protocol-specified prostaglandin) versus preoperative medicated IOP (primary outcome); and the proportion of eyes with postoperative IOP ≤ 15 and ≤ 18 mmHg on one medication (secondary outcome). Additional clinical and safety data included medications, visual field, pachymetry, gonioscopy, adverse events, visual acuity, and slit-lamp and fundus examinations. RESULTS: Preoperatively, mean medicated IOP was 22.0 ± 3.1 mmHg on 1.2 ± 0.4 medications, and mean unmedicated IOP was 26.4 ± 2.4 mmHg. Postoperatively, among eyes without later cataract surgery, mean medicated IOP at all visits through 48 months was ≤ 13.7 mmHg (≥ 37% reduction), and annual unmedicated IOP was ≤ 18.4 mmHg (reductions of ≥ 30% vs. preoperative unmedicated IOP and ≥ 16% vs. preoperative medicated IOP). At all postoperative visits among eyes without additional surgery or medication, ≥ 91% of eyes had ≥ 20% IOP reduction on one medication versus preoperative medicated IOP. At month 48, 97 and 98% of eyes achieved IOP ≤ 15 and ≤ 18 mmHg, respectively, on one medication. Six eyes required additional medication, no eyes required additional glaucoma surgery, and safety measurements were favorable throughout follow-up. CONCLUSION: IOP control was achieved safely with two trabecular micro-bypass stents, one suprachoroidal stent, and postoperative prostaglandin. This microinvasive, ab interno approach introduces a possible new treatment option for refractory disease. TRIAL REGISTRATION: NCT01456390. FUNDING: Glaukos Corporation.

Prospective unmasked randomized evaluation of the iStent inject (®) versus two ocular hypotensive agents in patients with primary open-angle glaucoma.

PURPOSE: The purpose of this study was to compare outcomes of subjects with open-angle glaucoma (OAG) not controlled on one medication who underwent either implantation of two iStent inject (®) trabecular micro-bypass devices or received medical therapy consisting of a fixed combination of latanoprost/timolol. PATIENTS AND METHODS: Of 192 subjects who qualified for the study and were enrolled, 94 were randomized to surgery with implantation of two iStent inject(®) devices in the treated eye and 98 to receive medical therapy. RESULTS: At the month 12 visit, 94.7% of eyes (89/94) in the stent group reported an unmedicated intraocular pressure (IOP) reduction of ≥20% versus baseline unmedicated IOP, and 91.8% of eyes (88/98) in the medical therapy group reported an IOP reduction ≥20% versus baseline unmedicated IOP. A 17.5% between-group treatment difference in favor of the iStent inject group was statistically significant (P=0.02) at the ≥50% level of IOP reduction. An IOP ≤18 mmHg was reported in 92.6% of eyes (87/94) in the iStent inject group and 89.8% of eyes (88/98) in the medical therapy group. Mean (standard deviation) IOP decreases from screening of 8.1 (2.6) mmHg and 7.3 (2.2) mmHg were reported in the iStent inject and medical therapy groups, respectively. A high safety profile was also noted in this study in both the iStent inject and medical therapy groups, as measured by stable best corrected visual acuity, cup-to-disc ratio, and adverse events. CONCLUSION: These data show that the use of iStent inject is at least as effective as two medications, with the clinical benefit of reducing medication burden and assuring continuous treatment with full compliance to implant therapy as well as having a highly favorable safety profile.

Prospective, unmasked evaluation of the iStent® inject system for open-angle glaucoma: synergy trial.

