RESUMEN

Purpose: To evaluate the efficacy of anti-suppression exercises in children with small-angle esotropia in achieving binocular vision. Methods: A retrospective review of patients aged 3–8 years who underwent anti-suppression exercises for either monocular or alternate suppression between January 2016 and December 2021 was conducted. Patients with esotropia less than 15 prism diopters (PD) and visual acuity ≥ 6/12 were included. Patients with previous intra-ocular surgery or less than three-month follow-up were excluded. Success was defined as the development of binocular single vision (BSV) for distance, near, or both (measured clinically with either the 4 prism base out test or Worth four dot test) and maintained at two consecutive visits. Qualified success was defined as the presence of diplopia response for both distance and near. Additionally, improvement in near stereo acuity was measured using the Stereo Fly test. Results: Eighteen patients with a mean age of 5.4 ± 1.38 years (range 3–8 years) at the time of initiation of exercises were included in the study. The male female ratio was 10:8. The mean best corrected visual acuity was 0.18 LogMAR unit(s) and the mean spherical equivalent was +3.8 ± 0.14 diopters (D). The etiology of the esotropia was fully accommodative refractive esotropia (8), microtropia (1), post–operative infantile esotropia (4), partially accommodative esotropia (1), and post-operative partially accommodative esotropia (4). Patients received either office-based, home-based, or both modes of treatment for an average duration of 4.8 months (range 3–8). After therapy, BSV was achieved for either distance or near in 66.6 % of patients (95 % CI = 40.03–93.31 %). Binocular single vision for both distance and near was seen in 50 % of children. Qualified success was observed in 38.46% of patients. Persistence of suppression was observed in one patient (5.5 %)... (AU)

Asunto(s)

Humanos , Niño , Supresión , Visión Binocular , Esotropía , Agudeza Visual , Terapéutica

RESUMEN

Purpose: To compare the eye defocus curves (DCs) obtained with stimuli on red, green, and white backgrounds and to investigate the applicability of the duochrome test (DT) in different age groups. Methods: 12 elderly (ELD: 59.3 ± 3.9 years) and 8 young (YG: 22.1 ± 1.1 years) subjects were recruited. An optometric assessment with the DT was carried out to obtain the subjective refraction at distance. DCs at distance on green, white, and red backgrounds were measured and the following parameters were deduced: dioptric difference between red-green, green-white, red-white focal positions (minima of the DCs), best corrected visual acuity (BCVA), and widths of the DCs for red, green, and white. Results: The DC difference between the green-white focal positions (mean ± standard deviation) was -0.12±0.17 diopters (D) (ELD, p = 0.012) and -0.11±0.12 D (YG, p = 0.039), while the red-white difference was not statistically significant. The DC red-green difference was 0.20±0.16 D (ELD, p = 0.002) and 0.18±0.18 D (YG, p = 0.008). The ELD BCVA with green background was significantly worse than BCVA with red (p = 0.007) and white (p = 0.007). The mean value of the DC's width in ELD for green (1.01±0.36 D) was higher than for red (0.77±0.21 D) and for white (0.84±0.35 D), but with no statistical significance. Conclusion: Both age groups showed a slight focusing preference for red when using white light. Moreover, ELD showed a worse BCVA with a green compared to a red background. Despite these results deduced by DC analyses, these aspects do not compromise the possibility of using the DT in clinical practice both in the young and in the elderly. Furthermore, the difference of about 0.20 D between red-green DC in both groups confirms the clinical appropriateness of the widespread use of 0.25 D step as the standard minimum difference in power between correcting lenses.(AU)

Asunto(s)

Humanos , Masculino , Femenino , Adulto Joven , Anciano , Visión Ocular , Agudeza Visual , Fondo de Ojo , Lentes de Contacto , Pruebas de Visión

RESUMEN

Perioperative vision loss following non-ophthalmic surgical procedures represents a rare but potentially serious complication. Although its occurrence in urology is infrequent, the consequences for patients and legal implications are significant. We present the case of a 53-year-old woman with no notable medical history, treated for renal lithiasis. Following the ureteroscopy, the patient experienced a sudden reduction in visual acuity. The diagnosis made was that of posterior ischemic optic neuropathy. This case illustrates a rare complication associated with ureteroscopy, highlighting the importance of increased awareness and rigorous postoperative monitoring, especially in patients with risk factors such as anemia or hypertension. Fortunately, the patient's rapid and complete recovery is encouraging, suggesting that early identification and appropriate management can lead to a favorable prognosis.

