A comparison of Scansys and Sirius tomography in healthy eyes.

PURPOSE: To assess the level of agreement and evaluate the reliability of measurements between two Scheimpflug imaging modalities, Scansys (MediWorks, China) and Sirius (CSO, Italy), in quantifying the anterior segment parameters in healthy eyes. METHODS: In a cross-sectional study, the right eyes of 38 healthy participants without any ocular or systemic diseases were examined. A range of anterior segment parameters including anterior and posterior flat and steep keratometry, central corneal thickness (CCT), thinnest corneal thickness (TCT), anterior chamber depth (ACD), anterior chamber angle (ACA), corneal volume, anterior chamber volume, and horizontal white to white diameter, derived from the sagittal curvature maps were measured. To evaluate the reliability of the measurements, intraclass correlation coefficient (ICC) and correlation coefficient were measured. Additionally, Bland-Altman plots were employed to examine the agreement in mean (bias line) and 95% limits of agreement between the two devices. RESULTS: The mean age was 31.5 ± 6.9 (range: 19-47) years. The ICC indicated that the majority of anterior segment parameters had an excellent or good level of reliability, surpassing the threshold of 0.9. Nevertheless, CCT and ACA exhibited a moderate level of reliability, with ICC values of 0.794 and 0.728, respectively. The correlation analysis showed a strong correlation for all the variables tested. The Bland-Altman plots revealed that the bias line was near zero and the 95% limits of agreement were narrow for most variables, except for the anterior flat and steep keratometry, which were found to range from - 0.57 to 0.84 D and - 0.68 to 0.87 D, respectively. CONCLUSION: Scansys and Sirius devices can be effectively used interchangeably for the evaluation of most anterior segment parameters; however, for anterior corneal curvatures, CCT and ACA, their alternative use is not recommended.

Evaluation of the effect of artificial tears on corneal epithelial thickness changes after photorefractive keratectomy.

PURPOSE: This study aimed to evaluate the corneal epithelial thickness changes after photorefractive keratectomy (PRK) and the impact of long-term artificial tear usage on epithelial thickness changes in these patients. METHODS: This study was performed on 71 patients (142 eyes) without dry eye disease who received PRK for myopic refractive correction. The corneal epithelial thickness profile was obtained before, one, three, and six months after surgery using anterior segment optical coherence tomography. Patients were randomly divided into two groups: group A, who received preservative-free artificial tears post-surgery, and group B, who did not receive artificial tears. RESULTS: The epithelial thickness decreased universally in the first month and then increased in the 3- and 6-month follow-ups. Group A had a significantly thicker epithelium in central, paracentral, and midperipheral zones compared with group B in the 3-month follow-up. In the 6-month follow-up, no significant differences were detected between groups. At the last follow-up, the central, paracentral, and midperipheral zone epithelial thicknesses in all patients were significantly higher than preoperative values, but peripheral zone thickness only increased to preoperative values. CONCLUSIONS: Patients using artificial tears showed a faster thickening, especially in the central and paracentral zones, but there were no significant differences between the two groups in the final follow-up. Artificial tear usage may increase the rate of the epithelial remodeling process in post-PRK patients without significantly altering the final epithelial thickness profile. Further studies are warranted to evaluate the influence of different factors on epithelial remodeling.

Comparison of the ocular ultrasonic and optical biometry devices in the different quality measurements

Purpose: To compare the reliability and agreement of axial length (AL), anterior chamber depth (ACD), and lens thickness (LT) measurements obtained with optical biometry based on swept-source optical coherence tomography (IOLMaster 700; Carl Zeiss, Germany) and an ultrasound biometry device (Nidek; US-4000 Echoscan, Japan) in different qualities of AL measurement. Methods: A total of 239 consecutive eyes of 239 cataract surgery candidates with a mean age of 56 ± 14 years were included. The quality measurements were grouped according to the quartiles of SD of the measured AL by IOLMaster 700. The first and fourth quartile's SD are defined as high and low-quality measurement, respectively, and the second and third quartiles’ SD is defined as moderate-quality. Results: The reliability of AL and ACD between the two devices in all patients and in different quality measurement groups was excellent with highly statistically significant (AL: all ICC=0.999 and P<0.001, ACD: all ICC>0.920 and P<0.001). AL and ACD in all quality measurements showed a very strong correlation between devices with highly statistically significant. However, there was poor (ICC=0.305), moderate (ICC=0.742), and good (ICC=0.843) reliability in measuring LT in low-, moderate-, and high-quality measurements, respectively. LT showed a very strong correlation (r = 0.854) with highly statistically significant (P<0.001) between devices only in patients with high-quality measurements. Conclusions: AL and ACD of the IOLMaster700 had outstanding agreements with the US-4000 ultrasound in different quality measurements of AL and can be used interchangeably. But LT should be used interchangeably cautiously only in the high-quality measurements group. (AU)