INTRODUCTION: Micro-invasive glaucoma surgical implantation of trabecular micro-bypass stents, previously shown to be safe and effective for open-angle glaucoma (OAG) subjects during cataract surgery, was considered for evaluation as a sole procedure. The aim of this study was to evaluate the safety and intraocular pressure (IOP)-lowering efficacy after ab interno implantation of two Glaukos Trabecular Micro-Bypass iStent inject second generation devices in subjects with OAG. This study was performed at sites in France, Germany, Italy, Republic of Armenia, and Spain. METHODS: In this pan-European, multi-center prospective, post-market, unmasked study, 99 patients with OAG on at least two topical ocular hypotensive medications who required additional IOP lowering to control glaucoma disease underwent implantation of two GTS400 stents in a stand-alone procedure. Patients were qualified if they presented with preoperative mean IOP between 22 and 38 mmHg after medication washout. Postoperatively, subjects were assessed at Day 1, Months 1, 3, 6, 7, 9, and 12. IOP, medication use and safety were assessed at each visit. RESULTS: Sixty-six percent of subjects achieved IOP ≤18 mmHg at 12 months without medication, and 81% of subjects achieved Month 12 IOP ≤ 18 mmHg with either a single medication or no medication. Mean baseline washout IOP values decreased by 10.2 mmHg or 39.7% from 26.3 (SD 3.5) mmHg to 15.7 (SD 3.7) mmHg at Month 12. Mean IOP at 12 months was 14.7 (SD 3.1) mmHg in subjects not using ocular hypotensive medications. Reduction from preoperative medication burden was achieved in 86.9% of patients, including 15.2% with reduction of one medication and 71.7% with reduction of two or more medications. Postoperative complications occurred at a low rate and resolved without persistent effects. CONCLUSION: In this series, implantation of two trabecular micro-bypass second generation stents in subjects with OAG resulted in IOP and medication reduction and favorable safety outcomes.

Analysis of results related to good and bad outcomes of Intacs implantation for keratoconus correction.

PURPOSE: To evaluate factors influencing good and poor outcomes after intracorneal ring segment implantation to correct keratoconus. SETTING: Instituto Oftalmológico de Alicante (Vissum Corporation), University of Miguel Hernandez, Alicante, Spain. METHODS: A retrospective comparative study of the visual outcome, 25 eyes of 21 patients were implanted after intracorneal ring segments (Intacs, Addition Technology) as a method to correct keratoconus. Outcomes were evaluated 6 months after implantation based on the visual results. Group A comprised 20 eyes that gained 3 lines or more of best spectacle-corrected visual acuity (BSCVA) to correct keratoconus, and Group B comprised 5 eyes that lost 1 line of BSCVA. RESULTS: In Group A, the preoperative mean BSCVA was 0.43 (20/50) and the postoperative mean BSCVA, 0.82 (20/20) (P< or =.0001). In Group B, the preoperative mean BSCVA was 0.36 (20/63) and the postoperative mean BSCVA, 0.24 (20/80) (P< or =.02). The preoperative mean sphere power was 3.90 diopters (D) greater in Group B than in Group A (P< or =.007); the mean spherical equivalent was 4.36 D greater (P< or =.007), and the mean K-reading was 6.91 D greater (P< or =.001). The postoperative reduction in spherical dioptric power was 2.11 D (P< or =.027) and the mean spherical equivalent, 2.81 D (P< or =.003), significant only in Group A. The reduction in mean central K-readings was 4.30 D (P< or =.0001) in Group A and 6.19 D (P< or =.014) in Group B. The correlation of the preoperative mean K value to the postoperative BSCVA was significant at the .01 level by the Pearson test (-0.67). In Group A, all eyes (100%) had a mean K-reading < or =53 D. In Group B, 4 eyes (80%) had a mean K-reading > or =55 D. CONCLUSION: Intacs provided better results in visual acuity and corneal topography quality and significantly reduced the spherical equivalent in eyes with keratoconus with relatively low mean K values (< or =53 D) and a relatively low spherical equivalent. In advanced keratoconus (mean K-reading > or =55 D), poor results can be anticipated.

LASIK in myopic patients with dermatological keloids.

