The effects of ambient narrowband long-wavelength light on lens-induced myopia and form-deprivation myopia in tree shrews.

Here we examine the effects of ambient red light on lens-induced myopia and diffuser-induced myopia in tree shrews, small diurnal mammals closely related to primates. Starting at 24 days of visual experience (DVE), seventeen tree shrews were reared in red light (624 ± 10 or 634 ± 10 nm, 527-749 human lux) for 12-14 days wearing either a -5D lens (RL-5D, n = 5) or a diffuser (RLFD, n = 5) monocularly, or without visual restriction (RL-Control, n = 7). Refractive errors and ocular dimensions were compared to those obtained from tree shrews raised in broad-spectrum white light (WL-5D, n = 5; WLFD, n = 10; WL Control, n = 7). The RL-5D tree shrews developed less myopia in their lens-treated eyes than WL-5D tree shrews at the end of the experiment (-1.1 ± 0.9D vs. -3.8 ± 0.3D, p = 0.007). The diffuser-treated eyes of the RLFD tree shrews were near-emmetropic (-0.3 ± 0.6D, vs. -5.4 ± 0.7D in the WLFD group). Red light induced hyperopia in control animals (RL-vs. WL-Control, +3.0 ± 0.7 vs. +1.0 ± 0.2D, p = 0.02), the no-lens eyes of the RL-5D animals, and the no-diffuser eyes of the RLFD animals (+2.5 ± 0.5D and +2.3 ± 0.3D, respectively). The refractive alterations were consistent with the alterations in vitreous chamber depth. The lens-induced myopia developed in red light suggests that a non-chromatic cue could signal defocus to a less accurate extent, although it could also be a result of "form-deprivation" caused by defocus blur. As with previous studies in rhesus monkeys, the ability of red light to promote hyperopia appears to correlate with its ability to retard lens-induced myopia and form-deprivation myopia, the latter of which might be related to non-visual ocular mechanisms.

Therapeutic visual rehabilitation in a patient with high hyperopia and flat cornea years after radial keratotomy.

A 51-year-old man was referred for refractive surgery evaluation. Spectacle dependence and poor visual quality in both eyes was his chief complaint. He cannot tolerate contact lenses. Corrected distance visual acuity (CDVA) was 20/40 in both eyes. Manifest refraction was +5.25 -2.25 @ 90 (20/40) in the right eye and +6.25 -2.25 @ 105 (20/40) in the left eye. The patient had a history of radial keratotomy (RK) almost 30 years ago in both eyes and at the slitlamp presented 8 RK incisions, proportionally spaced between one another. All incisions were closed, and there were no relevant signs of scarring. The patient denied any history of ocular trauma, systemic disease, or medications. Corneal topography with different technologies revealed an irregular pattern with marked central flattening in both eyes, with some points below 30 diopters (D) (Supplemental Figures 1 and 2, available at http://links.lww.com/JRS/A862 and http://links.lww.com/JRS/A863, respectively). There were no signs of cataract, and fundus examination was normal. Optical coherence tomography (OCT) of the right eye revealed a more homogeneous thickness pattern, little variation between the thinnest and thickest areas, and adequate transparency (Figure 1JOURNAL/jcrs/04.03/02158034-202306000-00018/figure1/v/2023-05-31T172126Z/r/image-tiff). In the left eye, there is wide variability between the thinnest and thickest stromal points, with annular thinning and central thickening (Figure 2JOURNAL/jcrs/04.03/02158034-202306000-00018/figure2/v/2023-05-31T172126Z/r/image-tiff). Both eyes show marked epithelial irregularity. Considering this patient's current ocular status, how would you reach visual rehabilitation? Because he is contact lens intolerant, would you consider surface ablation, for example, photorefractive keratectomy (PRK) with mitomycin-C (MMC)? If that were the case, would you think of an optimized or a topography-guided (TG) treatment? Would you immediately consider a corneal transplant option? Would you instead consider a more conservative approach? Which one and why?

Chorio-Retinal Folds Associated With Orbital Cavernous Venous Malformations.

