EVALUATION OF THE INCLUSION OF SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IN A TELEMEDICINE DIABETIC RETINOPATHY SCREENING PROGRAM: A Real Clinical Practice.

PURPOSE: To evaluate whether combining spectral domain optical coherence tomography with monoscopic fundus photography using a nonmydriatic camera (MFP-NMC) improves the accuracy of diabetic macular edema (DME) referrals in a teleophthalmology diabetic retinopathy screening program. METHODS: We conducted a cross-sectional study with all diabetic patients aged 18 years or older who attended screening from September 2016 to December 2017. We assessed DME according to the three MFP-NMC and the four spectral domain optical coherence tomography criteria. The sensitivity and specificity obtained for each criterion were estimated by comparing them with the ground truth of DME. RESULTS: This study included 3,918 eyes (1,925 patients; median age, 66 years; interquartile range, 58-73; females, 40.7%; once-screened, 68.1%). The prevalence of DME ranged from 1.22% to 1.83% and 1.54% to 8.77% on MFP-NMC and spectral domain optical coherence tomography, respectively. Sensitivity barely reached 50% in MFP-NMC and less for the quantitative criteria of spectral domain optical coherence tomography. When macular thickening and anatomical signs of DME were considered, sensitivity increased to 88.3% and the false DMEs and non-gradable images were reduced. CONCLUSION: Macular thickening and anatomical signs showed the highest suitability for screening, with a sensitivity of 88.3% and a specificity of 99.8%. Notably, MFP-NMC alone missed half of the true DMEs that lacked indirect signs.

Atomic force microscopy for the evaluation of corneal surface roughness after femtosecond laser flap creation and excimer ablation.

INTRODUCTION: It is well known that the femtosecond laser lamellar cut induces some degree of surface roughness. Nevertheless, as in femtosecond laser-assisted LASIK (FS-LASIK), an excimer LASIK ablation is performed, and the post-ablation stromal bed should show some degree of smoothening. We decided to compare, using atomic force microscopy (AFM), the roughness of the corneal stromal bed, after a femtosecond lasers device flap was created with or without an excimer myopic ablation. METHODS: Using 6 freshly enucleated porcine eyes, we created in every eye a flap using a femtosecond laser. Additionally, in 3 eyes, an excimer laser ablation to correct-3 diopters (D) was made. AFM imaging of the remaining corneal stroma was performed. Ten different square areas of 20 µm x 20 µm at the central area of the stroma of each corneal sample were studied. The roughness parameters used were the root-mean-square deviation from a perfectly flat surface. RESULTS: The RMS deviation was 360 ± 120 nm in femtosecond laser only, and 110 ± 20 nm in those cases where excimer is also involved (p < 0.0001). CONCLUSIONS: Our results show that the roughness of the surface treated with excimer is clearly lower than in the group with no excimer ablation; thus, the application of laser excimer after a flap created by femtosecond laser seems to soften the nano-irregularities created by this technique.

Effect of prostaglandin analogues on the biomechanical corneal properties in patients with open-angle glaucoma and ocular hypertension measured with dynamic scheimpflug analyzer.

PURPOSE: The aim of the study is to evaluate the effect of topical prostaglandin (PG) treatment on the corneal biomechanical properties in treatment-naïve patients with either primary open-angle glaucoma (POAG) or ocular hypertension (OHT) using the Corvis ST device. METHODS: This is an observational study. We analyzed the Corvis ST dynamic corneal response parameters of our database using the newest software available. Thirty-four eyes of 34 patients were included. They were all newly diagnosed and treatment-naïve. Patients were evaluated at baseline and after 6 months of treatment with prostaglandin analogues. Ultrasound pachymetry, Optical Coherence Tomography (OCT) and a 24-2 visual field test were performed in baseline visit. Goldman Applanation Tonometry (GAT-IOP) and Corvis ST dynamic corneal response parameters were registered at baseline and at the 6-month visit. RESULTS: After 6 months of treatment, the IOP decrease (Δ) values obtained with the different tonometers were ΔGAT -6.5 ± 3.7, ΔIOPnct -4.4 ± 5.7 and ΔbIOP -3.8 ± 5.4. The differences between ΔGAT vs ΔIOPnct, ΔGAT vs ΔbIOP, and ΔIOPnct vs ΔbIOP, were statistically significant (p < 0.05 for all comparisons). Statistically significant lower values of the stress-strain index (SSI) (1.77 ± 0.3 at baseline vs 1.54 ± 0.27 at the 6-month visit) were found (p = 0.0002). CONCLUSION: The SSI provided by the Corvis ST seems to decrease significantly after topical prostaglandin therapy. We believe that our results support the hypothesis that topical PG therapy does decrease the corneal stiffness and thus, that the ocular hypotensive effect of these drugs is overestimated if GAT is used for IOP measurement.

