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Purpose: The aim of this study is to demonstrate the functionality of a new design of a thick endocapsular open ring for prevention of anterior capsule opacification (ACO) and posterior capsule opacification (PCO). Setting: The Institute of Vision and Optics, University of Crete and University Hospital of Heraklion, Crete, Greece. Design: Prospective, interventional pilot study. Methods: Fifteen patients (17 eyes) underwent cataract surgery with phacoemulsification. During surgery, a thick endocapsular open ring (peripheral capsule reconstructor) was inserted into the capsular bag, prior to intraocular lens (IOL) implantation. Six different models of IOL were implanted. Postoperatively, the degree of ACO and PCO was evaluated and described as none, mild, moderate, or severe. Results: The mean follow-up period was 30±8.06 months (range: 12-36 months). At the last follow-up, mild PCO was observed in only three eyes and mild ACO in three patients. The centration of IOLs was good in all but one eye, which had a tilted IOL. Conclusion: The results of this pilot study suggest that the implantation of a new design of thick endocapsular open ring is feasible and may contribute to the prevention of PCO and ACO after cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To present a case of fungal keratitis that was successfully treated with direct intrastromal medication delivery through a corneal incision created with the femtosecond laser.Methods: A 71-year-old female patient with recurrent episodes of an unresponsive, deep stromal keratitis for six months' duration, resistant to various therapeutic approaches, was referred to our institute. The 150 kHz Intralase iFS laser (Abbott Medical Optics Inc., Santa Ana, CA) was used to create a corneal pocket in an attempt to permit drug delivery directly into the corneal abscess.Results: Five days after the intrastromal injections, the clinical condition was improved. Two years after the procedure, the cornea is stable and free of any clinical signs or symptoms of recurrence.Conclusions: In this case report, an alternative application of femtosecond laser technology is presented, performing intrastromal drug delivery through a corneal incision for the treatment of fungal keratitis. [ABSTRACT FROM AUTHOR]

Purpose: Our purpose was to evaluate the long-term visual outcomes after bilateral implantation of Crystalens® HD (Bausch and Lomb, Inc.) accommodative intraocular lenses. Methods: In this study, 25 patients (50 eyes) who underwent cataract surgery and bilateral Crystalens HD accommodative intraocular lens implantation were included. The Crystalens HD lens was implanted in the bag in both eyes, without any intra- or postoperative complications. The visual parameters measured before and after surgery were: uncorrected distance visual acuity, corrected distance visual acuity (CDVA) (using the Early Diabetic Retinopathy Study [EDTRS] logMAR charts), uncorrected intermediate visual acuity, and uncorrected near visual acuity using a Birkhäuser reading chart, at a distance of 66 cm and 33 cm for intermediate and near vision, respectively, directly illuminated by a lamp of 60 watts. After surgery, the patients were evaluated at 1, 3, 6, 12, 24, and 36 months. Results: The mean age was 68.70±7.1 (range: 54 to 83) years. The mean follow-up was 42.72±0.49 (range: 42.33 to 43.27) months. The uncorrected distance visual acuity improved from 0.56±0.41 (range: 0 to 2) preoperatively to 0.19±0.13 (range: 0 to 0.38) (logMAR scale) at the last follow-up visit, and the CDVA improved from 0.17±0.18 (range: 0 to 0.7) preoperatively to 0.05±0.05 (range: -0.02 to 0.22) at the last follow-up visit. No eyes lost lines of CDVA during the follow-up period, while 54% of patients gained one or more lines of CDVA. The uncorrected intermediate and near visual acuity was J2 or better in 71% and 69% of our patients, respectively. Conclusion: Crystalens HD implantation seems to provide an improvement in visual acuity for far, intermediate, and near distances. [ABSTRACT FROM AUTHOR]

A bstract Ocular rigidity (OR) refers to the relationship between pressure and volume changes in the eyeball. Since the description of the differential tonometry method for the calculation of an OR coefficient by Friedenwald, several other methodologies have been proposed to measure OR, including the anterior chamber manometry, axial length (AL) changes, measurement of pulse amplitude and fundus pulse, ultrasound elastography and evaluation of corneal hysteresis. However, most of these methodologies suffer from deficiencies, such as invasive nature, poor accuracy or reproducibility or technical complexity. Nevertheless, it is possible that OR affects the pathogenesis and clinical course of a variety of ocular conditions, including glaucoma, age-related macular degeneration, presbyopia, corneal changes following refractive surgery as well as the accuracy of IOP measurements by many tonometers. Thus, the future development of non-invasive and easy-to-use methodologies for the accurate measurement of OR in the every-day practice would be clinically important. [ABSTRACT FROM AUTHOR]

Purpose: To determine the morphologic changes in human corneas over time following radiofrequency-based conductive keratoplasty (CK) treatment. Design: Prospective, observational case series. Methods: In a single-center study six human corneas of six patients with localized peripheral keratoconus underwent CK treatment followed by penetrating keratoplasty. Three spots were applied in the periphery of each cornea (6 mm optical zone). Corneal buttons were examined with light and electron microscopy at different postoperative intervals up to 6 months post-CK. Results: In samples assessed on day one post-CK, small areas of detachment between the basal layer of epithelial cells and Bowman’s layer were observed. At 1 week after the CK procedure, the epithelium appeared almost normal. Endothelium and Descemet’s membrane had no alterations. In all samples, thermally induced misconfiguration of collagen fibers, described as “crumpled” changes of collagen layers, was observed reaching 75% to 80% of the stromal depth. The area of alterations had a cylindrical shape with a diameter of 120 μm. Conclusions: The conductive keratoplasty procedure produced collagen “crumpling and splitting” changes in human corneas, which were observed during the follow-up of 6 months. Areas adjacent to treatment site were minimally damaged. [Copyright &y& Elsevier]

