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Purpose: The aim of this study was to present the 3-year outcomes after simultaneous transepithelial phototherapeutic keratectomy (t-PTK) and conventional photorefractive keratectomy (PRK) followed by corneal crosslinking (CXL) for keratoconus., Methods: In this prospective, interventional case series, patients with progressive keratoconus underwent simultaneous t-PTK and conventional PRK followed by CXL (Cretan protocol plus). Visual, refractive, and topographic outcomes were evaluated along with endothelial cell density (ECD) preoperatively and at 1, 2, and 3 years postoperatively., Results: Twenty-two patients (31 eyes) were enrolled. No intraoperative or postoperative complications were observed in any of the patients. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected and mean corrected distance visual acuity improved from 0.81 ± 0.40 and 0.18 ± 0.21 preoperatively to 0.38 ± 0.33 ( P < 0.001) and 0.06 ± 0.12 ( P < 0.001) at 3-year follow-up. Mean spherical equivalent improved from -5.39 ± 3.89 diopters (D) preoperatively to -2.29 ± 2.65 D ( P < 0.001) at 3 years postoperatively. Mean corneal astigmatism reduced from -4.70 ± 2.86 D preoperatively to -3.55 ± 2.45 D ( P = 0.001) at 3 years postoperatively. No ECD alterations were observed throughout the 3-year follow-up ( P > 0.05)., Conclusions: Simultaneous t-PTK and conventional PRK followed by CXL seems to be an effective and safe treatment for progressive keratoconus over 3-year follow-up., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To investigate in vitro the accuracy of dynamic contour tonometry, Goldmann applanation tonometry, and Tono-Pen XL in edematous corneas., Methods: Experimental study included 20 freshly enucleated porcine eyes. Epithelium was debrided, and eyes were divided in four groups. Groups were immersed in 35%, 40%, 50%, and 60% glycerin solutions for 3 hours. Subsequently, globes were mounted in a special holder, and their intraocular pressure was hydrostatically adjusted. Intraocular pressure was measured by means of dynamic contour tonometry, Goldmann applanation tonometry, and Tono-Pen XL while adjusting true intraocular pressure to 17, 33, and 50 mm Hg. Ultrasound pachymetry was performed., Results: Mean corneal thickness was 914.5 ± 33.3 μm (730-1015 μm). In true intraocular pressure of 33 mm Hg, Goldmann applanation tonometry and dynamic contour tonometry significantly underestimated true intraocular pressure (mean Goldmann applanation tonometry: 14.7 ± 4.8 mm Hg, p  < 0.001, mean dynamic contour tonometry: 21.6 ± 6.8, p  < 0.001). Tono-Pen XL also underestimated, but difference was not statistically significant (Tono-Pen XL: 27.9 ± 9.7, p  = 0.064). In true intraocular pressure of 50 mm Hg, all three methods significantly underestimated (Goldmann applanation tonometry: 17.6 ± 5.3 mm Hg, p  < 0.001, dynamic contour tonometry: 26.8 ± 6.3 mm Hg, p  < 0.001, Tono-Pen XL: 35.6 ± 8.4 mm Hg, p  < 0.001). The error in measured intraocular pressure for each method (true minus measured intraocular pressure) was significantly correlated to true intraocular pressure ( p  < 0.001). The intraocular pressure measurements of each eye taken under true intraocular pressure of 17 and 33 mm Hg with the three methods were correlated to each other. Measurements taken under intraocular pressure of 50 mmHg were not correlated to each other. Corneal thickness was not correlated to intraocular pressure measurement., Conclusion: Goldmann applanation tonometry, dynamic contour tonometry, and Tono-Pen XL underestimate intraocular pressure when measured under edematous conditions. Tono-Pen XL showed better accuracy, especially in lower true intraocular pressure. The measurement error increases when true intraocular pressure increases in all three methods., Competing Interests: Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s), 2020.)