Femtosecond LASIK for the correction of low and high myopic astigmatism.

INTRODUCTION: Higher preoperative myopic astigmatism is associated with a higher probability of retreatment due to patient dissatisfaction as a result of residual cylindrical error. Nonetheless, retreatment is safe and the final clinical results are comparable to those of patients with lower preoperative astigmatism who were satisfied with the primary treatment. Our purpose is to compare the efficacy and safety of femtosecond LASIK (FS-LASIK) for the refractive correction of patients with low (< 1.5 Diopters (D) versus high (≥ 1.5 D) myopic astigmatism. METHODS: Retrospective observational study of 841 eyes of 825 eligible patients treated with FSLASIK for the correction of simple or compound myopic astigmatism. Outcome measures included residual error, best corrected and uncorrected distance visual acuity (BCVA and UCVA), efficacy and safety 3 months after the primary procedure or the retreatment. RESULTS: Of 841 eyes in total, 432 (51.37%) had < 1.5 D (Group 1) and 409 (48.63%) had ≥ 1.5 D (Group 2) preoperative myopic astigmatism. The efficacy index of primary treatment was 0.94 ± 0.18 in Group 1 and 0.89 ± 0.22 in Group 2 (P = 0.001). Of 138 eyes (16.41%) that were retreated due to dis-satisfaction related to residual refractive error, 28 belonged to Group 1 (6.5%) and 110 (26.9%) to Group 2 (P < 0.001). Following retreatment, small but statistically significant differences in the residual mean postoperative cylinder (-0.08 ± 0.24 vs -0.27 ± 0.46 D, P = 0.001) and UCVA (1.11 vs 0.96, P = 0.0001) were detected for Groups 1 and 2, respectively. However, there were no statistically significant differences in the safety and efficacy indices. CONCLUSION: Following FS-LASIK, eyes with myopic astigmatism ≥ 1.5 D have approximately four times more chances of undergoing retreatment due to dis-satisfaction caused by residual refractive error compared to eyes with myopic astigmatism < 1.5 D. However, the clinical results after retreatment are highly satisfactory and comparable in both groups.

Atomic force microscopy comparative analysis of the surface roughness of two posterior chamber phakic intraocular lens models: ICL versus IPCL.

BACKGROUND: To compare the anterior surface roughness of two commercially available posterior chamber phakic intraocular lenses (IOLs) using atomic force microscopy (AFM). METHODS: Four phakic IOLs were used for this prospective, experimental study: two Visian ICL EVO+ V5 lenses and two iPCL 2.0 lenses. All of them were brand new, were not previously implanted in humans, were monofocal and had a dioptric power of - 12 diopters (D). The anterior surface roughness was assessed using a JPK NanoWizard II® atomic force microscope in contact mode immersed in liquid. Olympus OMCL-RC800PSA commercial silicon nitride cantilever tips were used. Anterior surface roughness measurements were made in 7 areas of 10 × 10 µm at 512 × 512 point resolution. The roughness was measured using the root-mean-square (RMS) value within the given regions. RESULTS: The mean of all anterior surface roughness measurements was 6.09 ± 1.33 nm (nm) in the Visian ICL EVO+ V5 and 3.49 ± 0.41 nm in the iPCL 2.0 (p = 0.001). CONCLUSION: In the current study, we found a statistically significant smoother anterior surface in the iPCL 2.0 phakic intraocular lenses compared with the VISIAN ICL EVO+ V5 lenses when studied with atomic force microscopy.

Effect of Laser-assisted Subepithelial Keratectomy with Mitomycin C on Corneal Optical Density Measured with Confocal Microscopy.

