Cystoid macular edema occurring after intracameral bimatoprost implantation.

PURPOSE: This case report aims to report the development of cystoid macular edema (CME) unilaterally following the administration of bimatoprost implant (Durysta) injections in both eyes for the treatment of primary open-angle glaucoma (POAG). OBSERVATIONS: An 84-year-old female patient, previously diagnosed with POAG, underwent bimatoprost implant (Durysta) injections in both eyes, spaced one month apart. Subsequently, the patient experienced a gradual decline in visual acuity in her left eye attributed to the development of CME. The condition resolved following a treatment regimen involving topical dexamethasone and nepafenac. CONCLUSION: The use of bimatoprost implant may lead to the occurrence of CME. Ophthalmologists must vigilantly monitor patients post-implantation, especially if they exhibit visual symptoms or have risk factors for a CME.

Refining Glaucoma Diagnosis and Treatment in Cataract Surgery Candidates: The Contribution of Preoperative OCT RNFL.

PURPOSE: To evaluate the clinical significance of preoperative spectral domain optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) thickness in identifying glaucoma and better managing patients scheduled for routine cataract surgery. SETTING: Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.Design: retrospective cohort study. METHODS: Consecutive patients scheduled for cataract surgery were enrolled from February 2022 to August 2022. Participants underwent routine OCT RNFL studies which were evaluated by a glaucoma specialist. Findings were compared with those of preoperative fundus biomicroscopic examinations conducted by the referring ophthalmologist. The main outcomes were the incidence of newly detected glaucoma based upon OCT RNFL findings and the consequent changes in patient management. RESULTS: In total, 486 patients met the inclusion criteria, of whom 112 (23%) had abnormal RNFL. Thirty-one patients (6.4%) had abnormal OCT RNFL findings attributed to comorbidities other than glaucoma, and 81 patients (16.7%) were suspected to have glaucoma based upon their OCT RNFL findings, from which 44 patients (9%) were newly diagnosed with glaucoma or as glaucoma suspects, resulting in management modifications that included routine glaucoma follow-up (25 patients, 5.1%), initiation of intraocular pressure-lowering treatment (12 patients, 2.5%), and conversion to combined cataract-glaucoma surgery (7 patients, 1.4%). CONCLUSIONS: OCT RNFL for cataract surgery candidates proved valuable in detecting glaucoma that had not been revealed by standard fundus biomicroscopic examination. The additional information provided by OCT RNFL can potentially enhance patient management and optimize outcomes.

[PUBLICATION TRENDS AND IMPACT OF OPHTHALMOLOGY DEPARTMENTS IN ISRAEL: SUMMARIZING OVER A DECADE OF RESEARCH WITH AN INTERNATIONAL PERSPECTIVE (2011-2021)].

BACKGROUND: A focused bibliographic analysis of Israel's ophthalmology research productivity has never been performed. OBJECTIVES: To assess the research output of Israeli ophthalmology departments between the years 2011-2021 and compare to leading countries in the discipline. METHODS: The PubMed search engine was used to detect all medical articles published between the years 2011 and 2021, with at least one author from an Israeli ophthalmology department. Each entry was reviewed for: year of publication, journal, department, sub-specialty, and study design. Journals were ranked according to Scopus Cite Score. Research output and population data of 7 top-ranked countries in ophthalmology (USA, UK, Japan, Germany, Australia, Canada, China) were documented for comparisons. RESULTS: Overall, 1,919 publications were included. Total research output of Israeli ophthalmology departments significantly increased throughout the study period (R2=0.85, P<0.0001). Medical retina publications were the most prevalent (493 articles, 25.6%), and the most commonly utilized design was cohort (536 articles, 28%). Over a third of all articles (669) were published in Q1 ophthalmology journals, and 16% were published in the top-10 journals. Israel was ranked (1/8) and (3/8) in publications per population and physician, respectively, compared to the other assessed countries. CONCLUSIONS: Between 2011-2021, the research productivity of the Israeli ophthalmological community has constantly increased across all sub-specialties and in high-impact journals. Israel's relative contribution to the ophthalmic medical literature is noteworthy internationally.

