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We aimed to summarize the outcomes reported following the implantation of the V4c implantable collamer lens with a central port (ICL, STAAR Surgical Inc) for myopia correction. A literature search in PubMed, Web of Science and Scopus was carried out to identify publications reporting clinical outcomes of patients who were implanted with the V4c ICL model and had a follow‐up period of at least 6 months. A total of 35 clinical studies published between 2012 and 2020 were included in the present review. A comprehensive analysis of the available data was performed, focusing on visual and refractive outcomes at different time‐points post‐surgery. In addition, adverse events and other parameters such as endothelial cell density, intraocular pressure and vault measurements—which were evaluated in some of the studies—were also compared. This review encompassed a total of 2904 eyes. The outcomes reported in this review lead us to conclude that ICL V4c implantation for myopia correction is a safe and efficient procedure, with stable visual and refractive outcomes and low adverse event rates. The patient’s anterior segment should be thoroughly characterized, and the ICL parameters should be carefully selected so as to achieve good outcomes and avoid complications.

To assess the interchangeability of different devices for measuring white-to-white (WTW) distance. WTW distance was measured in 53 eyes of 53 patients using Anterion swept-source optical coherence topographer (SS-OCT), IOLMaster 700 SS-OCT, Pentacam HR Scheimpflug and Cassini color LED. Statistical analysis was done by means of the Friedman test and the post hoc Tukey test. The Bland–Altman analysis was applied to carry out pairwise comparisons with the average difference, 95% confidence interval of the average difference and limits of agreement 95% (LoA). WTW values obtained by the Anterion, IOLMaster 700, Pentacam HR and Cassini were: 11.84 ± 0.41 mm, 11.96 ± 0.41 mm, 11.68 ± 0.38 mm and 12.65 ± 0.52 mm, respectively. Statistically significant differences were found in all pairwise comparison (p

We report the surgical management of a patient with bilateral anterior lenticonus due to Alport syndrome using femtosecond laser-assisted cataract surgery (FLACS) and the Optiwave Refractive Analysis (ORA) system. A 38-year-old man with Alport syndrome presented to our department with visual loss due to anterior lenticonus in both eyes. Adjustments during bilateral FLACS were performed with the software’s calipers to manually delineate the anterior capsulotomy. Multifocal toric intraocular lenses (IOLs) were selected and placed in the posterior chamber with the aid of intraoperative aberrometry. The intended postoperative positioning parameters for the IOL as well as the planned visual acuity and refraction were achieved. The implementation of FLACS and intraoperative wavefront aberrometry is a safe and useful surgical approach for the management of cataract in challenging cases such as patients with anterior lenticonus due to Alport syndrome.

Purpose. To assess the efficacy, safety, and predictability of the Visian Implantable Collamer Lens (ICL) model having a central port in patients over 40 years of age. Methods. This study included 33 eyes from 21 patients who underwent V4c ICL implantation for the correction of myopia and myopic astigmatism. We assessed uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault, and adverse events occurring over a 1-year period. Results. Mean age of the patients at the time of implantation was 43.52 ± 4.49 years (range: 40 to 56 years). Efficacy and safety indexes were 1 and 1.09, respectively. Surgical outcomes for CDVA were as follows: no eye lost any lines, 19 eyes (57.58%) showed no CDVA changes, 7 eyes (21.21%) gained 1 line, 4 eyes (12.12%) gained 2 lines, and 3 eyes (9.09%) gained ≥3 lines. Mean postoperative spherical equivalent (SE) was −0.09 ± 0.47 D. A total of 29 eyes (87.8%) were within ±0.50 D and 31 eyes (93.9%) were within ±1.00 D of the desired SE. At 1-year, mean IOP was 15.27 ± 3.03 mmHg (range: 9 to 20 mmHg, p=0.12 pre vs. post) and mean ECD was 2516 ± 234 cells/mm2 (p=0.29 pre vs. post). Mean postoperative vault was 320 ± 136 μm, with 201–300 μm being the most prevalent vault range for 9 eyes (31.03%). None of the eyes showed a vault >701 μm. There were neither intraoperative nor postoperative complications; in fact, all ICL implantation procedures were uneventful. Conclusions. Our study’s findings support the use of this lens in patients over 40 years of age. A long follow-up period is advisable to monitor ICL position relative to the crystalline lens.