Asunto(s)

Ceguera , Neuropatía Óptica Isquémica , Complicaciones Posoperatorias , Ureteroscopía , Humanos , Femenino , Persona de Mediana Edad , Ureteroscopía/efectos adversos , Ureteroscopía/métodos , Ceguera/etiología , Ceguera/diagnóstico , Neuropatía Óptica Isquémica/etiología , Neuropatía Óptica Isquémica/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Agudeza Visual , Cálculos Renales/cirugía , Factores de Riesgo

RESUMEN

OBJECTIVES: Anti-vascular endothelial growth factor (VEGF) therapy restores retinal architecture and enhances vision in diabetic macular edema (DME). Bevacizumab is an off-label anti-VEGF drug that effectively treats DME. The safety and efficacy of bevacizumab biosimilars, which are more affordable than the original medication, still need to be established. This study aimed to assess the cost-effectiveness, efficacy, and safety of biosimilars for treating patients with naïve DME across various price ranges that are accessible in the Indian market. MATERIALS AND METHODS: Two biosimilars, BevaciRelTM (Reliance Life Sciences Pvt. Ltd.) and ZyBev (Cadila Healthcare Limited), were compared to their original, Avastin (Roche Products [India] Pvt. Ltd.), in a randomized, control study. Three end-notes were used to assess safety and efficacy: persistence, improvement, and adverse events. Cost-effective analysis was carried out using a decision-tree analysis model. RESULTS: This study included 69 (59%) men and 54 (41%) women with naïve DME. The cohort had an average log MAR visual acuity of 0.87 ± 0.22, and the central retinal thickness at baseline on OCT was 398.5 ± 37.61 µm. The visual acuity showed a similar improvement, and there was a decrease in central retinal thickness as observed on OCT across the groups. The incremental cost-effectiveness ratio was 10.8. CONCLUSIONS: The biosimilars of bevacizumab are safe and efficacious in treating DME in a cost-effective manner.

Asunto(s)

Inhibidores de la Angiogénesis , Bevacizumab , Biosimilares Farmacéuticos , Análisis Costo-Beneficio , Retinopatía Diabética , Edema Macular , Humanos , Bevacizumab/uso terapéutico , Bevacizumab/economía , Edema Macular/tratamiento farmacológico , Biosimilares Farmacéuticos/economía , Biosimilares Farmacéuticos/uso terapéutico , Biosimilares Farmacéuticos/administración & dosificación , Masculino , Femenino , Retinopatía Diabética/tratamiento farmacológico , Retinopatía Diabética/economía , Inhibidores de la Angiogénesis/economía , Inhibidores de la Angiogénesis/uso terapéutico , Inhibidores de la Angiogénesis/efectos adversos , Inhibidores de la Angiogénesis/administración & dosificación , Persona de Mediana Edad , Resultado del Tratamiento , Anciano , Agudeza Visual , India , Adulto

Asunto(s)

Hiperopía , Queratomileusis por Láser In Situ , Agudeza Visual , Humanos , Queratomileusis por Láser In Situ/métodos , Hiperopía/cirugía , Hiperopía/fisiopatología , Agudeza Visual/fisiología , Recuperación de la Función/fisiología , Láseres de Excímeros/uso terapéutico , Periodo Intraoperatorio

RESUMEN

PURPOSE: To compare the clinical and aberrometric outcomes obtained with a new diffractive pentafocal intraocular lens (IOL) and a diffractive trifocal IOL. METHODS: Patients bilaterally implanted with the pentafocal Intensity SeeLens IOL (Hanita Lenses) (n = 30) and the trifocal FineVision POD F IOL (PhysIOL) (n = 30) during cataract surgery were studied after 1 month for refraction, visual acuity, defocus curve, contrast sensitivity, Hartmann-Shack aberration, and double-pass aberration. The Quality of Vision (QoV) questionnaire was used to evaluate visual comfort. RESULTS: Distance and near visual acuities were similar with the two IOLs, but distance-corrected intermediate visual acuity was better with the Intensity IOLs (0.03 ± 0.04 vs 0.11 ± 0.04 logMAR in the FineVision eyes, P < .01). The difference between objective and subjective refraction was more myopic for the Intensity IOL (-1.15 vs -0.29 diopters [D]). The defocus curve was flatter with the Intensity IOL. Contrast sensitivity was similar in both IOLs. Hartmann-Shack aberration and double-pass aberration were similar, but the modulation transfer function cut-off value was worse with the Intensity IOL: 11.6 ± 2.7 vs 15.3 ± 4.9 (P < .01). QoV scores were better with the Intensity IOL, in particular for glare, halos, and starburst. CONCLUSIONS: In this comparative series, the pentafocal Intensity IOL provided better intermediate vision and better defocus curve than the FineVision IOL, with comparable distance and near vision. The optical disturbances as reported by the patients were higher with the FineVision IOL. Additional studies will better define the aberration profile obtained with the pentafocal IOL. [J Refract Surg. 2024;40(9):e604-e613.].