PURPOSE: To determine the incidence of clinically detectable chorio-retinal folds (CRFs) with orbital cavernous venous malformations (OCVMs) and their recovery. METHODS: Retrospective case-note and imaging review, with estimation of odds ratios in relation to the position and volume of the mass. RESULTS: Records for 402 patients were reviewed, 83 (21%) having CRFs. The mean logarithm of minimum angle of resolution acuity was similar with or without CRFs (0.37 and 0.31, respectively; p = 0.46), but induced hyperopia was commoner with CRFs (76% vs. 12%; p < 0.001), exophthalmos greater (4.52 mm vs. 2.97 mm; p < 0.001), eye movement restriction commoner (37% vs. 21%; p = 0.004), and disc swelling more prevalent (42%, vs. 17%; p < 0.001). Orbital cavernous venous malformations with CRFs were almost all intraconal (98%; odds ratio 9.96; p = 0.002), and 93% (77/83) midorbital (odds ratio 6.02; p < 0.001). The median size with CRFs was twice that of those without (3.85 ml vs. 1.92 ml; p < 0.001), and two-thirds OCVMs with folds had volumes >2.5 ml ( p < 0.001). The OCVM was excised in 76 of 83 (92%) of CRF group and 213 of 319 (67%) of those without ( p < 0.001). The postoperative acuity was improved or unchanged in 67 of 76 (88%) eyes with folds, and 184 of 213 (83%) without CRFs ( p = 0.84). The proportion recovering an acuity within 1 Snellen line (or better than) the unaffected side was 80% with CRFs and 77% in their absence ( p = 0.63). Induced hyperopia persisted in 39% of all patients, with the mean being higher with CRFs (2.22D vs. 1.02D; p = 0.017). CONCLUSIONS: CRFs occur in ~25% of mid-intraconal OCVMs. Despite OCVM excision, 39% of operated patients retain significant residual hyperopia (54% if CRFs present before surgery), and 41% of such CRFs remain clinically detectable after surgery (with variable visual impairment). Earlier surgery might, therefore, be advisable in patients with CRFs and/or induced hyperopia.

Ten-year refractive and visual outcomes of intraocular lens implantation in infants with congenital cataract.

INTRODUCTION: There is no consensus regarding optimal target refraction after intraocular lens implantation in infants. This study aimed to clarify relationships of initial postoperative refraction with long-term refractive and visual outcomes. METHODS: This retrospective review included 14 infants (22 eyes) who underwent unilateral or bilateral cataract extraction and primary intraocular lens implantation before the age of 1 year. All infants had ≥10 years of follow-up. RESULTS: All eyes exhibited myopic shift over a mean follow-up period of 15.9 ± 2.8 years. The greatest myopic shift occurred in the first postoperative year (mean=-5.39 ± +3.50 dioptres [D]), but smaller amounts continued beyond the tenth year (mean=-2.64 ± +2.02 D between 10 years postoperatively and last follow-up). Total myopic shift at 10 years ranged from -21.88 to -3.75 D (mean=-11.62 ± +5.14 D). Younger age at operation was correlated with larger myopic shifts at 1 year (P=0.025) and 10 years (P=0.006) postoperatively. Immediate postoperative refraction was a predictor of spherical equivalent refraction at 1 year (P=0.015) but not at 10 years (P=0.116). Immediate postoperative refraction was negatively correlated with final best-corrected visual acuity (BCVA) (P=0.018). Immediate postoperative refraction of ≥+7.00 D was correlated with worse final BCVA (P=0.029). CONCLUSION: Considerable variation in myopic shift hinders the prediction of long-term refractive outcomes in individual patients. When selecting target refraction in infants, low to moderate hyperopia (<+7.00 D) should be considered to balance the avoidance of high myopia in adulthood with the risk of worse long-term visual acuity related to high postoperative hyperopia.

Descemet Membrane Endothelial Keratoplasty-Induced Refractive Shift and Descemet Membrane Endothelial Keratoplasty-Induced Intraocular Lens Calculation Error.