Purpose: To assess the long-term safety, efficacy, predictability, and stability of conductive keratoplasty (CK) for the treatment of low to moderate hyperopia and to evaluate the impact of the procedure on the quality of vision. Setting: University of Crete, Medical School, Vardinoyannion Eye Institute of Crete, Crete, Greece. Methods: In this prospective nonrandomized noncontrolled single-center study, 38 eyes of 26 patients (13 women and 13 men) were treated for hyperopia with a Refractec ViewPoint CK system and followed for 30 months. Preoperatively, the mean manifest refraction spherical equivalent (MRSE) was +1.89 diopters (D) ± 0.6 (SD) (range +1.00 to +3.25 D), and the mean follow-up was 30.9 ± 1.1 months. All eyes were treated with the regular CK nomogram for the treatment of spherical hyperopia. The treatment consisted of 8 to 32 spots applied to the periphery of the cornea. Mean age was 50.3 ± 8.8 years (range 31 to 71 years). All treated eyes were analyzed for safety, efficacy, predictability, and stability. Results: At 12 months, the MRSE was −0.06 ± 0.8 D and at 30 months was −0.02 ± 0.7 D. At 30 months, the mean MRSE was within ±0.50 D in 68%, within ±1.00 D in 92%, and within ±2.00 D in all eyes. At 30 months, uncorrected visual acuity was 20/20 or better in 52.5% and 20/40 or better in 89% of eyes. No eye lost 2 or more Snellen lines or had an induced cylinder of 2.00 D or greater. The procedure did not cause statistically significant changes in contrast sensitivity. Conclusion: Results show that CK for low to moderate hyperopia is a safe, effective, predictable, and stable procedure. [Copyright &y& Elsevier]

Purpose: To evaluate the clinical results of epi-LASIK, a new surface ablation surgical technique for the treatment of low myopia. Setting: Vardinoyannion Eye Institute of Crete, University of Crete, Greece. Methods: Forty-four eyes of 31 patients had epi-LASIK for the correction of low myopia. Mean preoperative spherical equivalent was 3.71 diopters (D) ± 1.2 (SD) (range −1.75 to −7.00 D) and the mean baseline logMAR best spectacle-corrected visual acuity was −0.01 ± 0.06 (range 0.10 to −0.10). All the epithelial separations were performed with the Centurion epikeratome (CIBA Surgical). The enrolled patients were followed daily until the epithelial healing was complete as well as at 1- and 3-month intervals. On the operative day, patients filled out a questionnaire grading visual performance and pain score of treated eyes every 2 hours for a total of 5 records. Results: The mean epithelial healing time was 4.86 ± 0.56 days (range 3 to 5 days). The mean logMAR uncorrected visual acuity on the day of reepithelization was 0.19 ± 0.09 (range 0.40 to 0.10). At 1 month, the mean was spherical equivalent of the treated eyes (N=44), −0.3 ± 0.6 D (range −1.0 to 0.87 D), and at 3 months it was (N=37), −0.10 ± 0.4 D (range −0.75 to 0.75 D); 97% of eyes had clear corneas or trace haze 3 months after treatment. Conclusions: Preliminary clinical results suggest that epi-LASIK is a safe and efficient method for the correction of low myopia. Further studies will establish this method as an alternative surface ablation procedure. [Copyright &y& Elsevier]

Purpose: To evaluate the efficacy and safety of implantation of a new posterior chamber phakic refractive lens (PRL, Ciba Vision Surgical) in highly myopic eyes.Setting: Department of Ophthalmology, Medical School, University of Crete, Vardinoyannion Eye Institute of Crete, Crete, Greece.Methods: Thirty-four myopic eyes of 19 patients were treated for high myopia with implantation of a silicone PRL in the posterior chamber. Mean patient age was 29.0 years ± 7.9 (SD) (range 18 to 44 years). Manifest refraction in spherical equivalent (MR), uncorrected (UCVA) and best corrected (BCVA) visual acuity (decimal scale), intraocular pressure, higher-order aberrations (root-mean-square [RMS] wavefront error measured with a Shack-Hartmann wavefront sensor WASCA analyzer [Carl Zeiss, Meditec]), possible complications, and subjective symptoms were evaluated.Results: Phakic refractive lenses were successfully implanted in all eyes. Mean follow-up was 17.17 ± 3.76 months (range 12 to 24 months). There was a statistically significant reduction in the MR (from -14.70 D ± 2.65 D [range -20.75 D to -10.50 D] to -0.61 D ± 0.89 D [range -2.25 D to 1.00 D]) (P<.001). Twenty-seven (79%) and 15 eyes (44%) were within ±1.00 D and ±0.50 D of target refraction, respectively. Mean UCVA significantly improved (from counting fingers to 0.62 ± 0.28 (range 0.08 to 1.20) (P<.001). Mean BCVA also improved from 0.70 ± 0.24 (range 0.10 to 1.00) to 0.85 ± 0.24 (range 0.10 to 1.20) (P<0.001). Overall, there was a mean increase in BCVA of 1.5 ± 1.5 lines (range loss of 2 lines to gain of 5 lines). There was no statistically significant difference in higher-order aberrations after PRL implantation (pre-PRL RMS: 0.18 μm ± 0.08 μm [range 0.09 μm to 0.38 μm]; post-PRL RMS: 0.21 μm ± 0.08 μm; [range 0.05 μm to 0.38 μm]) (P = .12).Conclusion: The PRL showed encouraging results in treating high myopia. Additional patients and longer follow-up period are needed to detect the long-term efficacy and safety of this refractive lens. [Copyright &y& Elsevier]

: PurposeTo compare the effect of mechanical and alcohol-assisted excision on the histological ultrastructure of epithelial disks from human corneas.: SettingVardinoyiannion Eye Institute of Crete, University of Crete, Medical School, Crete, Greece.: MethodsTen eyes of 10 patients were deepithelialized by 1 of 2 two techniques. In 6 eyes, a customized instrument was used to mechanically separate the epithelial layer. In 4 eyes, the epithelial disks were obtained using the conventional laser-assisted subepithelial keratectomy (LASEK) technique; that is, with alcohol concentrations of 15% and 20%. All specimens were assessed by light and electron microscopy, and the histological findings of the 2 methods were compared.: ResultsTransmission electron microscopy showed that when the epithelial disks were excised by mechanical separation, the lamina densa and lamina lucida were preserved and the hemidesmosomes had normal morphology along almost the entire length of the basement membrane. The basal epithelial cells of the separated epithelial disks showed minimal trauma and edema. Specimens obtained using 15% and 20% alcohol concentrations showed formation of cytoplasmic fragments of the basal epithelial cells, enlargement of the intercellular spaces, and extensive discontinuities in the basement membrane, which was excised at the level of the lamina lucida.: ConclusionsMechanical separation did not affect the normal cell morphology of the excised epithelial disks. Transmission electron microscopy of the specimens proved the manual technique is less invasive to epithelial integrity than LASEK using either alcohol concentration. [Copyright &y& Elsevier]

