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To evaluate the effect of visual axis positioning on the optical performance of the Tecnis MIOL and the Diff-aA MIOL. In this prospective, randomized comparative study, 70 eyes of 35 subjects with senile cataract were implanted with the spherical aberration–correcting diffractive, bifocal Tecnis ZLB00 IOL and 60 eyes of 30 age-matched subjects with the spherical aberration neutral, diffractive, bifocal Diffractiva IOL. Observation procedure was performed 1, 3, and 6 months postoperatively. Main outcome measures included uncorrected and corrected distance and near visual acuity, manifest refraction, ocular aberrations, and visual quality metrics with 2 mm and 4 mm pupil and the position of visual axis. At the 6-month visit, no significant difference was found in monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance and near (UNVA, CNVA) visual acuity between the groups. Spherical and coma-like aberrations were similar measured with a 2-mm pupil, but with a 4-mm pupil, the SA was significantly larger (in negative direction) in the Diffractiva group. The higher-order Strehl ratio and MTF was significantly larger in the Diffractiva group measured at 2 mm entrance pupil; however, this difference disappeared by the 4-mm pupil measurements. Postoperative angle alpha distance had a significant influence on HO Strehl value. The size of angle alpha is a predictive factor of image quality by multifocal IOL patients. Trial registration number and date of registration: NCT04274088, 14.02.2020.

Die Keratokonjunktivitis sicca (KCS) gewinnt mit stetig steigenden Pravalenzen vor allem in den alteren Bevolkerungsgruppen zunehmend an Bedeutung in der Augenheilkunde. Chirurgische Interventionen am Auge, im Speziellen die Katarakt-Chirurgie als haufigste durchgefuhrte Operation in der Ophthalmologie, gelten als bedeutende Risikofaktoren fur die Entwicklung einer KCS. Der folgende Artikel gibt eine Ubersicht uber Risikofaktoren, Pathophysiologie sowie pra- und postoperatives Management einer vorbestehenden oder neu aufgetretenen KCS bei Katarakt-Chirurgie.

Introduction. The aim of this randomized, observer-masked, parallel group study was to evaluate the short-term and long-term effects of topical hydrocortisone administered in addition to topical ciclosporin A for the first 2 weeks of the treatment in patients with dry eye disease associated with Sjögren syndrome. Materials and Methods. 24 eyes of 12 patients with severe dry eye disease associated with Sjögren syndrome were included in this study. Both eyes of all patients were treated with preservative-free Ciclosporin A eye drops once daily for 6 months. Additionally, one eye of each patient received hydrocortisone eye drops three times daily for the first two weeks of treatment. The study parameters were assessed before treatment, after 2 weeks, and after 6 months of treatment. Results. Tear BUT and corneal fluorescein Oxford staining grade showed significant differences with respect to the baseline when treated with ciclosporin A and hydrocortisone (CsA + Hc) and a nonsignificant increase when treated with ciclosporin A (CsA) alone. After 6 months of treatment, significant increases of tear BUT and corneal Fluorescein Oxford staining grade compared to baseline could be observed in both treatment groups. Aberrometry measurements showed significantly increased optical image quality after 6 months in the CsA + Hc group, while no significant changes could be detected in the eyes treated with CsA alone. However, no significant differences between the two treatment groups could be detected. Discussion. This study indicates that hydrocortisone combined with ciclosporin A therapy may provide fast improvement of clinical symptoms and could have long-term positive effects on the optical image quality in severe DED patients with Sjögren syndrome.

To describe the topographic and tomographic characteristics of normal fellow eyes of unilateral keratoconus cases and to evaluate the accuracy of machine learning classifiers in discriminating healthy corneas from the normal fellow corneas.Department of Ophthalmology, Semmelweis University, Budapest, Hungary.Retrospective case-control study.Patients with bilateral keratoconus (keratoconus group), clinically and according to the keratoconus indices of the Pentacam HR Scheimpflug camera; normal fellow eyes of patients with unilateral keratoconus (fellow-eye group); and eyes of refractive surgery candidates (control group) were compared. Tomographic data, topographic data, and keratoconus indices were measured in both eyes using the Scheimpflug camera. Receiver operating characteristic (ROC) analysis was used to assess the performance of automated classifiers trained on bilateral data as well as individual parameters to discriminate fellow eyes of patients with keratoconus from control eyes.Keratometry, elevation, and keratoconus indices values were significantly higher and pachymetry values were significantly lower in keratoconus eyes than in fellow eyes of unilateral keratoconus cases (P.001). These fellow eyes had significantly higher keratometry, elevation, and keratoconus index values and significantly lower pachymetry values than control eyes (P.001). Automated classifiers trained on bilateral data of index of height decentration had higher accuracy than the unilateral single parameter in discriminating fellow eyes of patients with keratoconus from control eyes (area under ROC 0.96 versus 0.88).Automatic classifiers trained on bilateral data were better than single parameters in discriminating fellow eyes of patients with unilateral keratoconus with preclinical signs of keratoconus from normal eyes.No author has a financial or proprietary interest in any material or method mentioned.