PURPOSE: The aim of this study was to determine the mechanisms leading to the refractive shift and intraocular lens calculation error induced by Descemet membrane endothelial keratoplasty (DMEK), using ocular biometry and corneal elevation tomography data. METHODS: This is a retrospective, monocentric cohort study. Eyes which underwent uncomplicated DMEK surgery with available pre-DMEK and post-DMEK Scheimpflug rotating camera data (Pentacam, Oculus, Wetzlar, Germany) were considered for inclusion with an age-matched control group of healthy corneas. Cataract surgery data were collected for triple-DMEK cases. DMEK-induced refractive shift (DIRS) and intraocular lens calculation error (DICE) were calculated. Pearson r correlation coefficient was calculated between each corneal parameter variation and both DIRS and DICE. RESULTS: DIRS was calculable for 49 eyes from 43 patients. It was 30.61% neutral, 53.06% hyperopic (36.73% > 1D), and 16.32% myopic (6.12% > 1 D). DICE was calculable for 30 eyes of 26 patients: It was 46.67% neutral, 40.00% hyperopic (10.00% > 1D), and 13.33% myopic (3.33% > 1D). DIRS and DICE were mainly associated with variations in PRC/ARC ratio, anterior average radii of curvature (ARC), posterior average radii of curvature (PRC), and posterior Q. CONCLUSIONS: Our results suggest that ARC variations, PRC/ARC ratio variations, PRC variations, and posterior Q variations are the most influential parameters for both DIRS and DICE. We suggest that a distinction between those different phenomenons, both currently described as "hyperopic shift" in the literature, should be made by researchers and clinicians.

[Changes in accommodation in children with hyperopic anisometropia and unilateral amblyopia after laser refractive surgery and pleoptic treatment]. / Izmenenie akkomodatsii u detei s gipermetropicheskoi anizometropiei i odnostoronnei ambliopiei posle refraktsionno-lazernoi operatsii i pleopticheskogo lecheniya.

PURPOSE: This study comparatively analyzes the state of accommodation in children with hyperopic anisometropia and amblyopia after femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) combined with pleoptic treatment, and after conventional pleoptic treatment. MATERIAL AND METHODS: The first group consisted of 30 children with medium and high hyperopia, high and medium amblyopia, and anisometropia greater than 3.0 diopters, who underwent Femto-LASIK in the amblyopic eye. The second group consisted of 28 children with similar local status, who were prescribed traditional correction and received conservative treatment. The follow-up period was 1.5 years. RESULTS: After 1.5 years, higher visual acuity (p<0.05) was achieved in the first group. A significant increase in the coefficient of accommodative response (CAR) was observed in the operated amblyopic eyes in group 1 - by 0.1±0.02 c.u. compared to the control group (p<0.05). In both groups there was an upwards trend for the coefficient of microfluctuations (CMF) in the amblyopic eye, but in the first group CMF increased more significantly (p<0.05). The objective accommodative response (OAR) and positive relative accommodation (PRA) of the amblyopic eye showed a double increase - by 1.0±0.23 and 0.9±0.38 diopters, respectively, at the end of treatment in the first group. The increase in similar indicators in the second group was insignificant (p<0.05). In children of the first group the difference in ciliary muscle thickness (CMT) of the amblyopic eye with disabled and enabled accommodation increased by 0.04±0.01 mm (p<0.05) in the anterior part of the ciliary muscle at the levels of CMTmax and CMT1. CONCLUSION: The data obtained in this study indicate the strong effect of refractive laser surgery in combination with pleoptic treatment on improving the visual acuity and the state of accommodation of the amblyopic and paired dominant eyes in children with hyperopic anisometropia, in contrast to conventional methods of treatment.

[Anatomical and morphometric features of anterior eye segment structures in hyperopia and the risk of developing primary angle-closure glaucoma]. / Anatomo-morfometricheskie osobennosti struktur perednego segmenta glaza pri gipermetropii i risk razvitiya pervichnoi zakrytougol'noi glaukomy.