: PurposeTo determine how refractive error, visual acuity, and high-order aberrations (3rd- and 4th-order) are affected by the formation of a lamellar corneal flap during laser in situ keratomileusis (LASIK).: SettingUniversity refractive surgery center.: MethodsThe effect of lamellar corneal flap formation was analyzed in 15 myopic eyes (mean preoperative refraction −4.72 diopters [D] [range −1.25 to −7.25 D]). The flap was created using a 2-step procedure: (1) a nasally hinged lamellar corneal flap was created; (2) the flap was lifted and stromal ablation performed 2 months after the flap was made. A Hartmann-Shack aberrometer was used to measure the aberrations.: ResultsThere was no significant change in the refractive error (spherical equivalent pre-flap −4.72 ± 1.99 D and post-flap −4.62 ± 1.99 D [P = .28]) or visual acuity (pre-flap uncorrected visual acuity [UCVA] 0.07 and best corrected visual acuity [BCVA] 0.96; post-flap UCVA 0.08 and BCVA 0.95 [P = .16 and P = .33, respectively]). A statistically significant increase in total higher-order wavefront aberrations was observed following flap formation (root mean square pre-flap 0.344 ± 0.125 and post-flap 0.440 ± 0.221 [P = .04]).: ConclusionFlap formation during LASIK can modify the eye’s existing natural higher-order aberrations (especially spherical and coma-like aberrations along the axis of the flap’s hinge), while visual acuity and refractive error remain unaffected. [Copyright &y& Elsevier]

Objective: To identify the incidence and refractive outcome of intraoperative laser in situ keratomileusis (LASIK) complications using one type of microkeratome. Design: Retrospective noncomparative case series. Participants: Three hundred thirty-four consecutive myopic LASIK patients (September 1997 to November 1998) operated on by one surgeon. Intervention: Myopic LASIK surgeries were performed with the Mediate Mel 60 Aesculap Meditec Laser system. Main Outcome Measures: Preoperative and 1 -year postoperative spherical equivalent, best spectacle-corrected visual acuity (BSVA), and corneal anatomic features (as obtained from videokeratography) were recorded, as was the incidence of intraoperative complications. Results: Forty-eight (14%) eyes had keratome-related complications. Thirty-seven (77%) eyes were immediately treated; the remaining eyes were treated on a later date. One year after treatment, 13% of the immediately treated complicated eyes maintained the preoperative BSVA; 24% had a 1-line loss; 2.7% had a greater loss of BSVA. Conclusions: Microkeratome-related complications may result in loss of BSVA. The complication of an irregular flap had the poorest refractive outcome in this series of eyes. We did not find any statistically significant relationship between corneal anatomic factors and keratome-related complications in this series. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to two articles including "The Final Frontier: Pediatric Intraocular Lens Power," by K.J. Hoffer et al and "Accuracy of Intraocular Lens Power Calculation Formulae in Children Less than Two Years," by R. Kekunnaya et al both in a 2012 issue.

Purpose: To compare the ocular rigidity in vivo measurements of patients with age-related macular degeneration (AMD) and control subjects. Design: Prospective comparative clinical study. Methods: The pressure-volume relation and the ocular rigidity coefficient were compared among 32 patients with AMD (AMD group: 16 with neovascular and 16 with nonneovascular AMD) and 44 age-matched control patients (control group) who underwent operation for cataract. This was achieved by an injection of 200 μl of a balanced salt solution (in steps of 4.5 μl) through the limbus in the anterior chamber, while the intraocular pressure was monitored continually with a transducer, up to the limit of 30 mm Hg. Results: The mean age (AMD group: 69.89 ± 15.92 years vs control group: 65.28 ± 12.34 years; P = .195), gender (AMD group: 13 female vs control group: 17 female; P = .513), eye’s axial length (AMD group: 23.14 ± 0.75 mm vs control group: 23.04 ± 1.16 mm; P = .725) of patients with AMD and the healthy control subjects were comparable. No statistically significant difference in ocular rigidity measurements between patients with AMD and control subjects (AMD group: 0.0142 ± 0.0077 μl−1 vs control group: 0.0125 ± 0.0049 μl−1; P = .255) was found. When we examined separately the two subgroups of patients with AMD (neovascular and nonneovascular AMD), the average ocular rigidity measurements were higher in patients with neovascular AMD vs both control subjects and patients with nonneovascular AMD (neovascular AMD group: 0.0186 ± 0.0078 μl−1 vs control group: 0.0125 ± 0.0048 μl−1 [P = .014] vs nonneovascular AMD group: 0.0104 ± 0.0053 μl−1 [P = .004]). Conclusions: Despite the limitations placed by the small sample of the examined cases, patients with neovascular AMD who are treated (with photodynamic therapy) have increased ocular rigidity measurements compared with patients with nonneovascular AMD and control patients. [Copyright &y& Elsevier]

We present the case of a patient who had refractive corneal inlay implantation for near vision improvement after bilateral cataract surgery. The patient had a history of bilateral cataract, and a 2-step procedure was suggested to improve her near and distance visual acuities. The first step was bilateral cataract extraction with a power target of plano intraocular lens implantation. Six months later, a refractive corneal inlay, Presbia Microlens, was implanted in the nondominant eye in the intracorneal pocket made with the femtosecond laser. No intraoperative or postoperative complications occurred. The bilateral uncorrected near visual acuity improved from less than Jaeger (J)6 to J1 and remained stable during the 2-year follow-up. The refractive corneal inlay is a safe, simple, and efficient method for improving near visual acuity in patients after cataract surgery. Financial Disclosure: Dr. Pallikaris is the chair of the medical advisory board of Presbia Coöperatief U.A. No other author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To report the 2-year follow-up of the initial clinical evaluation of Infinite Vision Optics multicomponent intraocular lens (IOL) implantation. Setting: Institute of Vision and Optics, University of Crete, Crete, Greece. Design: Case series. Methods: All patients had routine cataract surgery and multicomponent IOL implantation. The primary objectives of the study were to evaluate the manufacturing feasibility of the IOL, the evaluation of the surgical implantation technique, and the incidence of interlenticular fibrosis. Results: This initial clinical evaluation comprised 6 patients with a mean age of 63.3 years ± 12.7 (SD) (range 49 to 82 years). Implantations were uneventful in all cases. There were no intraoperative or postoperative complications. There was no interlenticular fibrosis. There was no statistically significant difference in the endothelial cell density, anterior chamber depth, or pachymetry readings between preoperatively and 2 years postoperatively. No patient lost lines of corrected distance visual acuity. Conclusions: Multicomponent IOL implantation was easy and safe and resulted in excellent visual recovery. No cases of interlenticular fibrosis developed. Financial Disclosure: Dr. Portaliou has received travel grant and meeting expenses from Infinite Vision Optic. Neither of the other 2 authors has a financial or proprietary interest in any material or method mentioned. [Copyright &y& Elsevier]