A 51-year-old woman developed severe fibrosis and occlusion of the visual axis in 1 eye, maintaining a pinhole aperture in the fellow eye, 2 months after uneventful cataract surgery and implantation of a hydrophilic trifocal intraocular lens in the capsular bag. She had not exhibited any risk factor for anterior capsule contraction preoperatively. Femtosecond laser–assisted capsulotomy with a fluid-filled interface system was used to perform a simultaneous anterior capsulotomy in both eyes. Preoperative calculations of the incision depth of the capsulotomy were performed using optical coherence tomography (OCT) and adjusted intraoperatively with the OCT system of the femtosecond laser. The energy level used in the first eye was increased for the second eye (4 μJ to 6 μJ) because of severe capsulotomy tags that had to be cut with scissors. Despite the increase in energy, a free-floating capsulotomy could not be achieved in the second eye.

PURPOSE: To measure the refractive index (RI) of the human corneal stroma in vivo using an objective Abbe refractometer (VCH-1) and to determine if RI of the stroma is related to age. METHODS: VCH-1 was used to measure RI at the central anterior stroma immediately after lifting the flap in neophyte patients preselected for laser in situ keratomileusis. Surgical procedures continued as preplanned after measuring the RI, and in binocular cases, measurements were taken from the right eye only. Corneal flaps were created using a femtosecond laser system. RESULTS: Mean RI (±SD, range) and age (±SD, range) values were 1.373 (±0.006, 1.358-1.385) and 36.55 (±12.26, 18-74). A significant linear correlation was found between age and RI. Least squares regression lines equating RI with age (x, years) were of the form: RI = 1.36911 + 0.000096x (r = +0.195; n = 115; P = 0.037). Mean RI (± SD) in the 2 age groups separated by the median age (≤34 and ≥35) were 1.371 (±0.007; n = 57) and 1.374 (±0.005; n = 58). The difference was statistically significant (P = 0.018). CONCLUSIONS: RI of the anterior stroma in vivo tends to be increased in older patients when the corneal flap is created using a femtosecond laser device.

PURPOSE: To compare the visual acuity outcomes as well as the ocular optical performance of eyes implanted with either a monofocal or one of two diffractive multifocal intraocular lenses (IOLs). METHODS: One hundred two consecutive eyes of 51 bilateral cataract patients (age 49 to 80 years) were divided into three groups: 22 eyes were implanted with a monofocal IOL (monofocal group), 40 eyes with the Acrysof ReSTOR SN6AD3 IOL (ReSTOR group), and 40 eyes with the Acri.Lisa 366D IOL (Acri.Lisa group). Visual acuity and contrast sensitivity were evaluated pre- and postoperatively. Additionally, ocular optical quality and intraocular aberrations were evaluated postoperatively. RESULTS: Significant improvement after surgery in uncorrected and corrected distance and near visual acuity was observed in all three groups ( P ≤.05). Uncorrected near visual acuity was significantly better in eyes from the ReSTOR and Acri.Lisa groups compared to the monofocal group ( P ≤.01). Photopic contrast sensitivity was significantly better for the spatial frequency of 3 cycles/degree in the monofocal group ( P P =.01). An acceptable range of vision between near and distance peaks was observed in the defocus curves of the ReSTOR and Acri.Lisa groups. CONCLUSIONS: The AcrySof ReSTOR and Acri.Lisa 366D IOLs are able to successfully restore near and intermediate visual function after cataract surgery; however, the Acri.Lisa design seems to provide better optical performance. These results need to be confirmed in a randomized, prospective trial.