Purpose: To compare the long-term outcomes of corneal cross-linking (CXL) for the treatment of keratoconus using two different techniques for epithelial removal: transepithelial phototherapeutic keratectomy (t-PTK) and mechanical epithelial debridement., Methods: In this prospective, comparative, interventional case series, 26 patients (30 eyes) with progressive keratoconus underwent CXL treatment. Fifteen eyes (13 patients) underwent epithelial removal with t-PTK (Cretan protocol) and 15 eyes (13 patients) underwent mechanical epithelial debridement (Dresden protocol) during CXL. Visual, refractive, and keratometric outcomes were evaluated preoperatively and at 1, 2, 3, and 4 years postoperatively., Results: No intraoperative or postoperative complications were observed in any of the patients. In the Cretan protocol group, mean uncorrected (UDVA) and corrected (CDVA) visual acuity improved from 0.99 ± 0.42 and 0.33 ± 0.28 logMAR preoperatively to 0.75 ± 0.32 (P = .018) and 0.21 ± 0.16 (P = .024) logMAR at 4 years postoperatively, respectively. In the Dresden protocol group, mean UDVA improved from 0.83 ± 0.47 logMAR preoperatively to 0.63 ± 0.40 logMAR (P = .033) at 4 years postoperatively, whereas mean CDVA did not demonstrate a statistically significant improvement postoperatively (P > .05). In the Cretan protocol group, mean corneal astigmatism improved from -6.19 ± 4.54 diopters (D) preoperatively to -4.68 ± 3.10 D (P = .041) at last follow-up, whereas in the Dresden protocol group there was no statistically significant difference postoperatively (P > .05)., Conclusions: Epithelial removal with t-PTK during CXL (Cretan protocol) resulted in better visual, refractive, and keratometric outcomes compared with mechanical epithelial debridement over a long-term follow-up. [J Refract Surg. 2019;35(10):650-655.]., (Copyright 2019, SLACK Incorporated.)

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., (Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

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.

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., Competing Interests: Dr Pallikaris has a pending patent for peripheral capsule reconstructor and declares no other conflicts of interest in this work. The remaining authors have no financial or proprietary interest in any material or method presented herein and declare no conflicts of interest in this work.

Purpose: To compare clinical outcomes of three different techniques of combined cataract and Presbia Flexivue Microlens refractive corneal inlay (Presbia Coöperatief U.A., Amsterdam, Netherlands) implantation surgery for presbyopia compensation over a 12-month follow-up., Methods: In this comparative pilot study, 15 patients with bilateral cataract were allocated to one of three groups with a different combination of surgical steps (cataract surgery, intrastromal pocket creation, and inlay implantation). In the three-step group, the intracorneal pocket was created in the non-dominant eye, bilateral cataract surgery was performed 3 months later, and the intracorneal inlay was inserted 3 months after that. In the two-step at 3 days group, bilateral cataract surgery was performed 3 days after pocket creation and inlay implantation in the non-dominant eye. In the two-step at 3 months group, the pocket creation and the inlay implantation were performed in the non-dominant eye 3 months after bilateral cataract surgery. Visual, refractive, and contrast sensitivity outcomes were evaluated and compared between the three groups., Results: Twelve months after the inlay implantation, mean monocular uncorrected distance visual acuity was 20/32 in the three-step group, 20/32 in the two-step at 3 days group, and 20/25 in the two-step at 3 months group. Achieved mean monocular uncorrected near visual acuity was similar in the three groups (20/25). The visual and refractive outcomes did not show significant differences between groups. Contrast sensitivity was similar between groups under mesopic and photopic conditions. No intraoperative or postoperative complications were observed., Conclusions: Clinical outcomes of three different techniques of combined cataract surgery and refractive corneal inlay implantation had no apparent differences between them. The corneal inlay provided excellent near vision acuity, with high patient satisfaction and a high spectacle independence rate after cataract surgery. [J Refract Surg. 2016;32(5):318-325.]., (Copyright 2016, SLACK Incorporated.)

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.

Purpose: The purpose of this study was to compare selected MRI pulse sequences and to evaluate their utility for depicting specific anatomic regions in the eye., Methods: A High-Resolution (HR) 0.08 × 0.08 × 0.60 mm(3) MRI protocol was developed on a 1.5-T clinical system and applied in the left eye of an albino rabbit, utilizing a small field of view surface coil. The comprehensive MRI protocol consisted of two 3D (T2/T1)w sequences (3D-PSIF and 3D-CISS), and one 3D T1w sequence (3D-VIBE). The T1w 3D-VIBE sequence was acquired, before and after intravenous injection of 0.2 mmol/kgr gadolinium-DTPA. Signal-to-Noise Ratios (SNR) and Contrast-to-Noise Ratios (CNR) amongst specific eye anatomical areas were calculated for each sequence. The presence of artifacts was rated subjectively utilizing a 5 point scale., Results: 3D-PSIF and 3D-CISS provide better delineation and visualization of the eye as compared with 3D-VIBE sequences. 3D-CISS images present the highest SNR and revealed better discrimination of the ocular surrounding tissues; its basic drawback though is related to ghost artifacts appearing in the anterior chamber and resulting in the lowest image quality. In post-contrast imaging, the T1w 3D-VIBE sequence provided the best overall image quality. Moreover, 3D (T2/T1)w sequences can provide good anatomic depiction of the eye segments. Agreement between the two independent readers was good., Conclusions: Optimization of a comprehensive MR eye imaging protocol is achieved. A higher SNR, a better spatial resolution and a reduction of the total scan time were obtained, thus making clinical MRI systems more reliable in eye imaging., (Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.)