SIGNIFICANCE: The development of confocal microscopy allows one to obtain high-resolution corneal images like its optical density. Some studies have evaluated the optical density with Scheimpflug cameras in the early post-operative period after photorefractive keratectomy, but no studies have evaluated the long-term evolution of optical density after surface ablation when mitomycin C is used. PURPOSE: This work aimed to study the changes in corneal optical density measured with confocal microscopy in eyes treated with laser-assisted subepithelial keratectomy (LASEK) and intraoperative mitomycin C (MMC) to correct myopia. METHODS: A study of 24 consecutive myopic eyes that underwent LASEK with 0.02% MMC and a control group of 24 healthy nontreated eyes was performed. Optical density was measured using the images by the confocal microscopy of the Heidelberg Retina Tomograph II with the Rostock Cornea Module. An analysis of confocal microscopy images was performed using the ImageJ software to obtain the optical density, in gray-scale units (GSU). The optical density of the stromal bed was evaluated 3 months, 15 months, and 3 years after surgery and was compared with the optical density at the equivalent depth of the stroma in controls. RESULTS: The mean values of optical density for the LASEK group were 81.7 ± 9.7, 78.6 ± 11.7, and 73.6 ± 18.7 GSU at 3 months, 15 months, and 3 years, respectively, and it was 61.8 ± 8.2 GSU for the control group. A statistically higher optical density 3 and 15 months after LASEK with MMC was found compared with controls (P < .001). No significant difference was found in optical density at 3 years post-operatively. CONCLUSIONS: Our study suggests that, after LASEK with MMC, the anterior corneal stroma has a higher optical density at 3 and 15 months post-operatively, which gradually returns to normal values 3 years after surgery.

Thinner retinal nerve fibre layer in healthy myopic eyes with thinner central corneal thickness.

PURPOSE: Thinner central corneal thickness (CCT) is a risk factor for conversion from ocular hypertension to glaucoma and for disease progression. However, little is known about the relationship between CCT and characteristics of the optic nerve and the retinal nerve fibre layer (RNFL) in non-glaucomatous eyes. Because myopic eyes may pose diagnostic challenges when assessed for glaucoma, characterising the relationship between CCT and RNFL in these eyes is clinically relevant. Our aim was to investigate the relationship between CCT and RNFL thickness in non-glaucomatous eyes with small/moderate myopia. METHODS: This was a single-centre, observational, prospective, assessor-masked study. Consecutive eligible patients (myopia ≤ - 6.0 dioptres, astigmatism ≤ 2.0 dioptres) without other ocular or neurodegenerative diseases were included. Based on their CCT, the participants were allocated to group 1 (CCT > 555 µm) or group 2 (CCT < 555 µm). Peripapillary RNFL measurements were performed by a masked observer using the Spectralis OCT platform. RESULTS: Sixty eyes were included in group 1 and 63 in group 2. The CCT in the two groups was significantly different (584.27 ± 22.8 µm vs 522.23 ± 20.03 µm, p = 0.0001). There were no other significant differences in the groups in terms of age, refraction, or intraocular pressure. The peripapillary RNFL thickness was higher (all p < 0.005) in group 1 at several sectors: superior-temporal, inferior-temporal, inferior-nasal, and average. A significant positive correlation between CCT and average RNFL thickness was found for the whole population (r = 0.31, p = 0.0001). CONCLUSION: Otherwise, healthy myopes with thinner CCT have thinner RNFL compared with participants of similar age and refraction with thicker CCT.

Optical coherence tomography analysis of filtering blebs after long-term, functioning trabeculectomy and XEN® stent implant.

PURPOSE: The purpose of this study was to use Triton® SweptSource OCT to evaluate the morphology of blebs formed when eyes are treated with XEN® implants and to compare these with the blebs in successfully functioning eyes after trabeculectomy (TB) and with eyes of healthy controls. METHODS: A cross-sectional, observational study. We analyzed 25 eyes, 15 after TB and 10 with XEN® implants, comparing them with 23 healthy eyes (controls). We evaluated the conjunctival morphology of the eyes using AS-OCT. The main parameters evaluated were bleb height, sub-epithelial fibrosis, epithelial thickness, and changes in intraocular pressure (IOP). RESULTS: We found that the filtering blebs formed in eyes in which a XEN® stent was implanted were significantly flatter (bleb height 417 ± 183 µm) than the blebs formed in TB eyes (bleb height 618 ± 256 µm, p < 0.05). Moreover, sub-epithelial fibrosis did not develop in any of the blebs produced by the XEN stent, whereas some fibrosis was evident in 40% of the blebs that formed after TB (p < 0.05). The epithelium was thicker when the XEN implant was used (65 ± 18.5 µm) than when eyes underwent TB (60 ± 17.7 µm), and it was thicker than in control eyes (51 ± 9.7 µm, p < 0.05). Moreover, the decrease in the IOP induced by the XEN® stent (- 8.5 ± 5.3 mmHg) was similar to that produced by TB (- 8.8 ± 5.2 mmHg, p > 0.05). CONCLUSIONS: Filtering blebs obtained after the introduction of a XEN® stent were morphologically distinct to those produced by TB, and they are more similar to the healthy conjunctiva.