PURPOSE: To evaluate the visual and refractive out come of LASIK in myopic patients with a known history of dermatological keloid scar. METHODS: This retrospective case series included 10 eyes of 5 white patients with a known history of dermatological keloids. All patients had low to moderate myopia with no corneal or limbal keloid. All underwent uneventful bilateral LASIK. Postoperatively, visual outcomes, refractive outcomes, and complications were evaluated. Minimum 1-year follow-up was indicated for all patients in this study. RESULTS: Mean preoperative uncorrected visual acuity (UCVA) was 20/320 and 1 year postoperative 20/20. Mean preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 and 1 year postoperative was 20/20. The mean preoperative spherical equivalent refraction was -5.00 +/- 2.6 diopters (D) and +0.1 +/- 0.2 D 1 year postoperative. The safety index was 1.02 and the efficacy index was 1.02. None of the included in this study underwent retreatment for correction of residual error or regression up to 1 year postoperatively. No sight-threatening complications were reported. No patient reported postoperative haze, severe dry eye syndrome, or flap-related problems. CONCLUSIONS: LASIK is a safe, effective, and predictable technique for correcting low and moderate myopia in patients with dermatological keloids.

LASIK in patients with rheumatic diseases: a pilot study.

PURPOSE: To investigate the safety of LASIK in patients with a known history of controlled rheumatic diseases. DESIGN: Retrospective consecutive observational clinical study. PARTICIPANTS: Forty-two eyes (22 patients) known to have had a history of rheumatic diseases underwent LASIK. All patients had a history of controlled rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, scleroderma, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, arthritis, or Behçet's disease. METHODS: Assessments were made preoperatively and at 1, 3, and 6 months postoperatively and included visual acuity (VA), refraction, keratometric readings, slit-lamp biomicroscopy, and corneal topography. All the patients underwent LASIK. Postoperative treatment included a topical steroid-antibiotic combination. MAIN OUTCOME MEASURES: Visual acuity, refraction, keratometric readings, and slit-lamp biomicroscopy findings at 1, 3, and 6 months postoperatively. RESULTS: LASIK was performed uneventfully on all patients. The mean pre-LASIK spherical equivalent (SE) was -5.39+/-2.25, and the sixth month postoperative SE was -0.15+/-0.38 diopters (D) (P<0.001). Uncorrected VA 6 months after the LASIK procedure was 20/25. Enhancement procedures were performed in 6 of 42 eyes (14.3%) at variable times after the primary procedure. Postoperative follow-up showed development of a moderate degree of dry eye syndrome in 4 eyes (9.5%). Corneal haze, melting, flap, or interface complications were not observed in any of the study eyes. CONCLUSIONS: In this small series, we found good outcomes when correcting refractive errors using LASIK in selected patients with controlled rheumatic diseases. In this series, a favorable postoperative visual outcome was obtained with no operative or postoperative vision-threatening complications.

Hyaluronic acid combined with mannitol to improve protection against free-radical endothelial damage: experimental model.

PURPOSE: To evaluate the protective properties of combined sodium hyaluronate 2% and mannitol 0.5% (Visiol) on the corneal endothelium in the presence of oxidative stress induced by hydrogen peroxide (H(2)O(2)). SETTING: Instituto Oftalmológico de Alicante, Universidad Miguel Hernández, Alicante, Spain. METHODS: This was an exploratory randomized controlled parallel-group, masked-assessor study of 3 sodium hyaluronate-based ophthalmic viscosurgical devices (OVDs): Visiol, Healon (sodium hyaluronate 1%), and Viscoat (sodium hyaluronate 3%-chondroitin sodium 4%). The OVDs were tested for protective effects on the endothelium following oxidative stress induced by H(2)O(2) at increased concentrations: control (lactated Ringer's solution), 1 mM, 10 mM, and 100 mM. Groups without OVD were used as controls at the same concentrations of peroxide. Each animal received the same treatment in both eyes (10 eyes per group). Endothelial cell lesion was assessed using the Janus green photometry absorbance technique. RESULTS: At 10 mM peroxide concentration, the value of endothelial cell lesion was significantly lower in the Visiol (16.8%, P=.0056), Healon (22.2%, P=.0302), and Viscoat (21.6%, P=.0336) groups than in the control group (29.4%, no OVD). There was a trend in favor of Visiol to more efficiently reduce cell lesions of the endothelium, than Healon (P=.055) and Viscoat (P=.1013). Values of endothelial cell lesion at peroxide concentrations of 1 mM and 100 mM showed the same trends than those observed at 10 mM. CONCLUSIONS: All of the OVDs tested efficiently reduced endothelial lesions against free radicals compared with the control group in which no OVD was used. The following sequence for the efficacy of endothelial cell protection was established: Visiol>Viscoat>Healon>no OVD.