Purpose To evaluate the effect of lipid- versus sodium hyaluronate-based eye drops on optical quality and ocular surface parameters. Methods Sixty eyes of 30 patients with mild-to-moderate dry eye disease were included in a prospective randomized study. Each patient received either lipid- or sodium hyaluronate-based eye drops. Ocular symptom scores, breakup time, Schirmer test, fluorescein staining, noncontact meibography, and aberrometry were evaluated before and after 3 months of therapy. Results At the 3-month visit, a statistically significant improvement (P ≤ 0.05) was noted in both groups on the Schirmer test, breakup time, ocular surface staining, and symptom score. In the lipid group, patients with progressive meibomian gland (MG) loss (>50%) showed a significantly greater increase in their corneal higher-order (HO) Strehl ratio (0.25 ± 0.26 vs. -0.01 ± 0.25, P = 0.02) and modulation transfer function (MTF) (0.12 ± 0.17 vs. -0.02 ± 0.06, P = 0.03) than patients with less advanced MG disease. In the lipid group, a significant positive correlation was noted between the MG dropout rate and improvement in Schirmer values [Spearman correlation coefficient (CC): 0.79], corneal HO Strehl (CC: 0.75), and HO modulation transfer function (CC: 0.6), but a significant negative correlation was noted between the MG dropout rate and the HO root mean square (CC: -0.73). Conclusions Lipid-containing artificial tears seem to be superior to sodium hyaluronate-containing drops in terms of improving HO aberrations and optical quality in patients with significant MG dysfunction.

Purpose. Long-term follow-up of patients with diabetic macular edema (DME) treated with intravitreal antivascular endothelial growth factor (anti-VEGF) combined focal laser and identification of prognostic morphological characteristics. Methods. Prospective clinical trial (50 treatment-naive eyes) with DME randomized 1 : 1 receiving intravitreal ranibizumab (0.5 mg/0.05 ml) and prompt grid laser compared with ranibizumab and deferred laser. Morphological characteristics potentially relevant for prognosis were assessed at baseline, month 6, month 9, and years 1, 2, 3, 4, and 5 of follow-up. Results. Although functional results were slightly higher in the prompt group at week 12 (0.5; 20/40 Snellen (SD = 0.04, 0.3 logMAR) versus 0.4; 20/50 Snellen (SD = 0.04, logMAR: 0.4), p=0.4) and month 9 (prompt group: 0.5; 20/40 Snellen (SD = 0.03, 0.3 logMAR) versus deferred group: 0.4; 20/50 Snellen (SD = 0.04, 0.4 logMAR), p=0.4), these were statistically insignificant. There was no significant benefit regarding functionality during long-term follow-up in the prompt group compared to the deferred group. BCVA in the eyes with clusters of hyperreflective foci in the central macular region was inferior compared with the eyes without these alterations at year 5 (0.39; 20/50 Snellen, (SD = 0.25, 0.4 logMAR) versus 0.63; 20/80 Snellen (SD = 0.22, 0.2 logMAR), p<0.01). Conclusion. Grid laser and ranibizumab therapy are effective in DME management during the long-term follow-up. Intraretinal hyperreflective material in SD-OCT is negatively related to BCVA.

Background. The purpose of this prospective, randomised study was to interocularly compare the visual performance after implantation of two different toric IOLs with different haptic design. Methods. 59 subjects with corneal astigmatism greater than 1.25 diopter (D) were implanted with an AT TORBI 709M IOL (Carl Zeiss Meditec AG) in one eye and with a Tecnis toric aspheric IOL (Abbot Medical Optics) in the other eye. Observation procedure was performed 12 months postoperatively. Main outcome measures included uncorrected distance visual acuity (UDVA), manifest refraction, IOL rotation, and IOL position. Results. Mean UCDVA was 0.04 ± 0.14 logMAR for AT TORBI eyes and 0.06 ± 0.15 logMAR for Tecnis eyes (p=0.3). The postoperative spherical equivalent values were significantly lower in the AT TORBI group. Mean toric IOL axis rotation was 3.0 ± 2.26 degrees for AT TORBI eyes and 3.27 ± 2.37 for Tecnis eyes (p=0.5). The mean vertical IOL tilt and vertical decentration values measured with the Visante OCT were significantly larger in the AT TORBI group (p<0.05). Conclusions. Both the Tecnis and the AT TORBI toric IOLs successfully reduced ocular astigmatism. Emmetropia could be better achieved with the AT TORBI IOL, whereas the Tecnis showed better positional stability. This trial is registered with ICMJE NCT03371576.

To assess the rotational stability of a single-piece intraocular lens (IOL) with C-loop haptic during the first six postoperative months. Department of Ophthalmology, Hietzing Hospital, Vienna, Austria. Prospective clinical trial. This study enrolled consecutive patients with 1.5 diopters (D) or more of preexisting corneal astigmatism having cataract surgery. Patients had phacoemulsification with implantation of the open-C-loop toric IOL Lentis Unico LU-312 T through a 2.5 mm astigmatically neutral incision. Uncorrected distance visual acuity (UDVA) and best corrected visual acuity (BCVA), refraction, keratometry, and the cylinder axis of the toric IOL were measured. Postoperative examinations were scheduled at week 1, month 1, month 3, and month 6. A total of 60 eyes of 39 patients were evaluated. The mean preoperative refractive astigmatism was 2.82± 1.34 D (SD) and the mean keratometric astigmatism 2.33 ± 1.10 D, respectively. Six months postoperatively the refractive cylinder decreased significantly to 1.12 ± 0.63 D. The mean postoperative UDVA was 79.05 ± 7.48 letters, improving to 83.78 ± 5.60 letters BCVA. The mean IOL rotation was 5.22 ± 5.82° (range: 0.0–32) at month 6 with less than 10° in 88.3 % of eyes. Five eyes needed reoperation due to IOL misalignment. The Lentis LU-312 T showed some tendency to rotate for up to 6 months. The C-loop design seems to be less suitable for toric IOLs.