Myopic Laser-Assisted Subepithelial Keratectomy (LASEK) outcomes using three different excimer laser platforms: a retrospective observational study.

BACKGROUND: To compare the visual and refractive outcomes after myopic LASEK using three different excimer lasers and standardized surgical and mitomycin C (MMC) application protocols. METHODS: In this retrospective, observational cohort study, we examined 122 eyes treated with Allegretto, 135 eyes treated with Esiris and 137 eyes treated with Technolas excimer lasers. All eyes were treated under the same surgical protocol, and a standardized MMC dosage was used. The three groups were refraction-matched, and both visual and refractive outcomes were evaluated at 1 and 7 days and 1 and 3 months after surgery. RESULTS: At 3 months postsurgery, Allegretto provided significantly better outcomes than Esiris and Technolas in terms of postoperative uncorrected distance visual acuity (UDVA) (1.11 ± 0.2 vs 1.01 ± 0.2 vs 0.98 ± 0.2) (P = 0.0001), corrected distance visual acuity (CDVA) (1.13 ± 0.2 vs 1.10 ± 0.1 vs 1.04 ± 0.2) (P = 0.0001), residual sphere (- 0.01 ± 0.2 vs + 0.29 ± 0.7 vs + 0.27 ± 0.6) (P = 0.0001), and efficacy index (0.99 ± 0.2 vs 0.90 ± 0.2 vs 0.91 ± 0.2) (P = 0.0004). CONCLUSIONS: We found slightly better visual and refractive outcomes in the Allegretto group at 3 months post-op after LASEK with MMC to correct myopia.

Influence of LASEK on Schiøtz, Goldmann and dynamic contour Tonometry.

PURPOSE: Our purpose was to assess the effect of LASEK surgery on ocular rigidity and to compare its effect on intraocular pressure (IOP) readings with Goldmann applanation tonometry (GAT), Schiøtz indentation tonometry (ST) and dynamic contour tonometry (DCT). METHODS: Prospective, observational, single-masked cohort study. One eye per patient from 31 consecutive subjects who underwent LASEK refractive surgery to correct myopia, as well as from 108 non-operated myopic patients, were included. IOP was measured using GAT, DCT, and ST. The coefficient of ocular rigidity (Ko) was obtained from the regression line of the three readings obtained with each weight of the ST. Linear multiple regression analysis was performed with dummy variables to assess the effect of age, central corneal thickness (CCT), and previous refractive surgery on IOP values. RESULTS: Age, CCT, and LASEK surgery explained 23% of the IOP readings with GAT, 11% with DCT, and had no significant influence on ST readings. The IOP readings obtained with GAT and DCT, but not with ST, were significantly different between LASEK and control groups. Significant differences in Ko were observed between LASEK (0.014 mmHg/µL ±0.007) and control groups (0.021 mmHg/µL ±0.013) (P = 0.001). Ko values were not related with age or CCT, in either LASEK or control groups. CONCLUSIONS: ST readings seems to be less affected by LASEK surgery than the other tonometers evaluated. There is a difference in the ocular rigidity between the control and the LASEK eyes that it is not correlated with CCT, so it seems that ST can detect changes in the biomechanical behavior of the LASEK operated corneas.

Tear Film Osmolarity in Response to Long-Term Orthokeratology Treatment.