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., (© 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose of Review: The aim of this review is to offer a comprehensive overview of the different PresbyLASIK approaches, which have been published in peer-reviewed journals., Recent Findings: Comprehensive search was conducted in scopus using keywords presbyLASIK, presbyopia, LASIK, corneal multifocality. We reviewed binocular uncorrected and corrected distance and near visual acuity, and loss of lines of best corrected visual acuity, for presbyopic patients among three different basic treatment modalities., Summary: Additional trials and standards for reporting results for presbyopic approaches are necessary. Careful patient selection and counseling is imperative in all PresbyLASIK treatments.

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.

Purpose: The primary objective of the study was to explore the statistics of ocular higher-order aberrations in a population of primary and secondary school children., Methods: A sample of 557 children aged 10-15 years were selected from two primary and two secondary schools in Heraklion, Greece. Children were classified by age in three subgroups: group I (10.7±0.5 years), group II (12.4±0.5 years) and group III (14.5±0.5 years). Ocular aberrations were measured using a wavefront aberrometer (COAS, AMO Wavefront Sciences, USA) at mesopic light levels (illuminance at cornea was 4lux). Wavefront analysis was achieved for a 5mm pupil. Statistical analysis was carried out for the right eye only., Results: The average coefficient of most high-order aberrations did not differ from zero with the exception of vertical (0.076μm) and horizontal (0.018μm) coma, oblique trefoil (-0.055μm) and spherical aberration (0.018μm). The most prominent change between the three groups was observed for the spherical aberration, which increased from 0.007μm (SE 0.005) in group I to 0.011μm (SE 0.004) in group II and 0.030μm (SE 0.004) in group III. Significant differences were also found for the oblique astigmatism and the third-order coma aberrations., Conclusions: Differences in the low levels of ocular spherical aberration in young children possibly reflect differences in lenticular spherical aberration and relate to the gradient refractive index of the lens. The evaluation of spherical aberration at certain stages of eye growth may help to better understand the underlying mechanisms of myopia development., (Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.)

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/cm(2)) 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.

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.

Purpose: The aim of this study was to present the long-term results of corneal collagen cross-linking (CXL) in patients with keratoconus., Methods: In this prospective, interventional case series, patients with progressive keratoconus underwent CXL treatment according to the Dresden protocol. Visual, refractive, and topographic outcomes along with endothelial cell density were evaluated preoperatively and at 1, 2, 3, 4, and 5 years postoperatively., Results: Twenty-one patients (25 eyes) were enrolled. The mean follow-up was 43.7 ± 12.2 (range, 24-60) months. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected visual acuity and the mean best spectacle-corrected visual acuity improved significantly from 0.92 ± 0.54 and 0.29 ± 0.21 preoperatively to 0.63 ± 0.41 (P = 0.010) and 0.18 ± 0.18 (P = 0.011), respectively, at the last follow-up. Mean steep and mean flat keratometry readings reduced significantly from 52.53 ± 6.95 diopters (D) and 48.11 ± 5.98 D preoperatively to 49.10 ± 4.50 D (P < 0.001) and 45.58 ± 3.81 D (P = 0.001), respectively, at the last follow-up. The mean endothelial cell density was 2708 ± 302 cells per square millimeter preoperatively and did not change significantly (P > 0.05) at any postoperative interval (2593 ± 258 cells/mm at the last follow-up; P = 0.149)., Conclusions: CXL seems to be effective and safe in halting progression of keratoconus over a long-term follow-up period up to 5 years postoperatively.