PURPOSE: To study features of anatomical and morphometric parameters of the structures of anterior eye segment in young patients with moderate and high hyperopia in order to identify the signs of an increased risk of developing primary angle-closure glaucoma (PACG) and its acute attack. MATERIAL AND METHODS: The study included 160 eyes (80 patients) with axial length (AL) of less than 23 mm. Patients with moderate or high hyperopia were divided into two groups according to their age ranges (the 1st - 27 patients (54 eyes) under 40 years old; the 2nd - 27 patients (54 eyes) of 41-50 years old, the comparison group - 26 patients (52 eyes) of 42-50 years old with the initial stage of PACG. AL of the eyes, anterior chamber (AC) depth in the central zone, lens thickness (LT) in the optical zone were measured using IOL Master 700 («Carl Zeiss Meditec AG¼, Germany). AC volume and peripheral AC depth were measured using rotating Scheimpflug camera Pentacam («Oculus¼, Germany). RESULTS: While the average values of AL in patients of the 1st and 2nd groups were comparable, a statistically significant decrease in AC depth and a significant increase in LT were revealed in the 2nd group. There was a statistically significant increase in LT, a decrease in peripheral AC depth and AC volume in the comparison group relative to the 2nd group. In the 1st group: in 2 eyes of one 38-year-old patient the maximum proximity of all 3 indices to the median values of the group of patients with PACG was found; in 4 eyes of two other patients (35 and 38 years old), a combination of small AC volume with increased LT or small AC volume with small AC on the periphery was noted. CONCLUSION: Significant differences in terms of LT, peripheral AC depth and AC volume were found between age-comparable (41-50 years old) healthy individuals with short eyes and patients with initial PACG. In 11% of the eyes of healthy patients with hyperopia aged 21 to 40 years, there was a combination of two or three of the studied morphometric signs, which may indicate the risk of developing PACG.

Presbyopic Corneal Inlay Extrusion Consequent to Sterile Keratolysis: Surgical Revision and Long-Term Management.

PURPOSE: The purpose of this study was to report a serious complication of early sterile keratolysis associated with a presbyopia inlay implantation combined with hyperopic laser in situ keratomileusis (LASIK). METHODS: A 55-year-old hyperopic man underwent uneventful topography-guided bilateral femtosecond laser-assisted hyperopic LASIK, combined with same-day polymer refractive inlay implantation in the nondominant eye for additional presbyopia correction. Within 2 months, anterior sterile keratolysis and partial extrusion required surgical explantation of the inlay, and long-term medical management over 9 years achieved effective visual rehabilitation documented also with corneal imaging. RESULTS: Immediate postoperative results were binocular 20/20 uncorrected distance visual acuity and J1 uncorrected near visual acuity. The early progressive anterior sterile keratolysis and partial extrusion necessitated surgical explantation at 2 months, severe anterior scarring of the perforated flap area and severe focal flattening of the cornea of over 10 diopters, developed despite aggressive topical corticosteroid use. The uncorrected distance visual acuity in the OS dropped from 20/25 to 20/400. The LASIK flap portion that underwent keratolysis and perforated, remodeled long-term from a scarred, epithelial plug with early significant surface concavity to evidently a mild subepithelial localized hazy area with regularized curvature over a period of 9 years. CONCLUSIONS: Some refractive synthetic corneal inlays have been recalled because they may result in significant corneal haze. We present herein a case of severe keratolysis that necessitated surgical explantation and further document long-term care for eventual visual rehabilitation.

Effects of air pollution on myopia: an update on clinical evidence and biological mechanisms.

Myopia is one of the most common forms of refractive eye disease and considered as a worldwide pandemic experienced by half of the global population by 2050. During the past several decades, myopia has become a leading cause of visual impairment, whereas several factors are believed to be associated with its occurrence and development. In terms of environmental factors, air pollution has gained more attention in recent years, as exposure to ambient air pollution seems to increase peripheral hyperopia defocus, affect the dopamine pathways, and cause retinal ischemia. In this review, we highlight epidemiological evidence and potential biological mechanisms that may link exposure to air pollutants to myopia. A thorough understanding of these mechanisms is a key for establishing and implementing targeting strategies. Regulatory efforts to control air pollution through effective policies and limit individual exposure to preventable risks are required in reducing this global public health burden.