Purpose It is widely accepted that monocular deprivation results in improved visual performance in the non-pathological eye. The current study investigates the effect of deprivation due to severe impairment in one eye during late childhood or adulthood, on the spatial performance of the fellow 'good' eye. Methods Twenty patients (age: 29 ± 9 years) with severe visual impairment in one eye (visual acuity equal or worse than count fingers at 1 m), for a period longer than 2 years, participated in the study. Only patients with an age less than 50 years and monocular deprivation onset greater than 9 years were included. On the basis of the time of deprivation the patients were categorised into two subgroups: (i) long-past deprivation (N = 8, age 28 ± 8 years, 9-20 years of deprivation) and recent deprivation (N = 12, age 30 ± 11 years, 2-4 years of deprivation). Eighteen more participants (age: 28 ± 5 years) with normal binocular vision served as the control group. Best-corrected contrast sensitivity was evaluated using reversing (2 Hz) vertical sinusoidal gratings. Seven spatial frequencies (1, 2, 4, 8, 12, 16 and 24 c/deg) were tested. Performance of the control group was tested both monocularly (dominant eye) and binocularly. Results In normal subjects, binocular viewing improved contrast sensitivity on average by 4.2 dB (corresponding to a 70% improvement in contrast threshold) compared to monocular recordings. Average contrast sensitivity in subjects with impaired vision in one eye was found to be higher by 5.0 dB (corresponding to an 83% improvement in contrast threshold) compared with the dominant eye of the control group. The increase in sensitivity was independent of spatial frequency. No differences were observed between the two subgroups with recent and long-past deprivation. Conclusions Notable improvement in contrast sensitivity was found in the non-pathological eye of patients with severe impairment in the other eye at an age after the 'critical' period of visual development. These findings are consistent with growing evidence supporting functional changes as a result of altered experience or injury in the adult vision system. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate differences between Goldmann Applanation Tonometry (GAT) and Dynamic Controur Tonometry (DCT) in eyes with pseudoexfoliation syndrome (PEX). Methods: Thirty-eight patients (38 eyes) with PEX in both eyes (pseudoexfoliative group, PG) as well as 19 patients (19 eyes) without PEX in either eye (control group, CG), were included. All eyes were phakic. GAT, DCT, the central corneal thickness (CCT) and the axial length of the eyeball (AL) were measured and the difference between GAT and DCT (dIOP) was calculated. Differences in dIOP between CG and PG and correlations of dIOP with CCT and AL were examined. Results: dIOP was significantly ( P = 0.02) higher in PG (mean value 3.69 mmHg), compared with CG (mean value 2.15 mmHg). In PG (but not in CG), dIOP was also significantly correlated with AL but not with CCT. Conclusion: The fact that dIOP was significantly higher in PG than in CG implies that PEX may affect ocular biomechanical properties. The significant association of dIOP with AL but not with CCT is in agreement with previous reports and complies with the fact that pseudoexfoliative material is not deposited in corneal stroma. [ABSTRACT FROM AUTHOR]

Background. To evaluate differences between Goldmann Applanation Tonometry (GAT) and Dynamic Controur Tonometry (DCT) following trabeculectomy. Methods. Thirty eight glaucomatous eyes with a history of trabeculectomy (Trabeculectomy group, TG), 20 eyes without a history of trabeculectomy but with a history of latanoprost use (Latanoprost group, LG), and 19 nonglaucomatous eyes (Control group, CG) were included. GAT-IOP, DCT-IOP, the difference between them (dIOP), the central corneal thickness (CCT), the axial length (AL), and the depth of the anterior chamber (ACD) were measured. Results. dIOP was significantly higher in TG (5.19 mmHg) than in LG (4.01 mmHg) and CG (1.98 mmHg). Correlations between AL and dIOP were statistically significant in both TG and LG but not in CG whereas correlations between dIOP and other clinical parameters examined were statistically not significant in all groups. Conclusions. The significantly higher dIOP in TG implies that the biomechanical properties of the ocular walls are altered following trabeculectomy. [ABSTRACT FROM AUTHOR]

Purpose: To test the accuracy and reliability of the first-generation prototype of Tracey-1, a ray-tracing refractometer.Setting: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.Methods: The refractive spherical equivalent (SE) and astigmatism measured by Tracey-1, subjective manifest refraction (MR), and autorefraction (AR) (Nidek AR-3300) were compared in 58 pseudophakic eyes of 44 patients with a mean age of 69.95 years ± 8.6 (SD). The astigmatic values obtained from Tracey-1 and computerized videokeratography were also compared. Astigmatism values were compared using power vector analysis.Results: The mean SEs measured by MR, Tracey, and AR were −0.76 diopter (D) ± 0.96 (SD) (range 1.00 to −3.00 D), 0.37 ± 0.64 D (range 1.68 to −1.49 D), and −0.44 ± 1.13 D (range 1.63 to −3.50 D), respectively. The Pearson correlation coefficients between MR and Tracey values and between MR and AR values were high (r = 0.895 and r = 0.875, respectively; both P < .0001). However, the mean difference between the Tracey and MR values was 1.13 ± 0.48 D (range 2.45 to −0.06 D) (P < .001). The mean cylindrical differences between MR and Tracey and between MR and AR were 0.03 ± 0.51 D (range 1.22 to −1.07 D) (P = .709) and −0.30 ± 0.62 D (range 0.50 to −2.25 D) (P = .003), respectively. Power vector analysis revealed difference vectors of −0.16 × 60 between Tracey and MR and −0.22 × 87 between AR and MR.Conclusions: Spherical and cylindrical refractive data obtained with the Tracey system correlated well with those derived from MR; however, there was a mean spherical error of approximately 1.10 D. Further work is required to refine the accuracy and range of this device. [Copyright &y& Elsevier]