Asunto(s)

Sensibilidad de Contraste , Implantación de Lentes Intraoculares , Lentes Intraoculares Multifocales , Facoemulsificación , Diseño de Prótesis , Seudofaquia , Refracción Ocular , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Refracción Ocular/fisiología , Sensibilidad de Contraste/fisiología , Femenino , Masculino , Seudofaquia/fisiopatología , Anciano , Persona de Mediana Edad , Encuestas y Cuestionarios , Estudios Prospectivos , Satisfacción del Paciente , Aberrometría , Lentes Intraoculares , Aberración de Frente de Onda Corneal/fisiopatología

RESUMEN

PURPOSE: To compare the postoperative outcomes following implantation of KERATACx ring segments (Imperial Medical Technologies Europe GmbH) in patients having eccentric keratoconus with three different topographic patterns. METHODS: This retrospective cohort study was conducted at Maadi Eye Subspeciality Center, Cairo, Egypt. The study included patients with keratoconus who had implantation of KERATACx ring segments. Three groups were segregated based on topographic keratoconus patterns using the Sirius CSO Topographer (CSO Italia): type I ectasia where the cone coincides with the corneal flat axis, type II ectasia in which the cone coincides with neither the steep nor the flat axis and lies between the two axes, and type II ectasia for cones coinciding with the corneal steep axis. The visual and topographic outcomes were compared preoperatively and postoperatively for the three enrolled groups. RESULTS: This study enrolled 92 eyes of 92 patients and had a mean ± standard deviation follow-up of 16.9 ± 9.2 months. The patients' medical records revealed that night vision complaints and halos around the light were experienced the most by the type III ectasia group (31.25%). For the type III ectasia group, four topographic indices and one visual parameter did not show statistically significant differences between the preoperative and postoperative data (inferior-superior difference at 2- and 4-mm diameter, coma aberration, higher order aberrations, and uncorrected distance visual acuity), contrary to the type I and II ectasia groups, which showed significant improvements in all evaluated parameters. CONCLUSIONS: The type III morphological pattern of ectasia is the least likely to benefit from KERATACx ring segments implantation. [J Refract Surg. 2024;40(9):e625-e634.].

Asunto(s)

Sustancia Propia , Topografía de la Córnea , Queratocono , Prótesis e Implantes , Implantación de Prótesis , Agudeza Visual , Humanos , Queratocono/cirugía , Queratocono/fisiopatología , Estudios Retrospectivos , Agudeza Visual/fisiología , Masculino , Femenino , Sustancia Propia/cirugía , Sustancia Propia/patología , Adulto , Adulto Joven , Estudios de Seguimiento , Refracción Ocular/fisiología , Adolescente , Resultado del Tratamiento , Periodo Posoperatorio

RESUMEN

PURPOSE: To evaluate the intrasession repeatability of wavefront aberrations obtained by a combined adaptive optics visual simulator and Hartman-Shack aberrometer in pseudophakic eyes with and without previous corneal refractive surgery. METHODS: Three consecutive measurements were performed in one eye of each individual. Total ocular aberrations were recorded up to the 5th Zernike order for a 4.5-mm pupil. Repeatability was assessed by calculating the within-subject standard deviation (Sw), the repeatability limit (R), and the intraclass correlation coefficient (ICC). Vector analysis was performed to assess astigmatism variability between scans. RESULTS: The study enrolled 32 normal individuals and 24 individuals with a history of refractive surgery. In normal and eyes that had previous refractive surgery, respectively, the Sw values were 0.155 and 0.176 diopters (D) for sphere and 0.184 and 0.265 D for cylinder. The Sw values for all 3rd order terms ranged from 0.037 to 0.047 µm in normal eyes and 0.044 to 0.063 µm in eyes that had previous refractive surgery. The Sw for primary spherical aberration was 0.020 µm in normal eyes and 0.026 µm in eyes that had previous refractive surgery. ICC values for measurements of astigmatism yielded larger variability (ICC = 0.751 and 0.879). However, both groups demonstrated excellent repeatability (ICC > 0.9) for root mean square higher order aberrations (RMS-HOA) and total RMS values. CONCLUSIONS: In pseudophakic eyes, the adaptive optics Hartmann-Shack device demonstrated acceptable repeatability for measurement of sphere and 3rd and 4th order HOAs with higher variability for astigmatism measurements, especially in eyes with a prior history of corneal refractive surgery. [J Refract Surg. 2024;40(9):e645-e653.].

