Improvement of intermediate vision with new monofocal intraocular lenses: A systematic review and meta-analysis.

PURPOSE: Monofocal intraocular lenses (IOLs) used in cataract surgery are designed to improve visual acuity (VA). The available evidence of new monofocal IOLs" functional benefits is limited. The aim of this meta-analysis was to analyze the improvement in VA using Tecnis Eyhance monofocal IOLs compared to standard monofocal IOLs Tecnis ZCB00. METHODS: MEDLINE, Web of Science and Scopus were searched for studies assessing improvement in intermediate VA using Tecnis Eyhance IOLs versus Tecnis ZCB00 IOLs. Studies evaluating post-operative VA in patients who underwent cataract surgery were selected. This meta-analysis followed PRISMA guidelines and was registered in PROSPERO. The Cochrane Risk of Bias Tool 2.0. was used to assess the methodological quality of the included studies, risk of selection bias and comparability of cohorts and outcomes. RESULTS: The search resulted in 1153 articles. Five studies met the inclusion criteria and were included in the meta-analysis. A total of 604 eyes were evaluated, of which 309 received Tecnis Eyhance IOLs and 295 were implanted with Tecnis ZCB00 IOLs. Mean binocular distant-corrected intermediate VA with Tecnis Eyhance IOLs at 2 weeks-1 month showed a significant difference of -0,21 logMAR, p < 0.001; and mean binocular distance-corrected intermediate VA with Tecnis Eyhance IOLs at 6 months showed a significant difference of -0,11 logMAR, p < 0.001. CONCLUSION: Near VA could not be assessed in this meta-analysis as it was measured in very few studies. Preliminary pooled evidence indicates that intermediate VA improved with Tecnis Eyhance IOLs. Further studies evaluating near VA and with longer follow-up are still necessary.

Influence of tomographic and biomechanical corneal indexes on myopic refractive surgery indications: A multicenter study.

PURPOSE: To evaluate the influence of corneal tomographic and biomechanical indexes on the refractive technique indication. METHODS: A total of 251 eyes from 251 patients interested in refractive surgery were enrolled in this cross-sectional and multicenter study. Previous to the surgeon decision, a preoperative protocol was performed by refractive optometrists, containing four sections: refraction, biometry, corneal tomography and biomechanics. The refractive surgeons made a first decision based only on refraction, biometric and tomographic information. Biomechanical indexes were revealed, and refractive surgeons made a second indication. Additionally, for Laser-Assisted in-situ Keratomileusis cases, the percent tissue altered were calculated. Possible indications were no refractive surgery, photorefractive keratectomy, Laser-Assisted in-situ Keratomileusis or intraocular Collamer lens. RESULTS: After the first surgery indication, the distribution was photorefractive keratectomy (47.4%), Laser-Assisted in-situ Keratomileusis (48.2%) while intraocular Collamer lens achieved 2.8%. This proportion changed significantly after the second indication regarding corneal biomechanics and photorefractive keratectomy and Laser-Assisted in-situ Keratomileusis decreased by 24% while intraocular Collamer lens increased 19%. A total of 69 eyes changed the indication (27.5%) and 182 eyes (72.5%) remained unchanged. All indications changes were from photorefractive keratectomy or Laser-Assisted in-situ Keratomileusis to intraocular Collamer lens or no surgery. Indication changes to intraocular Collamer lens were observed in 49 eyes (71%). Tomographic, biomechanical indexes, ablation depth and percent tissue altered achieved statistically significant differences between eyes without and with indication changes (all, P < .01). CONCLUSION: New corneal biomechanical indexes could change the indication decision regarding biometric and tomographic data alone. Intraocular Collamer len was the preferred indication for eyes at risk of ectasia or with subclinical keratoconus due to corneal biomechanical parameters.