Purpose: To present the long-term results of combined transepithelial phototherapeutic keratectomy (PTK) and corneal collagen crosslinking (CXL) for keratoconus., Setting: Vardinoyiannion Eye Institute of Crete, University of Crete, Heraklion, Crete, Greece., Design: Prospective case series., Methods: Patients with progressive keratoconus had combined transepithelial PTK and CXL (Cretan protocol). Visual and refractive outcomes and the endothelial cell density (ECD) were evaluated preoperatively and postoperatively., Results: Twenty patients (23 eyes) were enrolled; postoperatively 23 eyes were evaluated at 1 and 2 years, 11 at 3 years, and 7 at 4 years. The mean follow-up was 33.83 months±10.82 (SD) (range 24 to 56 months). No intraoperative or postoperative complications occurred. The mean uncorrected distance visual acuity improved significantly from 0.99±0.57 logMAR preoperatively to 0.61±0.36 logMAR at the last follow-up (P<.001) and the mean corrected distance visual acuity, from 0.27±0.24 logMAR to 0.17±0.14 logMAR (P=.018), respectively. The mean steep and mean flat keratometry readings decreased significantly from 53.39±7.14 diopters (D) and 47.17±4.87 D, respectively, preoperatively to 49.99±4.36 D (P<.001) and 45.47±2.95 D (P=.002), respectively, at the last follow-up. The mean corneal astigmatism improved significantly from -6.27±4.19 D preoperatively to -4.52±2.80 D (P<.001) at the last follow-up. No significant ECD alterations occurred (P>.05)., Conclusion: Combined transepithelial PTK and CXL was effective and safe in keratoconic patients over a long-term follow-up., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to report 3 cases of persistent epithelial defects (PEDs) successfully treated with the combined topical application of a regenerative agent (RGTA; Cacicol20, OTR3, Paris, France) with a bandage contact lens (BCL)., Methods: This is a case series., Results: Three patients suffering from a PED for 4-8 weeks and unresponsive to conventional therapy were treated with the combined application of an RGTA (Cacicol20) and a silicone hydrogel BCL. The PED healed in all patients after 4-21 days, and no side effects were noted., Conclusions: The combination of an RGTA (Cacicol20) with a BCL seems to be an effective treatment for PED.

This study employs optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) imaging as well as optical aberrometry to examine correlations between the anterior chamber angle aperture and visual acuity for near vision as well as coma along the horizontal and vertical axes in eyes implanted with an accommodative intraocular lens (Crystalens). A retrospective comparative consecutive case series of 22 eyes of 11 patients (5 males) uneventfully implanted with a Crystalens. Eyes with signs of posterior capsular opacification were excluded. All eyes were examined with 40 MHz UBM (Ellex Eyecubed) and spectral-domain OCT (Zeiss Visante). The angle aperture along the horizontal and vertical meridians was recorded based on the software of the systems. The coma root mean square (RMS) scores for the horizontal and vertical meridians were also recorded with the iTrace aberrometer. The anterior chamber angle was significantly wider along the horizontal axis compared with the vertical axis by UBM (46.37° and 44.20°, respectively) and by OCT (46.79° and 43.58°, respectively) (p = 0.02 in both cases, paired-samples t test). The correlations between the logMAR-converted Jaeger near vision score and the horizontal or vertical angle apertures was not statistically significant. Horizontal coma RMS was significantly inversely correlated with the horizontal angle aperture (r = -0.45, p = 0.03 and r = -0.39, p = 0.04 by OCT and UBM, respectively). Measurement of the horizontal angle aperture by the modalities used may represent an anatomical and clinical predictor of the optical aberrations induced by the Crystalens.

Unlabelled: 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., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the outcomes after Wichterle Intraocular Lens-Continuous Focus (Medicem, Kamenné Zehrovice, Czech Republic) accommodative bioanalogic intraocular lens implantation., Methods: In this prospective case series, 50 eyes of 25 patients (mean age: 65.3 ± 8.4 years; range: 53 to 83 years) were included. All patients underwent routine cataract surgery and Wichterle Intraocular Lens-Continuous Focus implantation., Results: Mean follow-up was 11.44 ± 2.46 months (range: 9 to 17 months). Both monocular uncorrected and corrected distance visual acuity statistically and significantly (P < .05) improved from 0.31 ± 0.17 (20/63 Snellen) (range: counting fingers to 0.7) to 0.74 ± 0.19 (20/25 Snellen) (range: 0.2 to 1) and from 0.61 ± 0.19 (20/32 Snellen) (range: 0.2 to 1) to 0.82 ± 0.13 (20/25 Snellen) (range: 0.4 to 1), respectively. Target postoperative refraction was -0.5 diopters (D) and preoperative and 1-year postoperative spherical equivalent refraction were 0.72 ± 2.71 D (range: -7.25 to 2.37 D) and -0.24 ± 0.65 D (range: -1.0 to 1.0 D), respectively. No eyes lost lines of corrected distance visual acuity during the follow-up period, whereas 88% of patients gained one or more lines of corrected distance visual acuity. Uncorrected intermediate and near visual acuity were J2 (Snellen 20/25) or better in 72% of patients. No complications occurred intraoperatively or postoperatively. The evaluation of the mean values of root mean square of third and fourth order higher-order aberrations at 1 year postoperatively revealed a mean negative spherical aberration of -0.18 ± 0.13 μm., Conclusions: Wichterle Intraocular Lens-Continuous Focus accommodative bioanalogic IOL implantation provides satisfactory visual acuity for far, intermediate, and near distances and the promising results remain stable throughout the follow-up period., (Copyright 2014, SLACK Incorporated.)