To evaluate the reading performance, changes in quality of life, and optical performance after cataract surgery with multifocal diffractive intraocular lens (IOL) implantation.Vissum Corporation, Alicante, Spain.Prospective case series.Patients with bilateral cataract had implantation of Acri.LISA 366D multifocal IOLs. Visual acuity and contrast sensitivity outcomes were evaluated during a 6-month follow-up. Other parameters evaluated included reading performance (Salzburg Reading Desk), a 25-item quality-of-life questionnaire (National Eye Institute Visual Functioning Questionnaire-25 [NEI VFQ-25] and appendix NEI VFQ-39), and ocular optical performance (ocular aberrometry and modulation transfer function).The study included 48 eyes (24 patients) ranging in age from 47 to 77 years. The mean uncorrected distance visual acuity (logMAR) improved significantly 1 month postoperatively (P.01), with no significant changes afterward (6 months, P≥.06). The mean reading acuity without correction improved significantly from 0.68 logRAD ± 0.20 (SD) to 0.16 ± 0.08 logRAD 1 month after surgery (P.01). However, it was worse by the end of the follow-up (6 months, P = .04). During the follow-up, no significant changes were found in the mean reading speed without near correction (6 months, P = .50). Contrast sensitivity improved significantly at all spatial frequencies under photopic and scotopic conditions after surgery (6 months, P≤.02). The quality-of-life index related to reading ability also improved significantly (3 months, P = .03).Implantation of the multifocal diffractive IOL significantly improved reading performance, which had a positive effect on the patient's quality of life postoperatively.No author has a financial or proprietary interest in any material or method mentioned.

To determine the factors affecting corneal biomechanics using biomechanical waveform analysis after microincision cataract surgery (MICS) and standard coaxial phacoemulsification with different incision sizes.Vissum-Instituto Oftalmologico de Alicante, Alicante, Spain.This prospective nonrandomized study comprised eyes with significant cataract that had MICS (sub-1.8 mm incision) or coaxial phacoemulsification (2.75 mm incision). Corneal hysteresis (CH) and the corneal resistance factor (CRF) were measured by biomechanical waveform analysis (Ocular Response Analyzer) preoperatively, immediately postoperatively, and at 1 month. Results were analyzed and compared between groups.In the MICS group (n = 30), there was a significant increase in Goldmann-correlated intraocular pressure (IOP) and corneal-compensated IOP, although CH decreased in the immediate postoperative period (P.05). At 1 month, all parameters in the MICS group returned to normal. The coaxial group (n = 30) had an increase in Goldmann-correlated IOP and corneal-compensated IOP, both of which were higher than normal at 1 month. Backward multiple regression analysis showed significant correlations between CH and preoperative Goldmann-correlated IOP and preoperative CRF (r(2) = 0.631, P.05); between age, axial length (AL), and preoperative CRF (r(2) = 0.418, P.05); and between the change in CH and AL, total incision length, and preoperative CH (r(2) = 0.429, P.05).Cataract surgery with MICS and coaxial phacoemulsification significantly altered corneal biomechanics. Corneal hysteresis was inversely correlated with Goldmann-correlated IOP; CRF was inversely correlated with age and AL. The MICS technique provided more stable corneal biomechanical properties than standard coaxial phacoemulsification 1 month postoperatively.

PURPOSE To report a case of severe keratoconjunctivitis after chemical exposure that was treated by a conjunctival-limbal autograft transplantation according to conjunctival impression cytology (CIC) results. METHODS A 48-year-old woman was diagnosed with a severe keratoconjunctivitis developed after exposure to a mixture of abrasive cleaning agents. Based on CIC results, decision to perform a limbal-conjunctival autotransplantation from the contralateral eye was taken after conventional topical treatment failed to improve symptoms. Polyethersulfone papers were used to take samples from the superior and inferior bulbar conjunctiva of affected and contralateral eyes, and Periodic acid Schiff's (PAS) staining was used to reveal the status of goblet cell (GC) population of the conjunctiva. RESULTS Tearing, burning sensation, keratitis, squamous metaplasia, and GC improved noticeably, as observed by CIC, after autotransplantation. CONCLUSIONS CIC helped on the diagnosis, treatment decision, and follow-up of a patient severely affected by alkali exposure by checking the status of GC in the conjunctiva. Limbal-conjunctival autotransplantation decision was taken and performed consequently, and a significant improvement was observed through a follow-up by CIC.