A 36-year-old male underwent uneventful small incision lenticule extraction (SMILE) for the correction of his high residual refractive error 12 years after photorefractive keratectomy (PRK). Preoperatively, uncorrected distance visual acuity (UDVA) was counting fingers in both eyes. Corrected distance visual acuity was 20/20 in the right and 20/30 in the left eye due to amblyopia. One month after SMILE, UDVA was 20/20 and 20/30 in the right and left eye, respectively; post-PRK corneal haze had reduced. During the 4-year follow-up, UDVA remained stable and there were no complications. SMILE could be a good alternative approach for retreatment in post-PRK patient. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the visual, refractive, and topographic outcomes after combined transepithelial phototherapeutic keratectomy (PTK) and conventional photorefractive keratectomy (PRK) followed simultaneously by corneal crosslinking (CXL) for keratoconus. Setting Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece. Design Prospective case series. Methods Patients with progressive keratoconus had simultaneous conventional PRK followed by CXL; the corneal epithelium was removed using transepithelial PTK (Cretan protocol plus). The visual, refractive, and topographic outcomes and the endothelial cell density (ECD) were evaluated preoperatively and 1, 3, 6, and 12 months postoperatively. Results Forty-three patients (55 eyes) were enrolled. The mean uncorrected and corrected distance visual acuities improved significantly from 0.98 ± 0.63 (SD) logarithm of minimum angle of resolution (logMAR) and 0.20 ± 0.23 logMAR preoperatively to 0.39 ± 0.35 logMAR ( P  < .001) and 0.08 ± 0.16 logMAR ( P  < .001) 12 months postoperatively, respectively. The mean spherical equivalent improved significantly from −4.67 ± 4.00 diopters (D) preoperatively to −2.24 ± 2.81 D ( P  < .001) at 12 months. The mean steep keratometry (K) and flat keratometry readings decreased significantly from 50.30 ± 5.00 D and 45.62 ± 3.10 D preoperatively to 46.27 ± 3.90 D ( P  < .001) and 43.46 ± 3.00 D ( P  < .001) 12 months postoperatively, respectively. No ECD alterations were observed throughout the follow-up ( P  > .05). Conclusion Combined transepithelial PTK and conventional PRK followed simultaneously by CXL was effective in corneal stabilization and vision improvement in keratoconic patients. [ABSTRACT FROM AUTHOR]

Purpose: To compare Plusoptix (Gmbh, Nuremberg, Germany), 2WIN (Adaptica, Padua, Italy), the benchtop refractometer (Auto-Kerato-Refractometer KR-8900; Topcon Co, Tokyo, Japan), and retinoscopy with regard to the consistencies.Materials and Methods: In our prospective study, 200 eyes of 100 patients were included. We analyzed the demographics and characteristics of the patients, the percentage of patients from whom measurements could not be obtained, the measurements from both patients' eyes of pupil diameter, spherical, cylindrical, axis, and spherical equivalence.Results: The mean age ± SD was 7.8±4.5 years (range, 1-18 years). Pupil diameter measurements were found to be consistent (Cronbach's alpha value >0.8). The sphere and spherical equivalence measurements for both eyes were found to be consistent with each other in all apparatus (Cronbach's alpha value >0.8). However, consistency was found to be lower in cylindrical values and the Jackson cross-cylinder measurements at 0° and 45° axis were found to be inconsistent with each other (Cronbach's alpha value <0.8).Conclusions: While consistency was observed in all methods in terms of sphere and spherical equivalence, consistency dropped in cylindrical values and no consistency was observed in axis values. It is important to take this point into consideration, especially in axis measurements. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the feasibility of anterior segment optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) for the imaging of EX‑PRESS® implant. Materials and Methods: This nonrandomized comparative case series was performed at the Department of Ophthalmology of the University Hospital of Heraklion, Crete, Greece. The Ellex Eye Cubed (40 MHz) UBM and the Zeiss Visante OCT systems were used. The filtering bleb morphology (BL), aqueous outflow (AS), and tube position (TB) were evaluated by two independent observers using a quality scale of 1 (worst) to 4 (best). Data were also collected on corneal and iris clearance from the tip of the tube (CC and IC, respectively). Data from both the devices were statistically analyzed. P < 0.05 was considered as statistically significant. Results: Ten eyes of 10 patients (6 males) with EX‑PRESS® implant were examined. TB, AS, and BL scores using UBM were 2.40 ± 0.39, 3.45 ± 0.72, and 2.45 ± 0.64, respectively. TB, AS, and BL scores for OCT were 3.35 ± 0.41, 1.55 ± 0.43, and 2.55 ± 0.55, respectively. AS was significantly higher with UBM whereas the opposite was true for TB. Differences in BL between OCT and UBM were not statistically significant (P > 0.05). Conclusion: Imaging of the EX‑PRESS® implant is feasible with both UBM and OCT. Both modalities allow visualization of the position of the implant tube in relation to the iris or cornea and delineate the internal structure of the filtering bleb. [ABSTRACT FROM AUTHOR]

Purpose. To report a case of Parinaud's oculoglandular syndrome (POS) in which, despite the initially negative, a late onset of serologic positive titers was observed. Methods. Case report. Results. A 65-year-old man was examined for a foreign body in the left eye associated with granulomatous nodule on the palpebral conjuctiva, chemosis and a swollen preauricular lymph node. Despite the initially negative serologic titers to Bartonella henselae , a clinical diagnosis of POS was made and treatment was instituted initially with oral ciprofloxacin (500 mg twice a day). Three weeks later, serologic positive titers were found which confirmed the diagnosis of POS. Conclusion. Even though the improvements in diagnostic testing such as indirect immunofluorescence antibody, negative titles could be initially observed, confusing the diagnostic process. Other techniques (such as polymerase chain reaction (PCR) testing) should be also taken into consideration in cases with increased clinical suspicious of B. henselae indections. [ABSTRACT FROM AUTHOR]

Purpose The intraocular pressure ( IOP) is determined by a dynamic equilibrium between the production and outflow of the aqueous humour. The relationship between IOP and the outflow rate through the conventional and unconventional pathway is quantified by the outflow facility coefficient ( C). The purpose of this study is to employ a direct (manometric) tonographic technique and determine C as well as its inverse, resistance ( R), as a function of IOP in the living human eye. Methods Nineteen cataract patients were enrolled in the study. An intraoperative manometric device was used to measure IOP. After cannulation of the anterior chamber, the IOP was increased by infusion of controlled amounts of saline solution. At 40 mmHg, the infusion stopped, and a pressure sensor recorded the IOP. The measured pressure-volume relationship was considered in order to convert pressure changes to corresponding ocular volume changes. An appropriate mathematical model was applied to calculate C and (its inverse), R. Results The average C was 0.0672 ± 0.0296 μl/min/mmHg at 40 mmHg and 0.2652 ± 0.1164 μl/min/mmHg at 20 mmHg. There was a strong dependence of coefficient C on IOP in all subjects (p < 0.001). The corresponding values for R were 17.9 ± 11.17 min mmHg/ μl at 40 mmHg and 4.51 ± 2.69 min mmHg/ μl at 20 mmHg. Conclusion This study provides measurement of outflow facility and its dependence with pressure in healthy living human eyes. This relation is shown to be non-linear, using a direct manometric method. [ABSTRACT FROM AUTHOR]