Manifestaciones oftalmológicas en 6 pacientes con síndrome de Williams-Beuren y revisión de la literatura / Ophthalmological manifestations in 6 patients diagnosed with Williams-Beuren syndrome and literature review

Se revisó la historia clínica de 6 pacientes diagnosticados de síndrome de Williams-Beuren en la edad pediátrica. Todos los pacientes presentaron la facies de elfo característica y anomalías cardiovasculares. Todos presentaron buena agudeza visual, excepto un caso de ambliopía unilateral. El error refractivo más frecuente fue la hipermetropía (n=6; 100%) y el astigmatismo (n=5; 83,3%). En 2 pacientes se encontraron alteraciones de la motilidad ocular (un caso de exoforia con hiperfunción de oblicuo inferior derecho y otro de endotropía congénita con hiperfunción del oblicuo inferior bilateral). Cognitivamente un 66,7% (n=4) tenía alteraciones visoperceptivas. Otros hallazgos fueron epicantus (n=6; 100%) y obstrucción congénita del conducto nasolagrimal con epífora unilateral (n=1; 16,7%). El síndrome de Williams-Beuren es un trastorno poco frecuente con manifestaciones oftalmológicas y sistémicas complejas. Por ello, es recomendable realizar un seguimiento oftalmológico a estos niños (AU)

Medical history of 6 patients diagnosed with Williams-Beuren Syndrome (SWB) in pediatric age was revised. All the patients presented characteristic elf facies and cardiovascular abnormalities. All presented good visual acuity, except one case of unilateral amblyopia. The most frequent refractive error was hyperopia (n=6; 100%) and astigmatism (n=5; 83.3%). Ocular motility alterations were found in 2 patients (1 case of exophoria with hyperfunction of right inferior oblique and another of congenital endotropia with bilateral hyperfunction of inferior oblique). On the cognitive function, 66.7% (n=4) had visoperceptive disorders. Other findings were epicanthus (n=6; 100%) and congenital obstruction of the nasolacrimal duct with unilateral epiphora (n=1; 16.7%). SWB is a rare disorder with complex ophthalmological and systemic manifestations. For this reason, ophthalmological follow-up of these children is recommended (AU)

Toxic anterior segment syndrome following EyePCL implantation in a hyperopic patient.

INTRODUCTION: Toxic anterior segment syndrome (TASS) is a rare but serious complication of anterior segment surgery characterised by an acute sterile inflammation. The ICL implantation has gained popularity for the correction of moderate and high ametropias in cases where classical keratorefractive procedures are contraindicated. OBJECTIVE: The purpose of this case report is to present the evolution and management of toxic anterior segment syndrome after EyePCL implantation in a 19 year old hyperopic male patient. METHODS: Case report. RESULTS: The onset of the disease occurred in the first 48h postsurgery with a sudden loss of vision (with a VA of HM at 2m), mild photophobia and burning sensation in the absence of pain, severe inflammatory reaction of the anterior chamber with hypopyon, a Tyndall of 3+, cyclitic membrane and no posterior chamber inflammation. The evolution under antiinflammatory corticoid treatment along with topical antibiotic, mydriatic and hypotensor treatment was favorable with a BCVA of 7/10, resolution of hypopyon and complete detachment of the cyclitic membrane at day 5 postsurgery. A tapering of the corticoid treatment was started along with NAIDS and at one-month follow-up the patient got a 100% recovery of the visual function. CONCLUSION: The most important differential diagnosis to rule out is an infectious endophthalmitis. This case demonstrates that early diagnosis and management of TASS is essential in order to preserve the eye function and structures intact. Treated on time the eye can get a 100% recovery with no sequelaes.

Quantitative proteomic analysis of scleras in guinea pig exposed to wavelength defocus.

Myopia is the most common optical disorder in the world, and wavelength defocus induced ametropia and myopia have attracted great attention. The objective was to identify and quantify scleral proteins involved in the response to the wavelength defocus. Guinea pigs were randomly divided into 3 groups that received different lighting conditions for 8 weeks: white light, short wavelength light, and long wavelength light. Refraction and axial length were measured, Hematoxylin-Eosin staining and transmission electron microscope were adopted to observe the scleral structure, and scleral proteome was also detected to analyze protein abundance by employing TMT labeling method. After light stimulation, the long- and short -wavelength light induced myopic and hyperopic effect on the guinea pig's eye and induced distinct protein signature, respectively. 186 dyregulated proteins between the short- and long-wavelength group were identified, which were mainly located in extracellular region and involved in metabolic process. We also found that 5 proteins in the guinea pigs scleras in response to wavelength defocus were also human myopic candidate targets, suggesting functional overlap between dyregulated proteins in scleral upon exposure to wavelength defocus and genes causing myopia in humans. SIGNIFICANCE: Wavelength defocus induces refractive errors and leads to myopia or hyperopia. However, sclera proteomics respond to wavelength defocus is lacking, which is crucial to understanding how wavelength defocus influences refractive development and induces myopia. In this proteome analysis, we identified unique protein signatures response to wavelength defocus in sclera of guinea pigs, identified potential mechanisms contributing to myopia formation, and found that several human myopia-related genes may involve in response to wavelength defocus. The results of this study provide a foundation to understand the mechanisms of myopia and wavelength defocus induced ametropia.