Purpose To study the potential use of human anterior lens capsule as a scaffold for stem cell transplantation in treatment of limbal cell deficiency. Methods Limbal biopsies and anterior lens capsules were obtained (same eye) from 30 patients during cataract surgery. Biopsies were suspended in Dulbecco modified Eagle medium under sterile conditions and stored at 4 degrees C. Capsules were treated in distilled water under strict asepsis for 2 hours to eliminate the crystalline epithelium and stored at 4 degrees C. After initial processing, the limbal biopsy was plated epithelial-side down (48 hours) on the capsular specimen in a 35-mm culture dish. Samples were sorted into 4 groups. Group 1 was made up of 10 samples in which limbal biopsies were allowed to grow on corresponding capsules from the same eye (autologous). Group 2 was 10 limbal biopsies that were allowed to grow on capsules of different eye (allogeneic). The remaining specimens were randomized into 2 groups. Group 3 included 10 capsules on which an ex vivo expanded cell line was allowed to grow. Group 4 harbored 10 limbal biopsies that were allowed to grow on polystyrene culture plates. All specimens were incubated for 2 weeks at 37 degrees C and 5% CO2. Cell density, viability, morphology, and adherence of the cell-capsule complex were evaluated at 1, 3, 7, and 14 days. Results Rate of cell growth and density in groups 1 and 2 were comparable to the control groups. Cell viability was 95% or superior in all groups, and desmosomes developed between growing cells. Conclusions Human anterior lens capsule is a potential scaffold for ex vivo expansion of limbal epithelial cells, possibly providing a substrate for ocular surface reconstruction.

PURPOSE: To evaluate the visual and refractive outcome of LASIK in myopic patients with a known history of dermatological keloid scar. METHODS: This retrospective case series included 10 eyes of 5 white patients with a known history of dermatological keloids. All patients had low to moderate myopia with no corneal or limbal keloid. All underwent uneventful bilateral LASIK. Postoperatively, visual outcomes, refractive outcomes, and complications were evaluated. Minimum 1-year follow-up was indicated for all patients in this study. RESULTS: Mean preoperative uncorrected visual acuity (UCVA) was 20/320 and 1 year postoperative was 20/20. Mean preoperative best spectacle-corrected visual acuity (BSCVA) was 20/25 and 1 year postoperative was 20/20. The mean preoperative spherical equivalent refraction was -5.00±2.6 diopters (D) and +0.1±0.2 D 1 year postoperative. The safety index was 1.02 and the efficacy index was 1.02. None of the eyes included in this study underwent retreatment for correction of residual error or regression up to 1 year post-operatively. No sight-threatening complications were reported. No patient reported postoperative haze, severe dry eye syndrome, or flap-related problems. CONCLUSIONS: LASIK is a safe, effective, and predictable technique for correcting low and moderate myopia in patients with dermatological keloids. [J Refract Surg. 2006;22:505-508.]

PURPOSE: To describe interface corneal edema secondary to steroid-induced elevation of intraocular pressure (IOP) following LASIK. METHODS: Retrospective observational case series. Diffuse interface edema secondary to steroid-induced elevation of IOP was observed after LASIK simulating diffuse lamellar keratitis (DLK) in 13 eyes. Mean patient age was 31.4±5.3 years. Patients were divided into two groups according to provisional misdiagnosis: DLK group (group 1) comprised 11 eyes and infection group (group 2) comprised 2 eyes (microbial keratitis). Mean follow-up was 8.1±0.5 weeks. RESULTS: In the DLK group, typical diffuse haze was confined to the interface and extended to the visual axis, impairing vision in all eyes. Provisional diagnosis was late-onset DLK and topical steroids were started. Repeat examination showed elevated IOP as measured at the corneal center and periphery using applanation tonometry (mean 19.1 mmHg and 39.5 mmHg, respectively), causing interface edema with evident interface fluid pockets. Steroids were stopped and topical anti-glaucoma therapy was started. The interface edema decreased and at the end of follow-up the corneal transparency was restored and IOP dropped to normal values. The infection group demonstrated a microbial keratitis-like reaction and underwent flap lifting and interface wound debridement and biopsy with administration of fortified antibiotics and steroids. After elevated IOP was detected, steroids and antibiotics were stopped and topical anti-glaucoma therapy was started, resulting in the resolution of the interface edema. CONCLUSIONS: Interface fluid syndrome secondary to steroid-induced elevation of IOP might develop in steroid responders after LASIK with a misleading clinical picture simulating DLK or infectious keratitis. Management includes stopping topical steroids and starting topical antiglaucoma therapy. [J Refract Surg. 2006;22:441-447.]