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.

Purpose: To describe a new minimally invasive surgical technique for the symptomatic management of bullous keratopathy in blind eyes., Methods: Four patients with severe corneal edema due to endothelial decompensation and no visual function in the affected eye presented for the relief of their ocular symptoms (pain and tearing). Femtosecond laser technology was used to create a deep corneal pocket into which silicone oil was inserted., Results: After the procedure, all patients demonstrated immediate relief of their symptoms, along with restoration of a normal corneal surface 7 days after the procedure (no bullae and no epithelial defects). All patients remained free of symptoms during the entire follow-up period (from 24 to 31 months). Anterior to the inserted implant, the corneal lamellae remained compact, transparent, and without bullae; whereas the posterior corneal stroma under the implant was edematous. No intraoperative or postoperative complications were noted., Conclusions: Intracorneal insertion of silicone oil is a feasible new technique for the symptomatic treatment of bullous keratopathy in blind eyes.

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/cm(2) according to the standard Dresden protocol (Group 1) or for 10 minutes with 9 mW/cm(2) 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., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To present the results after simultaneous conventional photorefractive keratectomy combined with corneal collagen cross-linking for pellucid marginal corneal degeneration., Methods: In this prospective, interventional case series, 6 patients (8 eyes) with pellucid marginal corneal degeneration were enrolled. All patients underwent simultaneous conventional photorefractive keratectomy combined with corneal collagen cross-linking; corneal epithelium was removed by transepithelial phototherapeutic keratectomy during treatment (Cretan protocol plus conventional photorefractive keratectomy). Visual and refractive outcomes were evaluated along with endothelial cell density preoperatively and at 1, 3, 6, and 12 months postoperatively., Results: No intraoperative or postoperative complications were observed in any of the patients. LogMAR mean uncorrected distance visual acuity improved significantly from 1.05 ± 0.33 preoperatively to 0.41 ± 0.27 (P = .018) at 12 months postoperatively. Mean corrected distance visual acuity did not change significantly (P > .05) postoperatively. Mean spherical equivalent improved significantly from -3.52 ± 2.29 diopters preoperatively to -1.57 ± 1.76 diopters (P = .028) at last follow-up. Mean corneal astigmatism was significantly reduced from -6.83 ± 2.33 diopters preoperatively to -4.71 ± 1.89 diopters (P = .018) at the last follow-up. No endothelial cell density alterations were observed throughout the follow-up period (P > .05)., Conclusions: Simultaneous conventional photorefractive keratectomy combined with corneal collagen cross-linking seems to be an effective, safe, and promising treatment for the management of pellucid marginal corneal degeneration., (Copyright 2014, SLACK Incorporated.)

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., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

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/mm(2). Conclusions. PRK, with intraoperative use of MMC, demonstrates stable refractive and visual outcomes up to 44 months after surgery.

Purpose: The multi-component intraocular lens (IOL) (IVO; SAS, Strasbourg, France) is a novel approach to the treatment of pediatric cataract. Because the refractive requirements for pediatric eyes often change over time, current IOL technology does not easily allow refractive adjustments after the primary surgical intervention. The multi-component IOL concept allows easy, surgical refractive adjustments to the initial surgical implantation at any postoperative time period. Thus, both surgical implantation and enhancement surgery have been successfully accomplished in adult patients., Methods: A novel surgical approach to pediatric cataract surgery is described. At the time of the primary surgery, a two component IOL was implanted. At any postoperative time period, the front lens component, located in front of the capsular bag, could be easily surgically exchanged because the dioptric power requirements of the pediatric eye changed over time., Results: Both primary and enhancement surgeries have been done in adult patients with good results. Implantations have occurred uneventfully in all cases with no intraoperative or postoperative complications. There was no statistically significant difference in the endothelial cell density, anterior chamber depth, and pachymetry readings preoperatively and 2 years postoperatively. There was no interlenticular fibrosis present., Conclusion: The multi-component IOL should provide a unique and greatly needed surgically adjustable approach to the treatment of pediatric cataract., (Copyright 2014, SLACK Incorporated.)

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.