Is hypermetropia regressing in accommodative esotropia? / A hipermetropia regride na esotropia acomodativa?

ABSTRACT Purposes: To evaluate the relationship of changes in hypermetropia and ocular alignment in patients with accommodative esotropia. Methods: The medical records of consecutive patients diagnosed with refractive accommodative esotropia (esotropia eliminated or decreased to within 10 D with full hyperopic correction) were retrospectively reviewed. Cycloplegic refractions culled from medical records were converted into spherical equivalents. Presence of amblyopia, changes in refractive error and ocular alignment at admission and after the follow-up period were evaluated. Results: Seventy patients (mean age: 6.01 ± 5.41 years; female: 60.6%; mean follow-up: 5.8 ± 3 years) had corrected esotropia of 40 ± 20 prismatic diopters at admission. The average decrease per year in near and distance deviations with glasses was 1.71 ± 3.96 prismatic diopters/year and 1.09 ± 3.25 prismatic diopters/year, respectively. The total myopic shift of the right and left eyes was 1.08 ± 1.35 D and 1.20 ± 1.40 D, respectively. Myopic shift/year was 0.22 D/year and 0.26 D/year, respectively. The correlation between the rate of myopic shift and rate of change in corrected near deviation was weak. The correlation for the rate of myopic shift was not high for the right and left eyes (r=0.18; p=0.15). Conclusion: The amount of deviation and hypermetropia gradually decreased in accommodative esotropia during follow-up. On the other hand, it may be incorrect to assure patients that the amount of deviation will decrease in parallel with the refractive error.(AU)

RESUMO Objetivo: Avaliar a relação entre alterações na hipermetropia e o alinhamento ocular em pacientes com esotropia acomodativa. Métodos: Foram analisados retrospectivamente prontuários médicos de pacientes consecutivos diagnosticados com esotropia acomodativa refrativa (com esotropia eliminada ou reduzida a menos de 10 D com correção completa da hipermetropia). As medidas de refração em cicloplegia obtidas dos prontuários foram convertidas em equivalentes esféricos. Avaliaram-se ainda a presença de ambliopia, alterações do erro refrativo e o alinhamento ocular à admissão e depois do período de acompanhamento. Resultados: Setenta pacientes (média de idade=6,01 ± 5,41 anos, 60,6% do sexo feminino, acompanhamento médio de 5,8 ± 3 anos) apresentaram esotropia de 40 ± 20 dioptrias prismáticas (DP) para perto à admissão. A diminuição média anual no desvio para perto e para longe com o uso de óculos foi de 1,71 ± 3,96 DP/ano e 1,09 ± 3,25 DP/ano, respectivamente. Os desvios miópicos totais dos olhos direito e esquerdo foram de 1,08 ± 1,35 D e 1,20 ± 1,40 D, respectivamente. Os desvios miópicos anuais foram de 0,22 D/ano e 0,26 D/ano para os olhos direito e esquerdo, respectivamente. A correlação entre a taxa de desvio miópico e a taxa de alteração do desvio para perto corrigido foi fraca. A correlação da taxa de desvio miópico não foi alta para os olhos direito e esquerdo (r=0,18, p=0,15). Conclusão: A quantidade de desvio e a hipermetropia diminuem gradualmente na esotropia acomodativa durante o acompanhamento. Por outro lado, pode não ser apropriado garantir aos pacientes que o desvio diminuirá em paralelo ao erro refrativo.(AU)

The relationship between patient age and residual refractive error after uneventful laser in situ keratomileusis for moderate-to-high hyperopia.