Purpose To investigate the safety of LASIK in patients with a known history of controlled rheumatic diseases. Design Retrospective consecutive observational clinical study. Participants Forty-two eyes (22 patients) known to have had a history of rheumatic diseases underwent LASIK. All patients had a history of controlled rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis, scleroderma, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, arthritis, or Behcet's disease. Methods Assessments were made preoperatively and at 1, 3, and 6 months postoperatively and included visual acuity (VA), refraction, keratometric readings, slit-lamp biomicroscopy, and corneal topography. All the patients underwent LASIK. Postoperative treatment included a topical steroid–antibiotic combination. Main Outcome Measures Visual acuity, refraction, keratometric readings, and slit-lamp biomicroscopy findings at 1, 3, and 6 months postoperatively. Results LASIK was performed uneventfully on all patients. The mean pre-LASIK spherical equivalent (SE) was −5.39±2.25, and the sixth month postoperative SE was −0.15±0.38 diopters (D) ( P Conclusions In this small series, we found good outcomes when correcting refractive errors using LASIK in selected patients with controlled rheumatic diseases. In this series, a favorable postoperative visual outcome was obtained with no operative or postoperative vision-threatening complications.

Laser in situ keratomileusis (LASIK) was performed in the left eye of a 57-year-old man for residual ametropia after phacoemulsification. The patient was given topical tobramycin and a corticosteroid for 1 week postoperatively. Fifteen days later, he developed 3 corneal infiltrates beneath the flap with a gas bubble, suggesting an anaerobic infection. Tobramycin and ofloxacin were administered every 2 hours, but the condition worsened. Corneal scrapings were taken from beneath the flap for microbiological cultures and a polymerase chain reaction (PCR) test. The PCR amplification was negative for fungi and mycobacteria and positive for bacterial DNA. Sequence analysis showed Propionibacterium granulosum as the causal agent, but cultures were negative. Treatment with vancomycin and cefazolin led to clinical improvement, with resolution of corneal infiltrates. Anaerobic microorganisms can cause keratitis after LASIK. Polymerase chain reaction amplification and DNA typing can help detect microorganisms involved in these ocular infections.

Purpose: To describe the use of a motorized milling drill to perform nonpenetrating glaucoma surgery and to assess its safety. Setting: Instituto Oftalmologico de Alicante, Miguel Hernandez University, School of Medicine, Alicante, Spain. Methods: This prospective noncomparative study included 16 eyes (13 patients) diagnosed with primary open-angle glaucoma. The eyes were divided into 2 groups. Group 1 (8 eyes) had a milling procedure, and Group 2 (8 eyes) had combined phacoemulsification and milling. A fornix-based conjunctival flap was created, and then the milling procedure was performed using a notched hemispherical metallic tip. Evolution of intraocular pressure (IOP), visual outcomes, and the development of intraoperative and postoperative complications were evaluated. Results: The mean age of the patients was 67.9 years ± 10.9 (SD) (range 50 to 80 years). In Group 1, the mean IOP preoperatively was 27.6 ± 10.1 mm Hg (range 18 to 50 mm Hg) and after 6 months, 15.8 ± 5.2 mm Hg (range 12 to 24 mm Hg). The mean IOP reduction 6 months postoperatively was 15.4 ± 10.6 mm Hg, a 55.7% decrease from preoperatively. In Group 2, the mean IOP preoperatively was 21.7 ± 4.6 mm Hg (range 13 to 30 mm Hg), and after 6 months, 16.2 ± 3.4 mm Hg (range 13 to 23 mm Hg). The mean reduction in IOP at 6 months was 5.5 ± 2.8 mm Hg, a decrease of 25.3% from the preoperative value. In Group 1 at 6 months, 5 eyes (62.5%) had a diffuse filtering bleb and 3 (37.5%), localized filtration. In Group 2, 7 eyes (87.5%) had a diffuse filtering bleb and 1 (12.5%) had fibrosis of the bleb and reduction of filtration. Conclusion: The motorized milling drill can be safely used to mill and refine the remaining scleral thickness, eliminating the rupture of trabeculo-Descemet's membrane.

