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1.
Sci Rep ; 11(1): 16141, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373485

RESUMO

To assess the repeatability and comparability of the Galilei G4 versus the Cassini topographer in post-refractive eyes and in normal eyes, including older patients representative of an initial cataract evaluation. Simulated keratometric (simK), total corneal and posterior corneal power and astigmatism were evaluated in both post-refractive and normal eyes. Repeatability was measured by calculating within-subject standard deviation (Sw), coefficient of variation (CoV), and intraclass correlation coefficient (ICC). Vector analyses and Bland-Altman plots were employed to assess agreement between devices. We studied 32 subjects with a history of refractive surgery and 32 subjects without a history of refractive surgery undergoing cataract surgery. The mean age was 55 ± 18.5 years and the age range was 21.5-91.5 years. In non-refractive and post-refractive eyes, the ICC was > 0.9 (P < 0.001) for all corneal powers and for simK and total corneal astigmatism for both analyzers. The ICC for posterior corneal astigmatism magnitude using the Galilei was 0.62 and 0.67 and for the Cassini 0.55 and 0.38 in normal and post-refractive eyes, respectively. In both post-refractive and normal eyes, the Galilei G4 and Cassini analyzers have high repeatability in simK, total, and posterior corneal power and low repeatability for posterior corneal astigmatism.


Assuntos
Astigmatismo/fisiopatologia , Catarata/fisiopatologia , Córnea/fisiopatologia , Topografia da Córnea/métodos , Procedimentos Cirúrgicos Refrativos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/diagnóstico , Catarata/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Refração Ocular/fisiologia , Reprodutibilidade dos Testes , Testes Visuais/métodos , Adulto Jovem
2.
Invest Ophthalmol Vis Sci ; 62(10): 11, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34379095

RESUMO

Purpose: To quantify astigmatism-related meridional anisotropy in visual resolution at central, nasal, and inferior visual fields. Methods: Three groups of young adults (range, 18-30 years) with corrected-to-normal visual acuity (logMAR 0) were recruited: (1) myopic astigmats (MA): spherical-equivalent error (SE) < -0.75D, with-the-rule astigmatism ≥ 2.00D, n = 19; (2) simple myopes (SM): SE < -0.75D, astigmatism ≤ 0.50D, n = 20; and (3) emmetropes (EM): SE ± 0.50D, astigmatism ≤ 0.50D, n = 14. Resolution acuity was measured for the horizontal and vertical gratings at central and peripheral visual fields (eccentricity: 15°) using a 3-down 1-up staircase paradigm. On- and off-axis refractive errors were corrected by ophthalmic lenses. Results: The MA group exhibited meridional anisotropy preferring vertical gratings. At the central field, the MA group had better resolution acuity for vertical than horizontal gratings, and their resolution acuity for horizontal gratings was significantly worse than the SM and EM groups. At peripheral visual fields, both the SM and EM groups showed better resolution acuity for the radial (i.e., nasal field: horizontal gratings; inferior field: vertical gratings) than tangential orientation. However, the MA group tended to have better resolution acuity for the tangential orientation (i.e., vertical gratings), and their resolution acuity for horizontal gratings was significantly lower than the SM and EM groups at the nasal field. No significant differences were found in the inferior field among the three groups. Conclusions: This study provided evidence of astigmatism-related meridional anisotropy at the fovea and nasal visual fields, underscoring the significant impact of astigmatism on orientation-dependent visual functions.


Assuntos
Astigmatismo/fisiopatologia , Emetropia/fisiologia , Fóvea Central/diagnóstico por imagem , Miopia/fisiopatologia , Refração Ocular/fisiologia , Acuidade Visual , Campos Visuais/fisiologia , Adolescente , Adulto , Anisotropia , Astigmatismo/diagnóstico , Feminino , Fóvea Central/fisiopatologia , Humanos , Masculino , Miopia/diagnóstico , Adulto Jovem
3.
Sci Rep ; 11(1): 11514, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34075156

RESUMO

The aim of the study is to explore the distribution patterns and internal correlations of the morphological parameters of the cornea in patients with age-related cataract. The Pentacam HR was used to measure anterior corneal astigmatism (ACA), posterior corneal astigmatism (PCA), total corneal astigmatism (TCA) and keratometric corneal astigmatism (KCA). With age, the proportion of with-the-rule (WTR) ACA decreased from 65.31% to 23.63%, while the against-the-rule (ATR) ACA increased from 26.53% to 56.20%. PCA exceeded 0.50 D in 9.14% of eyes, while 76.35% of them were ATR. The magnitude of ACA was positively correlated with PCA in the whole sample, with a more significant correlation in WTR eyes (sr = 0.349, P < 0.001). The vector summation effect of PCA to ACA changed from compensation to augmentation with aging. In 57.53% of WTR eyes, KCA was overestimated by an average of 0.21 ± 0.17 D, while it was underestimated by 0.38 ± 0.27 D in 87.62% of ATR eyes. In conclusion, among age-related cataract patients, ACA and TCA gradually shifted from WTR to ATR with aging, while most PCA remained as ATR. Ignoring the age-related changes and real PCA might cause overestimation of WTR astigmatism and underestimation of ATR astigmatism.