Estudio comparativo entre sondajes lacrimonasales de primera intención con y sin control endoscópico / Comparative study of primary intention lacrimal probing with and without nasal endoscopy

Objetivo: Comparar los resultados de dos series de sondajes de primera intención, sin y con endoscopia nasal, acompañados en este segundo caso de luxación de cornete inferior y corrección de enfermedad del meato inferior si la hubiera, en casos de obstrucción nasolagrimal congénita. Métodos: Se practica un estudio de cohortes retrospectivos con 36 sondajes simples (grupo 1) frente a 36 sondajes con endoscopia (grupo 2), entre enero de 2011 y enero de 2013, en 2 grupos de población parecidos sin intervenciones previas. El rango de edad fue entre 8 y 27 meses en el grupo 1 y entre 7 y 30 meses en el grupo 2. Resultados: El 50% de cirugías lagrimales fueron realizadas con éxito en el grupo de los sondajes sin endoscopia, frente al 97,22% en el grupo guiado por endoscopia. En el grupo 2 se diagnosticó y corrigió intraoperatoriamente un 16,67% de vías lagrimales con aposición del cornete inferior en su porción distal y un 11,11% de falsas vías o trayectos submucosos. En un 30,56% de los sondajes practicados con endoscopia se observó más de una anomalía nasolagrimal, tanto a nivel del canal como en el meato inferior, que influía negativamente en su funcionamiento. Conclusión: Aunque clásicamente se ha reservado la endoscopia para fracasos quirúrgicos en reintervenciones, su utilización de primera intención mejora significativamente los éxitos. En nuestra serie un 97,22% tuvieron resolución completa de los síntomas, evitando un segundo paso por quirófano y la utilización de materiales y técnicas más costosas. Nos ayuda a la visualización y compresión de esta enfermedad y es el único método para confirmar directamente un correcto sondaje en tiempo real (AU)

Objective: Our objective was to compare the results of probing with and without endoscopy in cases of congenital nasolacrimal duct obstruction without prior probing. Methods: This was a retrospective analysis on 2 non-randomized cohorts, 36 simple soundings (group 1) and 36 soundings with endoscope (group 2), between January 2011 and January 2013. Both groups were similar in age and had no previous surgery. The age of the patients studied ranged between 8 and 27 months in the first group and between 7 and 30 months in the second group. Results: The procedure was successful in 50% of the conventional probing group and in 97.22% in the endoscopy probing group. In this group 16.67% of patients with tight inferior turbinate and 11.11% of those where the probe passed into the submucosal space were diagnosed and corrected intraoperatively. Some anomaly was observed in 30.56% of patients undergoing endoscopy. Conclusion: Although nasal endoscopy is classically reserved for unsuccessful probing, its use in primary intention increases the success rate of the procedure. In our study, 97.22% of eyes had complete resolution of symptoms, avoiding a second surgery and the use of more expensive materials and techniques. Nasal endoscopy helps intraoperative visualisation, understanding and management of congenital nasolacrimal duct obstruction and is the only method that confirms the correct anatomic position of the catheterisation in real time (AU)

Comparative study of primary intention lacrimal probing with and without nasal endoscopy.

OBJECTIVE: Our objective was to compare the results of probing with and without endoscopy in cases of congenital nasolacrimal duct obstruction without prior probing. METHODS: This was a retrospective analysis on 2 non-randomized cohorts, 36 simple soundings (group 1) and 36 soundings with endoscope (group 2), between January 2011 and January 2013. Both groups were similar in age and had no previous surgery. The age of the patients studied ranged between 8 and 27 months in the first group and between 7 and 30 months in the second group. RESULTS: The procedure was successful in 50% of the conventional probing group and in 97.22% in the endoscopy probing group. In this group 16.67% of patients with tight inferior turbinate and 11.11% of those where the probe passed into the submucosal space were diagnosed and corrected intraoperatively. Some anomaly was observed in 30.56% of patients undergoing endoscopy. CONCLUSION: Although nasal endoscopy is classically reserved for unsuccessful probing, its use in primary intention increases the success rate of the procedure. In our study, 97.22% of eyes had complete resolution of symptoms, avoiding a second surgery and the use of more expensive materials and techniques. Nasal endoscopy helps intraoperative visualisation, understanding and management of congenital nasolacrimal duct obstruction and is the only method that confirms the correct anatomic position of the catheterisation in real time.