Aims/purpose: To report the preoperative use of anterior segment optical coherence tomography (AS-OCT) for the determination of pre-existing posterior capsule defect in patients with posterior polar cataract., Methods: Three patients presented with posterior polar cataract and were evaluated preoperatively using AS-OCT, revealing in one patient intact posterior capsule and in the other two a pre-existing posterior capsule defect not detectable by slit-lamp evaluation. All patients underwent phacoemulsification and intraocular lens implantation., Results: Intraoperatively, AS-OCT findings were confirmed after cataract surgery in all patients. No intra- or late postoperative complications were noted., Conclusion: AS-OCT could be an additional useful imaging modality in these patients, essential for surgical planning and patient consultation.

Introduction: A previous study has employed shear-wave ultrasound elastographic imaging to assess corneal rigidity in an ex-vivo porcine eye model. This study employs the same modality in vivo in a rabbit eye model in order to assess lens, ciliary body and total ocular rigidity changes following the instillation of atropine and pilocarpine., Methods: Ten non-pigmented female rabbits were examined. Measurements of the lens, ciliary body and total ocular rigidity as well as lens thickness and anterior chamber depth were taken with the Aixplorer system (SuperSonic Imagine, Aix-en-Provence, France) with the SuperLinear™ SL 15-4 transducer in both eyes at baseline as well as after pilocarpine and atropine instillation. The IOP was also measured with the TonoPen tonometer., Results: Changes in rigidity in the examined areas following atropine instillation were statistically not significant. Ciliary body rigidity was significantly increased whereas lens and total ocular rigidity were significantly reduced following pilocarpine instillation. The decrease in lens rigidity following pilocarpine was significantly associated with the respective increase in ciliary body rigidity., Conclusions: Shear-wave ultrasound elastography can detect in vivo rigidity changes in the anterior segment of the rabbit eye model and may potentially be applied in human eyes, providing useful clinical information on conditions in which rigidity changes play an important role, such as glaucoma, pseudoexfoliation syndrome or presbyopia.

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/m(2)., Results: Interocular differences in monocular VEP latency (at 30 cd/m(2)) 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/m(2) (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.

Purpose: To report 3 cases of keratoconic patients who had progressive corneal topographic flattening during a 2-year follow-up period., Methods: Case series., Results: Three patients with bilateral keratoconus, each operated for advanced keratoconus in one of their eyes, were observed for possible progression of the disorder for a period of 2 years. During the 2-year follow-up period, topographic examination showed progressive corneal flattening in the nonoperated eye. Mean keratometry decreased in all patients, whereas topography showed significant flattening at the apex of the cone. Best-spectacle-corrected visual acuity increased in one of the patients, whereas the others had stable uncorrected and best-spectacle-corrected visual acuity during the follow-up period. All patients had positive family medical history for diabetes mellitus, but none of them was diabetic., Conclusions: This is the first report of topography-based keratoconus regression during a 2-year follow-up period.

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., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare ocular rigidity (OR) and outflow facility (C) coefficients in medically treated open-angle glaucoma (OAG) patients and controls, and to investigate differences in ocular pulse amplitude (OPA) and pulsatile ocular blood flow (POBF) between the two groups., Methods: Twenty-one OAG patients and 21 controls undergoing cataract surgery were enrolled. Patients with early or moderate primary or pseudoexfoliative OAG participated in the glaucoma group. A computer-controlled system, consisting of a pressure transducer and a microstepping device was employed intraoperatively. After cannulation of the anterior chamber, IOP was increased by infusing the eye with microvolumes of saline solution. IOP was recorded after each infusion step. At an IOP of 40 mm Hg, an IOP decay curve was recorded for 4 minutes. OR coefficients, C, OPA, and POBF were estimated from IOP and volume recordings., Results: There were no differences in age or axial length in the two groups. The OR coefficient was 0.0220 ± 0.0053 μl(-1) in the OAG and 0.0222 ± 0.0039 μl(-1) in the control group (P = 0.868). C was 0.092 ± 0.082 μL/min/mm Hg in the glaucoma group compared with 0.149 ± 0.085 μL/min/mm Hg in the control group at an IOP of 35 mm Hg (P < 0.001) and 0.178 ± 0.133 μL/min/mm Hg vs. 0.292 ± 0.166 μL/min/mm Hg, respectively, at an IOP of 25 mm Hg (P < 0.001). There were no differences in OPA or POBF between the two groups in baseline and increased levels of IOP (P > 0.05)., Conclusions: Manometric data reveal lower C in OAG patients and increased C with increasing IOP. There were no differences in the OR coefficient, OPA, and POBF between medically treated OAG patients and controls, failing to provide evidence of altered scleral distensibility and choroidal blood flow in OAG.