Assuntos
Envelhecimento/patologia , Astigmatismo , Catarata , Adulto , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/etiologia , Astigmatismo/patologia , Astigmatismo/fisiopatologia , Catarata/complicações , Catarata/patologia , Catarata/fisiopatologia , Topografia da Córnea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Rom J Ophthalmol ; 65(1): 80-84, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33817440

RESUMO

Objective: To report a case of hypercorrection of astigmatism (Cyl) after implantation of 2 segments of short arch ring for keratoconus treatment and to describe its replacement by long arch segment. Methods: This is a case report of a patient with keratoconus and no adaptation to glasses or contact lenses, who was implanted 2 ring segments: upper nasal (155º/ 200µm) and inferior temporal (155º/ 250µm). Results: First postoperative month: CVA = 20/ 50 (-10.50-2.50x135°) and SimK K1 = 48.4x143° and K2 = 51.2x53° (Cyl 2,8D). In the 3rd year: CVA 20/ 30 (-6.00-2.50x135º), with inversion of the axes: K1 = 49,5x60º and K2 = 52,0x150º (Cyl 2,6D). The hypercorrection increased up to the 8th year: CVA = 20/40 (-4,50-6,00x75º) and SimK 47,8x51º/ 60,4x141º (Cyl 12,6D). The 2 segments were replaced for a single segment (320º/ 300µm) and after 1 month: CVA = 20/ 25 (-5,75 spherical) with SimK 46,8x38º/ 48,9x128º (Cyl 2,1D). Conclusion: The ring aims to flatten the most curved meridian, but surpassing the previous value induces astigmatism in the opposite meridian. The hypercorrection of the 2 short segments must occur due to its movement of the extremities, which does not occur with the single long arc segment (≥ 300º). Abbreviations: CVA = Corrected visual acuity, SimK = Simulated keratometry, LE = Left eye, RE = Right eye.


Assuntos
Astigmatismo/terapia , Lentes de Contato , Córnea/cirurgia , Óculos , Ceratocone/cirurgia , Complicações Pós-Operatórias/terapia , Refração Ocular/fisiologia , Adulto , Astigmatismo/etiologia , Astigmatismo/fisiopatologia , Córnea/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Ceratocone/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Fatores de Tempo , Acuidade Visual
5.
Cornea ; 40(4): 440-444, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33881809

RESUMO

PURPOSE: We aimed to assess the corneal refractive changes induced by ptosis surgery in patients with acquired ptosis using Fourier harmonic analysis. METHODS: This retrospective observational study enrolled consecutive patients who underwent levator aponeurotic surgery for acquired ptosis at the Department of Ophthalmology in the University of Tokyo Hospital from May 2016 to January 2018. Best corrected visual acuity, central corneal thickness, average keratometric corneal power (AvgK), corneal astigmatism, and topographic data using Fourier analysis were analyzed preoperatively and 6 months postoperatively. RESULTS: Thirty-two eyes of 32 patients (age, 72.6 ± 8.5 years) were included in this study. There were no significant differences in best corrected visual acuity and central corneal thickness. However, there were significant decreases in anterior AvgK, anterior corneal astigmatism, and posterior corneal astigmatism 6 months postoperatively (all, P < 0.001). Fourier harmonic analysis showed that the anterior spherical component significantly decreased 6 months postoperatively (P < 0.001). There were no significant differences in other components of the anterior and posterior cornea. There was a significant negative correlation between preoperative posterior AvgK and changes in posterior AvgK (r = -0.891, P < 0.001) and between preoperative posterior corneal astigmatism and changes in posterior corneal astigmatism at 6 months (r = -0.858, P < 0.001). CONCLUSIONS: Anterior and posterior corneal keratometry and posterior corneal astigmatism significantly changed 6 months after ptosis surgery for acquired ptosis.


Assuntos
Blefaroplastia , Blefaroptose/cirurgia , Córnea/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/fisiopatologia , Blefaroptose/fisiopatologia , Topografia da Córnea , Feminino , Seguimentos , Análise de Fourier , Humanos , Masculino , Refração Ocular/fisiologia , Estudos Retrospectivos , Acuidade Visual/fisiologia
6.
PLoS One ; 16(3): e0247844, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33647069