To describe a very common corneal pathology in a patient with Kindler syndrome.We report the case of a 21-year-old woman, who presented to the Ophthalmology Department as an emergency presentation because of ocular pain in the left eye that radiated to other areas of the face and neck. After an exhaustive clinical interview, it was determined that the patient had a rare disease (Kindler syndrome). Ophthalmologic examination revealed corneal erosion on the left eye. No other significant conditions were found. After the application of conventional treatment, the corneal integrity was completely restored.We describe a very rare syndrome. Although conventional treatment restored corneal integrity, it is important to remember that ocular signs and symptoms are often associated with systemic pathologies.

PURPOSE To report a patient who presented an infectious keratitis 4 years after laser in situ keratomileusis (LASIK) without any other predisposing risk factor than the LASIK procedure itself. CASE REPORT We report a 32-year-old man operated by LASIK in January 2006 who presented with infectious keratitis in the OD in April 2010. Clinical examination showed a corneal abscess at 10-o'clock position in the interface and fibrin and Tyndall 4+ in the anterior chamber. Microbiological analysis identified Pseudomonas aeruginosa as the cause of infection. The patient was given ofloxacin, sulfate neomycin, polymyxin B, and prednisolone acetate to be used every 2 h. Treatment led to clinical improvement with resolution of corneal infiltrate. Keratitis with intact epithelium by Pseudomonas can occur up to 4 years after LASIK. CONCLUSIONS LASIK treatment is a predisposing factor for bacterial keratitis even years after surgery. This report demonstrates the importance of continued postoperative vigilance by patient and his/her clinician.

Purpose To compare bilateral reading performance within the first 6 months after implantation of 4 intraocular lens (IOL) models. Setting Vissum-Instituto de Oftalmologico de Alicante, Alicante, Spain, and University Eye Clinic, Paracelsus Medical University, Salzburg, Austria. Design Comparative case series. Methods Patients had bilateral phacoemulsification and implantation of Acri.Smart 48S monofocal, Acrysof Restor SN6AD3 apodized multifocal, Acri.LISA 366D diffractive multifocal, or Rezoom refractive multifocal IOLs. Bilateral reading performance with and without near correction was evaluated preoperatively and postoperatively using the Salzburg Reading Desk. Results The study comprised 304 eyes of 152 patients 51 to 90 years old. All groups had a significant improvement in uncorrected and corrected distance visual acuities postoperatively ( P ≤.01). The apodized multifocal and diffractive multifocal groups had significantly better uncorrected reading acuity than the monofocal and refractive multifocal groups 1 month and 6 months postoperatively ( P P P Conclusion Multifocal IOLs with a diffractive component provided a comparable reading performance that was significantly better than the one obtained with refractive multifocal and monofocal IOLs. Financial Disclosure Drs. Alio, Plaza-Puche, Rasp, Pinero, Seyeddain, Rodriguez-Prats, Ayala, Moreu, Hohensinn, and Riha have no financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

A 36-year-old woman with chronic psoriasis developed blurring of vision and intraepithelial infiltrates within the flap in the left eye concurrent with the appearance of acute psoriatic generalized skin lesions 14 days after bilateral laser in situ keratomileusis. After treatment with topical antibiotic and steroid agents and topical artificial tears, the intraepithelial infiltrates within the flap completely resolved. The final uncorrected distance visual acuity was 1.0 in both eyes, along with complete resolution of the dermatologic psoriatic lesions. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