PURPOSE: To compare tear film osmolarity (TFO) measurements in non-contact lens (CL) wearers and wearers of hydrogel or overnight orthokeratology (OK) CLs, and to assess possible effects of long-term OK on TFO. METHODS: Overall, 108 subjects with moderate myopia participated in 2 experiments, and TFO was measured using the TearLab osmolarity system. In experiment 1, TFO measurements were made in 77 right eyes of 23 non-CL wearers, 26 hydrogel wearers, and 28 OK wearers. Subjects in the last 2 groups had worn their CL for at least 3 years. In experiment 2, 31 individuals (habitual soft CL wearers) were enrolled for prospective long-term follow-up of OK treatment. These subjects were fitted with Paragon-CRT (n=16) or Seefree (n=15) lenses, and TFO readings were taken at baseline and after 1 month and 1 year of lens wear and after 1 month of OK treatment interruption. RESULTS: Values of TFO were within the normal limits in all 3 subject groups, although significantly lower osmolarities (P<0.01) were observed in non-CL wearers (281.7±5.9 mOsm/L) compared with hydrogel (291±16.5 mOsm/L) or OK lens wearers (301.7±10.8 mOsm/L). In experiment 2, TFO differed significantly at baseline between the Paragon-CRT and Seefree groups (P<0.05), and a significant decrease in TFO compared with baseline (P<0.01) was observed in the Paragon-CRT group after 1 month of cessation of lens wear. CONCLUSION: Higher TFO values were observed in lens wearers (hydrogel or OK) than non-CL wearers. After interruption of OK treatment, TFO returned to similar values to those found in non-CL wearers.

Comparison of Two Topical Lubricants on the Corneal Surface Recovery and Patient Discomfort After Photorefractive Keratectomy.

INTRODUCTION: This study aimed to compare the effect of two preservative-free (PF) artificial tears, one containing carboxymethylcellulose (CMC) (control group) vs another containing hyaluronic acid and hydroxypropyl guar (HA + HP-guar) (study group), on the healing of the corneal epithelium and the ocular discomfort after bilateral photorefractive keratectomy (PRK) surgery. METHODS: A total of 68 patients that were scheduled to have PRK to correct myopia were randomized into two groups: 34 patients (68 eyes) in the study group and 34 patients (68 eyes) in the control group. Ocular examinations were performed on postoperative days 1, 4, 7, 30, and 90, evaluating the diameter of the de-epithelized cornea, the fluorescein staining using the Oxford scale, the tear film osmolarity and stability (tear breakup time), and the pain using visual analog scale (VAS). RESULTS: On postoperative day 4, 97% of the study eyes vs 84.4% of the control eyes were completely re-epithelized (p = 0.01). Less ocular pain was observed on postoperative day 3 in the study group (5.0 (3.0-6.0) vs 6.0 (3.5-7.0), p = 0.03). No differences were observed beyond postoperative day 7 in the healing of the corneal epithelium, non-invasive Keratograph breakup time (NIKBUT), and the self-perceived ocular discomfort between the two groups. CONCLUSION: The current study shows faster healing of the corneal epithelium and less ocular pain and discomfort in the first days after PRK with the use of topical lubricants containing HA + HP-guar compared to conventional CMC artificial tears, probably due to the different trophic effect of the aforementioned tears on the corneal epithelial cells. TRIAL REGISTRATION: EudraCT No. 2020-003488-25.

Creation of a new femtosecond laser-assisted mini-flap to enhance late regression after LASIK.

PURPOSE: To describe a method of LASIK enhancement in which a new femtosecond laser-assisted mini-flap is created over the original LASIK flap. METHODS: The 60-kHz IntraLase femtosecond laser (IntraLase Corp., Irvine, CA) was used to create a new mini-flap over an original LASIK flap for the re-treatment of late regression after LASIK. The diameter of the mini-flap was 7 mm and the attempted flap depth was 100 µm. RESULTS: The procedure was performed on 10 eyes of 7 patients. No intraoperative or postoperative complications developed in any case during the follow-up. At the 6-month follow-up visit, all eyes were within ±0.5 diopters of the targeted refraction. CONCLUSIONS: The preliminary results suggest that creation of a femtosecond laser-assisted mini-flap over a previous LASIK flap seems to be a safe and effective procedure for the enhancement of late regression after LASIK. By creating a femtosecond laser-assisted mini-flap that is smaller in diameter than the original flap, the adhesion of the primary flap edges and peripheral interface remain intact, thus decreasing the risk of dislocation of the original LASIK flap and of losing a sliver of tissue.

Comparison of keratocyte density after femtosecond laser vs mechanical microkeratome from 3 months up to 5 years after LASIK.