PURPOSE: To evaluate the long-term visual outcome and intraocular (IOL) position parameters with a single-optic accommodating IOL after 5.5- or 6.0-mm femtosecond laser capsulotomy. METHODS: This prospective, randomized, pilot study comprised 17 eyes from 11 patients (7 men) with a mean age of 65.82±10.64 years (range: 51 to 79 years). All patients received a Crystalens AT-50AO (Bausch & Lomb) accommodating IOL after femtosecond laser refractive cataract surgery using either a 5.5-mm capsulotomy (5.5-mm group; 9 eyes) or 6.0-mm capsulotomy (6.0-mm group; 8 eyes). Near and distance visual acuities, manifest refraction spherical equivalent (MRSE), and IOL tilt and decentration were evaluated 1 year postoperatively. RESULTS: No significant differences were noted between groups for postoperative uncorrected distance visual acuity, uncorrected near visual acuity, distance-corrected near visual acuity, and MRSE. Vertical and horizontal tilt were significantly higher in the 6.0-mm group than in the 5.5-mm group ( P =.014 and P =.015, respectively). No significant difference was observed between groups regarding IOL decentration. CONCLUSIONS: A 5.5-mm capsulotomy created with a femtosecond laser is associated with less IOL tilt and therefore may be superior to a 6.0-mm capsulotomy when implanting a single-optic accommodating IOL.

PURPOSE: To evaluate corneal changes after corneal cross-linking (CXL) in progressive keratoconus with Scheimpflug imaging. METHODS: This prospective analysis included 40 eyes from 22 patients with progressive keratoconus. Corneal CXL was performed in 25 eyes (CXL group) and 15 fellow eyes served as controls (control group). Uncorrected (UDVA) and corrected distance visual acuity (CDVA), thinnest corneal thickness (ThCT), posterior elevation, and Holladay equivalent keratometry values (K1, K2) were determined with Pentacam (Oculus Optikgeräte GmbH) before and 1 year after CXL. Area under the receiver operator characteristic (ROC) curve and multivariable general estimating equation models were used to determine the most sensitive parameters of corneal changes. RESULTS: Manifest sphere (−2.55±3.21 to −1.48±2.39 diopters [D], P =.02), UDVA (0.23±0.25 to 0.31±0.25, P P =.019) improved significantly in the CXL group. Significant decreases were found in ThCT (472.53±33.18 to 440.53±38.67 μm, P P P P P >.05). According to ROC analysis, posterior elevation change was the most characteristic parameter of corneal change after CXL (area under the curve=0.99). General estimating equation model showed that CXL ( P =.001) and initial ThCT ( P =.007) were significant predictors of decrease in posterior elevation with a significant negative interaction of initial ThCT on CXL effect ( P =.005). CONCLUSIONS: Posterior elevation is a sensitive parameter to monitor corneal remodeling after CXL. Corneal CXL showed augmented effect on corneal protrusion in eyes with thinner corneas.

PURPOSE: To compare the effect of conventional phacoemulsification and femtosecond laser–assisted cataract surgery on the cornea using Scheimpflug imaging and noncontact specular microscopy. METHODS: In each group, 38 eyes (38 patients) underwent cataract surgery using either femtosecond laser–assisted (Alcon LenSx laser) (femtolaser group) or conventional phacoemulsification (phaco group). Central corneal thickness, 3-mm corneal volume, and Pentacam Nucleus Staging (PNS) were determined by a rotating Scheimpflug camera (Pentacam HR, Oculus Optikgeräte GmbH), and the volume stress index was calculated at 1 day and 1 month postoperatively. Endothelial cell count was measured by noncontact specular microscopy preoperatively, 1 day, 1 week, and 1 month postoperatively. RESULTS: Central corneal thickness was significantly higher in the phaco group (607±91 μm) than in the femtolaser group (580±42 μm) on day 1, but did not differ significantly preoperatively and at 1 week and 1 month. Volume stress index at day 1 was significantly lower in the femtolaser group than in the phaco group ( P CONCLUSIONS: Femtosecond laser–assisted cataract surgery causes less corneal swelling in the early postoperative period and may cause less trauma to corneal endothelial cells than manual phacoemulsification.

PURPOSE: To compare ocular and internal aberrations after femtosecond laser anterior capsulotomy and continuous curvilinear capsulorrhexis in cataract surgery. METHODS: In this prospective study, anterior capsulotomy was performed during cataract surgery with an intraocular femtosecond (FS) laser (Alcon LenSx Inc) in 48 eyes. As a control group, continuous curvilinear capsulorrhexis (CCC) was performed in 51 eyes. Wavefront aberrometry, corneal topography, and objective visual quality were measured using the OPD-Scan (NIDEK Co Ltd). Vertical and horizontal tilt, coma, and visual quality metrics were evaluated separately to determine whether the source of aberrations was ocular or internal. Main outcome measures included postoperative residual refraction, uncorrected and corrected visual acuities, ocular and internal aberrations, Strehl ratio, and modulation transfer function (MTF). RESULTS: No statistically significant differences were noted between the FS and CCC groups, respectively, in postoperative sphere (−0.60±1.50 vs −0.50±1.40 diopters [D]), postoperative cylinder (1.30±1.01 vs 1.10±1.10 D), uncorrected distance visual acuity (0.86±0.15 vs 0.88±0.08), or corrected distance visual acuity (0.97±0.08 vs 0.97±0.06). The FS group had significantly lower values of intraocular vertical tilt (−0.05±0.36 vs 0.27±0.57) and coma (−0.003±0.11 vs 0.1±0.15), and significantly higher Strehl ratios (0.02±0.02 vs 0.01±0.01) and MTF values at all measured cycles per degree, compared to the CCC group. CONCLUSIONS: Capsulotomy performed with an intraocular FS laser induced significantly less internal aberrations measured by the NIDEK OPD-Scan aberrometer compared to eyes that underwent CCC, which may result in better optical quality after the procedure.

