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Purpose: To evaluate spherical intraocular lens (IOL) implantation for cataracts in keratoconic eyes followed by optional refractive toric lens exchange to improve uncorrected visual acuity. Methods: This retrospective study evaluated cataract surgery outcomes in keratoconic eyes. Eyes treated with a spherical IOL targeted for -2.00 diopters (D) either achieved acceptable manifest refraction and desired exchange with a toric IOL (Group 1); achieved satisfactory manifest refraction and chose to use spectacles or contact lenses (Group 2); or did not achieve acceptable refraction and used contact lenses (Group 3). Group 4 had single-stage toric IOL implantation with plano target. Corrected and uncorrected distance visual acuity (CDVA and UDVA) and keratometry were analyzed. Results: Groups 1 to 4 had 18, 23, 18, and 26 eyes, respectively. A staged toric exchange resulted in significantly better (P =.02) UDVA (mean: 0.15 logMAR; 20/25 Snellen) than initial toric IOL implantation (0.24 logMAR; 20/30 Snellen). All toric IOL exchange eyes achieved 20/30 or better CDVA and 94% had 20/40 or better UDVA. Mean manifest cylinder significantly decreased from 3.39 D before lens exchange to 1.10 D postoperatively. Conclusions: Initial implantation of a spherical IOL in keratoconic eyes allows basing toric calculations on the manifest refraction, which may be more reliable than keratometry measurements in keratoconic eyes. UDVA after staged toric IOL exchange was significantly better than after initial toric IOL implantation. Importantly, by staging use of toric lenses, the authors avoided cases where patients required a rigid contact lens after a toric IOL was implanted. [J Refract Surg. 2024;40(4):e207–e217.] [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate remodeling of the corneal epithelium after epithelium-off corneal cross-linking (CXL). METHODS: In this prospective single-center study, 93 eyes of 93 patients with progressive keratoconus underwent standard CXL. The maximum keratometry was assessed before and after CXL with Scheimpflug imaging, and the epithelial thickness profile across the central 5 mm of the cornea was assessed with spectral-domain optical coherence tomography anterior segment imaging. RESULTS: The mean patient age was 27 ± 11 years; 76 patients (81%) were male and 17 (19%) were female. Between baseline and 6 months after CXL, the mean corneal maximum keratometry flattened from 58.90 to 57.80 diopters (P < .0001). The mean minimum epithelial thickness increased slightly (from 41 ± 6 to 42 ± 7 µm, P = .12), whereas the mean maximum epithelial thickness decreased slightly (from 65 ± 6 to 64 ± 7 µm, P = .067), reducing the net difference between the minimum and maximum epithelial thickness (from 24 ± 9 to 22 ± 9 µm, P = .0023). The difference between the minimum and maximum epithelial thickness was strongly positively correlated with the maximum keratometry reading at baseline (R2 = 0.38) and at 6 months after CXL (R2 = 0.59). CONCLUSIONS: Epithelium-off CXL resulted in modest regularization of the epithelial thickness profile across the central 5 mm of the cornea at 6 months. This could slightly mask flattening of the underlying stroma. [ABSTRACT FROM AUTHOR]

The article discusses the evolution of glued intrascleral posterior chamber intraocular lens (IOL) fixation technique. Topics discussed include sutureless intrascleral haptic fixation of posterior chamber IOL in eyes without capsular support in 2007, glued intrascleral posterior chamber IOL fixation to significantly reduce phacodonesis and psuedophakodonesis, handshake technique for externalization of the haptics, and no-assistant technique to eliminate need for an assistant to hold the haptic.

The article discusses how corneal surgeons are overcoming challenges and maximizing outcomes through Descemet's membrane endothelial keratoplasty (DMEK). Topics covered include how DMEK only involves replacement of tissue with donor endothelium and Descemet's membrane and how it involves a no-touch technique that can be challenging to learn for DMEK surgeons.