Purpose: To review the current literature on in vivo confocal microscopy anterior segment applications (cornea, conjunctiva, and glaucoma) and discuss its advantages in different pathological conditions. Methods: Review of selected relevant literature on in vivo confocal microscopy and its different applications. Results: In vivo confocal microscopy can be used to visualize most layers of the cornea and conjunctiva, providing excellent resolution. In the past, it was mainly utilized as a research tool; lately there seems to be an increasing interest for clinical applications; confocal microscopy aids the diagnosis and follow-up of many anterior segment disorders, such as corneal dystrophies, corneal and conjunctival inflammatory and neoplastic diseases, glaucoma patients, and assessment of surgical procedures. Conclusion: In vivo confocal microscopy is an important addition to the ophthalmic diagnostic tools with several anterior segment applications. Its clinical applications are being continuously explored and are quickly expanding to cover many new pathological aspects. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate combination treatment with reduced-fluence photodynamic therapy (RDPDT) with Verteporfin and intravitreal bevacizumab, compared to bevacizumab alone, for choroidal neovascularization (CNV) in age-related macular degeneration. Methods: This was a prospective, randomized comparative study comprising 95 patients with CNV. 49 patients received RDPDT (25 J/cm2) followed by intravitreal bevacizumab 1.25 mg one hour later, while 46 received intravitreal bevacizumab alone. Patients were followed for 12 months at four-week intervals with visual acuity (VA) assessment and Optical Coherence Tomography (OCT) of the macula. Bevacizumab re-injections were performed as needed. Results: On average, patients were re-injected 4.45 times in the combination group and 6.96 times in the bavacizumab group ( p < 0.001). At 12 months, VA improved by 8.64 letters in the bevacizumab group and by 8.37 letters in the combination group ( p = 0.922). Conclusion: Adding a reduced-fluence PDT arm in combination with bevacizumab offers similar results to those of intravitreal bevacizumab alone with significantly reduced number of injection repetitions. [ABSTRACT FROM AUTHOR]

Purpose: To use anterior segment optical coherence tomography (AS-OCT) to compare corneal stroma demarcation line depth after corneal collagen crosslinking (CXL) with 2 treatment protocols. Setting: Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece. Design: Prospective comparative interventional case series. Methods: Corneal collagen crosslinking was performed in all eyes using the same ultraviolet-A (UVA) irradiation device (CCL-365). Eyes were treated for 30 minutes with 3 mW/cm2 according to the standard Dresden protocol (Group 1) or for 10 minutes with 9 mW/cm2 of UVA irradiation intensity (Group 2). One month postoperatively, 2 independent observers measured the corneal stroma demarcation line using AS-OCT. Results: Sixteen patients (21 eyes) were enrolled. Group 1 comprised 7 patients (9 eyes) and Group 2, 9 patients (12 eyes). The mean corneal stroma demarcation line depth was 350.78 μm ± 49.34 (SD) (range 256.5 to 410 μm) in Group 1 and 288.46 ± 42.37 μm (range 238.5 to 353.5 μm) in Group 2; the corneal stroma demarcation line was statistically significantly deeper in Group 1 than in Group 2 (P=.0058, t test for unpaired data). Conclusion: The corneal stroma demarcation line was significantly deeper after a 30-minute CXL treatment than after a 10-minute CXL procedure with high-intensity UVA irradiation. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual and refractive outcomes and the corneal structural changes in myopic patients after surface refractive treatments (ie, photorefractive keratectomy [PRK] with adjuvant mitomycin-C [MMC] and epithelial laser in situ keratomileusis [epi-LASIK]). Setting: University of Crete, Heraklion, Crete, Greece. Design: Prospective comparative case series. Methods: One eye of consecutive myopic patients was randomly assigned to PRK–MMC, and the fellow eye was treated with epi-LASIK. Visual and refractive outcomes and corneal confocal microscopy findings were evaluated. All patients were examined preoperatively and 1, 3, 6, 12, and 24 months postoperatively. Results: Twenty-six eyes (13 patients) were included. The mean follow-up was 2.47 years ± 0.35 (SD) (range 1.64 to 2.93 years). In the PRK–MMC group, the mean preoperative spherical equivalent refraction was −3.84 ± 1.59 diopters (D) (range −1.5 to −8.7 D) and −0.21 ± 0.44 D (range −0.5 to 1.0 D) at the last follow-up and in the epi-LASIK group, −3.91 ± 1.48 D (range −1.5 to −8.5 D) and −0.18 ± 0.36 (range +0.5 to −0.5 D), respectively. Qualitative analysis of the subepithelial nerve plexus, haze development, and keratocyte distribution were similar in the 2 groups. There was no statistically significant difference in endothelial cell density between the groups throughout the follow-up (P>.05). Conclusion: Epithelial LASIK and PRK–MMC gave similar visual, refractive, and corneal structural outcomes in patients with myopia for up to 2 years postoperatively. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose. To study the long term refractive and visual outcomes of photorefractive keratectomy (PRK) with intraoperative application of mitomycin C (MMC). Methods. This study included 37 eyes who received myopic PRK; after photoablation, a sponge soaked in 0.02% MMC solution was applied in all corneas for 2 minutes. Efficacy, safety, predictability, and stability of PRK MMC were evaluated. Endothelial cell density was evaluated at the last postoperative interval. Results. Mean preoperative spherical equivalent (SEQ) was -6.03 ± 1.87 D (diopters) and reduced to -0.09 ± 0.53 D at the last postoperative examination. Mean followup was 44.73 ± 18.24 months. All the eyes were in the ±1.00 D of attempted versus achieved SEQ at the one-year follow-up interval. Furthermore, 95% of the eyes did not lose lines or gained 1 to 2 lines of CDVA, while 5% lost 1 line. At the third postoperative month, 89% of the eyes either were clear or had trace haze, while 4 eyes had mild haze; by the 12-month postoperative interval, none of the eyes demonstrated haze. Mean endothelial cell density (ECD) at the last postoperative interval was 2658 ± 153 cells/mm². Conclusions. PRK, with intraoperative use of MMC, demonstrates stable refractive and visual outcomes up to 44 months after surgery. [ABSTRACT FROM AUTHOR]