RESUMO

We evaluated the rotational stability of a new toric intraocular lens (IOL), HOYA XY-1 toric IOL that is an improved version of HOYA 355 toric IOL, with longer overall length (13.0 mm vs. 12.5 mm), shortened unfolding time, and texture processing of the surface of haptics. Data from 193 eyes of 165 patients (76.4 ± 8.3 years old) with preoperative corneal astigmatism exceeding 0.75 diopters who had undergone phacoemulsification and toric IOL implantation were collected and analyzed. Corneal astigmatism, refractive astigmatism, and uncorrected (UDVA) and corrected distance visual acuity (CDVA) were evaluated before and 1 day, 1 week, and 1 month after surgery. The degree of IOL decentration, IOL tilt, and toric axis misalignment was assessed at 1 day and 1 month postoperatively. Fifty eyes received AcrySof toric IOL, 51 eyes TECNIS toric IOL, 46 eyes HOYA 355 toric IOL, and 46 eyes HOYA XY-1 toric IOL. The amount of axis misalignment from the intended axis was significantly different among IOLs (p = 0.004, one-way ANOVA), and HOYA XY-1 showed significantly less amount of axis misalignment than TECNIS (p = 0.020, Tukey's multiple comparison) and HOYA 355 (p = 0.010). The proportion of eyes that showed axis misalignment <10° at 1 month postoperatively was significantly higher with HOYA XY-1 toric IOL than with other toric IOLs (χ2 test, p = 0.020). HOYA XY-1 toric IOL, the modified version of HOYA 355 toric IOL, showed excellent rotational stability in comparison with other models of toric IOLs.


Assuntos
Astigmatismo/cirurgia , Implante de Lente Intraocular , Lentes Intraoculares , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Facoemulsificação , Resultado do Tratamento , Acuidade Visual/fisiologia
7.
Invest Ophthalmol Vis Sci ; 62(2): 27, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33605983

RESUMO

Purpose: To determine the effects of optically imposed astigmatism on myopia development in chickens. Methods: Chicks were randomly assigned to wear either spherical (-10D, "LIM", n = 14) or sphero-cylindrical lenses (n ≥ 19 in each group) monocularly for a week from 5 days of age. All lenses imposed the same magnitude of spherical-equivalent hyperopic defocus (-10D), with the two astigmatic magnitudes (-8D or -4D) and four axes (45°, 90°, 135°, or 180°) altered to simulate four subtypes of clinical astigmatism. At the end of the treatment, refractive state was measured for all birds, whereas ocular axial dimensions and corneal curvature were measured for subsets of birds. Results: Sphero-cylindrical lens wear produced significant impacts on nearly all refractive parameters (P < 0.001), resulting in myopic-astigmatic errors in the treated eyes. Compared to LIM, the presence of astigmatic blur induced lower myopic error (all except L180 group, P < 0.001) but with higher refractive astigmatism (all P < 0.001) in birds treated with sphero-cylindrical lenses. Distributions of the refractive, axial, and corneal shape parameters in the sphero-cylindrical lens-wear groups indicated that the astigmatic blur had directed the eye growth toward the least hyperopic image plane, with against-the-rule (ATR) and with-the-rule (WTR) astigmatisms typically inducing differential biometric changes. Conclusions: The presence of early astigmatism predictably altered myopia development in chicks. Furthermore, the differential effects of WTR and ATR astigmatisms on anterior and posterior segment changes suggest that the eye growth mechanism is sensitive to the optical properties of astigmatism.


Assuntos
Astigmatismo/etiologia , Miopia/complicações , Óptica e Fotônica , Refração Ocular/fisiologia , Animais , Astigmatismo/fisiopatologia , Galinhas , Modelos Animais de Doenças , Progressão da Doença , Seguimentos , Miopia/fisiopatologia , Miopia/terapia , Fatores de Tempo
8.
Optom Vis Sci ; 98(1): 3-12, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394925

RESUMO

SIGNIFICANCE: This study presents the relationship between distance visual acuity and a range of uncorrected refractive errors, a complex association that is fundamental to clinical eye care and the identification of children needing refractive correction. PURPOSE: This study aimed to analyze data from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study to describe the relationship between distance uncorrected refractive error and visual acuity in children. METHODS: Subjects were 2212 children (51.2% female) 6 to 14 years of age (mean ± standard deviation, 10.2 ± 2.1 years) participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study between 2000 and 2010. Uncorrected distance visual acuity was measured using a high-contrast projected logMAR chart. Cycloplegic refractive error was measured using the Grand Seiko WR-5100K autorefractor. The ability of logMAR acuity to detect various categories of refractive error was examined using receiver operating characteristic curves. RESULTS: Isoacuity curves show that increasing myopic spherical refractive errors, increasing astigmatic refractive errors, or a combination of both reduces distance visual acuity. Visual acuity was reduced by approximately 0.5 minutes of MAR per 0.30 to 0.40 D of spherical refractive error and by approximately 0.5 minutes of MAR per 0.60 to 0.90 D of astigmatism. Higher uncorrected hyperopic refractive error had little effect on distance visual acuity. Receiver operating characteristic curve analysis suggests that a logMAR distance acuity of 0.20 to 0.32 provides the best balance between sensitivity and specificity for detecting refractive errors other than hyperopia. Distance acuity alone was ineffective for detecting hyperopic refractive errors. CONCLUSIONS: Higher myopic and/or astigmatic refractive errors were associated with predictable reductions in uncorrected distance visual acuity. The reduction in acuity per diopter of cylindrical error was about half that for spherical myopic error. Although distance acuity may be a useful adjunct to the detection of myopic spherocylindrical refractive errors, accommodation presumably prevents acuity from assisting in the detection of hyperopia. Alternate procedures need to be used to detect hyperopia.