Asunto(s)

Aberrometría , Aberración de Frente de Onda Corneal , Seudofaquia , Refracción Ocular , Agudeza Visual , Humanos , Seudofaquia/fisiopatología , Aberración de Frente de Onda Corneal/fisiopatología , Reproducibilidad de los Resultados , Femenino , Persona de Mediana Edad , Masculino , Adulto , Agudeza Visual/fisiología , Refracción Ocular/fisiología , Anciano , Topografía de la Córnea , Procedimientos Quirúrgicos Refractivos , Óptica y Fotónica , Estudios Prospectivos , Córnea/fisiopatología

RESUMEN

PURPOSE: To compare haze and refractive outcomes in patients undergoing combined accelerated corneal cross-linking (A-CXL) and selective wavefront-guided transepithelial photorefractive keratectomy (WG-transPRK) without mitomycin C (MMC) versus those undergoing A-CXL. METHODS: This prospective study analyzed 95 eyes (86 patients) with progressive keratoconus from October 2018 to October 2022. The first group underwent CXL combined with corneal or ocular WG-transPRK (CXL+PRK, n = 52), targeting higher order aberrations (HOAs). The second underwent CXL only (n = 43), both following the same accelerated CXL protocol without MMC on the SCHWIND Amaris laser platform (SCHWIND eye-tech-solutions). Baseline and postoperative evaluations (1, 3, 6, and 12 months) included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, tomography, corneal HOAs, and optical coherence tomography (OCT) scans. A patented machine learning algorithm objectively detected and quantified stromal haze on OCT scans in grayscale units. RESULTS: In both groups, anterior corneal haze reflectivity and subepithelial haze peaked at 3 months postoperatively, then progressively decreased at 6 and 12 months. Haze did not differ between groups at any time point. By 12 months, CDVA increased by 2.5 lines in the CXL+PRK group (P < .001) and by 0.7 lines in the CXL group (P = .10), and maximum keratometry decreased from 51.70 ± 5.10 to 47.90 ± 7.90 diopters (D) (CXL+PRK group) (P < .001) and from 51.20 ± 5.10 to 50.30 ± 4.60 D (CXL group) (P = .004). Corneal HOAs decreased in both groups but more in the CXL+PRK group. CONCLUSIONS: Combining CXL with WG-transPRK without MMC does not result in increased haze when compared to A-CXL alone. This combined approach achieves greater improvements in visual, topographic, and aberrometric parameters. [J Refract Surg. 2024;40(9):e583-e594.].

Asunto(s)

Colágeno , Opacidad de la Córnea , Sustancia Propia , Topografía de la Córnea , Reactivos de Enlaces Cruzados , Queratocono , Láseres de Excímeros , Mitomicina , Fotoquimioterapia , Queratectomía Fotorrefractiva , Fármacos Fotosensibilizantes , Refracción Ocular , Riboflavina , Tomografía de Coherencia Óptica , Agudeza Visual , Humanos , Estudios Prospectivos , Queratectomía Fotorrefractiva/métodos , Reactivos de Enlaces Cruzados/uso terapéutico , Agudeza Visual/fisiología , Femenino , Fármacos Fotosensibilizantes/uso terapéutico , Masculino , Mitomicina/administración & dosificación , Refracción Ocular/fisiología , Adulto , Queratocono/tratamiento farmacológico , Queratocono/fisiopatología , Queratocono/metabolismo , Riboflavina/uso terapéutico , Láseres de Excímeros/uso terapéutico , Sustancia Propia/metabolismo , Fotoquimioterapia/métodos , Opacidad de la Córnea/fisiopatología , Opacidad de la Córnea/etiología , Colágeno/metabolismo , Adulto Joven , Rayos Ultravioleta , Terapia Combinada , Reticulación Corneal

RESUMEN

PURPOSE: To report 12-month visual and refractive outcomes following topography-guided femtosecond laser-assisted laser in situ keratomileusis (LASIK) for myopia and compound myopic astigmatism correction. METHODS: This prospective, single-center observational study was conducted in an outpatient clinical practice at the Stanford University Byers Eye Institute in Palo Alto, California. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, 5% and 25% contrast sensitivity CDVA, and manifest refraction following topography-guided femtosecond laser-assisted LASIK were assessed. Refractive measurements were used to perform a vector analysis. RESULTS: Sixty eyes of 30 patients (mean age: 32.8 ± 7.0 years; range: 23 to 52 years) undergoing topography-guided LASIK for the correction of myopia and compound myopic astigmatism were analyzed. Mean postoperative UDVA was -0.09 ± 0.10 logarithm of the minimum angle of resolution (logMAR) at 12 months. Mean preoperative CDVA was -0.09 ± 0.09 and -0.13 ± 0.08 logMAR at postoperative 12 months. At 12 months, 26.9% of eyes had gained one or more lines of postoperative UDVA compared to baseline CDVA. Mean pre-operative 5% contrast sensitivity CDVA was 0.68 ± 0.07 and 0.64 ± 0.12 logMAR at 12 months (P = .014) following LASIK. CONCLUSIONS: Topography-guided LASIK for myopia and myopic astigmatism correction provided excellent visual and refractive outcomes that were predictable, precise, and stable up to 12 months postoperatively. [J Refract Surg. 2024;40(9):e595-e603.].