Background/aim To compare stromal bed smoothness in LASIK flaps created with two different femtosecond lasers (IntraLase FS150 and WaveLight FS200) and a mechanical microkeratome (MMK) (Carriazo-Pendular microkeratome). Methods Sixty freshly enucleated porcine eyes were used for the study. Twenty flaps were created and constitute each of the following three groups: IntraLase FS150 (IFS group), WaveLight FS200 (WFS group) and MMK (MMK group). In each of the three groups, 10 flaps were created with intended thickness of 110 μm and another 10 flaps with 130 μm. Images were assessed with light microscopy and scanning electron microscopy. Qualitative surface roughness grading of the images was performed by five masked observers and statistical comparisons of scores were made between groups. Results The results of qualitative surface roughness grading demonstrated that there was no significant difference between the two femtosecond (FS) lasers when comparing the subgroups with the same flap thickness (p>0.05 in both comparisons, Mann-Whitney U test). In addition, there was no statistically significant difference (p>0.05) in each flap maker group between different thickness subgroups. However, the scores of the FS laser subgroups were significantly better than the scores of the MMK subgroups with corresponding flap thicknesses ( p<0.05, Mann-Whitney U test). Conclusions Our study demonstrates that the IntraLase FS150 and the WaveLight FS200 had a similar performance and provided flaps with smooth surfaces. In comparison to the MMK, the studied femtosecond laser systems had a superior performance in terms of smoothness. [ABSTRACT FROM AUTHOR]

Purpose: To explore whether adaptation reduces the interocular visual latency differences and the induced Pulfrich effect caused by the anisocoria implicit in small-aperture monovision. Methods: Anisocoric vision was simulated in two adults by wearing in the non-dominant eye for 7 successive days, while awake, an opaque soft contact lens (CL) with a small, central, circular aperture. This was repeated with aperture diameters of 1.5 and 2.5 mm. Each day, monocular and binocular pattern-reversal Visual Evoked Potentials (VEP) were recorded. Additionally, the Pulfrich effect was measured: the task of the subject was to state whether a a 2-deg spot appeared in front or behind the plane of a central cross when moved left-to-right or right-to-left on a display screen. The retinal illuminance of the dominant eye was varied using neutral density (ND) filters to establish the ND value which eliminated the Pulfrich effect for each lens. All experiments were performed at luminance levels of 5 and 30 cd/m2. Results: Interocular differences in monocular VEP latency (at 30 cd/m2) rose to about 12–15 ms and 20–25 ms when the CL aperture was 2.5 and 1.5 mm, respectively. The effect was more pronounced at 5 cd/m2 (i.e. with larger natural pupils). A strong Pulfrich effect was observed under all conditions, with the effect being less striking for the 2.5 mm aperture. No neural adaptation appeared to occur: neither the interocular differences in VEP latency nor the ND value required to null the Pulfrich effect reduced over each 7-day period of anisocoric vision. Conclusions: Small-aperture monovision produced marked interocular differences in visual latency and a Pulfrich experience. These were not reduced by adaptation, perhaps because the natural pupil diameter of the dominant eye was continually changing throughout the day due to varying illumination and other factors, making adaptation difficult. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the results of thin-flap laser in situ keratomileusis (LASIK) using a femtosecond-laser platform for flap creation. Setting: Institute of Vision and Optics, Faculty of Medicine, University of Crete, Heraklion, Greece. Design: Prospective interventional case series. Methods: Patients had LASIK with the FS200 femtosecond laser for flap creation and the Allegretto Wave Eye-Q excimer laser. Flap thickness was set at 105 μm. All eyes were examined 1 month postoperatively. Flap thickness was assessed with anterior segment optical coherence tomography using the manual flap tool at 5 locations on a horizontal B scan. Results: This study comprised 50 eyes of 25 patients (mean age 28 years ±5.72 [SD]); 42 eyes completed 6 months of follow-up. Preoperatively, the mean sphere was −3.61 ± 1.87 diopters (D) and the mean cylinder, −1.08 ± 1.23 D. Six months postoperatively, no eye lost lines of corrected distance visual acuity (CDVA), 29% gained 1 line, and 7% gained 2 lines. The mean spherical equivalent was −0.03 ± 0.42 D (range −0.88 to +0.88 D); 86% had an uncorrected distance visual acuity of 20/20 or better. The mean central flap thickness at 1 month was 102.98 ± 6.33 μm (range 91 to 114 μm). There were no intraoperative or postoperative complications. Conclusions: No significant complications occurred after treatment with this new femtosecond-laser platform in thin-flap LASIK. Clinical (visual and refractive) results were satisfactory in terms of safety, predictability, and stability. Financial Disclosure: Dr. Henderson is a consultant to Alcon Laboratories, Inc., and Baush & Lomb, Inc. No other author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose To explore the interocular differences in the temporal responses of the eyes induced by the monocular use of small-aperture optics designed to aid presbyopes by increasing their depth-of-focus. Methods Monocular and binocular pattern-reversal visual evoked potentials ( VEPs) were measured at a mean photopic field luminance of 30 cd/m2 in seven normal subjects with either natural pupils or when the non-dominant eye wore a small-aperture contact lens (aperture diameter 1.5, 2.5 or 3.5 mm, or an annular opaque stop of inner and outer diameters 1.5 and 4.0 mm respectively). Responses were also measured with varying stimulus luminance (5, 13.9, 27.2 and 45 cd/m2) and a fixed 3.0 mm artificial pupil. Results Mean natural pupil diameters were 4.7 and 4.4 mm under monocular and binocular conditions respectively. The small-aperture contact lenses reduced the amplitude of the P100 component of the VEP and increased its latency. Inter-ocular differences in latency rose to about 20-25 ms when the pupil diameter of the non-dominant eye was reduced to 1.5 mm. The measurements with fixed pupil and varying luminance suggested that the observed effects were explicable in terms of the changes in retinal illuminance produced by the restrictions in pupil area. Conclusions The anisocoria induced by small-aperture approaches to aid presbyopes produces marked interocular differences in visual latency. The literature of the Pulfrich effect suggests that such differences can lead to distortions in the perception of relative movement and, in some cases, to possible hazard. [ABSTRACT FROM AUTHOR]