Assuntos
Percepção de Distância/fisiologia , Erros de Refração/fisiopatologia , Acuidade Visual/fisiologia , Acomodação Ocular , Adolescente , Astigmatismo/fisiopatologia , Criança , Feminino , Humanos , Hiperopia/fisiopatologia , Masculino , Miopia/fisiopatologia , Curva ROC , Sensibilidade e Especificidade , Testes Visuais
9.
Optom Vis Sci ; 98(1): 73-80, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394934

RESUMO

SIGNIFICANCE: Image simulation is a useful and efficient tool to explore the impact of defocus and astigmatism combinations on visual acuity and image quality score when accommodation is taken into account. PURPOSE: The goal of this experiment was to determine if a simulation is able to predict visual acuity and image quality score (IQS) with defocus and astigmatism combinations in presbyopes. METHODS: We measured visual acuity and IQS in five defocus and astigmatism combinations in either real or simulated conditions. In real conditions, the subjects viewed a stimulus through an ophthalmic lens or a deformable mirror. In simulated conditions, subjects viewed images of the same stimulus with simulated blur. The amounts of defocus and astigmatism combinations of a progressive addition lens in near vision were generated through a static correction of the subject's aberrations. We simulated three levels of accommodation: subject could not accommodate (FOC0), subject could accommodate to the less hyperopic focal point (FOC1), or subject could accommodate to the circle of least confusion (FOC2). RESULTS: Visual acuity or IQS did not differ between mirror and progressive addition lens conditions. Visual acuity measured in real blur conditions differed significantly from that in FOC0 simulated blur condition but were similar to that in FOC1 and FOC2 simulated blur conditions. Image quality score obtained in real conditions were between scores measured with the FOC0 and FOC1 simulated conditions, suggesting that the subjects were able to produce a low level of accommodation. CONCLUSIONS: Accommodation may play a role when comparing optical and simulated defocus and astigmatism combinations. Presbyopic subjects are able to produce a low level of accommodation that may counterbalance a part of the deleterious effect of the astigmatism on image quality. Simulation remains a useful tool if the correct accommodation state is taken into account.


Assuntos
Astigmatismo/fisiopatologia , Presbiopia/fisiopatologia , Erros de Refração/fisiopatologia , Acomodação Ocular/fisiologia , Astigmatismo/terapia , Simulação por Computador , Óculos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Presbiopia/terapia , Erros de Refração/terapia , Acuidade Visual/fisiologia
10.
Medicina (Kaunas) ; 57(1)2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33430228

RESUMO

Background and objectives: primary congenital glaucoma (PCG) is a rare, potentially blinding disease that affects children worldwide. The aim of the study was to describe the epidemiological and clinical characteristics, outcomes for newly diagnosed patients with PCG, as well as evaluate the prognostic factors that are related to the outcomes. Materials and Methods: a retrospective cohort study was conducted at a tertiary referral centre among patients diagnosed with PCG. Evaluation of the clinical data was performed preoperatively at three, six, and 12 months after the surgery and at the last follow-up. Results: during the 15 years of follow-ups, 24 eyes of 18 patients were diagnosed with PCG. Unilateral and bilateral PCG constituted 50% of cases each. A slight male predominance was observed (55.6% vs. 44.4%), with a relative risk of 1.3. The incidence of PCG was 1:19,033 live births. The mean age of the patients at the time of diagnosis was 10.1 ± 10.0 months, with a diagnostic delay of 2.0 ± 1.9 months. Furthermore, 75% of patients indicated an enlargement of an eyeball, followed by excessive tearing (58.3%) and corneal opacity (41.7%). After 85.9 ± 51.2 months, the mean intraocular pressure (IOP) value was 14.6 ± 4.9 mmHg. Surgical treatment provided sufficient IOP control in 75% of PCG cases at the last follow-up visit. The only prognostic factor that was related to the outcome of IOP control that was statistically significant was axial length at the time of diagnosis. Conclusions: the incidence of PCG in Latvia was 5.3 patients per 100,000 live births. PCG was more common among males than females with a relative risk of 1.3. The enlargement of an eyeball was the leading clinical sign.


Assuntos
Comprimento Axial do Olho/fisiopatologia , Glaucoma/congênito , Trabeculectomia , Administração Oftálmica , Ambliopia/fisiopatologia , Astigmatismo/fisiopatologia , Estudos de Coortes , Diagnóstico Tardio , Feminino , Glaucoma/epidemiologia , Glaucoma/fisiopatologia , Glaucoma/terapia , Humanos , Lactente , Recém-Nascido , Pressão Intraocular/fisiologia , Letônia/epidemiologia , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Acuidade Visual
11.
Am J Ophthalmol ; 223: 33-41, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33039376