Asunto(s)

Astigmatismo , Topografía de la Córnea , Queratomileusis por Láser In Situ , Láseres de Excímeros , Miopía , Refracción Ocular , Cirugía Asistida por Computador , Agudeza Visual , Humanos , Queratomileusis por Láser In Situ/métodos , Agudeza Visual/fisiología , Astigmatismo/cirugía , Astigmatismo/fisiopatología , Estudios Prospectivos , Miopía/cirugía , Miopía/fisiopatología , Refracción Ocular/fisiología , Adulto , Masculino , Femenino , Adulto Joven , Láseres de Excímeros/uso terapéutico , Persona de Mediana Edad , Cirugía Asistida por Computador/métodos , Sensibilidad de Contraste/fisiología , Resultado del Tratamiento , Estudios de Seguimiento

Asunto(s)

Hiperopía , Queratomileusis por Láser In Situ , Láseres de Excímeros , Recuperación de la Función , Agudeza Visual , Humanos , Queratomileusis por Láser In Situ/métodos , Hiperopía/cirugía , Hiperopía/fisiopatología , Agudeza Visual/fisiología , Láseres de Excímeros/uso terapéutico , Recuperación de la Función/fisiología , Refracción Ocular/fisiología

Asunto(s)

Astigmatismo , Córnea , Topografía de la Córnea , Aberración de Frente de Onda Corneal , Refracción Ocular , Humanos , Astigmatismo/fisiopatología , Astigmatismo/diagnóstico , Refracción Ocular/fisiología , Córnea/fisiopatología , Córnea/patología , Aberración de Frente de Onda Corneal/fisiopatología , Aberración de Frente de Onda Corneal/diagnóstico , Masculino , Adulto , Femenino , Voluntarios Sanos , Agudeza Visual/fisiología , Adulto Joven

RESUMEN

PURPOSE: To investigate the impact of back-to-front corneal radius ratio (B/F ratio) and posterior keratometry (PK) on the accuracy of intraocular lens power calculation formulas in eyes after myopic laser in situ keratomileusis (LASIK)/photorefractive keratectomy (PRK) surgery. METHODS: A retrospective, consecutive case series study included 101 patients (132 eyes) with cataract after myopic LASIK/PRK. Mean prediction error (PE), mean absolute PE (MAE), median absolute error (MedAE), and the percentage of eyes within ±0.25, ±0.50, and ±1.00 diopters (D) of PE were determined. RESULTS: The Barrett True K-TK formula exhibited the lowest MAE (0.59 D) and MedAE (0.48 D) and the highest percentage of eyes within ±0.50 D of PE (54.55%) in total. In eyes with a B/F ratio of 0.70 or less and PK of -5.70 D or greater, the Potvin-Hill formula displayed the lowest MAE (0.46 to 0.67 D). CONCLUSIONS: The Barrett True-TK exhibited the highest prediction accuracy in eyes after myopic LASIK/PRK overall. However, for eyes with a low B/F ratio and flat PK, the Potvin-Hill performed best. [J Refract Surg. 2024;40(9):e635-e644.].

Asunto(s)

Biometría , Córnea , Queratomileusis por Láser In Situ , Láseres de Excímeros , Implantación de Lentes Intraoculares , Lentes Intraoculares , Miopía , Queratectomía Fotorrefractiva , Refracción Ocular , Agudeza Visual , Humanos , Miopía/cirugía , Miopía/fisiopatología , Queratomileusis por Láser In Situ/métodos , Estudios Retrospectivos , Queratectomía Fotorrefractiva/métodos , Femenino , Masculino , Córnea/patología , Córnea/cirugía , Refracción Ocular/fisiología , Adulto , Persona de Mediana Edad , Láseres de Excímeros/uso terapéutico , Agudeza Visual/fisiología , Biometría/métodos , Óptica y Fotónica , Topografía de la Córnea , Reproducibilidad de los Resultados , Adulto Joven , Facoemulsificación

