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Purpose: To assess the safety and efficacy of the yellow sub-threshold micropulse laser (YSML) in eyes with uveitic macula edema (UME)., Methods: A prospective interventional study. Eyes with non-infectious UME and an unsatisfactory response to prior conventional treatments underwent navigated YSML (NAVILAS ® ). The treatment was planned on an imported macular OCT scan. The central macular thickness (CMT) and best-corrected visual acuity (BCVA) were recorded immediately before the treatment (baseline) and again after 1 and 3 months. The end of the follow up (FU) was the last available evaluation in the case of no UME recurrence; or when the CMT increase required rescue therapy., Results: Eight eyes of as many patients were included. The mean duration of the FU was 252 days (range: 170-398 days). No adverse events were observed. In the whole cohort the mean values improvement over time was significant for both CMT ( p  = 0.011) and BCVA ( p  < 0.001). The indication for a new treatment was stated in 4 eyes (50%) after a mean FU of 277 ± 43 days. This time was statistically comparable with the mean FU of eyes without UME recurrence. At the baseline the non-UME recurrence eyes had a significantly lower mean CMT (326 ± 80 vs 485 ± 112 μm, p  = 0.03)., Conclusions: The application of YSLM for UME has not previously been mentioned in literature. Our results were promising in terms of both safety and efficacy. This would authorize further studies on the procedure, also as a first line treatment in naif UME cases., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background/Objectives : To compare the clinical outcome of suture and sutureless iris fixation techniques for dislocated intraocular lenses (IOLs). Methods : Retrospective cohort study including patients who underwent surgery for late IOL dislocation over a 10-year period. IOL repositioning was achieved either by suturing the original IOL to the iris using the Siepser slipknot technique or by replacing it with a retropupillary sutureless iris claw IOL. Data collected during surgery included the type of dislocation, the need for anterior or posterior vitrectomy, duration of surgery, and intraoperative complications. Six months after surgery we assessed the eye and iris anatomy; refraction, astigmatism, and visual acuity; endothelial cell damage; and rate of postoperative complications. Results : Included in the study were 60 patients: 32 underwent IOL relocation and 28 underwent IOL exchange. Pseudoexfoliation (43.7% and 39.3%) and retinal surgery (34.4% and 28.6%) were identified as the main possible causes for IOL dislocation. The mean duration of the surgery was 62.9 ± 14.9 min for the Relocation group, and was 42.7 ± 11.4 min for the Exchange group ( p < 0.001), with similar low intraoperative complication rates (6.25% and 7.14%, respectively). The studied parameters showed no differences between the two groups postoperatively, except for corneal astigmatism which was 1.31 ± 0.45 D in the Relocation group and was 1.89 ± 0.86 D in the Exchange group ( p < 0.001). Conclusions : Both suture and sutureless iris fixation techniques for dislocated IOLs yielded similarly favorable outcomes in this study. IOL relocation resulted in less postoperative astigmatism, while IOL exchange offered the advantage of shorter surgical time.

Purpose: To compare the clinical and aberrometric outcomes obtained with a new diffractive pentafocal intraocular lens (IOL) and a diffractive trifocal IOL., Methods: Patients bilaterally implanted with the pentafocal Intensity SeeLens IOL (Hanita Lenses) (n = 30) and the trifocal FineVision POD F IOL (PhysIOL) (n = 30) during cataract surgery were studied after 1 month for refraction, visual acuity, defocus curve, contrast sensitivity, Hartmann-Shack aberration, and double-pass aberration. The Quality of Vision (QoV) questionnaire was used to evaluate visual comfort., Results: Distance and near visual acuities were similar with the two IOLs, but distance-corrected intermediate visual acuity was better with the Intensity IOLs (0.03 ± 0.04 vs 0.11 ± 0.04 logMAR in the FineVision eyes, P < .01). The difference between objective and subjective refraction was more myopic for the Intensity IOL (-1.15 vs -0.29 diopters [D]). The defocus curve was flatter with the Intensity IOL. Contrast sensitivity was similar in both IOLs. Hartmann-Shack aberration and double-pass aberration were similar, but the modulation transfer function cut-off value was worse with the Intensity IOL: 11.6 ± 2.7 vs 15.3 ± 4.9 ( P < .01). QoV scores were better with the Intensity IOL, in particular for glare, halos, and starburst., Conclusions: In this comparative series, the pentafocal Intensity IOL provided better intermediate vision and better defocus curve than the FineVision IOL, with comparable distance and near vision. The optical disturbances as reported by the patients were higher with the FineVision IOL. Additional studies will better define the aberration profile obtained with the pentafocal IOL. [ J Refract Surg . 2024;40(9):e604-e613.] .