RESUMO

PURPOSE: To conduct Fourier analysis on regular and irregular astigmatism of the anterior and posterior corneal surfaces using anterior segment optical coherence tomography in patients with Fuchs endothelial corneal dystrophy (FECD) DESIGN: Observational case series. METHODS: This study included 75 eyes of 43 FECD patients and 34 eyes of 34 healthy subjects in Osaka University Hospital. Corneal dioptric data from the central 6-mm zone of the anterior and posterior corneal surface were expanded into spherical, regular astigmatism, asymmetry, and higher-order irregularity components using Fourier analysis. We analyzed the association between each component and modified Krachmer grade. RESULTS: There were significant differences in regular astigmatism, asymmetry, and higher-order irregularity components of the anterior corneal surface, and spherical, regular astigmatism, asymmetry, and higher-order irregularity components of the posterior corneal surface among modified Krachmer grades (P = .036, <.001, <.001, <.001, <.001, <.001, and <.001, respectively). Asymmetry component of the anterior and posterior corneal surfaces gradually increased with FECD progression. Higher-order irregularity components of the anterior and posterior corneal surfaces drastically increased in Grade 6. Many eyes had an axis of 0°-180° for the asymmetry component of the anterior surface and 180°-360° for that of the posterior surface. CONCLUSION: Patients with severe FECD had a larger amount of asymmetry and higher-order irregularity components of the anterior and posterior corneal surfaces. Patients with FECD up to Grade 5 were characterized by anterior and posterior flattening in the inferior cornea, and those with Grade 6 showed irregularity in the anterior and posterior corneal surfaces.


Assuntos
Astigmatismo/fisiopatologia , Córnea/patologia , Distrofia Endotelial de Fuchs/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Topografia da Córnea , Feminino , Análise de Fourier , Humanos , Masculino , Pessoa de Meia-Idade , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Adulto Jovem
12.
Cornea ; 40(2): 133-141, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33155577

RESUMO

PURPOSE: To refine the diagnostic criteria for Terrien marginal degeneration (TMD) based on experience in 3 Nordic countries. METHODS: This is a retrospective, multicenter, hospital-based cross-sectional study of 49 eyes of 29 white patients in tertiary referral centers in Finland, Sweden, and Denmark from 1998 to January 2018. The median follow-up was 3 years. Symptoms, best corrected visual acuity, astigmatism, corneal thickness, curvature and cavities, stage, and progression were analyzed. RESULTS: TMD was diagnosed equally likely between 15 and 86 years of age (median, 47 years). Twenty patients (69%) had bilateral disease, and 62% were men. Seventeen patients (59%) had symptoms including blurred vision and ocular surface disease symptoms without inflammatory signs. Eight patients (28%) had slightly reduced corneal sensitivity. Median best corrected visual acuity was 20/25 (range, 20/16-20/200) and astigmatism was 2.6 diopters (D) (range, 0-10) with a mean progression of 0.41 D per year (range, 0-5.4). Age and astigmatism were not correlated. All eyes had peripheral vascularization, lipid deposits, and hyperreflectivity throughout thinned peripheral stroma and its anterior edge. The thinning progressed in 15 patients (52%). Of 26 patients, 8 (31%) had single or confluent paralimbal intrastromal cavities, most commonly superiorly. By Süveges classification, the stage was 2 (92%) or 3 (8%). Minimum corneal thickness and corneal curvature were loosely associated, leading to different stages in Wang classification in 34 eyes (69%). CONCLUSIONS: TMD is defined by peripheral corneal thinning, superficial neovascularization, lipid deposition at the leading edge, absence of ulceration and inflammation, and frequently cavitation. The most sensitive way to follow its progression is anterior segment optical coherence tomography.


Assuntos
Distrofias Hereditárias da Córnea/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Segmento Anterior do Olho/diagnóstico por imagem , Astigmatismo/fisiopatologia , Córnea/patologia , Distrofias Hereditárias da Córnea/epidemiologia , Distrofias Hereditárias da Córnea/fisiopatologia , Topografia da Córnea , Estudos Transversais , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Países Escandinavos e Nórdicos/epidemiologia , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Adulto Jovem
13.
Am J Ophthalmol ; 221: 97-104, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32890470

RESUMO

PURPOSE: To compare the accuracy of toric intraocular lens (IOL) alignment and visual outcomes using femtosecond laser-assisted capsulotomy marking (CM) versus conventional slit lamp-assisted manual marking (MM). DESIGN: Prospective cohort study. METHODS: A total of 57 patients who required cataract surgery and toric IOL implantation (Acrysof SN6AT3-T8) were assigned to the CM group (26 eyes) or the MM group (31 eyes). Uncorrected distant visual acuity (UCDVA), best-corrected distant visual acuity (BCDVA), residual astigmatism (RA), IOL misalignment, and modulation transfer function (area ratio [AR] value) were measured 1 and 3 months after surgery. RESULTS: Postoperative UCDVA (logarithm of minimal angle of resolution [logMAR]) was significantly lower in the CM group than that in the MM group (P < .05). Postoperative RA and IOL misalignment were significantly lower in the CM group than that in the MM group (both P < .05). No significant difference between the groups was observed for BCDVA or AR value (both P > .05). UCDVA (logMAR) was positively correlated with RA (r = 0.339; P < .05) and IOL misalignment (r = 0.317; P < .05) and negatively correlated with the the AR value (r = -0.272; P < .05); RA was positively correlated with IOL misalignment (r = 0.405; P < .05). CONCLUSIONS: The accuracy of the axis alignment was significantly higher in the CM group, which resulted in lower residual astigmatism and better visual outcomes.