PURPOSE: To measure and compare sizing and positioning parameters of femtosecond laser capsulotomy with manual continuous curvilinear capsulorrhexis (CCC). METHODS: Femtosecond capsulotomies (Alcon-LenSx Lasers Inc) and CCC were carried out in 20 eyes of 20 patients, respectively. Intraocular lens (IOL) decentration, circularity, vertical and horizontal diameters of capsulotomies, and capsule overlap were measured with Adobe Photoshop (Adobe Systems Inc) 1 week, 1 month, and 1 year after surgery. Between-group differences of parameters and predictors of IOL decentration were determined with repeated measures analysis of variance, chi-square test, and logistic regression analyses. RESULTS: Vertical diameter of CCC was statistically significantly higher in the first week and month. Significantly higher values of capsule overlap over 1 year and circularity in the first week showed more regular femtosecond capsulotomies. Horizontal IOL decentration was statistically significantly higher in the CCC group over 1 year. A significant difference was noted between the two groups in dichotomized horizontal decentration values at 0.4 mm with chi-square test after 1 week and 1 year ( P =.035 and P =.016, respectively). In univariable general estimating equation models, type of capsulorrhexis ( P P =.002) were significant predictors of horizontal decentration. Vertical diameter showed significant correlation to the overlap in the CCC group (1 week: r=−0.91; 1 month: r=−0.76, P P P >.05). CONCLUSIONS: More precise capsulotomy sizing and centering can be achieved with femtosecond laser. Properly sized, shaped, and centered femtosecond laser capsulotomies resulted in better overlap parameters that help maintain proper positioning of the IOL.

To evaluate ocular wavefront aberrations in keratoconus and describe their effect on visual quality.Department of Ophthalmology Semmelweis University, Budapest, Hungary.Case-control study.Ocular aberrations over a 4.5 mm pupil were measured with a Hartmann-Shack sensor in eyes with keratoconus or subclinical keratoconus or of refractive surgery candidates with normal corneas. Visual quality metrics were calculated using an optical design program. The correlation between Zernike polynomials was evaluated using correlation analysis. Predictors of subclinical keratoconus and keratoconus among ocular aberrations were evaluated. Visual quality (point-spread function, retinal spot radius, Strehl ratio) between groups was compared.Horizontal and vertical coma were significant predictors of subclinical keratoconus (P.05, r(2)=0.85) and oblique astigmatism and vertical coma of keratoconus (P.05, r(2)=0.64). Spot radius (P.05, r(2)=0.66) and the Strehl ratio (P.05, r(2)=0.64) were significant discriminators in all groups. On correlation analysis, interactions of ocular aberrations were different in keratoconus eyes than in control eyes. In keratoconus eyes, there was a negative correlation between defocus and spherical aberration (r = -0.41) and between astigmatism and secondary astigmatism (r=-0.68). In contrast, spherical aberration correlated positively with tetrafoil (r=0.47) and the positive correlation between vertical coma and vertical tilt decreased (r=0.67 versus r=0.34).Image quality in keratoconus was significantly decreased at equal levels of total root mean square error. A combination of ocular aberrations in eyes with keratoconus decreased image quality.

To compare anterior chamber parameters in normal eyes and eyes with mild to moderate keratoconus corneas using rotating Scheimpflug imaging and evaluate trends in corneal protrusion progression.Department of Ophthalmology, Semmelweis University, Budapest, Hungary.The anterior chamber depth (ACD) at the corneal center, thinnest point of the cornea, and 1.0 mm, 2.0 mm, and 3.0 mm paracentrally; central pachymetry; and posterior elevation were measured by Scheimpflug imaging (Pentacam) in eyes with keratoconus and eyes of refractive surgery candidates. A generalized estimating equation (GEE) was used to identify predictors of keratoconus. Correlations between posterior elevation and ACD at minimum pachymetry were analyzed by linear and piecewise linear regression.The keratoconus group comprised 41 eyes (24 patients) and the control group, 70 eyes (41 patients). The ACD was significantly deeper in the keratoconus group than in the control group (P.05) and was significantly correlated with posterior elevation. In the multivariable GEE model, posterior elevation (odds ratio [OR], 1.46; P.001) and ACD at minimum pachymetry (OR, 7.54; 95% confidence interval, 1.35-42.05) were significant predictors of keratoconus. Segmented analysis of the correlation between posterior elevation and central ACD showed a better fit to data than linear regression and identified a 40 mum threshold level for posterior elevation. The GEE determined 450 mum as a similar threshold for central corneal thickness.There was a threshold level of posterior corneal elevation and corneal thickness values beyond which the level of corneal protrusion in keratoconus accelerated.No author has a financial or proprietary interest in any material or method mentioned.