Artisan iris-claw phakic intraocular lens followed by laser in situ keratomileusis for high hyperopia.

PURPOSE: To evaluate safety, efficacy, predictability, stability, complications, and patient satisfaction after Artisan phakic intraocular lens (IOL) implantation followed by laser in situ keratomileusis (LASIK) for the correction of high hyperopia. SETTING: Instituto Oftalmólogico de Alicante, Alicante, Spain. METHODS: This prospective trial included 39 eyes with a mean preoperative spherical equivalent (SE) of 7.39 diopters (D) +/- 1.30 (SD) and a cylinder between 0 and -4.25 D. The Artisan iris-fixated phakic IOL (Ophtec) for hyperopia was implanted, and LASIK was performed 6 to 8 months later. The best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), refraction, endothelial cell loss (ECL), endothelium morphologic analysis, and patient satisfaction were recorded. The minimum follow-up was 12 months. RESULTS: At 1 year, 37 eyes (94.9%) were within +/-1.00 D of emmetropia and 31 eyes (79.5%) were within +/-0.50 D. Thirty-five eyes (89.7%) achieved a UCVA of 0.5 or better. There was a statistically significant decrease in BCVA after phakic IOL implantation, but this effect was corrected after LASIK. Nine eyes (23.1%) lost 1 line of BCVA; 7 eyes (17.9%) gained at least 1 line. One eye (2.6%) showed a change in SE greater than 1.0 D over the follow-up period. The mean ECL was 10.9%, but morphologic analysis suggested no additional damage caused by LASIK over that produced by phakic IOL surgery. Overall patient satisfaction was high. CONCLUSIONS: The combination of Artisan phakic IOL implantation and LASIK safely, predictably, and effectively reduced high hyperopia. A loss of 1 line of BCVA should be expected in about one third of eyes implanted with this IOL. Halos and glare at night remain a potential problem.

Topography-guided laser in situ keratomileusis (TOPOLINK) to correct irregular astigmatism after previous refractive surgery.

PURPOSE: To assess whether topography-driven laser in situ keratomileusis (LASIK) can correct induced corneal irregular astigmatism. METHODS: A prospective non-comparative case series of 41 eyes (38 patients) with irregular astigmatism following corneal refractive surgery, included two groups: Group 1 (26 eyes) with a defined topographic pattern and Group 2 (15 eyes) with no pattern. Ablation was performed using the Technolas 217C excimer laser with a software ablation program (TOPOLINK) based on corneal topography. Uncorrected and best spectacle-corrected visual acuity, manifest and cycloplegic refraction, corneal topography, superficial corneal surface quality, and image distortion were measured. RESULTS: At 6 months follow-up in Group 1 eyes (defined topographic pattern) mean preoperative BSCVA improved from 0.16 +/- 0.11 LogMAR (0.4 to 0) to 0.09 +/- 0.10 LogMAR (0.2 to 0) (P = .001) (safety index of 1.1). In Group 2 eyes (no pattern), mean preoperative BSCVA was 0.18 +/- 0.11 LogMAR (0.4 to 0), similar to the postoperative BSCVA of 0.17 +/- 0.10 LogMAR (0.3 to 0) (safety index of 0.98). Mean postoperative UCVA was > or = 0.3 LogMAR in 25 eyes (96.2%) in Group 1 (efficacy index of 0.8) and 7 eyes (46.6%) in Group 2 (efficacy index of 0.5). Both superficial corneal surface quality and image distortion significantly improved in Group 1; there were no significant changes in Group 2. We reoperated nine eyes (21.9%). CONCLUSIONS: Topographic-assisted LASIK was helpful in selected cases where irregular astigmatism showed a pattern. It was ineffective in undefined irregular astigmatism. Partial correction of the irregularity and regression of the obtained effect was common.