In vivo assessment of antimicrobial activity and toxicity of repeated 1% povidone-iodine applications versus a single 5% povidone-iodine application.

PURPOSE: To demonstrate the non-inferiority in antimicrobial effectiveness of thrice-repeated applications of 1% povidone-iodine (PI) compared to a single application of 5% PI on the ocular surface in vivo and to evaluate potential toxicity of PI to the corneal epithelium. SETTING: Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN: Prospective randomized, double-blind study. METHODS: Patients randomly received either a single application of 5% PI or repeated irrigations of 1% PI on the ocular surface before surgery. Bacterial colony counts were quantitatively analyzed by taking standardized conjunctival swabs before and after irrigation, and differences in bacterial colony counts were compared between the 2 groups. The presence of superficial punctate keratopathy was evaluated in all patients by the National Eye Institute grading system. RESULTS: The study comprised 102 eyes of 102 patients. Both 1% and 5% PI yielded a marked decrease in bacterial colonies compared to pre-application (P<.001). The repeated application of 1% PI showed a significantly lower bacterial count compared to the single application of 5% PI (P<.05) and resulted in significantly less damage to the corneal epithelium compared to a single 5% PI application (P<.001). CONCLUSION: Preoperative repeated applications of 1% PI effectively eradicated ocular surface bacteria equal to that of 5% PI with less deleterious impact on the corneal epithelium. Our findings suggest that 1% PI may be a promising alternative to 5% PI.

Comprehensive approach for capsular bag fixation in subluxated crystalline lens: preserving the anterior/posterior anatomical segment barrier.

PURPOSE: To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens. SETTING: Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel. DESIGN: Retrospective, consecutive case series. METHODS: This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt. RESULTS: 17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA ( P < .001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear. CONCLUSIONS: A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.

Influence of the Reference Center on the Calculation of Corneal Higher Order Aberrations.

PURPOSE: To evaluate the differences in corneal wavefront measurements in myopic and hyperopic eyes when calculated using three different reference centers and explore possible influencing factors for such differences. METHODS: Corneal wavefront measurements were performed in myopic and hyperopic eyes using a GALILEI Placido Dual Scheimpflug Analyzer (Ziemer Ophthalmic Systems AG). Corneal higher order aberrations (HOAs), including total, vertical, and horizontal coma-like aberrations, spherical aberrations, and total corneal HOAs through a 6-mm pupil size, were calculated over three different reference center positions: pupil center, corneal vertex, and limbus to limbus. Values were then compared between the myopic and hyper-opic eyes, and correlations with kappa distance and spherical equivalent were tested. RESULTS: A significant decrease in the level of total corneal HOAs (-0.04 ± 0.05 and -0.12 ± 0.09), total corneal coma (-0.07 ± 0.09 and -0.18 ± 0.12), and horizontal coma (-0.07 ± 0.11 and -0.22 ± 0.11) in myopic and hyperopic eyes, respectively, was found when recalculating from pupil center to corneal vertex centration, whereas a significant increase in the same aberrations was observed from pupil center or corneal vertex to limbus to limbus. Significant correlations were found between the kappa distance and changes in total corneal HOAs, total corneal coma, and horizontal coma from the pupil center to the corneal vertex in both groups. CONCLUSIONS: Corneal vertex centration generated the lowest level of corneal wavefront error in both groups. The differences in corneal aberrations between the reference centers for calculation were highly correlated with the kappa distance in hyperopic eyes. [J Refract Surg. 2023;39(5):340-346.].

Differences in retinal images quality between normal and subclinical keratoconus and its association to posterior corneal asymmetry.