Purpose The purpose of this study was to evaluate the alteration of keratometric, pachymetric, and elevation parameters of keratoconic and normal corneas with the Pentacam Scheimpflug camera. Methods Pentacam measurements were performed on 41 eyes of 24 patients with keratoconus and 70 eyes of 41 normal subjects. In each eye, keratometric values, central and minimal pachymetry, and anterior and posterior elevation were evaluated. Receiver operating characteristic curves were used to compare the sensitivity and specificity of the different parameters. Predictors of keratometric, pachymetric, and elevation data were evaluated by logistic regression analysis. Confirmatory factor analysis was performed in the keratoconus group to quantify the validity of critical parameters for keratoconus. Results All parameters were significantly different in the keratoconus group compared with the normal control group. Receiver operating characteristic curve analyses showed the best predictive accuracy for posterior and anterior elevation (area under the curve, 0.97 and 0.96) followed by minimal and central pachymetry (0.89 and 0.88). The optimal cutoff point for posterior elevation was 15.5 microm for the discrimination of keratoconus corneas from normal. Logistic regression analysis showed best fit to the data for the model completed with the height data of the Pentacam. Confirmatory factor analysis explained a 3-factor model satisfactorily showing minimal pachymetry (-0.99), anterior elevation (0.98), and keratometry (0.95) as the most representative clinical variables of the disease. Conclusion Posterior and anterior elevation, pachymetric, and keratometric parameters measured by the Pentacam camera can effectively discriminate keratoconus from normal corneas serving as a useful diagnostic tool for disease staging.

To evaluate optical quality and internal aberrations in patients with diabetic macular edema.In this prospective study, 33 eyes of patients with diabetic macular edema were scanned with a ray-tracing wavefront device. As a control group, wavefront aberrometry was performed in 31 patients. Ocular and internal aberrations and visual quality metrics were evaluated separately to determine whether the source of aberrations was ocular or internal. Main outcome measures included corrected visual acuities, ocular and internal aberrations, Strehl ratio, and modulation transfer function.There was a statistically significant difference between the groups in internal higher order (HO) root mean square (0.34 ± 0.24 vs. 0.16 ± 0.05), HO Strehl ratio (0.08 ± 0.05 vs. 0.18 ± 0.09), and modulation transfer function (0.29 ± 0.1 vs. 0.4 ± 0.1). There was no statistically significant difference in Strehl ratio and HO root mean square between phakic and pseudophakic patients. Height of cystoid spaces was a significant predictor (P0.001) of Strehl ratio. Besides inner and outer segment integrity, HO Strehl ratio significantly determined best-corrected visual acuity.In eyes with macular edema, internal HO wavefront aberrations were greater than in control eyes. This increase in HO wavefront error seems visually relevant. This study results suggest increased intraretinal edema as the source of HO aberrations.

Visual symptoms are common in patients with preeclampsia, and are caused by various underlying pathological changes in the retina. Blurred vision may be one of these symptoms. We describe three cases in which the underlying retinal pathology of blurred vision was clarified using optical coherence tomography (OCT), a novel, non-invasive ophthalmic imaging technique that provides micrometer-scale resolution images of the human retina.Three patients with preeclampsia complained of blurred vision postpartum. In all cases, ophthalmoscopy was performed at the bedside, followed by the assessment of best corrected visual acuity, slit-lamp biomicroscopy, fluorescein angiography (FLA), and OCT. In all cases, the presence of central visual defects was examined by an Amsler-grid.In one case, the symptoms were bilateral. In all affected eyes, the patients complained of a relative central scotoma. Ophthalmoscopy showed edema in the affected maculae, while OCT examination clarified a serous neurosensory detachment of the macula. In one case, a neurosensory detachment was also detected in the papillomacular region of a fellow eye with no symptoms. In two cases, FLA was performed, but only in one case could we detect late leakage and subretinal exudates. The serous detachments observed showed total resolution in all cases within 5 to 10 weeks, with restoration of visual acuity.In patients with preeclampsia, OCT may provide a useful method for the precise assessment of retinal changes, distinguishing retinal edema from serous neurosensory detachments. This finding may help to clarify the pathophysiological circulatory changes seen in preeclampsia.

Purpose: To determine ocular geometry and refraction in children with a history of preterm birth, and compare them to age-matched full-term children. Methods: In a prospective case–control study, 50 eyes of 27 premature patients 7 to 14 years of age were evaluated with Scheimpflug camera after cycloplegia. Age-matched full-term children comprised the control group (68 eyes of 34 children). All of the eligible eyes had a normal-appearing posterior pole. Anterior segment parameters such as keratometry, anterior chamber volume or thickness, and lens thickness were measured. Corneal thickness, lower- and higher-order aberrations refractive errors of the cornea (root mean square of lower- and higher-order aberrations: RMS LOA, RMS HOA) were also assessed and exported for further analysis. Results: In the premature eyes, anterior chamber depth was marginally smaller ( P = .06), the lens was significantly thicker ( P = .03), and axial length was significantly shorter ( P < .001). Scheimpflug imaging showed a significant difference in corneal RMS ( P = .03) and an increase in corneal RMS HOA ( P = .002) in the premature group. Preterm birth showed significant impact on axial length ( P < .01) and lens thickness ( P = .05); at the same time, anterior chamber depth was more influenced by retinopathy of prematurity stage ( P = .01). Laser treatment showed marginally significant impact ( P = .06) on anterior chamber depth. Conclusions: In premature eyes with or without mild retinopathy of prematurity, anterior segment anatomy is slightly different and they have more higher-order corneal aberrations compared to the eyes of term-born children. [J Pediatr Ophthalmol Strabismus 2014;51(4):235–241.]

