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PURPOSE: To clinically evaluate visual performance of the AcrySof IQ PanOptix TFNT00 and AT LISA tri 839MP intraocular lenses (IOLs) in binocular visual acuity (VA) and to characterize low-contrast visual performance at 6 months postimplantation. SETTING: Multicenter, 15 sites. DESIGN: Prospective, parallel-group, randomized, double-masked, postmarketing clinical study. METHODS: Binocular uncorrected distance (UDVA, 4 m), intermediate (UIVA, 60 cm), and near (UNVA, 40 cm) visual acuities and binocular defocus curves were evaluated under photopic lighting conditions. Photopic and mesopic contrast sensitivities with and without glare were assessed. RESULTS: The study included 182 subjects (62% women; mean age, 66 ± 9.4 years) who were implanted bilaterally with the TFNT00 IOL (n = 93) or 839MP IOL (n = 89), and binocular VA was evaluated 4 to 6 months (120-180 days) postimplantation. The TFNT00 IOL group showed superior visual outcomes compared with the 839MP IOL group in binocular UIVA (P = .001) and UNVA (P = .003) and noninferior outcomes in UDVA (95% CI, -0.023 to 0.041; upper limit <0.1 logarithm of the minimum angle of resolution [logMAR] [margin of noninferiority]). Mean defocus curve from 0.00 to -3.00 diopter (D) ranged from 0.1 to 0.0 logMAR for both IOLs; better mean VA values (logMAR) were observed in the TFNT00 IOL group between -1.50 and -2.50 D compared with those of the 839MP IOL group. Contrast sensitivity values were similar between the 2 groups in all conditions. CONCLUSIONS: The results of this study showed improved visual performance at near and intermediate distances with the TFNT00 IOL compared with that of the 839MP IOL.

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We report intraoperative finding of Granular Corneal Dystrophy Type-1 (GCD1) deposits after stromal pneumodissection in deep anterior lamellar keratoplasty (DALK) in a 61-year-old female. Pneumodissection was performed from the center to the periphery of the cornea, characterizing a big bubble type 1 technique which dissects the deep stroma from the predescemetic layer. After stromal removal, persistence of whitish deposits inside the predescemetic layer was noted. During post-operative evaluation, anterior biomicroscopy and anterior segment optical coherence tomography showed granular opacities between the patient's Descemet's membrane and the donor cornea, suggesting possible involvement of the predescemetic layer in GCD1. This may require the surgeon's attention to choose between DALK keratoplasty or penetrating keratoplasty.

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ABSTRACT We report intraoperative finding of Granular Corneal Dystrophy Type-1 (GCD1) deposits after stromal pneumodissection in deep anterior lamellar keratoplasty (DALK) in a 61-year-old female. Pneumodissection was performed from the center to the periphery of the cornea, characterizing a big bubble type 1 technique which dissects the deep stroma from the predescemetic layer. After stromal removal, persistence of whitish deposits inside the predescemetic layer was noted. During post-operative evaluation, anterior biomicroscopy and anterior segment optical coherence tomography showed granular opacities between the patient's Descemet's membrane and the donor cornea, suggesting possible involvement of the predescemetic layer in GCD1. This may require the surgeon's attention to choose between DALK keratoplasty or penetrating keratoplasty.

RESUMO Relatamos o achado intraoperatório de persistência dos depósitos de Distrofia Granular Tipo 1 (GCD1) após pneumodissecção estromal no transplante de córnea lamelar anterior profundo (DALK) em uma mulher de 61 anos. A pneumodissecção começou a partir do centro para a periferia da córnea, caracterizando uma big bubble tipo 1, que disseca o estroma profundo da camada pré-Descemet. Após a remoção do estroma, notamos a persistência de depósitos esbranquiçados no interior da camada pré-Descemet. Na avaliação pós-operatória, a biomicroscopia anterior e a tomografia de coerência óptica do segmento anterior evidenciaram opacidades granulares entre a membrana de Descemet e a córnea doadora, sugerindo o possível envolvimento da camada pré-Descemet na GCD1, o que pode chamar atenção do cirurgião para decidir entre manter o DALK ou converter para transplante penetrante.

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Objetivo: Analisar a secreção lacrimal, coloração da superfície ocular e estabilidade do filme lacrimal em indivíduos submetidos à cirurgia de PRK e LASIK com laser de femtossegundo (femto LASIK). Métodos: Vinte olhos de 10 pacientes submetidos à técnica de Femto LASIK e 11 olhos de 6 pacientes submetidos à técnica de PRK foram estudados de forma prospectiva, longitudinal e intervencionista. Tempo de rotura do filme lacrimal (TRFL), teste de Schirmer basal e coloração da superfície ocular com lissamina verde foram analisados no pré-operatório (pré), no 15º e no 30º dia pós-operatório (15º pós e 30º pós, respectivamente). Resultados: Agrupando todos os olhos, observou-se que o TRFL reduziu-se de forma estatisticamente significante no 15º pós em relação ao valor pré-operatório (p=0,025), mantendo-se reduzido no 30º pós (p= 0,001); não houve diferença estatisticamente significativa entre o 15º pós e o 30º pós (p=0,219). No teste da lissamina verde, houve aumento significativo desse escore, no 15º pós em relação ao período pré-operatório (p=0,021), havendo, posteriormente, redução no 30º pós (p=0,010). No teste de Schirmer basal, não foi detectada mudança estatisticamente significante ao longo dos três momentos (p=0,107). Comparando-se os testes TRFL, lissamina verde ou Schirmer basal, nos dois grupos estudados (PRK e LASIK), não houve diferença estatisticamente significante em nenhum dos três momentos (pré, 15º pós e 30º pós). Conclusão: Evidenciou-se alteração do filme lacrimal nos pacientes submetidos à cirurgia refrativa, quando foram utilizados os testes de TRFL e lissamina verde. Nas duas técnicas empregadas, não houve diferença estatisticamente significante de alteração do filme lacrimal, quando comparadas entre si (PRK e LASIK). .