RESUMEN

PURPOSE: To evaluate the influence of a capsular tension ring (CTR) on the intraocular lens (IOL)-capsule complex after cataract surgery in patients with long axial length. METHODS: This was a prospective study. Patients underwent phacoemulsification and IOL implantation, with or without CTR implantation. Swept-source optical coherence tomography was performed at 1 day, 1 week, 1 month, and 3 months postoperatively to determine the postoperative aqueous depth (PAD), capsular bend index (CBI), and IOL tilt and decentration. Spherical equivalent values were obtained through subjective refraction and autorefraction. Root mean square was adopted to evaluate the indices listed above. RESULTS: Forty-three patients (56 eyes) were included in the study. Generalized estimating equation analysis of PAD showed a statistical difference between groups (P = .031). The RMS of the change in PAD was smaller in the CTR group than in the non-CTR group during the 3 months after surgery (P = .015). CBI in the CTR group increased more from 1 to 3 months after surgery than that in the non-CTR group (P = .025). The RMS of the change in vertical decentration was smaller in the CTR group than in the non-CTR group during the 3-month follow-up (P = .009). CONCLUSIONS: CTR implantation can stabilize the axial position of the IOL within the capsular bag after cataract surgery in patients with long axial length without affecting the refractive stability. The formation of capsular bend may be slightly delayed in the early stage after CTR implantation, but it accelerates from 1 to 3 months after surgery. [J Refract Surg. 2024;40(9):e654-e661.].

Asunto(s)

Longitud Axial del Ojo , Cápsula del Cristalino , Implantación de Lentes Intraoculares , Lentes Intraoculares , Facoemulsificación , Refracción Ocular , Tomografía de Coherencia Óptica , Agudeza Visual , Humanos , Estudios Prospectivos , Masculino , Femenino , Anciano , Longitud Axial del Ojo/patología , Agudeza Visual/fisiología , Persona de Mediana Edad , Cápsula del Cristalino/patología , Cápsula del Cristalino/cirugía , Cápsula del Cristalino/diagnóstico por imagen , Refracción Ocular/fisiología , Prótesis e Implantes , Seudofaquia/fisiopatología

RESUMEN

PURPOSE: To determine the misclassification rate of the keratoconus percentage (KISA%) index efficacy in eyes with progressive keratoconus. METHODS: This was a retrospective case-control study of consecutive patients with confirmed progressive keratoconus and a contemporaneous normal control group with 1.00 diopters or greater regular astigmatism. Scheimpflug imaging (Pentacam HR) was obtained for all patients. KISA% index and inferior-superior (IS) values were obtained from the Pentacam topometric/keratoconus staging map. Receiver operating characteristic curves were generated to determine the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity values. RESULTS: There were 160 eyes from 160 patients evaluated, including 80 eyes from 80 patients with progressive keratoconus and 80 eyes from 80 control patients. There were 20 eyes (25%) with progressive keratoconus misclassified by the KISA% index, with 16 eyes (20%) of the progressive keratoconus cohort classified as normal (ie, KISA% < 60). There were 4 eyes (5%) with progressive keratoconus that would classify as having "normal topography" using the published criteria for very asymmetric ectasia with normal topography of KISA% less than 60 and IS value less than 1.45. All controls had a KISA% index value of less than 15. The optimal cut-off value to distinguish cohorts was 15.31 (AUROC = 0.972, 93.75% sensitivity). KISA% index values of 60 and 100 achieved low sensitivity (80% and 73.75%, respectively). CONCLUSIONS: The KISA% index misclassified a significant proportion of eyes with progressive keratoconus as normal. Although highly specific for clinical keratoconus, the KISA% index lacks sensitivity, does not effectively discriminate between normal and abnormal topography, and thus should not be used in large data analysis or artificial intelligence-based modeling. [J Refract Surg. 2024;40(9):e614-e624.].

Asunto(s)

Topografía de la Córnea , Progresión de la Enfermedad , Queratocono , Curva ROC , Humanos , Queratocono/clasificación , Queratocono/diagnóstico , Estudios Retrospectivos , Topografía de la Córnea/métodos , Masculino , Femenino , Adulto , Estudios de Casos y Controles , Adulto Joven , Córnea/patología , Córnea/diagnóstico por imagen , Sensibilidad y Especificidad , Agudeza Visual/fisiología , Adolescente , Área Bajo la Curva , Persona de Mediana Edad , Errores Diagnósticos

RESUMEN

PURPOSE: To compare early visual quality of small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK) in terms of low contrast acuity. METHODS: A secondary analysis was performed using a harmonized dataset derived from two completed prospective cohort studies on active-duty military service members undergoing either SMILE (n = 37), wavefront-guided (WFG) LASIK (n = 51), or wavefront-optimized (WFO) LASIK (n = 56). Night vision and photopic and mesopic low contrast visual acuity (LCVA) up to 3 months postoperatively were compared between groups. RESULTS: Compared to SMILE-treated eyes, WFG LASIK-treated eyes had significantly better night vision and photopic LCVA at 1 month postoperatively (beta = -0.039, P = .016; beta = -0.043, P = .007, respectively). WFO LASIK-treated eyes had significantly better photopic LCVA at 1 month postoperatively (beta = -0.039, P = .012) but had worse mesopic LCVA at 3 months postoperatively (beta = 0.033, P = .015) versus SMILE-treated eyes. CONCLUSIONS: SMILE and LASIK, on either a WFG or WFO laser platform, yielded excellent outcomes, but LCVA seemed to recover quicker following LASIK compared to SMILE. [J Refract Surg. 2024;40(9):e667-e671.].