PURPOSE: To compare retinal image quality in subclinical keratoconus and normal eyes using a double-pass aberrometer and to correlate it with posterior surface deformation. METHODS: Sixty normal corneas were compared to 20 subclinical keratoconus (SKC) corneas. Retinal image quality was assessed using a double-pass system in all the eyes. The objective scatter index (OSI) modulation transfer function (MTF) cutoff, Strehl ratio (SR), and Predicted Visual Acuity (PVA) values at 100%, 20%, and 9% were calculated and compared between the groups. Posterior corneal asymmetry was measured using a combined Placido Dual Scheimpflug Analyzer, and correlations were tested with all optical quality parameters. RESULTS: Significant decrease in optical quality parameters was observed in SKC eyes compared with that in normal eyes. Subclinical KC eyes expressed greater scattering (OSI = 0.66 ± 0.36 vs 0.47 ± 0.26) and reduced contrast images (MTF and SR) than normal eyes, with 38.82 ± 9.4 and 0.22 ± 0.04, and 44.35 ± 7.1 and 0.24 ± 0.04, respectively. The reduction in the image contrast parameters (MTF and SR) was strongly correlated to the level of posterior corneal asymmetry in SKC. The greater the posterior asymmetry, the more affected was the image contrast, with r = -0.63 and -0.59, respectively for MTF and SR. CONCLUSION: Retinal image quality was significantly more affected in eyes with subclinical keratoconus than in normal eyes. The reduction in optical quality observed in subclinical keratoconus was strongly associated with the increased asymmetry of the posterior cornea.

TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface.

The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.

Early Impact of Laser Vision Correction (LVC) on the Stability and Quality of the Retinal Image.

This retrospective comparative study analyzes the early postoperative impact of laser vision correction for myopia on the optical quality and stability of functional vision using a double-pass aberrometer. Retinal image quality and visual function stability were assessed preoperatively, one and three months after myopic laser in situ keratomileuses (LASIK) and photorefractive keratectomy (PRK) using double-pass aberrometry (HD Analyzer, Visiometrics S.L, Terrassa, Spain). The parameters analyzed included vision break-up time (VBUT), objective scattering index (OSI), modulation transfer function (MTF), and Strehl ratio (SR). The study included 141 eyes of 141 patients, of whom 89 underwent PRK and 52 underwent LASIK. No statistically significant differences were noted between the two techniques in any analyzed parameters at three months postoperatively. However, a significant drop was observed in all parameters one month after PRK. Only the OSI and VBUT remained significantly altered from baseline at the three months follow-up visit, with an increased OSI by 0.14 +/- 0.36 (p < 0.01) and a shortened VBUT by 0.57 +/- 2.3 s (p < 0.01). No correlation was found between the changes in optical and visual quality parameters and age, ablation depth, or postoperative spherical equivalent. The stability and quality of the retinal images were similar between LASIK and PRK at three months postoperatively. However, significant degradation in all parameters was found one month after PRK.

The Physical Activity Level of Ophthalmologists at Work: A Pedometer-Based Study.

BACKGROUND: Ophthalmology practice entails many hours of physical inactivity, a potential long-term health hazard. This study aims to perform a pedometer-based evaluation of the physical activity (PA) levels of ophthalmologists at work. METHODS: This is a prospective observational study. Ophthalmologists from a single tertiary medical center were monitored with electronic pedometers during six morning sessions in the ophthalmology clinics. Working hours and the number of patients seen per clinic session were retrieved. The age and body mass index (BMI) of participants were documented. Step number per working hour (SPH) was calculated for all participants. Comparisons between males and females, practicing ophthalmologists (attendings) and ophthalmology residents (residents), and sub-specialties were performed. Correlations between SPH and age, BMI, and patients seen per clinic session were computed. FINDINGS: Pedometer readings for a total of 673 working hours were analyzed for 24 ophthalmologists, 17% female, 17 attendings, mean age 44.2 years (standard deviation (SD = 9.8). The average number of SPH for all participants was 359.7 (SD = 166.7). The mean PA level of residents was significantly higher than that of attendings (410.17 SPH vs. 338.95 SPH, respectively, p = .019). Oculoplastic surgeons demonstrated significantly higher step counts per hour than cornea specialists (439.90 SPH vs. 245.55 SPH, respectively, p = .002). A negative correlation was observed between SPH and the number of patients seen per clinic session (ρ = -0.274, p = .001). CONCLUSIONS/APPLICATIONS TO PRACTICE: Low number of SPH for ophthalmologists in this study indicates ophthalmology to be a highly sedentary medical occupation. PA levels of ophthalmologists in the workplace may indicate a personal health care challenge.