Assuntos
Marcadores Fiduciais , Iris/anatomia & histologia , Implante de Lente Intraocular/métodos , Lentes Intraoculares , Facoemulsificação , Capsulotomia Posterior/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/fisiopatologia , Astigmatismo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pseudofacia/fisiopatologia , Refração Ocular/fisiologia , Microscopia com Lâmpada de Fenda , Acuidade Visual/fisiologia
14.
Am J Ophthalmol ; 221: 279-286, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32777380

RESUMO

PURPOSE: To investigate the effect of refractive astigmatism on all-distance visual acuity (VA) in eyes implanted with a diffractive trifocal or bifocal intraocular lens (IOL). DESIGN: Cross-sectional study. METHODS: Fifty eyes with trifocal IOLs (PanOptix; Alcon) and 50 eyes with bifocal IOLs (ReSTOR +3D) were enrolled. After simulating astigmatism by adding cylindrical lenses of 0, 0.5, 0.75, 1.0, and 1.5 diopters (D), the corrected logarithm of minimal angle of resolution (logMAR) VA was measured using an all-distance vision tester. RESULTS: Mean VAs at most distances significantly worsened in proportion to the added astigmatism (P ≤ .0111) with no significant differences in near VA at 0.3 m in the trifocal group or in intermediate VA at 0.7 m in the bifocal group. Mean intermediate VA at 0.5 m was significantly better in the trifocal group than in the bifocal group when the astigmatism was 0.75 D or less (P ≤ .0472), but VA at distances of ∞ and 5.0 m were significantly worse in the trifocal group when the astigmatism was 0.5 D or more (P ≤ .0457). Useful mean logMAR VA of 0.20 was achieved at all distances when the astigmatism was 0.75 D or less in the trifocal group and 1.0 D or less in the bifocal group. CONCLUSIONS: All-distance VA, particularly distance VA, worsened more in proportion to astigmatism with a trifocal IOL than with a bifocal IOL. Useful VA was achieved when the astigmatism was 0.75 D or less with a trifocal IOL, suggesting that astigmatism correction is necessary when astigmatism is more than 0.75 D.


Assuntos
Astigmatismo/fisiopatologia , Implante de Lente Intraocular , Lentes Intraoculares Multifocais , Refração Ocular/fisiologia , Acuidade Visual/fisiologia , Adulto , Idoso , Estudos Transversais , Óculos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Facoemulsificação , Pseudofacia/fisiopatologia , Visão Binocular , Adulto Jovem
15.
Br J Ophthalmol ; 105(1): 27-31, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32201375

RESUMO

AIMS: To evaluate the long-term outcomes of small incision lenticule extraction (SMILE) in subjects with myopic astigmatism of ≥2.00 dioptres (D). METHODS: Patients who underwent SMILE 4 years prior with astigmatism ≥2.00 D and ≤1.00 D were assigned to the high astigmatic group (HA group) or the low astigmatic group (LA group), respectively. The visual and refractive results as well as corneal wavefront aberrations were measured. RESULTS: The preoperative cylinder was -2.47±0.54 D in 43 eyes in the HA group and -0.55±0.28 D in 31 eyes in the LA group. At 4 years, the residual cylinder was -0.31±0.29 D in the HA group and -0.20±0.28 D in the LA group (p=0.088). An uncorrected distance visual acuity of 20/20 was achieved in 88.4% of eyes in the HA group and 93.5% of eyes in the LA group. The efficacy index was 0.99±0.14 and 1.10±0.21 (p=0.025), and the safety index was 1.11±0.20 and 1.22±0.21 in the HA and LA groups, respectively (p=0.012). Eighty-six per cent and 90.3% of eyes were within ±0.50 D of the attempted cylindrical correction in the HA and LA groups, respectively. Vector analysis showed that the magnitude of error was -0.14±0.28 D and -0.05±0.16 D (p=0.085), the angle of error was -0.13±4.48 degrees and -2.57±29.42 degrees (p=0.592), the correction index was 0.94±0.13 and 0.94±0.35 (p=0.959), the index of success was 0.15±0.14 and 0.46±0.62 (p=0.517), and the flattening index was 0.93±0.13 and 0.71±0.59 (p=0.450) in the HA and LA groups, respectively. CONCLUSIONS: This study demonstrates that SMILE is effective and safe for correcting high astigmatism. Vector analysis shows a tendency for the undercorrection of astigmatism in subjects with high astigmatism.