The aim of this study was to find predictive factors of 1-year visual outcome, analyzing novel optical coherence tomography (OCT) biomarkers in exsudative age-related macular degeneration (choroidal neovascularization (CNV)) in two groups of different treatment modalities. In all, 34 consecutive patients with new-onset CNV were randomized 1:1 to receive either ranibizumab monotherapy or ranibizumab combined with photodynamic therapy (PDT) with verteporfin. After three initial injections with ranibizumab, re-treatment was performed according to an as-needed scheme; PDT was performed once at baseline. Best-corrected visual acuity (BCVA) and OCT parameters like central macular volume (CMV), central macular thickness (or central retinal thickness (CRT)), subretinal and intraretinal fluid, fibrovascular lesion thickness, or inner segment/outer segment (IS/OS) junction were analyzed. After 12 months, a visual gain of 6.1 letters was found in the monotherapy group, whereas patients in the combination therapy group lost − 4.8 letters from baseline to the 12-month visit. CMV and CRT decreased considerably between baseline and month 2–3 in both groups, with a following slight increase until month 12. Additional application of PDT had negative effect to 12-month BCVA, whereas higher baseline BCVA and integrity of the IS/OS junction at month 12 had positive effect to 12-month BCVA. Better baseline BCVA and the integrity of IS/OS junction at 12-month visit were the most important predictive factors for final BCVA. Combination therapy caused worse final BCVA and a higher degree of IS/OS disruption.

Purpose To assess the correlation between keratoconus severity and intereye asymmetry of pachymetric data and posterior elevation values and to evaluate their combined accuracy in discriminating normal corneas from those with keratoconus. Methods This study included 97 patients: 65 subjects with bilateral normal corneas (NC) and 32 with keratoconus (KC). Central corneal thickness (CCT), thinnest corneal thickness (ThCT) and posterior elevation (PE) at the thinnest point of the cornea were measured in both eyes using Scheimpflug imaging. Intereye asymmetry and its correlation with keratoconus severity were calculated for each variable. The area under the receiver operating characteristic curve (AUROC) was used to compare predictive accuracy of different variables for keratoconus. Results In normal eyes, intereye differences were significantly lower compared with the keratoconus eyes (p

PURPOSE: To evaluate the accuracy of Scheimpflug camera topography indices in detecting the therapeutic effect of corneal collagen cross-linking (CXL) on progressive keratoconus in the long term. METHODS: Fifty eyes of 25 patients with keratoconus were enrolled. CXL was performed in 25 eyes with progressive keratoconus (CXL group) and 25 fellow eyes with nonprogressive keratoconus served as controls. Thinnest corneal thickness, anterior keratometry (flat, steep), and keratoconus indices were measured with Scheimpflug camera before and 12 to 25 months after CXL. Regression analysis was used to evaluate the influence of corneal thickness and follow-up time on flattening effect of CXL. RESULTS: At baseline, steep keratometric values were significantly higher and thinnest corneal thickness values were lower in the CXL group ( P = .027, .034), parallel with increased values of keratoconus indices: index of surface variance ( P = .013), index of vertical asymmetry ( P = .038), keratoconus index ( P = .019), center keratoconus index ( P = .039), index of height asymmetry ( P = .037), index of height decentration ( P = .0016), and radius minimum ( P = .008). After adjustment for thinnest corneal thickness and follow-up time, CXL showed significant flattening effect expressed by changes in radius minimum ( P < .001), index of surface variance ( P = .03), keratoconus index ( P = .006), center keratoconus index ( P = .03), and index of height asymmetry ( P = .026). Thinnest corneal thickness had significant influence on changes of index of surface variance ( P = .049), index of vertical asymmetry ( P = .01), and center keratoconus index ( P = .03). Follow-up time showed no significant influence in any models ( P > .05). CONCLUSIONS: Topographic indices indicate corneal flattening after CXL in the long term. Monitoring keratoconus index and index of height asymmetry should be the preferred choice in daily clinical practice because changes in values of these indices are independent from initial corneal thickness. [ J Refract Surg. 2014;30(6):374–378.]

PURPOSE: To compare intraocular lens (IOL) decentration and tilt following a circular capsulotomy created with a femtosecond laser (laser CCC) to a manually performed continuous curvilinear capsulorrhexis (manual CCC). METHODS: In a prospective, randomized study, a laser CCC (Alcon LenSx Inc) was performed in 20 eyes from 20 patients and a manual CCC was performed in 25 eyes from 25 patients. Intraocular lens decentration and tilt were measured using a Scheimpflug camera (Pentacam, Oculus Optikgeräte GmbH) 1 year after surgery. Uncorrected (UDVA) and corrected distance visual acuity (CDVA) and manifest refraction were also determined postoperatively. Between-group differences of IOL decentration and tilt as well as the correlation between IOL decentration and postoperative refractive changes and between IOL tilt and visual acuity were analyzed. RESULTS: Horizontal and vertical tilt were significantly higher in the manual CCC group ( P =.007 and P P =.034 and P =.022, respectively). Significant differences were found in the homogeneity of dichotomized IOL vertical tilt and both horizontal and total decentration distribution ( P =.008, P =.036, and P =.017, respectively). Total IOL decentration showed a significant correlation with changes in manifest refraction values between 1 month and 1 year after surgery (R=0.33, P =.032). A significant correlation was noted between IOL vertical tilt and CDVA (R 2 =0.17, β=−0.41, 95% confidence limit: −0.69 to −0.13, P =.005). CONCLUSIONS: Continuous curvilinear capsulorrhexis created with a femtosecond laser resulted in a more stable refractive result and less IOL tilt and decentration than manual CCC.