Accuracy of intraocular lens calculations in eyes with keratoconus.

PURPOSE: To compare the prediction accuracy of the Barrett True-K for keratoconus with standard formulas (SRK/T, Barrett Universal II, and Kane) and the Kane keratoconus formula. SETTING: Shaare Zedek Medical Center, Jerusalem, Israel, and University Eye Clinic, Maastricht, the Netherlands. DESIGN: Multicenter retrospective case series. METHODS: Eyes with stable keratoconus undergoing cataract surgery were included. The predicted refractions were calculated for SRK/T, Barrett Universal II, Barrett True-K for keratoconus (predicted and measured), Kane, and Kane adjusted for keratoconus formulas. Primary outcomes were prediction error (PE), absolute error (AE), and percentage of eyes with PE ±0.25 diopters (D), ±0.50 D, and ±1.00 D. Subgroup analyses were performed based on the severity of the keratoconus. RESULTS: 57 eyes were included in the study. The PE was not significantly different from zero for SRK/T, Barrett True-K (predicted and measured), and Kane keratoconus formulas (range 0.09 to 0.22 D, P > .05). The AE of Barrett True-K predicted (median 0.14 D) and Barrett True-K measured (median 0.10 D) were significantly lower from Barrett Universal II (median 0.47 D) and Kane (median 0.50 D), P < .001. CONCLUSIONS: The Barrett True-K formulas for keratoconus had higher prediction accuracy as compared with new generation formulas and a similar prediction accuracy as compared with the Kane keratoconus formula.

Advantageous effect of pupil dilation on the quality of optical biometry axial length measurement in individuals with dense cataract.

PURPOSE: To evaluate the effect of pharmacologic pupil dilation on the quality of axial length (AL) measurement in patients with dense cataracts and previous low-quality AL measurements performed without dilation. SETTING: Shaare-Zedek Medical Center, Jerusalem, Israel. DESIGN: Retrospective case series. METHODS: All participants underwent swept-source optical coherence tomographic (SS-OCT) biometry. Those with low-quality AL measurements due to dense cataract underwent an additional SS-OCT biometric evaluation after pupil dilation, and the AL measurement of the same eye was recorded. RESULTS: 2076 patients underwent SS-OCT during the study period, and 177 (8.52%) had low-quality AL measurements because of dense cataract. 79 (44.63%, mean age 72.53 ± 13.27 years, 43 females) of those 177 patients underwent repeat SS-OCT biometric imaging after pharmacologic pupil dilation, and formed the study group. After pupil dilation, high-quality AL measurements were successfully obtained in 60 (75.95%) of the 79 eyes. The mean SD of the AL measurements decreased significantly ( P &lt; .001), and the number of successful OCT scans per measurement increased significantly ( P &lt; .001) after pupil dilation. The mean difference of the AL before and after pupil dilation was 0.03 ± 0.07 mm ( P &lt; .001). CONCLUSIONS: Pharmacologic pupil dilation improved the quality of SS-OCT biometrically measured AL in patients with low-quality AL measurement due to dense cataract. These results could potentially improve postoperative refractive outcomes after cataract surgery and reduce the need of additional AL measurements by more complicated alternative means in this group.

Measured Corneal Astigmatism Versus Pseudophakic Predicted Refractive Astigmatism in Cataract Surgery Candidates.