BACKGROUND: To compare keratocyte density after mechanical microkeratome LASIK (MK-LASIK) and femtosecond-laser assisted LASIK (FS-LASIK). METHODS: We performed a prospective study of myopic patients that underwent MK-LASIK or FS-LASIK. We measured keratocyte density 3 and 15 months, and 3-5 years after the surgery using confocal microscopy, and compared them with healthy, non-operated corneas. RESULTS: Thirty-one eyes were included in the FS-LASIK group, 30 in the MK-LASIK group and 28 in the control group. Three months postoperatively, there was an increase in the keratocyte population of the whole cornea, mainly due to the mid and posterior stromal layers, in both treatment groups. It was also increased in the stromal bed after MK-LASIK, but not after FS-LASIK. In both groups, this was followed by a normalisation and stabilisation of cell density in those deeper layers 15 months after the surgery. Keratocyte density in the flap and stromal bed was decreased 15 months after FS- and MK-LASIK compared to 3 months postoperatively and compared to controls. It seemed to remain stable thereafter. In spite of this decrease, the average cell density throughout the cornea was not decreased compared to controls at any time point. CONCLUSION: We found a reorganization of keratocytes density after LASIK, with an initial increase, followed by a decrease in the stromal flap and stromal bed 15 months postoperatively, and stable from then onwards, but still maintaining normal average densities in the total cornea. There were no differences between MK- and FS-LASIK.

Orbscan topography in primary open-angle glaucoma.

PURPOSE: To compare anterior and posterior corneal curvatures between eyes with primary open-angle glaucoma (POAG) and healthy eyes. METHODS: This is a prospective, cross-sectional, observer-masked study. A total of 138 white subjects (one eye per patient) were consecutively recruited; 69 eyes had POAG (study group), and the other 69 comprised a group of healthy control eyes matched for age and central corneal pachymetry with the study ones. Exclusion criteria included any corneal or ocular inflammatory disease, previous ocular surgery, or treatment with carbonic anhydrase inhibitors. The same masked observer performed Goldmann applanation tonometry, ultrasound pachymetry, and Orbscan II topography in all cases. Central corneal thickness, intraocular pressure, and anterior and posterior topographic elevation maps were analyzed and compared between both groups. RESULTS: Patients with POAG had greater forward shifting of the posterior corneal surface than that in healthy control eyes (p < 0.01). Significant differences in anterior corneal elevation between controls and POAG eyes were also found (p < 0.01). CONCLUSIONS: Primary open-angle glaucoma eyes have a higher elevation of the posterior corneal surface than that in central corneal thickness-matched nonglaucomatous eyes.

Normative Data for Macular Thickness and Volume for Optical Coherence Tomography in a Diabetic Population without Maculopathies.

PURPOSE: The purpose was to establish normative data for the macular thicknesses and volume using spectral-domain optical coherence tomography (SD-OCT) in a diabetic population without maculopathies for use as a reference in diabetic retinopathy (DR) and diabetic macular edema screening programs. METHODS: This was an observational study nested in a cohort of diabetics from a telemedicine DR screening program. Each patient underwent SD-OCT centered on the fovea. Macular thickness and volume were described and compared using the built-in normative database of the device. Quantile regression models for the 97.5% percentile were fitted to evaluate the predictors of macular thickness and volume. RESULTS: A total of 3410 eyes (mean age, 62.25 (SD, 0.22) years) were included. Mean (SD) central subfield thickness (CST) was 238.2 (23.7) µm, while center thickness (CT), average thickness (AT), and macular volume (MV) were 205.4 (31.6) µm, 263.9 (14.3) µm, and 7.46 (0.40) mm3, respectively. Para- and perifoveal thicknesses were clinically and statistically significantly thinner in our population than in the normative reference database. The 97.5% percentile of the thickness of all sectors was increased in males and in the para- and perifovea among those with DR. CONCLUSIONS: All ETDRS sectors were thinner in patients with diabetes than in the reference population, except for the CST, which was the most stable parameter that only changed with sex. The upper cutoff limit to detect diabetic macular edema (DME) was different from that of the reference population and was influenced by conditions related to diabetes, such as DR. Therefore, specific normative data for diabetic patients should be used for the screening and diagnosis of DME using SD-OCT.

Predictive Value of Dynamic Corneal Response Parameters Evaluated with Scheimpflug High-Speed Video (Corvis ST) on the Visual Field Progression in Prostaglandin Treated Ocular Hypertension and Open-Angle Glaucoma Patients.