Comparison of the ocular ultrasonic and optical biometry devices in the different quality measurements.

PURPOSE: To compare the reliability and agreement of axial length (AL), anterior chamber depth (ACD), and lens thickness (LT) measurements obtained with optical biometry based on swept-source optical coherence tomography (IOLMaster 700; Carl Zeiss, Germany) and an ultrasound biometry device (Nidek; US-4000 Echoscan, Japan) in different qualities of AL measurement. METHODS: A total of 239 consecutive eyes of 239 cataract surgery candidates with a mean age of 56 ± 14 years were included. The quality measurements were grouped according to the quartiles of SD of the measured AL by IOLMaster 700. The first and fourth quartile's SD are defined as high and low-quality measurement, respectively, and the second and third quartiles' SD is defined as moderate-quality. RESULTS: The reliability of AL and ACD between the two devices in all patients and in different quality measurement groups was excellent with highly statistically significant (AL: all ICC=0.999 and P<0.001, ACD: all ICC>0.920 and P<0.001). AL and ACD in all quality measurements showed a very strong correlation between devices with highly statistically significant. However, there was poor (ICC=0.305), moderate (ICC=0.742), and good (ICC=0.843) reliability in measuring LT in low-, moderate-, and high-quality measurements, respectively. LT showed a very strong correlation (r = 0.854) with highly statistically significant (P<0.001) between devices only in patients with high-quality measurements. CONCLUSIONS: AL and ACD of the IOLMaster700 had outstanding agreements with the US-4000 ultrasound in different quality measurements of AL and can be used interchangeably. But LT should be used interchangeably cautiously only in the high-quality measurements group.

Vector analysis of moderate to high myopic astigmatism after small-incision lenticule extraction (SMILE): 12-month follow-up.

PURPOSE: To evaluate the refractive outcomes of small-incision lenticule extraction (SMILE) surgery in moderate to high myopic astigmatism. STUDY DESIGN: Prospective interventional case series. METHODS: This study evaluated 111 eyes of 68 patients treated with femtosecond SMILE surgery for the correction of myopia and astigmatism. Inclusion criteria were myopia of - 0.5 D or more and astigmatism between - 1.0 D and -5.0 D. Refractive and visual measurements were obtained preoperatively, 1 and 12 month(s) postoperatively. Vector analysis was used to study the astigmatic outcomes at 12-month follow-up. Comparison of results in two groups of patients with astigmatism below and over 3.00 D was performed. RESULTS: The preoperative mean spherical equivalent was -5.48 ± 2.17 D (range - 1.75 to - 10.00 D) and the mean cylinder was -2.02 ± 1.09 D (range - 1.00 to - 5.00 D). The mean postoperative cylinder value was -0.60 ± 0.52 D at 12-month visit. The 12-month safety and efficacy indices were 0.98 ± 0.07 and 0.97 ± 0.12, respectively. The high astigmatism group showed significantly lower safety and efficacy indices. The postoperative residual astigmatism was 0.5 D or less in 73% of the eyes. Higher amount of residual astigmatism was observed in the high astigmatism group. The angle of error was ± 5 degrees in 49% and ± 15 degrees in 87% of the eyes. CONCLUSION: SMILE surgery is effective and safe method for correcting myopic astigmatism. Vector analysis indicated a tendency for the under correction of astigmatism in subjects with high astigmatism.

Clinical Outcomes of a New Type of Continuous Intrastromal Corneal Ring for Treatment of Keratoconus.