PURPOSE: To compare standard and total corneal astigmatism measurements to the predicted pseudophakic (nontoric) refractive astigmatism in candidates for cataract surgery. DESIGN: A retrospective, cross-sectional study. METHODS: A single-center analysis of consecutive eyes measured with a swept-source optical coherence tomography biometer at a large tertiary medical center between February 2018 and June 2020. Corneal astigmatism was calculated based on standard keratometry astigmatism (KA), total corneal astigmatism (TCA), and predicted refractive astigmatism (PRA) for a monofocal nontoric intraocular lens (IOL) implantation calculated by the Barrett toric calculator using the predicted posterior corneal astigmatism (PRA(Predicted-PCA)) and the measured posterior corneal astigmatism (PRA(Measured-PCA)) options. Separate analyses were performed for each eye. SETTING: Ophthalmology Department, Shaare Zedek Medical Center, Jerusalem, Israel. RESULTS: In total, 8152 eyes of 5320 patients (4221 right eyes [OD] and 3931 left eyes [OS], mean age 70.6±12.2 years, 54.2% females) were included in the study. The mean vector values (centroid) for KA, TCA, PRA(Predicted-PCA), and PRA(Measured-PCA) were 0.07 diopters [D] at 19.5°, 0.27 D at 7.5°, 0.44 D at 2.9°, and 0.43 D at 179.3°, respectively (P < .01), for OD and 0.02 D at 150.3°, 0.23 D at 169.7°, 0.40 D at 179.4°, and 0.42 D at 169.5°, respectively (P < .01), for OS. More than 73% of eyes had a PRA >0.5 D. CONCLUSIONS: Standard and total corneal astigmatism measurements differ significantly from the PRA by the Barrett toric calculator. The PRA, rather than the KA or TCA, should be used as the reference guide for astigmatism correction with toric IOL implantation.

Long-Standing Corneal Edema and Endothelial Decompensation due to Ecballium elaterium.

PURPOSE: The purpose of this study was to report the most severe documented ocular injury caused by Ecballium elaterium , an invasive and toxic herb characterized by an explosive seed dispersal. METHODS: A 55-year-old man presented to the emergency department several hours after direct exposure to the contents of E. elaterium to his left eye. Clinical examinations, investigations, and imaging findings are reported. RESULTS: Medical and ocular histories were unremarkable. On presentation, the patient exhibited markedly decreased visual acuity, severe periorbital edema, conjunctival chemosis, and corneal edema. Although other signs gradually improved, corneal edema worsened despite rapid initiation of systemic and topical steroids and normal intraocular pressure. After 4 months of follow-up, the cornea cleared and visual acuity returned to normal; however, a significant decrease in endothelial cell count was observed. CONCLUSIONS: Ecballium elaterium may cause a severe corneal chemical burn, with subsequent long-standing corneal edema and endothelial decompensation. Specular microscopy is a modality of great importance in these cases.

Anxiety and pain perception using a speculum-free eyelid retraction technique for intravitreal injection.

PURPOSE: This study compared pain and anxiety levels in individuals receiving intravitreal injections (IVIs) using a speculum-free injection technique, the lid splinting eyelid retraction technique, or using a speculum. METHODS: This was a prospective study of individuals receiving IVI at a single tertiary care medical center who responded to a questionnaire and visual analog scale (VAS) between December 2019 and January 2020. In one group, a speculum was used prior to injection, whereas in the other group, a speculum-free injection technique was used. RESULTS: A total of 108 individuals were included in this study: 54 received IVI with the speculum-free lid splinting eyelid retraction technique and 54 received IVI with a speculum. A correlation between pain and anxiety was demonstrated in the control group (p-value < 0.01); however, in the speculum-free group, this correlation was lower and not significant. When comparing pain and anxiety between the study groups, lower median pain (Mood's: Z = 5.378, p-value < 0.001) and lower anxiety (Mood's: Z = 2.108, p-value = 0.035) scores were demonstrated in the speculum-free group than in the control group. The distribution of pain scores was significantly different between the study groups (Kolmogorov-Smirnov: D = 0.518, p-value < 0.001), and trending differences in anxiety between the groups were observed (Kolmogorov-Smirnov: D = 0.259, p-value = 0.053). CONCLUSION: The lid splinting eyelid retraction technique, a speculum-free technique, was associated with less anxiety and pain in patients than the use of a speculum. As IVI often involves repeated treatment, identifying modifiable factors that may relieve anxiety and pain is of utmost importance.