Assuntos
Astigmatismo/cirurgia , Substância Própria/cirurgia , Cirurgia da Córnea a Laser , Miopia Degenerativa/cirurgia , Adulto , Astigmatismo/fisiopatologia , Feminino , Humanos , Masculino , Microcirurgia , Miopia Degenerativa/fisiopatologia , Refração Ocular/fisiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
16.
Eur J Ophthalmol ; 31(1): 69-77, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635486

RESUMO

PURPOSE: To determine the total corneal refractive power in 1-8 mm corneal zones and the 8 mm Q-value in non-keratoconic patients with Down syndrome and normal subjects aged 10-30 years. METHODS: Right eye data from 203 Down syndrome patients (mean ± standard deviation age: 17.0 ± 4.7 years) and 189 age- and gender-matched normal subjects (17.1 ± 4.5 years) were compared. Main extracted Pentacam indices were total corneal refractive power in steep and flat axes, and mean and difference (corneal astigmatism) total corneal refractive power in 1-8 mm zones. RESULTS: Mean total corneal refractive power in 1-8 mm zones was 45.17-45.74 D and 42.91-43.52 D in Down and normal group, respectively (all p < 0.001). The coefficients of variation of total corneal refractive power from the center to the periphery were similar in the two groups (p = 0.855). None of the mean total corneal refractive powers significantly correlated with age, and all of them were significantly higher in females (p < 0.001). Mean total corneal refractive power-based corneal astigmatism in these zones changed from 1.46 to 1.66 D in Down syndrome patients and 1.64 to 1.99 D in normal group. All corneal astigmatism indices were similar between two groups (all p > 0.05). The prevalence of against the rule and oblique astigmatism in all zones were higher in the Down syndrome group (all p < 0.05). CONCLUSION: Adolescent and young non-keratoconic patients with Down syndrome have a more prolate cornea and a homogeneous keratometry distribution. In this population, females have a steeper cornea.


Assuntos
Astigmatismo/fisiopatologia , Córnea/fisiopatologia , Síndrome de Down/complicações , Refração Ocular/fisiologia , Adolescente , Criança , Topografia da Córnea , Feminino , Humanos , Masculino , Retinoscopia , Adulto Jovem
17.
Am J Ophthalmol ; 221: 1-8, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32828877

RESUMO

PURPOSE: To assess the influence of artificial tears of different viscosity on K-readings prior to cataract surgery. DESIGN: Prospective randomized crossover, before-and-after clinical study. METHODS: Setting: Department of Ophthalmology, Medical University of Vienna. PATIENT POPULATION: A total of 123 eyes of 80 patients prior to cataract surgery were assigned to 2 groups based on normal and dry eyes. INTERVENTION: Two native baseline keratometries were followed by instillation of either high- or low-viscosity eye drops. Keratometry was repeated 30 seconds, 2 minutes, and 5 minutes after instillation. MAIN OUTCOME MEASURES: Influence of eye drops of different viscosity in normal and dry eyes on short time K-readings. RESULTS: Repeatability between native baseline measurements was high (standard deviation = 0.02 mm in normal and in dry eyes). In normal and dry eyes, a statistically significant increase in measurement variability after instillation of both low-viscosity and high-viscosity eye drops was observed (P < .01). Measurement variability was most pronounced between baseline measurement and 30 seconds and diminished over time. Variability of K-readings appeared higher in dry eyes compared with normal eyes. Astigmatism changed more than 0.5 diopters in 13.2% of normal eyes and 34.4% in dry eyes using eye drops of high viscosity. CONCLUSION: Tear film-stabilizing eye drops prior to keratometry measurements influenced K-readings significantly, especially in dry eyes. A time period of more than 5 minutes should be allowed to pass after instillation of eye drops. The higher the viscosity of the eye drops, the stronger the influence and the longer its persistence.


Assuntos
Catarata/complicações , Córnea/patologia , Técnicas de Diagnóstico Oftalmológico/instrumentação , Síndromes do Olho Seco/tratamento farmacológico , Lubrificantes Oftálmicos/administração & dosagem , Administração Oftálmica , Idoso , Idoso de 80 Anos ou mais , Astigmatismo/fisiopatologia , Biometria/instrumentação , Estudos Cross-Over , Síndromes do Olho Seco/fisiopatologia , Feminino , Humanos , Lubrificantes Oftálmicos/química , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Facoemulsificação , Estudos Prospectivos , Reprodutibilidade dos Testes , Viscosidade
18.
Cornea ; 40(1): 78-87, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32956581