PURPOSE: To evaluate a laser technique and manual technique to perform capsulorrhexis in cataract eyes. METHODS: Anterior capsulotomy was performed with an intraocular femtosecond laser (LenSx Lasers Inc) in 54 eyes (FS group) and manual continuous curvilinear capsulorrhexis was performed in 57 eyes (CCC group). Circularity and area of capsulotomy and IOL decentration were measured using Photoshop CS4 Extended (Adobe Systems Inc) 1 week after surgery. Average keratometry, axial length, and preoperative anterior chamber depth were examined with the Lenstar LS 900 (Haag-Streit AG). RESULTS: No statistically significant differences were noted between groups in axial length, preoperative refractive state, and in the area of capsulotomy. Circularity values were significantly better in the FS group ( P =.032). We found incomplete overlap of capsulotomies in 28% of eyes in the CCC group and 11% in the FS group ( P =.033). Significant correlations were noted between axial length and area of capsulotomy, and between average keratometry and area of the capsulotomy in the CCC group (R=0.278, P =.036; and R=−0.29, P =.033, respectively), but both did not correlate in the FS group ( P >.05). In the CCC group, the pupillary area correlated significantly with the area of the capsulotomy (R=0.27, P =.039). Significant correlation was noted between IOL decentration and axial length in the CCC group (R=0.30, P =.026), but there was no correlation in the FS group ( P >.05). CONCLUSIONS: Femtosecond laser capsulorrhexis was more regularly shaped, showed better centration, and showed a better intraocular lens/capsule overlap than manual capsulorrhexis.

Purpose: To explore the effects of corneal astigmatism and asphericity on posterior elevation values calculated by different reference bodies and to compare their predictive accuracy in the diagnosis of keratoconus. Methods: In this prospective observational case series, 44 eyes of 24 patients with keratoconus and 70 eyes of 41 refractive surgery candidates as a control group were measured by the Pentacam Scheimpflug camera. Discriminating ability and predictors of posterior elevation measurements obtained by best fit toric ellipsoid (BFTE) and best fit sphere (BFS) reference surfaces were compared by receiver operator characteristic curves (ROC) and generalized estimating equation (GEE) models. Bland–Altman plots were used to determine the agreement between different reference surfaces. Results: Receiver operator characteristic curve analysis showed that posterior elevation measured by a BFTE auto had a significantly higher area under ROC curves (0.99) value than BFTE 8-mm or BFS reference surfaces. ROC analysis identified cut-off values for BFTE auto (9.5-μm), for BFTE 8-mm (10.5-μm), for BFS auto (16.5-μm) and for BFS 8-mm (15.5-μm) reference surfaces. According to GEE models, corneal cylinder and posterior asphericity had the least effect in toric ellipsoid models. Bland–Altman plots showed a systematic bias at higher values of average posterior elevation measured BFS reference surfaces. Conclusions: Posterior corneal elevation value measured by the Pentacam camera can effectively discriminate keratoconus from normal corneas although measured values and cut-off points depend on the selection of reference body and corneal asphericity. Toric ellipsoid reference surface seems to be the most sensitive method to differentiate keratoconus.

PURPOSE: To compare the effect of conventional and femtosecond laser–assisted (Alcon LenSx Inc) phacoemulsification on the macula using optical coherence tomography (OCT). METHODS: Twenty eyes of 20 patients underwent uneventful cataract surgery in both study groups: femtosecond laser–assisted (laser group) and conventional phacoemulsification (control group). Macular thickness and volume were evaluated by OCT preoperatively and 1 week and 1 month postoperatively. Primary outcomes were OCT retinal thickness in 3 macular areas and total macular volume at 1 week and 1 month postoperative. Secondary outcomes were changes in retinal thickness at 1 week and 1 month postoperatively, with respect to preoperative retinal thickness values and effective phacoemulsification time. RESULTS: Multivariable modeling of the effect of surgery on postoperative macular thickness showed significantly lower macular thickness in the inner retinal ring in the laser group after adjusting for age and preoperative thickness across the time course ( P =.002). In the control group, the inner macular ring was significantly thicker at 1 week (mean: 21.68 μm; 95% confidence limit [CL]: 11.93–31.44 μm, P P =.09) and became marginally significant. CONCLUSIONS: Results of this study suggest that femtosecond laser–assisted cataract extraction does not differ in postoperative macular thickness as compared with standard ultrasound phacoemulsification.