To compare vision-related quality of life using the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in patients with 1 of 3 types of intraocular lenses (IOLs) and to correlate it with postoperative visual outcomes.Vissum Corporation-Instituto Oftalmológico de Alicante, Alicante, Spain.Comparative case series.This study comprised eyes having cataract surgery with bilateral implantation of a monofocal IOL (Group A), apodized multifocal IOL (Group B), or full diffractive multifocal IOL (Group C). Distance and near visual acuities, contrast sensitivity, and quality of life were evaluated preoperatively and postoperatively.The study enrolled 106 eyes (53 patients; age range 49 to 80 years). All groups had significant improvement in uncorrected and corrected distance visual acuities postoperatively (P ≤.05). Near vision outcomes were significantly better in Groups B and C (P ≤.01). Groups B and C had significantly less difficulty in some near tasks, such as reading the newspaper (A-B, P=.02; A-C, P=.02) or reading bills (A-B, P=.04; A-C, P=.004). Group C also had significantly less difficulty driving at night than Group B (P.01). Near visual acuity and contrast sensitivity were significantly correlated with difficulty in near visual tasks in Groups B and C. Night-driving difficulty correlated significantly with contrast sensitivity in Group B.Patients with multifocal IOLs could perform several daily tasks at near and intermediate distances, with less night-driving limitation with the full diffractive IOL than with apodized multifocal and monofocal IOLs.No author has a financial or proprietary interest in any material or method mentioned.

PURPOSE: To study the effect of LASIK surgery on conjunctival goblet cells as one of the proposed mechanisms for dry eye occurring after LASIK. METHODS: This prospective study included 22 eyes (11 patients) that underwent LASIK for the correction of myopia. Three pairs of samples were taken from the bulbar conjunctiva of each eye. The first pair was taken preoperatively before application of the suction ring. The second and third pairs were taken from the same sites at 1 week and 1 month consecutively. The first site was at 12 o'clock and the second at the inferotemporal quadrant between 7 and 8 o'clock. Time of suction was recorded. RESULTS: Preoperatively, mean goblet cell density was 424+105 cells/mm2 (range: 284 to 630 cells/mm2). All postoperative samples showed a statistically significant decrease in goblet cell count: 216?81 cells/mm2 (range: 40 to 325 cells/mm2) at 1 week and 218?99 cells/mm2 (range: 50 to 396 cells/mm2) at 1 month. Other parameters of conjunctival impression cytology were normal. The difference between the samples in the inferior conjunctiva preoperatively and 1 week postoperatively was greater than that of the superior conjunctiva. Recovery rate in both sites was similar and the damage did not correlate with the duration of suction. CONCLUSIONS: The application of the microkeratome suction ring induced changes in the perilimbic conjunctiva. These changes contribute to the pathology of dry eye. Goblet cell count remains affected at 1 month postoperatively. [J Refract Surg. 2007;23:559-562.]

To compare outcomes of microincision cataract surgery (MICS) with coaxial phacoemulsification.Prospective randomized consecutive case series.One hundred eyes of 50 patients with nuclear or corticonuclear cataract (grades 2+ to 4) with Lens Opacities Classification System III.One hundred eyes (50 patients) were randomly operated through clear corneal incisions using 2 techniques: coaxial phacoemulsification (50 eyes) and microincision cataract surgery (50 eyes).Mean phacoemulsification time, total phacoemulsification percent, effective phacoemulsification time (EPT) (calculated by multiplying total phacoemulsification time in seconds by the average power percent used), intraoperative total balanced salt solution (BSS) volume, visual outcome, vectorial astigmatic changes, corneal thickness, endothelial cell count, and anterior chamber flare and cells preoperatively and at 1 day, 1 month, and 3 months.Statistically significant differences were found between MICS and coaxial phacoemulsification regarding mean incision size, mean total phacoemulsification percent, and EPT. There were no significant differences between the techniques regarding the mean percent of endothelial cell loss, anterior chamber cell count and flare, mean phacoemulsification time, pachymetric measures or total BSS volume utilized, or visual outcome. The vectorial astigmatic changes in the MICS group showed a change ofor =0.25 diopters (D) in 35% of the eyes, 0.25 to 0.5 D in 50% of the eyes, and 0.5 to 1.0 D in 15% of the eyes. These changes were induced by the surgery. Vectorial astigmatic changes of1 D were not observed. In the coaxial phacoemulsification group, vectorial astigmatic changes of0.25 D were not observed either. Changes of 0.25 to 0.5 D were seen in 20% of the eyes, and changes of 0.5 to 1.0 D were seen in 30%. Fifty percent of the eyes showed changes of1.0 D. Mean vectorial astigmatic changes were 0.36+/-0.23 D in the MICS group and 1.2+/-0.74 D in the coaxial phacoemulsification group (P0.001).Microincision cataract surgery significantly lowered mean phacoemulsification time, mean total phacoemulsification percent, mean EPT, and surgically induced astigmatism when compared with coaxial phacoemulsification.