Background: Endothelial Keratoplasty (EK) is now considered as the standard treatment for Congenital Hereditary Endothelial Dystrophy (CHED) by many surgeons. We present the 12-year clinical outcome of the youngest operated patient with CHED in which we successfully performed a bilateral EK procedure without removing the recipient endothelium-Descemet complex., Case Presentation: In November 2010 we performed EK without Descemet Stripping in a 3-month female newborn, thinking that the lower manipulation obtained by leaving the recipient endothelium-Descemet complex could be the key factor for the success of our surgery. Such a particular technique was new in newborns. The surgery was a success, but the long-term visual result was not predictable at that time. We followed the patient at 4 months, and then yearly. At the latest visit in October 2022 the visual, cognitive, and motorial developments were normal, with Best-corrected Distance Visual Acuity of 0.4 LogMAR with - 0.75 D sf + 2.75 D cyl @ 105° in the right eye (RE) and 0.4 LogMAR with + 1.50 D sf + 2.50 D cyl @ 60° in the left eye (LE). The endothelial microscope showed an unexpected healthy endothelium, with a cell count of 2383 cells/mm 2 in the RE and of 2547 cells/mm 2 in the LE from a starting donor count of 2900 cells/mm 2 . No secondary procedures were performed during the 12-year follow-up., Conclusion: EK without Descemet stripping has proved to be a successful procedure over time in our newborn. The unexpected healthy endothelium suggests a role of the Descemet membrane in CHED., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Purpose: The dynamics of the posterior capsule during femtosecond laser lens fragmentation has received little attention in the literature. We analysed the movements of the posterior capsule to identify the rupture risk factors, if any, and to suggest possible modification of the laser spot energy pattern during fragmentation., Materials and Methods: Posterior capsule ruptures during fragmentation were identified over a 10-year period of femtosecond laser use. In addition, the dynamics of the posterior capsule were identified through the real-time swept-source OCT lateral view available during the surgeries., Results: Out of the 1465 laser cataract procedures performed, we recorded 1 case of posterior capsule rupture during lens fragmentation, which was caused by eye movement that was detected but ignored by the surgeon. Three types of posterior capsule dynamics were identified, all related to a gas bubble formation during the first part of the lens fragmentation. In eyes with a hard nucleus, the concussion of the posterior capsule was evident, however, with no capsule rupture., Discussion: Maintaining good docking throughout the whole procedure seems important in avoiding a posterior capsule cut by the femtosecond laser. In addition, a Gaussian pattern of spot energy is suggested when fragmenting hard cataracts., (© 2023. The Author(s).)

Purpose: We evaluated the pupillary characteristics and response to light and drugs in eyes with posterior chamber (PC) placement of iris-claw intraocular lens (IC-IOL)., Methods: In this cross-sectional, comparative study, we included adults with an IC-IOL implanted in the PC of a single eye. We excluded patients with ocular trauma, postoperative IC-IOL displacement or complications, and extended iris atrophy. We used anterior segment optical coherence tomography to perform light-controlled pupillography, measure the pupil diameter (PD), and estimated the pupil circularity under mesopic conditions. PD was also assessed under photopic, scotopic, pharmacological mydriasis, and miosis conditions. The results were compared to those of the fellow eye, phakic, or regular pseudophakic., Results: The IC-IOL and control groups included 30 eyes each. The most frequent reasons for IC-IOL implantation were complicated cataract (37%) and dislocated/luxated prior IOL (33%). Compared to the control group, the IC-IOL group had lower visual acuity, a smaller PD under scotopic conditions (p = 0.0010) and after pharmacological mydriasis (p < 0.0001), and a larger PD after pharmacological miosis (p < 0.0001). Mesopic pupil circularity was comparable between the groups. We also considered ongoing extraocular treatments with possible effects on iris motility., Conclusions: The pupillary size and profile were similar between the groups in mesopic light. Reduced mydriasis was noted in response to light and drugs, while the degree of miosis was reduced in response to inducing drugs in the IC-IOL compared to the control group. This study complements previous results concerning the PC placement of IC-IOLs by adding original observations on drug-induced pupil motility., (© 2023. The Author(s).)