PURPOSE: To determine if the manifest sphero-cylindrical residual refractive error, at various time points over a 12-month postop period after laser in situ keratomileusis (LASIK) was associated with patient age at time of surgery. METHODS: Patients with moderate to high hyperopia (3.00-7.00 DS) and astigmatism ⩽2 DC underwent LASIK using Wavelight Allegretto Eye Q (400 Hz). Treatments were centered on corneal vertex, flaps were made with Moria M2 mechanical microkeratome. Pre-and postoperative uncorrected and corrected distant visual acuity, best corrected spherical equivalent (SEQ) were measured. Measurements were taken at 1 week, 1, 3, 6, and 12 months after the surgery. Target refraction was emmetropia. Total of 161 patients were treated. In binocular cases, data from the right eyes were included for analysis. In this article, we report on refraction data only. Raw data were subjected to several permutations to elicit any links between refractive outcomes and patient age. RESULTS: The key findings were as follows y = postop SEQ (diopters), x = patient age (years), ln(x) = natural logarithm of patient age: At 1 month, y = x[0.049 -0.011.ln(x)] (R = -0.205, p = 0.001, n = 161). At 3 months, y = x[0.077 -0.017.ln(x)] (R = -0.355, p < 0.001, n = 161). At 6 months, y = x[0.088 -0.020.ln(x)] (R = -0.382, p < 0.001, n = 161). At 12 months, y = x[0.093 -0.021.ln(x)] (R = -0.409, p < 0.001, n = 161). There was no significant association between x and y at 1 week (p > 0.05). CONCLUSION: Residual postop refractive error after LASIK for hyperopia has a logarithmic association with patient age at time of surgery. In younger patients there is tendency toward undercorrection, the opposite occurs in older patients and this persists 1 year after treatment.

Visual disturbances during prolonged space missions.

PURPOSE OF REVIEW: During prolonged spaceflight, astronauts often experience ocular changes, due to constant head-ward fluid shifts in space as compared with Earth. This article reviews symptoms, likely causes, and potential solutions, such as lower body negative pressure, to counteract space-associated neuroocular syndrome (SANS). RECENT FINDINGS: Low gravity conditions and other aspects of spaceflight affect the eye detrimentally, causing SANS which is characterized by optic disc edema, choroidal thickening, cotton wool spots, and a hyperopic shift. SANS is probably caused by altered hemodynamic flows in the head and neck as well as mildly elevated intracranial and intraocular pressures. Carbon dioxide and other chemicals in space-craft may influence SANS as well. SANS may be counteracted by using lower body negative pressure, thigh cuffs, spacecraft engineering, and/or artificial gravity by a centrifuge. SUMMARY: Prolonged space missions are associated with optic disc edema, choroidal thickening, cotton wool spots, and a hyperopic shift. Possible causes and countermeasures are currently being researched to reduce the risk of SANS. Although many countermeasures to SANS are under investigation lower body negative pressure exhibits great promise in counteracting the headward fluid shifts in space. Understanding and prevention of SANS is critical to future space exploration, especially to long-duration missions to the moon and Mars.

[On the question of progressive hyperopia correction after radial keratotomy]. / K voprosu o korrektsii progressiruyushchei gipermetropii posle radial'noi keratotomii.

Progressive hyperopia development in the long-term period after radial keratotomy (RC) is associated with not only surgical effects, but also individual biomechanical features of the fibrous tunic of the eye, its age-related changes, and hydrodynamic disturbances. When choosing a method of correction, one should take into account a number of features characteristic of this induced refractive disorder: instability and irregularity of refraction, coexisting presbyopia, and, in some cases, anisometropia. Correction of progressive hyperopia after RC can be achieved with eyeglasses, or contacts, or intraocular lenses depending on the subjective factor - the so-called patient adherence. The most effective in terms of functionality is contact correction with scleral rigid gas-permeable lenses, and in the presence of pronounced lens opacities - intraocular correction.

[Elastotonometry for evaluation of biomechanical characteristics of the eye after surgical hyperopia correction]. / Otsenka biomekhanicheskikh kharakteristik na osnove elastotonometrii posle operatsii po korrektsii gipermetropii.