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of implantation of a new continuous corneal ring in keratoconic corneas of an Iranian population. METHODS: This study was conducted on 95 contact lens-intolerant keratoconic eyes with clear central corneas. A continuous corneal ring, annular intrastromal corneal inlay (AICI), was inserted using femtosecond laser in all cases. Patients were followed up for 1, 3, and 12 months postsurgery. Visual and subjective refractive outcomes were evaluated in each examination. Besides, keratometry and aberrometric values were recorded before and 12 months after surgery. Finally, vector analysis of refractive astigmatism was performed using the Alpins method. RESULTS: The uncorrected and corrected distance visual acuities improved significantly 12 months after surgery from 0.91 ± 0.39 to 0.38 ± 0.22 (P < 0 0.001) and 0.33 ± 0.21 to 0.13 ± 0.11 logMAR (P < 0.001), respectively. Moreover, spherical and cylindrical refractive components reduced from -2.52 ± 2.62 to -0.76 ± 1.78 D (P < 0.001) and -4.14 ± 1.64 to -1.91 ± 1.18 D (P < 0.001), respectively. The mean anterior keratometry had a significant reduction 12 months after AICI insertion (P< 0.001). Primary coma and spherical aberration values showed a significant increase (both, P < 0.05). Our results showed 100% safety (safety index: 1.8) and 45% efficacy (efficacy index: 1). CONCLUSIONS: AICI implantation seemed to be a safe and effective procedure for improving visual acuity and refractive outcomes in subjects with keratoconus.

Changes in the Optical Corneal Densitometry, Visual Acuity, and Refractive Error after the Annular Intracorneal Inlay Implantation.

PURPOSE: To investigate the changes in the optical corneal densitometry as an objective method in assessing the corneal light back-scattering before and 1 year after the annular intracorneal inlay (AICI) implantation into the keratoconic corneas. METHODS: Changes in the optical corneal densitometry, visual acuity, refractive, and tomographical status were assessed before and 1 year after the AICI implantation into the corneas with different stages of keratoconus. Optical corneal densitometry was evaluated using the Pentacam-HR in 0-2, 2-6, 6-10, and 10-12 mm rings in the anterior 120 µ, central layers, posterior 60 µ and also the total value were measured for cornea in the Grey Scale Unit criterion. RESULTS: Totally, 34 patients with keratoconus were studied; the uncorrected and best corrected visual acuity were increased after the surgery (0.98 ± 0.25 to 0.53 ± 0.30 logMAR, P < 0.001 and 0.26 ± 0.18 to 0.19 ± 0.14, P = 0.007 logMAR, respectively); the spherical equivalent was decreased from -4.45 ± 2.25 to - 2.06 ± 2.01 D (P = 0.004). AICI implantation led to an increase in the amount of optical corneal densitometry in 0-2 mm central, 2-6 mm central, 6-10 mm central, total central, 2-6 mm posterior, and 2-6 mm total rings (all, P < 0.05); however, a decrease was observed in 0-2 mm anterior ring (P = 0.049). Results of statistical analysis showed that the total optical corneal densitometry, anterior total, and posterior total back-scattering did not change after the AICI implantation (all, P > 0.05). CONCLUSIONS: Our results revealed a significant improvement in the visual function, including refractive error and visual acuity following the AICI implantation. Changes in the optical corneal densitometry were different in distinct regions and layers however, the total amount did not change after the AICI implantation.

Sutureless Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty Using a Bioengineered Cornea as a Viable Alternative to Human Donor Transplantation for Superficial Corneal Opacities.

PURPOSE: To evaluate the safety and efficacy of a bioengineered corneal implant using femtosecond laser-assisted anterior lamellar keratoplasty for superficial corneal opacities. METHODS: Six eyes of 6 consecutive patients with superficial corneal stromal opacities involving <220 µm owing to various pathologies were included in the study. Preoperatively, all patients underwent anterior segment optical coherence tomography (Visante; Carl Zeiss Meditec AG) to evaluate the depth of the corneal opacity. All patients underwent sutureless femtosecond laser-assisted anterior lamellar keratoplasty using a bioengineered collagen corneal implant (linkcor). Visual indices, refraction, and keratometry were evaluated preoperatively and 12 months postoperatively. RESULTS: Corrected distance visual acuity improved significantly in all patients (P = 0.02). A significant decrease was seen in refractive astigmatism postoperatively (P = 0.04). Flat keratometry reduced significantly 12 months after the intervention (P = 0.04). No intraoperative or early postoperative complications were noticed. All implants were fully covered by healthy epithelium within a month after the surgery and remained clear at follow-up visits. The results of this procedure remained stable throughout the follow-up period. In 1 patient, mild inferior collagen melting and epithelial defect formation occurred at 1-year follow-up. Despite frequent topical corticosteroid therapy the melting progressed, the collagen tissue was removed and the patient was treated accordingly with good visual outcomes. CONCLUSIONS: Femtosecond laser-assisted anterior lamellar keratoplasty with bioengineered corneal (linkcor) implantation is an effective treatment for improving vision quality in anterior stromal opacities. This procedure reduces the need for human donor tissue and avoids human donor-related and suturing complications.