Background: The aim of the present study was to investigate the value of pattern visual-evoked potentials (pVEP) and pattern electroretinograms (pERG) in early glaucoma diagnosis., Materials and Methods: Thirty-eight eyes of 38 patients were included. Patients were classified into normal control (NC) and glaucoma patient (GP) groups. Patients underwent a detailed clinical ophthalmic examination and an electrodiagnostic examination using steady-state pVEP and pERG. Differences between groups in the amplitudes of the second harmonic of the pVEP and pERG responses to 480' (A480) and 48' (A48) check sizes and the ratio of the above amplitudes (A48/A480) were examined., Results: Differences in the 48' and 480' pVEP between groups were not statistically significant. The pVEP A48/A480 ratio was significantly higher in NC than in GP. Differences in pERG between groups were statistically not significant for both 48' and 480' check sizes. In contrast, respective differences in pERG A48/A480 ratio were statistically significant., Conclusions: Steady-state pVEP and pERG A48/A480 ratio may be of value in glaucoma diagnosis.

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., (Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

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/m(2) 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/m(2)) 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., (Ophthalmic & Physiological Optics © 2012 The College of Optometrists.)

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., (Ophthalmic & Physiological Optics © 2013 The College of Optometrists.)

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 logMAR 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 logMAR 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 logMAR) compared to the letter chart (0.10 logMAR). 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., (Ophthalmic & Physiological Optics © 2013 The College of Optometrists.)

Purpose: Previous studies have shown a negative correlation between axial length (AL) and pulsatile ocular blood flow (POBF). This relation has been questioned because of the possible confounding effect of ocular volume on ocular rigidity (OR). The purpose of this study was to investigate the relation between AL, as a surrogate parameter for ocular volume, and OR, ocular pulse amplitude (OPA), and POBF., Methods: Eighty-eight cataract patients were enrolled in this study. A computer-controlled device comprising a microdosimetric pump and a pressure sensor was used intraoperatively. The system was connected to the anterior chamber and used to raise the intraocular pressure (IOP) from 15 to 40 mm Hg, by infusing the eye with a saline solution. After each infusion step, the IOP was continuously recorded for 2 seconds. Blood pressure and pulse rate were measured during the procedure. The OR coefficient was calculated from the pressure volume data. OPA and POBF were measured from pressure recordings., Results: Median AL was 23.69 (interquartile range 3.53) mm. OR coefficient was 0.0218 (0.0053) μL(-1). A negative correlation between the OR coefficient and AL (ρ = -0.641, P < 0.001) was documented. Increasing AL was associated with decreased OPA (ρ = -0.637, P < 0.001 and ρ = -0.690, P < 0.001) and POBF (ρ = -0.207, P = 0.053 and ρ = -0.238, P = 0.028) at baseline and elevated IOP, respectively., Conclusions: Based on manometric data, increasing AL is associated with decreased OR, OPA, and POBF. These results suggest decreased pulsatility in high myopia and may have implications on ocular pulse studies and the pathophysiology of myopia.

Background: The purpose of this study is to evaluate in-vitro the immediate effect of corneal collagen cross-linking (CXL) on corneal hydration and stiffness., Methods: Forty-two corneal buttons from freshly enucleated porcine eyes were immersed in riboflavin 0.1% in dextran 20% dilution for 3 h in order for their hydration to reach equilibrium. Corneal buttons where divided into two groups; the first group was stored in dark conditions while the other group was irradiated with UV radiation (370 nm) for 30 min to simulate CXL according to the clinically applied protocol. After irradiation, all corneas were immersed in dextran 20% solution for 3 additional hours. Subsequently, each button underwent weighing, thickness measurement, and was mounted in a special device for the measurement of force versus deformation by compression. Finally, all corneal buttons were dehydrated for 48 h in a desiccating oven set at 62 °C and weighed again to obtain their dry mass. Hydration (%) of each button was calculated., Results: Mean corneal hydration in the irradiated and the non-irradiated group of corneas was 69.8 and 72.2%, respectively (p < 0.001). Differences in thickness and compressibility were not statistically significant. Thickness and hydration were positively correlated (Pearson's r = 0.714, p < 0.001)., Conclusions: CXL causes corneal dehydration that can be detected immediately after the procedure. This phenomenon may contribute to increased mechanical stiffness of the cornea. A change in stiffness by means of compressibility could not be detected in porcine corneas.