Effects of delay in anti-vascular endothelial growth factor intravitreal injections for neovascular age-related macular degeneration.

PURPOSE: To assess the impact of COVID-19-related delay in intravitreal injection timing on macular structure and visual acuity (VA) among patients treated for neovascular age-related macular degeneration (nvAMD). METHODS: We reviewed demographic and clinical data and macular ocular computerized tomographic images of 34 patients (48 eyes, group A) who did not follow their injection schedule during the first wave of COVID-19 and compared them to 46 patients (71 eyes, group B) who did. Functional worsening was defined as a loss of at least 0.1 in decimal VA. Anatomic worsening was defined as new or increased subretinal/intraretinal fluids or new hemorrhage. RESULTS: The planned mean ± standard deviation intervals between the intravitreal injections were 5.7 ± 2.7 weeks for group A and 5.5 ± 2.4 weeks for group B (P = 0.60). The actual intervals were 13.6 ± 6.8 (7.9 ± 5.2 weeks' delay) and 5.3 ± 2.4 weeks (no delay), respectively (P < 0.001). The best corrected visual acuity worsened in 23 group A eyes (47.9%) and in 6 group B eyes (8.5%) (odds ratio [OR] 9.97, P < 0.001). Anatomic features indicative of nvAMD worsening were detected in 31 group A eyes (64.6%) and in 16 group B eyes (22.5%) (OR 5.73, P < 0.001). A new macular hemorrhage was observed in 4 group A eyes (8.3%) and in no group B eyes (P = 0.09). CONCLUSION: Delay in timely retinal care during the COVID-19 restrictions period resulted in short-term negative outcomes, including macular bleeding, in nvAMD patients.

Seven years follow-up of corneal cross-linking (CXL) in pediatric patients: Evaluation of treated and untreated eye.

BACKGROUND: Retrospective cohort study evaluating long term keratoconus progression amongst cross-linking (CXL) treated pediatric patients in the treated and the fellow untreated eyes. METHODS: Data on 60 eyes of 30 patients, 18 years old or younger, who underwent CXL in at least one eye was collected and analyzed. Follow-up measurements taken from the treated and untreated eye up to 7 years after CXL treatment, were compared to baseline measurements. Parameters included uncorrected distance visual acuity (UCDVA), best-corrected spectacle visual acuity (BCSVA), manifest refraction, pachymetry, corneal tomography, and topography. RESULTS: Mean age of patients was 16 ± 2.1 years. For the treated eyes, during follow-up period mean UCDVA had improved (from 0.78 ± 0.22 at baseline to 0.58 ± 0.26 logMAR at 7 years; p = 0.13), as well as mean BCSVA (from 0.23 ± 0.107 at baseline to 0.172 ± 0.05 logMAR at 7 years; p = 0.37). The mean average keratometry showed a significant flattening (from 49.95 ± 4.04 to 47.94 ± 3.3 diopters (D); p < 0.001), However there was no change in the mean maximal keratometry. The mean minimal corneal thickness (MCT) showed a significant mild reduction of 26 µm (p = 0.006). Although statistically insignificant, the mean manifest cylinder was also reduced to 2D (p = 0.15). During the follow-up period, eight untreated eyes (26.6%) deteriorated and underwent CXL, while only one treated eye (3.33%) required an additional CXL. CONCLUSION: CXL is a safe and efficient procedure in halting keratoconus progression in the pediatric population, the fellow eye needs to be carefully monitored but only a 25% of the patients will require CXL in that eye during a period of 7 years.

Ocular Biometric Characteristics Measured by Swept-Source Optical Coherence Tomography in Individuals Undergoing Cataract Surgery.