RESUMO

PURPOSE: To evaluate the long-term efficacy and safety of topography-guided photorefractive keratectomy (TG-PRK) for postkeratoplasty refractive error correction. METHODS: A retrospective interventional case series of 54 eyes of 50 patients who underwent previous corneal transplants. Unaided distance visual acuity (UDVA) and best corrected visual acuity (CDVA), manifest refraction, mean central keratometric value, mean keratometric astigmatism, and postoperative complications were reviewed. RESULTS: Final follow-up was at mean 31 (±17) months. Sixteen point seven percent of eyes underwent more than 1 surface ablation. Mean UDVA improved from 0.96 ± 0.06 logarithm of the minimum angle of resolution (LogMAR) preoperatively to 0.46 ± 0.05 LogMAR of resolution at the final follow-up (Bonferroni, P < 0.0001). Mean UDVA improved by 4.4 Snellen lines. Improvement in CDVA was not significant, although a significant improvement was noted when eyes with preoperative CDVA <20/40 were analyzed separately (t test, P = 0.005). Mean astigmatism improved from -4.4 ± 0.26 D preoperatively to -2.4 ± 0.26 D at the final follow-up (Bonferroni, P < 0.0001), whereas mean SEQ improved from -2.5 ± 0.39 D preoperatively to -1.1 ± 0.25 D (Bonferroni, P = 0.02). In total, 9% at the preoperative visit and 55% at the final visit had less than 2 D of astigmatism, respectively. Keratometric astigmatism decreased from 5.24 ± 0.36 D preoperatively to 2.98 ± 0.34 D at the final follow-up (t test, P < 0.0001). No eyes developed clinically significant haze, 14.8% developed regression, and 13% had a reduction of 2 or more CDVA lines. CONCLUSIONS: Postkeratoplasty topography-guided photorefractive keratectomy has good long-term efficacy and safety, resulting in significant UDVA, refractive, and keratometric improvement. Regression can occur after the first year of treatment, emphasizing the importance of long-term follow-up.


Assuntos
Astigmatismo/cirurgia , Ceratoplastia Penetrante/efeitos adversos , Lasers de Excimer/uso terapêutico , Ceratectomia Fotorrefrativa/métodos , Complicações Pós-Operatórias , Adulto , Idoso , Astigmatismo/etiologia , Astigmatismo/fisiopatologia , Topografia da Córnea , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Refração Ocular/fisiologia , Estudos Retrospectivos , Cirurgia Assistida por Computador , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
19.
Curr Opin Ophthalmol ; 32(1): 3-12, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33122490

RESUMO

PURPOSE OF REVIEW: The aim of this article is to review techniques to maximize all-distance uncorrected visual acuity and minimize photic phenomena after the implantation of multifocal and extended-depth of focus (EDOF) intraocular lenses (IOLs). This review examines the role of femtosecond laser-assisted cataract surgery (FLACS) in postoperative minimization of astigmatism and optimization of outcomes with multifocal and EDOF lenses. RECENT FINDINGS: By incorporating intraoperative and preoperative imaging, femtosecond platforms such as those that utilize iris or conjunctival vessel registration, can enable a precision of corneal incisions and toric IOL markings that enable the lowest possible postoperative levels of astigmatism. Current studies suggest that with increasing IOL complexity, that is, trifocal versus bifocal, image degradation with even low levels of postoperative astigmatism are increased. To this end, current data support the utility of femtosecond laser arcuate incisions to enable the achievement of 0.5 D or less postoperative astigmatism for best outcomes with multifocal lenses. SUMMARY: The synergistic combination of multifocal/EDOF IOLs with FLACS is an extremely promising route in achieving postoperative spectacle independence for patients. The marriage of the precision of FLACS with the increasing complexity of multifocal/EDOF IOLs will fuel nomogram adjustment and systematic improvements, such as the Wörtz-Gupta formula. Such strategies provide an unprecedented precision to cataract surgery that makes FOCUSED (Femtosecond Optimized Continuous Uncorrected Sight with EDOF and Diffractive Multifocal IOLs) a reality.


Assuntos
Percepção de Profundidade/fisiologia , Terapia a Laser/métodos , Implante de Lente Intraocular/métodos , Lentes Intraoculares Multifocais , Facoemulsificação , Acuidade Visual/fisiologia , Astigmatismo/fisiopatologia , Humanos , Pseudofacia/fisiopatologia , Refração Ocular/fisiologia
20.
Curr Opin Ophthalmol ; 32(1): 13-18, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33196544

RESUMO

PURPOSE OF REVIEW: There are several different approaches to handling regular and irregular astigmatism during cataract surgery, but still much debate on which solutions are most effective given unique patient circumstances. In this review, we examine recent literature and studies to highlight some of the most effective ways to plan preoperatively, manage regular and irregular astigmatism during cataract surgery, as well as managing postoperative complications. RECENT FINDINGS: Recent developments in technology have provided increased courses of action for astigmatism management during cataract surgery. Additional options of toric IOLs with presbyopic platforms, light adjustable lenses, intraocular pinhole lenses, online technological tools and platforms, wavefront or topographic laser technology, and phototherapeutic keratectomy are all effective solutions to managing regular and irregular astigmatism. In this review, we will explore optimal approaches for unique situations. SUMMARY: With increased technology, research, and methods, correcting regular and irregular astigmatism during cataract surgery is achievable in most patients. With in-depth preoperative planning, analysis of patient-specific factors, and a tailored approach, surgeons can obtain excellent uncorrected vision for patients.


Assuntos
Astigmatismo/cirurgia , Implante de Lente Intraocular/métodos , Facoemulsificação/métodos , Astigmatismo/fisiopatologia , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ , Ceratectomia Fotorrefrativa , Pseudofacia/fisiopatologia , Refração Ocular/fisiologia , Acuidade Visual/fisiologia
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