Retraction notice to "Endophthalmitis Occurring after Cataract Surgery: Outcomes of More Than 480 000 Cataract Surgeries, Epidemiologic Features, and Risk Factors" (Ophthalmology. 2016;123:295-301).

This article has been retracted: please see Elsevier policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). The editors wish to note that concerns were raised regarding coding errors in the data set that formed the basis of this study. Patient record numbers were found to be duplicated, so that the number of endophthalmitis cases was unclear as was the associated treatment, and the number of unique patients estimated to be far less than the 480,000 reported. Upon review of the information provided, Ophthalmology has determined the dataset to be flawed with unverifiable elements from which reliable conclusions cannot be drawn, and therefore has made the decision to issue a retraction of the manuscript.

Central serous chorioretinopathy following ingestion of sildenafil citrate.

INTRODUCTION: We report a case of a 35-year-old man who presented with headache followed by decreased vision, metamorphopsia, and altered color perception in his left eye, after repeated intake of sildenafil citrate (four times; 100 mg) in a limited period (3 days). METHODS: On the first ocular examination, best-corrected distance visual acuity (CDVA) was 20/80 in his left eye and 20/20 in his right eye. On fundus examination, loss of foveal reflex and serous retinal detachment in the foveal region were detected. Fluorescein angiography of the left eye was compatible with a leakage area with determined borders. The patient was advised to stop sildenafil intake. RESULTS: After 4 weeks, CDVA increased to 20/25, and the fundus examination revealed significant improvement of the macular edema. Optical coherence tomography showed increased foveal thickness to 350 µm. CONCLUSION: Advising patients with central serous chorioretinopathy to stop sildenafil intake should be considered.

Characteristics of Astigmatism after MyoRing Implantation.

Considering the rising number of MyoRing implantation procedures in keratoconic corneas and the refractive outcomes associated with this treatment modality, this study aimed to evaluate and compare the magnitude and axis orientation of total and corneal astigmatism between before and after MyoRing implantation in 34 eyes of 28 patients with keratoconus (KCN) (mean age: 29.41 ± 7.0 years). The inclusion criterion was a reliable diagnosis of clinical KCN based on corneal biomicroscopic and tomographic findings. The mean total astigmatism of ocular refraction decreased significantly from -4.27 ± 3.15 D (before MyoRing implantation) to -2.18 ± 1.63 D (after MyoRing implantation) (P < 0.001). The mean astigmatism in the anterior and posterior surface of the cornea decreased significantly by 1.16 D (P = 0.001) and 0.24 D (P = 0.009), respectively, after MyoRing implantation. Before MyoRing implantation, the axis orientation of total ocular astigmatism for with-the-rule, oblique, and against-the-rule astigmatism was 21%, 42%, and 37%, respectively; at 6 months after MyoRing implantation, it was 18%, 24%, and 58%, respectively. Before MyoRing implantation, the axis orientation for with-the-rule, against-the-rule, and oblique astigmatism of the anterior surface of the cornea was 59%, 24%, and 17%, respectively; at 6 months after MyoRing implantation, it was 52%, 24%, and 24%, respectively. Before MyoRing implantation, the axis orientation of with-the-rule, oblique, and against-the-rule astigmatism of the posterior surface of the cornea was 68%, 29%, and 3%, respectively; at 6 months after MyoRing implantation, it was 67%, 12%, and 12%, respectively. MyoRing implantation significantly decreased the amount of total, anterior, and posterior corneal astigmatism.

Post-cataract surgery endophthalmitis: Brief literature review.