Asunto(s)

Sensibilidad de Contraste , Sustancia Propia , Queratomileusis por Láser In Situ , Láseres de Excímeros , Miopía , Agudeza Visual , Humanos , Queratomileusis por Láser In Situ/métodos , Agudeza Visual/fisiología , Miopía/cirugía , Miopía/fisiopatología , Estudios Prospectivos , Adulto , Masculino , Láseres de Excímeros/uso terapéutico , Femenino , Sustancia Propia/cirugía , Sensibilidad de Contraste/fisiología , Adulto Joven , Refracción Ocular/fisiología , Cirugía Laser de Córnea/métodos , Visión Nocturna/fisiología , Personal Militar , Resultado del Tratamiento

RESUMEN

PURPOSE: To investigate the feasibility and safety of a new small-aperture device, which is implanted on top of the intraocular lens. METHODS: Regular cataract surgery was performed in both eyes in 7 patients. In the non-dominant eye, a small-aperture device (VisionXtender; Morcher) was additionally implanted into the capsular bag at the end of the surgery. The mask had an inner diameter of 1.4 mm. Feasibility and safety were investigated 3 months and 2 years after surgery. RESULTS: In all cases, the device was successfully positioned in the capsular bag without any intraoperative complications. No inflammation was observed at the 3-month follow-up visit. All patients achieved binocular uncorrected distance visual acuity of 0 logarithm of the minimum angle of resolution (log-MAR) or better. Additionally, distance-corrected intermediate visual acuity of 0.1 logMAR or better was measured in the non-dominant eye. Two years postoperatively, Nd:YAG capsulotomy was performed in three patients in both eyes. CONCLUSIONS: This clinical feasibility trial demonstrates that the use of the new small-aperture device is both easy and safe. No intraoperative or postoperative complications were reported. All patients attained satisfactory distance, intermediate, and near visual acuity. The device shows significant potential when used in combination with different intraocular lenses (eg, toric). In the future, different opening shapes seem to be possible. [J Refract Surg. 2024;40(9):e662-e666.].

Asunto(s)

Estudios de Factibilidad , Implantación de Lentes Intraoculares , Lentes Intraoculares , Facoemulsificación , Diseño de Prótesis , Agudeza Visual , Humanos , Agudeza Visual/fisiología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Refracción Ocular/fisiología , Visión Binocular/fisiología , Estudios Prospectivos , Seudofaquia/fisiopatología

RESUMEN

Accurate measurement of astigmatism parameters is the basis for prescribing modern means of optical correction. In recent years, another direction for correcting astigmatism has emerged - implantation of toric intraocular lenses (TIOL). PURPOSE: This study evaluates the diagnostic accuracy of various methods for measuring the parameters of regular astigmatism. MATERIAL AND METHODS: The study included 83 patients (122 eyes) with regular astigmatism exceeding 1.0 D. Three groups were formed depending on the type of astigmatism. Spherical and cylindrical (power and axis) components of refraction were determined using automatic refractometry. The results were refined with subjective tests: power and axis tests with a cross-cylinder. The criterion for diagnostic accuracy was the level of corrected visual acuity. To assess the impact of cylinder position on visual acuity, discrete deviations of the axis of trial astigmatic lenses from the correct position (determined based on subjective tests) were modeled at 5, 10, and 15 degrees in both clockwise and counterclockwise directions. RESULTS: In the overall sample of observations, coincidence of results was found only in one-third of cases, with a tendency for discrepancies in data between the two methods in nearly 70% of cases. Statistical processing revealed significant differences only in the magnitude of the cylinder in the group with against-the-rule astigmatism (p<0.0005). An increase in maximum visual acuity corrected based on subjective test data was noted. With a deviation of the cylinder axis from the correct position by 10-15 degrees, regardless of the type of astigmatism, a significant tendency for a decrease in visual acuity was identified. At the same time, with a deviation of the cylinder axis within 5 degrees, a significant decrease in visual acuity was noted only in with-the-rule astigmatism and counterclockwise deviation. CONCLUSION: To achieve maximum visual acuity in the correction of regular astigmatism, objective method data must be refined with subjective tests. The results of modeling the deviation of the axis of the corrective lens from the proper position can be considered when evaluating the functional outcomes of TIOL implantation.