Purpose: To evaluate tear film stability, ocular surface staining and tear secretion in patients undergoing PRK and femtosecond laser LASIK. Methods: Twenty eyes of 10 patients submitted to femtosecond laser LASIK and 11 eyes of the 6 patients submitted do PRK underwent tear film break-up time (TBUT), Schirmer’s basal and lissamine green staining measurements pre and postoperatively on days 15 (PO 15) and 30 (PO 30). Results: When grouping all eyes TBUT was reduced on PO 15 (p=0.025) and on PO 30 (p=0.001) compared to preoperative values. No difference was found between PO 15 and PO 30 (p=0.219). Compared to preoperative measurements, lissamine green test demonstrated a significant increase in score on PO 15 (p=0.021) and a significant reduction on PO 30 (p=0.010), when both groups were analyzed together (all 42 eyes). No changes in Schirmer’s basal test were detected in all 3 time periods (p=0.107). TBUT, lissamine green and Schirmer’s basal measurements were no different in all 3 time periods when both groups (PRK and femtosecond laser LASIK) were compared. Conclusion: TBUT and lissamine green measurements were altered after refractive surgery regardless the technique (PRK or femtosecond laser LASIK). When comparing one technique to the other, no difference was found in all measurements. .

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OBJECTIVE: To assess the visual quality of life in patients with multiple sclerosis (MS), and to observe whether this parameter could be correlated to the findings of the ophthalmologic examination. METHOD: The translated and validated 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was used to assess the visual quality of life. Clinical data on MS, visual acuity, visual fields, optic coherence tomography (OCT) and disc cupping were used for assessing correlation with VFQ-25. RESULTS: The mean VFQ-25 value was 78.6 ± 18.2% in 27 patients. VFQ-25 did not correlate with patients' ages, with disability (EDSS), disease duration or medication use. Visual acuity showed a relatively poor (<60%) correlation to VFQ-25, while no correlation could be established between visual fields, OCT and disc cupping with VFQ-25. CONCLUSION: MS patients present several alterations in their eyes and sight that cannot be assessed by isolated measures. Ophthalmological examination of these patients must include many parameters not usually used in standard ophthalmologic consultations.

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OBJECTIVE: To assess the visual quality of life in patients with multiple sclerosis (MS), and to observe whether this parameter could be correlated to the findings of the ophthalmologic examination. METHOD: The translated and validated 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) was used to assess the visual quality of life. Clinical data on MS, visual acuity, visual fields, optic coherence tomography (OCT) and disc cupping were used for assessing correlation with VFQ-25. RESULTS: The mean VFQ-25 value was 78.6±18.2 percent in 27 patients. VFQ-25 did not correlate with patients' ages, with disability (EDSS), disease duration or medication use. Visual acuity showed a relatively poor (<60 percent) correlation to VFQ-25, while no correlation could be established between visual fields, OCT and disc cupping with VFQ-25. CONCLUSION: MS patients present several alterations in their eyes and sight that cannot be assessed by isolated measures. Ophthalmological examination of these patients must include many parameters not usually used in standard ophthalmologic consultations.

OBJETIVO: Avaliar a qualidade de vida visual de pacientes com esclerose múltipla (EM) e observar se este parâmetro pode ser relacionado aos achados do exame oftalmológico. MÉTODO: O questionário traduzido e validado 25-Item National Eye Institute Visual Function Questionnaire (VFQ-25) foi utilizado para avaliar a qualidade de vida visual. Dados clínicos da EM, acuidade visual, campo visual, tomografia de coerência óptica (OCT) e escavação do disco foram utilizados para correlação com VFQ-25. RESULTADOS: A média do VFQ-25 foi 78,6±18,2 por cento em 27 pacientes. VFQ-25 não se correlacionou com a idade dos pacientes, com a incapacidade (EDSS), duração da doença ou medicação em uso. A acuidade visual mostrou uma correlação relativamente pobre (<60 por cento) com VFQ-25, enquanto não foi observada nenhuma correlação entre campo visual, OCT e escavação de disco com VFQ-25. CONCLUSÃO: Pacientes com EM apresentam diversas alterações oculares e na visão que não podem ser avaliadas por medidas isoladas. O exame oftalmológico destes pacientes deve incluir parâmetros que não são habitualmente utilizados em consultas oftalmológicas padronizadas.

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