Purpose: To assess the in vitro susceptibility of Streptococcus pneumoniae, Staphylococcus aureus and coagulase-negative staphylococci (CoNS) ocular isolates to antibiotics, and identify changing trends in resistance over a 10-year period., Methods: All isolates from ocular infections collected between 2000 and 2009 were prospectively tested against several antibiotics in vitro. S. pneumoniae isolates (n = 93) were tested against 20 and S. aureus (n = 120) and CoNS (n = 214) against 19 antibiotics. To identify changes in susceptibility patterns, we compared results from 2000-2004 with those from 2005-2009. We also compared the antibiotic susceptibilities against aminoglycosides and quinolones between methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) isolates., Results: All S. pneumoniae isolates were susceptible to quinolones, and 99% were susceptible to chloramphenicol. Regarding S. aureus, we noted a significant increase in resistance against penicillin in recent years (p = 0.016). Over 90% of S. aureus isolates were susceptible to quinolones and aminoglycosides. MRSA isolates were more resistant to ciprofloxacin and ofloxacin than MSSA isolates were (p = 0.016). Concerning CoNS, a significant increase in susceptibility to amikacin was noted in the second study period (p = 0.01)., Conclusion: Quinolones remain an excellent treatment option for bacterial conjunctivitis and keratitis due to Gram-positive cocci in our region., (Copyright © 2011. Published by Elsevier B.V.)

Purpose: To compare visual acuity (VA) assessed in healthy eyes and eyes with diabetic retinopathy (DR) using three different logMAR charts: the Sloan letter European-wide chart, the tumbling E chart, and the Landolt C chart., Methods: Measurements on one eye of 40 volunteers (aged 29 ± 4 years) without visual impairment and 31 DR patients (aged 70 ± 9 years) with mild/moderate visual impairment were included. Visual acuity was assessed, with habitual refractive correction, using each of the three charts. Bland-Altman charts were constructed, and 95% limits of agreement were calculated to measure agreement., Results: Mean VA in the group of young adults was -0.05 ± 0.10 (Sloan letter), -0.02 ± 0.13 (tumbling E), and 0.00 ± 0.12 (Landolt C) logMAR. Average VA estimates differed to a statistically significant extent between all charts. Mean VA in the DR group was 0.46 ± 0.25 (Sloan letter), 0.48 ± 0.26 (tumbling E), and 0.59 ± 0.28 (Landolt C). A statistically significant difference was observed for average Sloan letter versus Landolt C (p < 0.001) and tumbling E versus Landolt C (p < 0.001) acuities. Moreover, in healthy eyes, a moderate correlation (r = -0.38, p = 0.015) was found between the discrepancy in Sloan letter and Landolt C acuity and the mean VA estimate. The 95% limits of agreement were wide (more than approximately 0.2 logMAR for each comparison) and wider in the DR group chart comparisons than in healthy eyes., Conclusions: Landolt C charts resulted in worse VA estimates compared with letter and tumbling E charts in both young adults and visually impaired subjects with DR. These differences seem more pronounced in DR patients who exhibit worse VAs. The specific study population must be considered in comparing outcomes from different clinical practices.

Purpose: To evaluate the outcomes and safety of a refractive inlay (Flexivue Micro-Lens, Presbia Coöperatief U.A.) for the corneal compensation of presbyopia., Methods: This prospective, interventional clinical study comprised 47 emmetropic presbyopes with a mean age of 52±4 years (range: 45 to 60 years). The inlay was inserted, centered on the line of sight, inside a corneal pocket created in the patient's nondominant eye, using a femtosecond laser. Follow-up was 12 months. Visual acuity, corneal topography, wavefront aberrometry, contrast sensitivity, structural corneal alterations, and questionnaires were evaluated., Results: Twelve months after surgery, uncorrected near visual acuity was 20/32 or better in 75% of operated eyes, whereas mean uncorrected distance visual acuity (UDVA) of operated eyes was statistically significantly decreased from 0.06±0.09 logMAR (20/20) (range: -0.08 to 0.26) preoperatively to 0.38±0.15 logMAR (20/50) (range: 0.12 to 0.8) (P<.001), and mean binocular UDVA was not significantly altered (P=.516). Seventeen patients lost one line of corrected distance visual acuity in the operated eye. No patient lost 2 lines in CDVA in the operated eye. Overall, higher order aberrations increased and contrast sensitivity decreased in the operated eye. No tissue alterations were found using corneal confocal microscopy. No intra- or postoperative complications occurred., Conclusions: Twelve months after implantation, the Flexivue Micro-Lens intracorneal refractive inlay seems to be an effective method for the corneal compensation of presbyopia in emmetropic presbyopes aged between 45 and 60 years old., (Copyright 2013, SLACK Incorporated.)

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., (© 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.)