Modern tonometers (Ocular Response Analyzer) can only show the presence of biomechanical disorders of the fibrous membrane, while elastotonometry reacts not only to their presence, but also to their type. PURPOSE: To build a mathematical model that would use elastotonometry to assess biomechanical properties of the eye in treatment of hyperopia with LASIK and FemtoLASIK surgeries. MATERIAL AND METHODS: The study included 64 operations: 34 FemtoLASIK surgeries, and 31 LASIK surgeries. All patients before and after surgery underwent standard examination necessary for keratorefractive surgery, including elastotonometry. The next step was the analysis of elastotonometry curves and eye finite element model in the software package Ansys (Ansys, Inc.; U.S.A.). During the analysis, the fibrous membrane was modeled by two spherical segments, which before elastotonometry were influenced only by true intraocular pressure (IOP). There was a problem of determining tonometric IOP when the cornea is pressured with flat bottomed loads during elastotonometry. It was taken into account that at the first stage of loading, the IOP was applied, and then the force corresponding to the weight of the tonometer. After tonometry, IOP increased so that the volume inside the composite membrane corresponded to the value before loading. RESULTS: Mathematical modeling has shown that after surgical treatment of hyperopia, flexural stiffness of the cornea decreases, elevation of the elastotonometry curve increases, and the higher the true IOP, the greater the elevation. The greatest increase in lift due to increased IOP is observed after LASIK operation, while after FemtoLASIK this change is not significant, in which case the dependence of tonometric IOP on the weight of the load is almost linear. CONCLUSION: The obtained results allow for elastotonometry to be recommend for further medical research as a promising method for assessing biomechanical characteristics of the fibrous membrane of the eye.

Consultation Section: Refractive. Consecutive hyperopia after myopic laser in situ keratomileusis.

A 31-year-old woman was seen at our clinic with dissatisfying hyperopic error after a myopic laser treatment of her left eye in April 2018. The surgery took place 1 year previously. There were no abnormalities in her medical history.The preoperative corrected distance visual acuity (CDVA) in the left eye was 20/16 with -7.50 -0.50 × 75. The refraction in the right eye was -3.50 -1.25 × 90. The cycloplegic correction of the left eye preoperatively was -6.50 -0.50 × 68. A femtosecond-assisted laser in situ keratomileusis procedure was performed with an optical zone of 6.3 mm, an ablation zone of 7.97 mm, and a maximum ablation depth of 121 µm. The laser was set at a correction of -7.50 -0.5 × 75. The temperature and humidity during the laser treatment were 20 degrees and 47%, respectively. shows the excimer laser treatment data (AMARIS 750, SCHWIND eye-tech-solutions).At 1 week postoperatively the uncorrected distance visual acuity (UDVA) was 20/25, and at 1 month postoperatively the CDVA was 20/16 with +2.50. Slitlamp examination showed a clear cornea. No corneal topography was made at that timepoint. At referral 7 months later, the patient's UDVA was 20/100 and CDVA was 20/16 with +2.50 -1.25 × 140 in the left eye. The patient reports decreased vision since the treatment in 2018 and wants to see better without spectacles. shows the postoperative Scheimpflug topography of the left eye, flat keratometry (K1) 36.1 @ 178.4 and steep keratometry (K2) 36.6 @ 88.4. What do you believe could be the cause of this overcorrection? What is your advice in terms of correction of the refractive error for this patient?

Lensectomía refractiva en coloboma de iris / Refractive lensectomy for iris coloboma

RESUMEN El coloboma de iris es un defecto congénito, que se describe como un orificio, fisura o hendidura en dicha estructura.​ Esta condición tiene la posibilidad de ser hereditaria o aparecer sin historia familiar previa. Se presenta un caso de un paciente de 51 años de edad con coloboma bilateral de iris asimétrico e hipermetropía, quien acudió a la consulta médica con el deseo de independizarse de su corrección óptica habitual. Se propuso cirugía facorrefractiva de ambos ojos con pupiloplastia del ojo derecho, en el que se obtuvieron resultados visuales satisfactorios después de la intervención quirúrgica(AU)

ABSTRACT The iris coloboma is a congenital defect, present since birth, which is described as a hole, fissure or cleft in the mentioned structure. This condition has the possibility of being inherited or can appear without previous family history. The case is presented of a 51-year-old patient with bilateral asymmetric iris coloboma and farsightedness. The patient went to the doctor's office with the desire to become independent of his usual optical correction. Facorrefractive surgery of both eyes with pupilloplasty of the right eye was proposed, in which satisfactory visual results were obtained after the intervention(AU)