INTRODUCTION: The aim of this work is to compare the Corvis ST stress-strain index (SSI) and highest concavity (HC) parameters at baseline and 1 month after initiating monotherapy with prostaglandin analogues (PGs) in eyes showing visual field (VF) progression or stability. METHODS: In this prospective, single-center, observational study, newly diagnosed and treatment-naïve OAG patients were examined at baseline and 1 month after beginning monotherapy with topical PGs monotherapy. Goldmann applanation tonometry pressure readings, Corneal Hysteresis (ORA-CH), and the Corvis ST measurements were obtained at both visits. VF progression (Humphrey) was evaluated based on data from 6 years of follow-up after the baseline visit. Stress-strain index (SSI) and HC parameters in progressing (P) and non-progressing (NP) eyes were the main outcome measures. RESULTS: Sixty-three eyes were analyzed; mean age was 64.63 ± 11.26 years; 47 eyes were NP and 16 eyes were P according to the event analysis performed by the Humphrey device. There were no significant differences in IOP, CCT, or Corvis parameters between NP and P groups at baseline. Nevertheless, at 1 month, the SSI index was 1.60 ± 0.34 vs. 1.80 ± 0.34 (p = 0.003) in NP vs. P eyes, respectively. HC parameters were different between the groups at 1 month (p < 0.05) suggesting an increased scleral rigidity in the P group. There was no significant difference in IOP between groups at 1 month. CONCLUSIONS: The Corvis ST provides a corneal rigidity index (SSI) that seems to be related to VF progression when measured 1 month after initiating PGs monotherapy. Differences in HC parameters, indicative of increased scleral stiffness, are also evident at 1 month on latanoprost in the P eyes.

Three-year multinational clinical study on an aspheric hydrophobic acrylic intraocular lens.

PURPOSE: To present the results of a study investigating the 3-year effectiveness and safety of the Clareon single-piece intraocular lens (IOL). SETTING: 19 multinational sites. DESIGN: Prospective multicenter single-arm study. METHODS: Patients were bilaterally implanted with Clareon IOLs. Assessments included uncorrected distance visual acuity, corrected distance visual acuity (CDVA), manifest refraction, tilt, decentration, applanation tonometry, and fundus examination, including glistenings and posterior capsule opacification (PCO) evaluation. The primary outcomes for effectiveness and safety were evaluated at 1 year and compared with ISO historical safety and performance endpoint (SPE) rates. Patients were followed for up to 3 years after implantation. RESULTS: 424 eyes of 215 patients were implanted (n = 215 first eye, n = 209 second eye), and 183 patients completed the trial at 3 years (with 364 binocular and 1 monocular patient). At 1 year, the cumulative and persistent adverse event rates were below SPE targets, and 99.5% of eyes achieved a monocular CDVA of ≤0.3 logMAR (vs the SPE target of 92.5%). At 3 years, the mean monocular CDVA was -0.032, with 93.4% (341/365) of eyes achieving a CDVA of 0.1 logMAR or better, 100% of eyes presented with grade 0 glistenings ≤25 MV/mm 2 , and 92.9% of eyes (394/424) had either no PCO or clinically nonsignificant PCO. CONCLUSIONS: This study supports the long-term safety and effectiveness of the Clareon IOL. The visual outcomes were excellent and stable over the 3-year study period, PCO rates were very low, and 100% of IOLs had grade 0 glistenings.

Selective Focal Laser Therapy as the Primary Treatment for Exudative Perifoveal Vascular Anomalous Complex (ePVAC): Case Series and Literature Review.

Perifoveal anomalous exudative vascular complex (PEVAC) was first described in 2011. Since then, individual clinical cases and a couple of case series have been published, and their characteristics have been studied in multi-modal images. To date, there is no consensus on its treatment. Initially, it was thought that PEVACs could be left to spontaneous evolution because they presented a slow progression. But it has been shown that the growth of the lesion covers a spectrum from non-exudative lesions to PEVAC with vision impairment over time. We present an updated bibliographic review of this pathology. We explain the changes in the diagnostic criteria that have been undergone. And we focus the discussion on selective treatment with focal laser, which has shown an excellent anatomical response and visual improvement or stabilization in the cases described and in our series of three patients systematically treated with focal laser. [Ophthalmic Surg Lasers Imaging Retina 2023;54:43-49.].