PURPOSE: To investigate recent evidence in prophylaxis and management of post-cataract surgery endophthalmitis. METHODS: We conducted a literature search using Pubmed database for post cataract surgery endophthalmitis, and relevant articles were selected from original English papers published since 2015. RESULTS: Forty-nine articles were published regarding post-cataract surgery endophthalmitis from January 2015 to February 2016. A low incidence of post-cataract surgery endophthalmitis has been reported. A growing number of articles are focusing on preventing endophthalmitis using intracameral antibiotics. CONCLUSION: Based on the current evidence, intracameral antibiotics seems to be effective in preventing endophthalmitis after cataract surgery.

Changes in stereopsis after photorefractive keratectomy.

PURPOSE: To evaluate the effects of photorefractive keratectomy (PRK) on the stereopsis of myopic and hyperopic patients. SETTING: Farabi Eye Hospital, Tehran, Iran. DESIGN: Prospective case series. METHODS: This study included patients having PRK to achieve emmetropia. The patients were divided into the following 3 groups: low myopia (<-6.0 diopters [D]), high myopia (>-6.0 D), and hyperopia (<+4.0 D). Near stereoacuity was measured using the Randot test under photopic conditions (with corrective glasses) at 40 cm preoperatively (with corrective glasses) and 1, 3, and 12 months postoperatively. Repeated-measure analysis of variance was used to assess changes in stereopsis over time in the 3 groups. RESULTS: Each group comprised 60 patients. The mean preoperative stereoacuity was 121.16 seconds of arc (arcsec) ± 149.92 (SD), improving to 83.66 ± 75.84 arcsec 1 month postoperatively and 80.66 ± 64.31 arcsec at 3 months (both P < .001). It remained unchanged (83.33 ± 75.01 arcsec) at 12 months (P = .610). Patients with high myopia had the greatest improvement in stereopsis after PRK compared with low myopic and hyperopic patients (P < .001). The improvement in stereoacuity was significantly higher in the severe anisometropic group; the lowest improvement was in the group without anisometropia. CONCLUSION: Photorefractive keratectomy could result in an improvement in stereopsis. Patients with high myopia benefitted most from PRK in terms of improvement in stereopsis. FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Endophthalmitis Occurring after Cataract Surgery: Outcomes of More Than 480 000 Cataract Surgeries, Epidemiologic Features, and Risk Factors.

PURPOSE: To report the incidence of endophthalmitis after senile cataract surgery and to describe the epidemiology and main risk factors. DESIGN: Retrospective, single-center, cross-sectional descriptive study. PARTICIPANTS: Patients who underwent cataract surgery in Farabi Eye Hospital from 2006 through 2014. METHODS: All patients were evaluated retrospectively to compare risk factors, epidemiologic factors, and prophylaxis methods related to endophthalmitis. Patient records were used to gather the data. MAIN OUTCOME MEASURES: Epidemiologic factors, systemic diseases, other ocular pathologic characteristics, complications during the surgery, technique of cataract surgery, intraocular lens type, method of antibiotic prophylaxis, surgeon experience, vitreous culture, and vision outcome were evaluated in these patients. RESULTS: One hundred twelve endophthalmitis cases among 480 104 operations reported, equaling an incidence of 0.023%. Patients with diabetes mellitus (14.3%) and of older age (mean age, 81 years), perioperative communication with the vitreous (17.9%), extracapsular cataract surgery procedure (11%), and surgery on the left eye (58.9% vs. 41.1% for right eye; P = 0.03) showed a statistically significant association with endophthalmitis. Short-term treatment with topical or systemic preoperative antibiotics or postoperative subconjunctival injection was associated with a 40% to 50% reduced odds of endophthalmitis compared with no prophylaxis (P = 0.2). No cases of endophthalmitis were observed among the 25 920 patients who received intracameral cefuroxime, suggesting that this approach to antibiotic prophylaxis may be far more effective than traditional topical or subconjunctival approaches. CONCLUSIONS: The incidence of endophthalmitis after cataract surgery in our center was 0.023%, comparable with that of other previously published international studies. Older rural patients with immune suppressive diseases, such as diabetes mellitus, are particularly more prone to endophthalmitis. Vitreous loss at the time of surgery was associated with a significantly increased risk. Whereas antibiotic prophylaxis overall showed a 40% to 50% reduction in risk, intracameral cefuroxime was 100% effective in preventing endophthalmitis in this series.