PURPOSE: To determine glare-induced change during visual acuity testing in patients with and without cataract using the controlled point source light-emitting diode (LED) glare tester (EpiGlare Tester; Epico, LLC, Columbus, OH), a new medical device for identification of glare disability. METHODS: This prospective, multicenter study enrolled 40 patients (80 eyes with cataracts) and 49 control subjects (98 eyes without cataracts). Corrected distance visual acuity (CDVA) was measured with and without glare using the EpiGlare Tester as a glare source. Functional visual ability was evaluated using driving and glare subscales from the Refractive Status Vision Profile questionnaire. The primary efficacy measure was change in CDVA measurement with and without glare in patients with senile cataract compared to participants without cataract. Secondary efficacy measures included correlation of the CDVA change caused by functional glare disability and subjective patient and investigator assessments. RESULTS: CDVA reduction was greater for patients with cataract, with a mean reduction of -0.49 ± 0.3 logMAR, than for participants without cataracts at -0.13 ± 0.2 logMAR (CDVA reduction was greater for patients with cataract, with a mean reduction of -0.49 ± 0.3 logMAR, than for participants without cataracts at -0.13 ± 0.2 logMAR (P < .001). This equates to a 5-line Snellen reduction (0.49 logMAR) in patients with cataracts and a 1-line reduction (-0.13 logMAR) in patients without cataracts. Among patients with cataracts, 83% stated the device accurately represented the difficulty experienced while driving at night (P < .001); among participants without cataracts, 71% reported being minimally affected by glare from the device (P = .003). CONCLUSIONS: A new controlled point source LED glare tester demonstrated the adverse effect on visual acuity due to glare in patients with cataract, accurately simulated night driving glare issues for patients with cataracts, and was rated as easy to use and useful by investigators. [ABSTRACT FROM AUTHOR]

The article reports that the gold standard treatment for corneal disease until the advent of endothelial keratoplasty in the late 1990s was full thickness corneal transplantation or penetrating keratoplasty (PK). PK is indicated for combined stromal and endothelial pathologies while endothelial keratoplasty (EK) is indicated for endothelial dysfunction. Descemet's stripping endothelial keratoplasty (DSEK) is regarded as the leading EK technique as of March 2012.

The article looks at Descement Membrane Endothelial Keratoplasty (DMEK) and its role in treating corneal conditions. Prior to its development, eye surgeons and patients have accepted the endothelial keratoplasty as an efficient surgical corneal treatment, leading to the development of Descemet stripping endothelial keratoplasty (DSEK) and DMEK. DMEK can handle endothelial dysfunctions including congenital hereditary, iridocorneal endothelial syndrome and failed penetrating keratoplasty.

Purpose: To determine the safety and efficacy of the Ophtec model 311 iris reconstruction lens for treatment of visual disturbances, such as glare or photophobia, related to partial or total absence of the human iris.Design: Phase I multicenter, nonrandomized, investigational device study.Participants: Ten iris reconstruction lenses were placed in 10 subjects at 6 sites.Methods: Iris reconstruction lenses were placed in 9 patients who had lost all or part of their iris from trauma and in 1 patient who lacked iris pigmentation due to congenital albinism. Patients were examined preoperatively, intraoperatively, and postoperatively at day 1; week 1; and months 1, 3, 6, and 12.Main outcome measures: Efficacy measures were uncorrected visual acuity (UCVA), glare, starbursts, and photophobia. Safety measures were best-corrected visual acuity (VA), surgical complications, and adverse events.Results: Uncorrected VA improved in all eyes after implantation of the iris reconstruction lens. Best-corrected VA did not change significantly (P = 0.24). Postoperative photophobia was reduced in all 9 eyes that experienced moderate to severe preoperative photophobia. Likewise, postoperative glare was reduced in all 6 eyes with moderate to severe preoperative glare. There were no surgical complications. Adverse events included 2 cases of iritis and 1 case of macular edema.Conclusions: Preliminary results suggest that the Ophtec model 311 iris reconstruction lens can improve UCVA and reduce glare and photophobia in patients with partial or total absence of the iris or iris pigmentation. [Copyright &y& Elsevier]

Purpose: To describe the development and treatment of cataracts following posterior lamellar keratoplasty (PLK) in phakic eyes with Fuchs'' endothelial dystrophy.Setting: Price Vision Group, Indianapolis, Indiana, USA.Methods: A retrospective chart review was performed on 47 PLK cases performed by a single surgeon between June 2001 and December 2002 in a tertiary care setting. Four of the eyes were phakic at the time of surgery. The PLK procedure consisted of dissecting a stromal pocket across the cornea and excising a central button. Then a posterior lamellar donor button, consisting of posterior stroma, Descemet''s membrane, and endothelium, was transplanted without suture fixation.Results: All 4 phakic eyes that were treated with PLK developed a cataract within 1 year of transplant. The cataracts were removed with phacoemulsification through a clear corneal incision, and intraocular lenses (IOLs) were placed in all 4 eyes with no adverse effect on graft clarity.Conclusions: It is preferable to perform PLK in pseudophakic rather than phakic eyes because the manipulation involved in the procedure can induce cataract formation. Cataract surgery with placement of an IOL can be successfully performed following PLK. [Copyright &y& Elsevier]