Angle-supported phakic intraocular lenses followed by laser-assisted in situ keratomileusis for the correction of high myopia.

To evaluate the safety, effectiveness, predictability, and stability of the combination of angle-supported phakic intraocular lens (PIOL) implantation and laser-assisted in situ keratomileusis (LASIK) for the correction of high myopia. Noncomparative interventional case series. At the Instituto Oftalmológico de Alicante, Spain, 24 consecutive eyes of 12 patients with a preoperative spherical equivalent between -9 and -26 diopters were studied. Implantation of an angle-supported PIOL was done as the first surgery. Laser-assisted in situ keratomileusis was performed at least 6 months after PIOL surgery, once stability of topography and refraction were proved. Main outcome measures were uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refraction, applanation tonometry, and corneal endothelial study (cell density, hexagonality, and coefficient of variation), with a minimum follow-up of 12 months after LASIK. The mean spherical equivalent refraction decreased from -15.17 +/- 5.15 diopters before PIOL implantation to -1.33 +/- 1.18 diopters after PIOL surgery and to 0.01 +/- 0.53 12 months after LASIK. Uncorrected visual acuity was 0.39 +/- 0.12 after PIOL surgery, increasing to 0.65 +/- 0.23 12 months after LASIK. There was an increase in 20/40 or better UCVA from 16.6% after PIOL surgery alone to 83.3% after addition of LASIK. At final follow-up, spherical equivalent was within +/- 1 diopter of emmetropia in 22 eyes (91.7%) and in 18 eyes (75%) within +/- 0.50 diopters. Vector analysis demonstrated that astigmatic components of refractive error after PIOL surgery were well corrected by LASIK. At final follow-up the mean endothelial cell loss was 4.88% (P <.001). There were no statistically significant differences between mean endothelial cell count, percentage of hexagonality, or coefficient of variation before LASIK and 12 months after LASIK, suggesting that no corneal endothelial damage was produced by LASIK itself. No sight-threatening complications occurred through the follow-up period. The combination of angle-supported PIOL implantation and LASIK appears to be a safe, effective, predictable, and stable procedure for the correction of high myopia. This paper emphasizes the benefits of adding LASIK to the use of PIOL alone.

Laser in situ keratomileusis to correct myopia after scleral buckling for retinal detachment.

We describe 5 patients with a previously placed encircling scleral buckle for a retinal detachment who had laser in situ keratomileusis (LASIK) to correct myopia. Uncorrected (UCVA) and best corrected visual acuity, ultrasound pachymetry before and 6 months after LASIK, and development of intraoperative or postoperative complications were measured. In all patients, the UCVA improved and the myopic spherical equivalent decreased after the procedure. The mean ultrasonic pachymetry after LASIK was 413 microm +/- 23.1 (SD) (range 380 to 436 microm). No patient had difficulties with LASIK or postoperative complications. To correct myopia in eyes with a previous scleral buckle, LASIK was a feasible and relatively safe procedure.

Cataract after minor trauma in a young patient with an iris-fixated intraocular lens for high myopia.

PURPOSE: To report a case of traumatic cataract in a young patient with an iris-fixated phakic intraocular lens (PIOL). DESIGN: Interventional case report. METHOD: A 32-year-old woman with bilateral iris-fixated PIOLs for high myopia presented with a cortical cataract 2 weeks after minor ocular trauma. Ultrasound biomicroscopy and endothelial cell count were performed before and after cataract surgery. RESULTS: The distance between the PIOL and the crystalline lens was 0.82 mm; the distance between the PIOL and the corneal endothelium was 2.30 mm. Endothelial cell count was 2,500 cells/mm(2) before surgery and 2,476 cells/mm(2) at 1 year follow-up. CONCLUSIONS: Patients with iris-fixated PIOLs are at risk of rapid cataract progression after minor ocular traumatism.