PURPOSE: To study the distribution of ocular biometric parameters using a swept-source optical coherence tomography (SS-OCT) biometer in adult candidates for cataract surgery. DESIGN: A retrospective cross-sectional study. METHODS: This is a single-center analysis of consecutive eyes measured with the IOLMaster 700 SS-OCT biometer at a large tertiary medical center between February 2018 and June 2020. RESULTS: Three thousand eight hundred thirty-six eyes of 3836 patients were included in the study. The mean ± SD age was 72.3 ± 12.8 years and 53% were female. The mean biometric values were as follows: total corneal power (44.17 ± 1.70 diopters [D]), total corneal astigmatism (TCA; 1.11 ± 0.87 D), mean posterior keratometry (-5.87 ± 0.26 D), posterior corneal astigmatism (-0.26 ± 0.15 D), axial length (AL; 23.95 ± 1.66 mm), anterior chamber depth (ACD; 3.18 ± 0.42 mm), lens thickness (LT; 4.49 ± 0.47 mm), white-to-white distance (WTW; 11.92 ± 0.44 mm), central corneal thickness (CCT; 0.54 ± 0.04 mm), angle alpha (0.49 ± 0.17 mm), and angle kappa (0.34 ± 0.17 mm). There were sex-related differences in all biometric parameters save for LT (P = .440), angle kappa (P = .216), and corneal astigmatism (P = .103). Biometric parameters demonstrated correlations between AL, WTW distance, ACD, and LT (P < .001). Age correlated with all parameters (P < .001) except CCT and posterior keratometry. Angle alpha and angle kappa magnitudes also correlated (P < .001). The prevalence of patients with TCA ≥0.75 D, 1.0 D, and 1.5 D were 59.1%, 43.4%, and 22.6%, respectively. CONCLUSIONS: Age significantly correlated with most of the biometric parameters and significant differences between sexes were noted. In addition, the high prevalence of TCA and relatively large angle alpha and angle kappa magnitudes were noted among subjects. These data can be relevant in planning local and national health economics.

Evaluating the prediction accuracy of the Hill-RBF 3.0 formula using a heteroscedastic statistical method.

PURPOSE: To evaluate the accuracy of the Hill-RBF 3 formula, with and without direct measurements of total corneal power, using a heteroscedastic statistical method for analysis. SETTING: Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. DESIGN: Retrospective, consecutive case series. METHODS: Records of consecutive patients who underwent routine cataract surgery between February 2018 and June 2020 were retrospectively reviewed. The prediction accuracy of the Hill-RBF 3.0 formula was compared with that of the Barrett Universal II, Emmetropia Verifying Optical 2.0, Haigis, Hill-RBF 2.0, Hoffer Q, Holladay 1, Holladay 2, Kane, Olsen, and SRK/T formulas, based on biometry measurements by swept-source optical coherence tomography (SS-OCT) with standard keratometry (K), SS-OCT with total keratometry (TK), and an optical low-coherence reflectometer (OLCR). Statistical analysis was applied according to a heteroscedastic statistical method with SD of prediction errors as the main parameter for formula performance. RESULTS: The study included 153 eyes of 153 patients. The SD values that were obtained by Hill-RBF 3.0 (0.266 to 0.285 diopters [D]) were significantly lower compared with those by Hill-RBF 2.0 (0.290 to 0.309 D), Hoffer Q (0.387 to 0.407 D), Holladay 1 (0.367 to 0.385 D), Holladay 2 (0.386 to 0.401 D), and SRK/T (0.377 to 0.399 D) formulas (P < .036). The prediction accuracy of the Hill-RBF 3.0 was similar across the SS-OCT (K), SS-OCT (TK), and OLCR methods of measurement (P > .51). CONCLUSIONS: The Hill-RBF 3.0 was more accurate than the Hill-RBF 2.0 and older generation formulas and had similar prediction accuracy compared with new generation formulas. The use of TK did not provide significant improvement to its prediction accuracy.