PURPOSE: The purpose of this study was to document the learning curve and evaluate the success of laser in situ keratomileusis (LASIK) performed by fellows in a Cornea/External Disease and Refractive fellowship program. METHODS: Two surgeons performed LASIK within a fellowship training program between July 2000 and August 2001. A retrospective review was conducted to determine the visual outcomes and operative complications from this non-comparative case series of 755 consecutive eyes. All LASIK procedures were performed using a Bausch & Lomb Technolas 217A laser and the Bausch & Lomb Hansatome or the Automated Corneal Shaper microkeratome. All eyes were evaluated for operative complications. Visual acuity was reported with a minimum of 1 month follow-up. RESULTS: Data analysis revealed that uncorrected visual acuity of 20/40 or better was attained in 99.4% of treated eyes, and 20/20 or better in 77.2%. With both eyes open, 100% of patients saw 20/30 or better, 94% saw 20/20 or better, 70% saw 20/15 or better, and 5.5% saw 20/10. Flap related complications occurred in 7 of 755 eyes (0.9%) and all were successfully treated. Forty-two eyes (5.6%) were lost to follow-up prior to the 1-month examination and were excluded from analysis of visual acuity. CONCLUSIONS: Favorable operative and visual acuity 1-month results in 755 eyes after LASIK with the Bausch & Lomb Technolas 217A laser were in part due to a well organized system of education, patient examination, execution of surgery, and postoperative care. A team approach was essential. [ABSTRACT FROM AUTHOR]

PURPOSE: Studies show significant variability in the thickness of laser in situ keratomileusis (LASIK) corneal flaps cut by various microkeratomes. Most studies of corneal flap thickness are based on contact ultrasonic pachymetry measurements taken during the surgical procedure. This study reports a technique to obtain reproducible corneal flap thickness and residual stromal bed thickness measurements using noncontact optical coherence tomography (OCT) following LASIK. METHODS: The corneal flap thicknesses of 26 eyes of 15 patients were measured following LASIK in which the flap was created using the Amadeus microkeratome: 160-µm head, 9.5-mm ring, 4.0-mm/s translation speed, 8000 oscillations/ m, and full vacuum. Zeiss Humphrey OCT-2 line scans were performed on postoperative days 1 and 7. The raw data from three scans for each eye and day were exported to Microsoft Excel for processing, averaging, and analysis. RESULTS: The OCT corneal flap thickness and residual stromal bed thickness measurements correlated well with ultrasonic pachymetry measurements performed during surgery (R⊃2=.92). The OCT technique yielded reproducible results, as the variance for repeated scans was only 2.5% of the variance between eyes. In bilateral cases a single blade was used for both eyes. The mean flap thickness of 15 first eyes was significantly greater than that of the 10 second eyes: 181 ± 31 µm vs. 143 ± 41 µm (P<.01). A positive correlation was found between the preoperative pachymetry and corneal flap thickness. CONCLUSIONS: The OCT scan averaging technique is a reproducible, noncontact postoperative method for measuring corneal flap and residual stromal bed thicknesses following LASIK. [ABSTRACT FROM AUTHOR]

: PurposeTo describe a technique of suture fixating posterior chamber silicone intraocular lenses (PC IOLs) to the iris through a limbal incision and to evaluate its effectiveness in preventing intraocular hemorrhages.: SettingPrice Vision Group, Indianapolis, Indiana, USA.: MethodsThis retrospective single-center study comprised 7 eyes (5 patients) that had suture fixation of a silicone PC IOL from a limbal approach to the midperipheral iris using 9-0 polypropylene (Prolene®) suture. All patients were taking warfarin sodium (Coumadin®) preoperatively and postoperatively. At each follow-up examination, visual acuity and intraocular pressure were measured, the stability of the PC IOL was assessed, and the anterior chamber and posterior segment were evaluated for blood.: ResultsThere was no incidence of intraocular hemorrhage during surgery in any eye. In 6 eyes, there was no blood in the anterior chamber or posterior segment at any postoperative examination. A nonlayering hyphema that resolved within 1 week without sequelae was noted in 1 patient 6 weeks postoperatively. The mean follow-up was 10.7 months (range 6 to 25 months).: ConclusionSuture fixating a PC IOL to the iris through a limbal approach was an effective means of placing an IOL in anticoagulated patients without capsule support. [Copyright &y& Elsevier]

Ocular penetration of two topical antibiotics used to treat bacterial conjunctivitis was assessed in adult volunteers scheduled for cataract surgery. In this randomized, parallel-group study, patients instilled trimethoprim sulfate 0.1%/polymyxin B (n = 23) or ofloxacin 0.3% (n = 25) QID for 3 days, plus 4 instillations in the hour before surgery. Analysis of aqueous humor samples obtained during surgery showed a 2.4-fold greater concentration of ofloxacin over trimethoprim (1.135 μg/ml vs 0.470 μg/ml; P < .0001). The greater concentration of ofloxacin in ocular tissue coupled with its superior antibacterial activity profile supports its use as an alternative to trimethoprim/polymyxin B for treatment of bacterial conjunctivitis. [ABSTRACT FROM AUTHOR]