We report a case of Intacs(R) (KeraVision) implantation for the correction of pellucid marginal degeneration (PMD). Preoperatively, the patient's uncorrected visual acuity (UCVA) was 0.05, the best spectacle-corrected visual acuity (BSCVA) was 0.1, and the refraction was -2.00 -7.00 x 90 in the right eye. The flattest meridian (K1) measured 43.8@104 and the steepest meridian (K2), 51.3@14. Ultrasound pachymetry revealed a thin cornea of 420 micrometers. One month postoperatively, the UCVA was 0.2, the BSCVA was 0.5, and the refraction was -8.00 -7.00 x 50. Contact lens best corrected visual acuity was 0.9; 6 months postoperatively, it improved to 1.0. The use of Intacs to treat PMD seems to be viable and improves visual acuity. The residual error can be corrected with contact lenses.

Purpose To investigate the potential role of autologous platelet-rich plasma in promoting healing in dormant corneal ulcers. Design Prospective, consecutive, interventional, noncomparative, nonrandomized, observational study. Participants Forty eyes of 38 patients with dormant corneal ulcers. Methods Autologous platelet-rich plasma was used in a total of 40 eyes with dormant corneal ulcers divided into 2 groups: group I, 26 eyes treated with topical eyedrops of autologous platelet-rich plasma (12 neurotrophic, 9 herpetic, and 5 immunological ulcers), and group II, 14 eyes treated surgically with a solid clot of autologous platelet-rich plasma combined with amniotic membrane transplantation in perforated corneas or with impending perforation. The treatment was used in patients with chronic nonhealing ulcers (mean, 2 years of evolution) that had been unresponsive to conventional topical therapy. Autologous blood from each patient was obtained by venipuncture, and platelet-rich plasma was prepared from each blood sample without additives. Main Outcome Measures Ulcer size, inflammation, healing, visual acuity, and patient's subjective symptoms. Results Autologous platelet-rich plasma promoted healing of ulcers. In group I, 13 eyes healed, 11 eyes improved significantly, and 2 eyes showed no change. In group II, 10 eyes healed and 4 eyes improved significantly. Inflammation and subjective symptoms, particularly pain, improved in all patients. Vision remained stable or improved in all cases. Conclusion Autologous platelet-rich plasma promoted healing of dormant corneal ulcers even in eyes threatened by corneal perforation and was accompanied by a reduction in pain and inflammation.

PURPOSE. To study the effect of the LASIK procedure performed with a femtosecond laser and a manual microkeratome on the conjunctival goblet cell and epithelial cell populations. METHODS. In this prospective, nonrandomized, masked study, 64 eyes undergoing LASIK were included: 30 with the Moria M2 (M2) microkeratome and 34 with the IntraLase femtosecond laser (IL). The preoperative spherical equivalent was 2.0 3.8 D in the M2 group and 3.1 3.1 D in the IL group. The time that the suction ring was applied on the eye was registered, and goblet cell density (GCD), epithelial cell morphology, and inflammatory cells were evaluated by conjunctival impression cytology, before and after the surgery. RESULTS. All the patients in both groups showed a decrease in GCD after LASIK (P 0.001) that recovered after 6 months. At 1 week, 1 month, and 3 months, GCD was lower with IL than with M2 (P 0.019, P 0.001, and P 0.024, respectively). The mean period that the suction ring was applied was longer in the IL than in the M2 group (P 0.001). There was a high correlation between the decrease in GCD and the suction time (R 0.8), and the preoperative spherical equivalent (R 0.4). CONCLUSIONS. Impression cytology showed a greater reduction in goblet cell populations after IL than after M2, probably because of the length of time that the suction ring exerted pressure on the conjunctiva. These changes in the goblet cells may contribute to the development of the ocular surface syndrome after LASIK procedures. (Invest Ophthalmol Vis Sci. 2007;48:2570‐2575) DOI:10.1167/iovs.06-1259