Purpose: To measure corneal density and evaluate corneal haze in unoperated eyes and in eyes after photorefractive keratectomy (PRK). Methods: Forty-nine patients (91 eyes) who underwent PRK and 48 control patients (76 unoperated eyes) were measured with the densitometry program of the Pentacam Scheimpflug imaging system (Oculus Optikgeräte GmbH) (0=no clouding, 100=tissue completely opaque). Eyes were categorized as myopic or hyperopic (myopia group and hyperopia group), with subgroups defined as unoperated (unoperated myopia group and unoperated hyperopia group), postoperative clear corneas (clear cornea myopia group and clear cornea hyperopia group), and postoperative with haze (myopia haze group and hyperopia haze group). The ANOVA option of the Statistica 8.1 program package (StatSoft Inc) was used to compare subgroups. Results: Maximum density of postoperative corneas with haze (myopia haze group, 46.2±16.2; hyperopia haze group, 50.2±25.8) was higher than in postoperative clear corneas (clear cornea myopia group, 29.9±8.7; clear cornea hyperopia group, 22.9±3.1), but maximum corneal density in the latter subgroups showed no difference compared with unoperated controls (unoperated myopia group, 25.1±2.4; unoperated hyperopia group, 22.8±3.2). Differences among subgroups were not found outside the 6-mm diameter ablation zone. In hazy myopic corneas, there was a strong decreasing density trend from the apex to the 3-mm radius ( P P =.019, R=−0.21). Hyperopic mild hazy corneas showed a density increase from the apex to 3 mm ( P P Conclusions: The densitometry program of the Pentacam can provide a useful objective measure of postoperative and other mild corneal haze.

To evaluate ocular wavefront aberrations owing to keratoconus compared with normal controls and to describe the changes in the axis of line of sight (LoS) among keratoconic patients.Prospective case-control study.Fifty-five eyes of 30 patients with keratoconus and 100 eyes of 50 refractive surgery candidates with normal corneas.Ocular aberrations over a 4.5 mm (undilatated) pupil were measured with a Hartmann-Shack sensor. Corneal topographic measurement was performed with a Tomey corneal topographer. The axis of the displacement of LoS was calculated by vector analysis.Root mean square (RMS) and higher order RMS values, ocular aberrations up to the 6th Zernike order and the distance of the LoS from the pupillary center (x and y offset values) in keratoconic and normal eyes were measured with aberrometry. The steepest and average keratometric values and the axis of the steepest meridian were measured in keratoconic eyes with topography. Correlations were made between the size and the direction of the shift in the LoS and ocular aberrations.The following parameters were significantly higher in the keratoconus group compared to the control group: higher order RMS (P0.001), Z(3)(-1) (P0.001), Z(3)(-3) (P0.002), Z(3)(3) (P = 0.001), Z(4)(-2) (P0.001), Z(4)(2) (P0.001), Z(4)(4) (P = 0.016), Z(5)(-5) (P = 0.03), Z(5)(-1) (P = 0.04), Z(5)(3) (P = 0.01), and y offset value (P0.001). In keratoconic patients there was a significant correlation between the axis of the shift in the LoS and the steepest keratometric axis on topography (r = 0.59; P0.001), the distance of the LoS from pupil center and vertical coma (r = -0.39; P = 0.004), and spherical aberration (SA; r = 0.29; P0.04). There was also a significant correlation between the average keratometry value measured by topography and SA (r = -0.49; P0.001). A factorial regression model testing the interactive effects of vertical coma and SA on the shift of LoS had a good fit on our data (r(2) = 0.69; P0.001).A significant displacement of the LoS is observed in keratoconus and relates to the position of the cone on topography and the induced vertical coma measured by aberrometry.The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Keratoconus (KC) is the most common primary corneal ectatic disease which has considerable importance in public health. Corneal collagen crosslinking (CXL) is a procedure to mitigate progression of KC and reduce demand for corneal transplantation. Although studies have proven the efficacy of CXL regarding corneal shape, none have investigated the effects of CXL on tear biomarkers which are useful tools to understand molecular mechanisms behind CXL. Our purpose was to determine the effect of CXL on tear mediators in patients with KC and analyze associations with corneal changes. Tear samples were collected pre-CXL from 26 eyes of 23 patients and during a 12-month follow-up. The mediators’ concentration was measured by Cytometric Bead Array technology. Corneal topography parameters measured by Scheimpflug Camera included: Thinnest-corneal-thickness (ThCT), keratometry values (K1, K2), Radii-Minimum (Rmin), Keratoconus-Index (KI), Center-KI (CKI), Index-of-Height Asymmetry (IHA) and Index-of-Surface Variance (ISV). At baseline, KI was correlated negatively with chemokine (C-C motif) ligand 5 (CCL5) (p=0.015) and matrix metalloproteinase (MMP)-13 (p=0.007). At day 4, interleukin (IL)-6 and IL-8 increased, while IL-13, IL-17A, interferon (IFN)-γ, CCL5, MMP-13, epidermal growth factor (EGF), nerve growth factor (NGF) and plasminogen activator inhibitor (PAI-1) decreased significantly compared to pre-CXL concentrations (p≤0.02). At 6 months tissue plasminogen activator (t-PA) increased (p=0.02), while at 12 months Rmin increased (p≤0.004), and IL-6 and CXCL8 (p=0.005 and p=0.047) as well as K1, ISV and KI decreased. After 6 months CKI and ISV showed significant associations with IL-17A; CKI with IL-13 and ThCT with IL-13 (p≤0.02), while at 12 months there were reverse associations between ThCT and IL-6, IL-13, INFγ, CCL5 and PAI-1 (p≤0.02). Alterations of mediators in tear fluid after CXL associate with topographic changes highlight the fact that many mediators are involved in the complex mechanisms after CXL. Further studies on biomarkers to investigate the efficacy of CXL are needed.