Purpose To compare the effects of defocus induced blur and blur adaptation on visual acuity and to evaluate any differences between emmetropes and myopes using letter and Landolt C log MAR charts. Methods The sample consisted of 26 volunteers, with a mean age of 27 ± 3 years, comprising 13 emmetropes (spherical equivalent range: −0.63 to +0.50 D) and 13 myopes (spherical equivalent range: −0.75 to −5.00 D). Monocular visual acuity ( VA) was measured in each eye using letter and Landolt C log MAR charts under the following conditions: (1) with the distance refractive correction, (2) immediately after exposure to +2.00 D defocus and (3) following 60 min of binocular adaptation to +2.00 D blur. Objective refraction at the beginning and at the end of the experimental procedure was evaluated. Averaged VA data between the two eyes were used for analysis. Results Deterioration in VA with +2.00 D defocus was greater in the emmetropes compared to myopes for both charts. The mean difference between the two refractive groups was more pronounced for the Landolt- C (0.17 log MAR) compared to the letter chart (0.10 log MAR). The reduction in VA with blur was related to the amount of the refractive error. Following 60 min of adaptation, a significant improvement in VA was observed in both groups that did not differ between the two charts. The improvement in VA following adaptation using the letter chart was linearly correlated with spherical equivalent refractive correction. Conclusions Myopes show higher tolerance to retinal defocus compared to emmetropes, which could be attributed to previous blur experience. The effect of blur on VA is more pronounced using Landolt C optotypes than with letters. Prolonged exposure to blur results in equally improved performance for both refractive groups. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have evaluated macular retinal thickness (RT) and nerve fiber layer thickness (RNFLT) changes in early glaucoma using elaborate optical coherence tomography (OCT) scanning protocols. Materials and Methods: This study examines RT and RNFLT using standard scanning protocols in early glaucoma. In this prospective, nonrandomized case series, 95 eyes of 95 patients were evaluated, including 29 nonglaucomatous subjects (control group), 34 glaucoma suspects, and 32 early manifest glaucoma patients. RT and RNFLT were measured using scanning fast macular thickness map and Fast RNFLT (3.4) protocols on a 1.70 mm radius around the macular center (respectively) in all four quadrants. The fast RNFLT (3.4) protocol was transposed on the macula from the peri-papillary area. Data were statistically analyzed for differences between groups, and for correlations between parameters. P<0.5 was statistically significant. Results: Both early manifest glaucoma patients and glaucoma suspects had significantly lower RT than controls in all quadrants. RNFLT differences in all quadrants were not statistically significant (P>0.05). RT was significantly inversely correlated with axial length in early manifest glaucoma patients and glaucoma suspects but not in controls. Conclusions: The finding that RT was significantly lower in early manifest glaucoma patients and glaucoma suspects indicates that the transposition of the OCT fast RNFL thickness (3.4) protocol from the peri-papillary area to the peri-macular area can be used for early glaucoma diagnosis. Intraretinal changes in early glaucoma, likely precede nerve fiber changes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate blue-light attenuation in eyes with a tinted intraocular lens (IOL) or an untinted IOL. Setting: Department of Ophthalmology, University Hospital of Crete, Crete, Greece. Design: Comparative case series. Methods: Patients had lens extraction and implantation of an Acrysof Natural tinted or Tecnis ZA9003 or Softec III untinted acrylic IOL. The luminance ratio of green (530 nm) and blue (465 nm) light (green:blue ratio) required for isoluminant perception was determined by heterochromatic flicker photometry. Patients were tested preoperatively and 20 days postoperatively. The parafoveal measure of the green:blue ratio, expressed in decibels, is proportional to the blue-light attenuation by the lens. Results: Twenty-two patients received the tinted IOL and 21 the untinted IOL. Preoperatively, age was strongly linearly correlated with the green:blue ratio (r = 0.59, P<.001). The mean postoperative decrease in the green:blue ratio was greater in the untinted IOL group (P=.003). Postoperatively, the tinted IOL group had a significantly higher green:blue ratio than the untinted IOL group (P<.001). In the tinted IOL group, the green:blue ratio was linearly related to IOL dioptric power. Conclusion: Less blue light reached the retina with tinted IOLs than with untinted IOLs. The absorption properties of tinted IOLs seemed to resemble those of the aging human crystalline lens, while untinted IOLs resembled the lower levels of blue-light attenuation of younger lenses. Thus, tinted IOLs may protect against the presumed blue-light hazard. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose: To report complications after the implantation of intrastromal corneal ring segments (Keraring; Mediphacos, Belo Horizonte, Brazil) in keratoconic eyes using a femtosecond laser (IntraLase; Advanced Medical Optics, Santa Ana, California, USA) for channel creation. Methods: Retrospective chart review of 531 patients (850 eyes) who underwent Keraring insertion using a femtosecond laser for channel creation. Intraoperative and postoperative complications were recorded. Results: Intraoperatively, there were 22 (2.7%) cases of incomplete channel formation. The rest of the intraoperative complications were galvo lag error (system malfunction) [five eyes (0.6%)], endothelial perforation [five eyes (0.6%)] and incorrect entry of the channel [two eyes (0.2%)]. Postoperatively, there were 11 (1.3%) cases of segment migration, two (0.2%) cases of corneal melting and one (0.1%) case of mild infection. The overall complication rate was 5.7% (49 cases out of 850 eyes). Conclusion: In this study, intracorneal ring segment implantation using a femtosecond laser for channel creation was related to a number of complications. The most common complications were incomplete channel creation (intraoperatively) and segment migration (postoperatively). [ABSTRACT FROM AUTHOR]

Purpose: To determine the possible effect of corneal collagen crosslinking (CXL) with riboflavin and ultraviolet A (UVA) on intraocular pressure (IOP) measurements by Goldmann applanation tonometry (GAT). Setting: Institute of Vision and Optics, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece. Design: Prospective case series. Methods: This noncomparative study measured IOP by GAT before CXL and 6 months and 12 months after CXL. Results: The study evaluated 55 eyes (55 patients). There was a statistically significant increase in the measured IOP 6 months and 12 months after CXL (both P<.001). The mean measured IOP was 9.95 mm Hg ± 3.01 (SD) before CXL, 11.40 ± 2.89 mm Hg at 6 months, and 11.35 ± 3.38 mm Hg at 12 months. The change in IOP measurements at both postoperative examinations was not correlated with patient age, preoperative pachymetry, or preoperative keratometry readings. Conclusion: After riboflavin–UVA CXL in eyes with keratoconus, there was a significant increase in IOP measured by GAT that was probably caused by an increase in corneal rigidity. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]