Asunto(s)

Astigmatismo , Refracción Ocular , Agudeza Visual , Astigmatismo/diagnóstico , Astigmatismo/fisiopatología , Humanos , Refracción Ocular/fisiología , Masculino , Reproducibilidad de los Resultados , Femenino , Persona de Mediana Edad , Lentes Intraoculares , Adulto , Refractometría/métodos , Pruebas de Visión/métodos

RESUMEN

PURPOSE: This study analyzes the effectiveness and safety of brolucizumab in the treatment of neovascular age-related macular degeneration (nAMD) in real clinical practice. MATERIAL AND METHODS: The study included patients with nAMD who received brolucizumab treatment and evaluated the changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), macular volume, as well as the number of injections and adverse events. RESULT: The group of previously treated patients included 28 subjects (28 eyes) that were switched to brolucizumab with a loading phase. By 12 months, BCVA changed from 0.43±0.29 to 0.33±0.27 LogMAR (p=0.11), CRT decreased from 281.5±58.2 to 239.9±45.6 µm (p=0.02). The group of previously untreated patients included 29 subjects (29 eyes). By 12 months, BCVA changed from 0.47±0.32 to 0.40±0.30 LogMAR (p=0.09), CRT decreased from 333.2±77.3 to 226.2±49.6 µm (p<0.001). Patients received 6.3±0.7 injections. In this group, baseline choroidal thickness showed a statistically significant correlation with final visual acuity (r=0.54; p<0.05) and CRT (r= -0.5; p<0.05). The group of previously treated patients switched without a loading phase included 18 patients (18 eyes). By 6 months, BCVA changed from 0.42±0.2 to 0.37±0.26 LogMAR (p=0.42). CRT remained stable at 285.6±56.9 µm (p=0.97). No adverse events related to intraocular inflammation were reported during the course of 385 injections. CONCLUSION: Brolucizumab therapy helps achieve significant anatomical and functional improvements in real clinical practice both in patients switched from previous treatments and in treatment-naïve patients. Greater baseline choroidal thickness may be associated with better anatomical and functional outcomes with brolucizumab treatment.

Asunto(s)

Inhibidores de la Angiogénesis , Anticuerpos Monoclonales Humanizados , Inyecciones Intravítreas , Agudeza Visual , Humanos , Masculino , Femenino , Anciano , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Resultado del Tratamiento , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/efectos adversos , Tomografía de Coherencia Óptica/métodos , Degeneración Macular/tratamiento farmacológico , Degeneración Macular/diagnóstico , Degeneración Macular/fisiopatología , Degeneración Macular Húmeda/tratamiento farmacológico , Degeneración Macular Húmeda/diagnóstico , Degeneración Macular Húmeda/fisiopatología

RESUMEN

PURPOSE: This study was performed to assess the prevalence of the vascularized foveal zone, including macular-foveal capillaries (MFC) and congenital retinal macrovessels (CRM), and to analyze the structural characteristics of the macular area in patients with MFC. MATERIAL AND METHODS: The first phase of the study evaluated the prevalence of MFC and CRM. Optical coherence tomography angiography (OCT-A) was performed, and OCT-A images of the foveal avascular zone were analyzed. In the second phase, two groups were formed: the MFC group (12 eyes, 9 patients, mean age 43.8±10.7 years) and the control group (18 eyes, 17 patients, mean age 43.0±11.8 years). A comparative analysis was performed assessing central retinal thickness (CRT), thickness of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), and foveal pit depth. RESULTS: MFCs were detected in 45 eyes from a total sample of 1031 eyes of 536 patients. The presence of CRM was recorded in three eyes of three patients. RNFL thickness was significantly higher in the MFC group in the inferior parafoveal sector (26.50 [26.00; 29.50] and 24.50 [21.75; 26.50] µm; p=0.022) and in the foveal zone (15.50 [14.00; 16.00] and 12.00 [11.00; 14.00] µm; p=0.017). Additionally, patients with MFC had a higher thickness of GCL and IPL in the fovea, inferior, nasal, and temporal parafoveal sectors. The depth of the foveal pit was significantly lower in the MFC group compared to the control group (83.0 [77.4; 101.6] and 128.0 [107.5; 147.05] µm; p=0.001). CONCLUSION: The prevalence of MFC was 4.36% (calculated per number of eyes), while the prevalence of CRM - 0.29%. The macular area in patients with MFC had increased thickness of the inner retinal layers and decreased depth of the foveal pit, suggesting potential disruption in the natural process of ganglion cell migration and apoptosis during embryogenesis.

Asunto(s)

Fóvea Central , Vasos Retinianos , Tomografía de Coherencia Óptica , Humanos , Fóvea Central/irrigación sanguínea , Fóvea Central/diagnóstico por imagen , Adulto , Femenino , Masculino , Tomografía de Coherencia Óptica/métodos , Prevalencia , Persona de Mediana Edad , Vasos Retinianos/diagnóstico por imagen , Capilares/diagnóstico por imagen , Capilares/patología , Enfermedades de la Retina/epidemiología , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/etiología , Federación de Rusia/epidemiología , Agudeza Visual , Angiografía con Fluoresceína/métodos