Pars plana vitrectomy is today a common first-line procedure for treatment of rhegmatogenous retinal detachment (RRD). Removal or preservation of the natural lens at the time of vitrectomy is associated with both advantages and disadvantages. The combination of cataract extraction (i.e., phacoemulsification) with pars plana vitrectomy (PPVc) enhances visualization of the peripheral retina and the surgical management of the vitreous base. However, PPVc prolongs the surgical time and is associated with iatrogenic loss of the accommodation function in younger patients, possible postoperative anisometropia, and unexpected refractive results. Performance of pars plana vitrectomy alone (PPVa) requires good technical skills to minimize the risk of lens damage, and quickens cataract development. We retrieved all recent papers that directly compared PPVc and PPVa using parameters that we consider essential when choosing between the two procedures (the success rate of anatomical RRD repair, postoperative refractive error, intra- and postoperative complications, and costs). PPVa and PPVc were generally comparable in terms of RRD anatomical repair. PPVc was associated with fewer intraoperative, but more postoperative, complications. Macula-off RRD PPVc treatment was often associated with undesirable myopic refractive error. PPVa followed by phacoemulsification was the most expensive procedure., Competing Interests: The authors declare no conflict of interest.

Automated refraction (Scheiner principle) is universally used to start a visual examination. Although the results are reliable in eyes implanted with monofocal intraocular lenses (IOLs), they may be less precise with multifocal (mIOL) or extended depth-of-focus (EDOF) IOLs and can even indicate a refractive error that does not clinically exist. Autorefractor results with monofocal, multifocal, and EDOF IOLs were investigated through literature search analyzing the papers reporting the difference between automated and clinical refraction. The average difference ranged between -0.50 diopter (D) and -1.00 D with most mIOL and EDOF IOLs. The differences in astigmatism were generally much lower. Autorefractors using infrared light cannot measure eyes with high technology IOLs precisely because of the influence of the refractive or of the diffractive near add. The systematic error induced with some IOLs should be mentioned in the IOL label to prevent possible inappropriate refractive procedures to treat apparent myopia., (Copyright © 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To investigate the advantages/disadvantages of a 1.0 D toric IOL vs spherical IOL after regular phacoemulsification in eyes with preoperative astigmatism ≤ 1 D., Methods: Retrospective comparative series involving pseudophakic eyes with preoperative topographic astigmatism ≤ 1.0 D implanted either with monofocal 1.0 D Toric IOL (T-group), or with spherical IOL (S-group). The postoperative refractive astigmatism (PRA, i.e. surgically induced + corneal) was the main outcome; also considered in the analyses were the uncorrected and best-corrected distance visual acuity (VA). The data were referred to the last postoperative follow-up visit, 2 to 4 months after surgery., Results: A total of 60 eyes were included: 30 in the T-group and 30 in the S-group, matched for patient's age, laterality, and axial length. Before surgery, the mean corneal astigmatism was 0.62 ± 0.39 D in the T-group and 0.54 ± 0.33 D in the S-group (p = 0.4). In the S-group, PRA was 0.73 ± 0.37 D, higher than the corresponding preoperative corneal astigmatism (p = 0.040). In the T-group, PRA was 0.58 ± 0.31 D; the variation was not statistically significant. Uncorrected VA was significantly better in the T-group vs the S-group (p = 0.007), and the best-corrected VA was comparable in the two groups., Conclusion: The present study indicated that in eyes with very low preoperative astigmatism, 1.0 D toric IOLs were able to limit the increase of the PRA instead of those observed with the spherical IOLs. This could support the better uncorrected VA recorded in the T-group., (© 2022. The Author(s).)

Introduction: To compare the short-term visual and aberrometric outcomes and the long-term capsulotomy incidence in a cohort of patients receiving IOLs with similar structural profile but with a hydrophobic matrix in one eye (PHOB group) and a hydrophilic matrix in the other one (PHIL group)., Methods: In this retrospective, contralateral study, 26 patients sequentially undergoing phacoemulsification were implanted as mentioned above. Refraction and aberrometry were evaluated 6 months after surgery. For the quality of vision, the Hartmann-Shack optical aberration, Double-Pass Modulation Transfer Function (MTF), contrast sensitivity, and dysphotopsia results were compared. Capsulotomy was ascertained and dated by medical chart revision or phone call., Results: All the considered quantitative and qualitative visual parameters tested statistically comparable between PHIL and PHOB group. After 5 years, four patients (16.7%) in the PHOB group and five patients (20.8%) in the PHIL group underwent a Nd:YAG posterior capsulotomy (P > 0.5)., Conclusion: In this contralateral comparative study, the hydrophobic and hydrophilic matrix of the IOL similarly influenced the visual and aberrometric outcomes. Also the long-term laser capsulotomy incidence did not statistically differ between groups. The posterior IOL profile, rather than matrix hydrophilia, could consistently influence the posterior capsule opacification., (© 2023. The Author(s).)

Purpose: This retrospective case-control study was conducted to quantitatively and qualitatively assess the visual impairment in eyes with Epithelial Basement Membrane Dystrophy (EBMD) after regular cataract surgery., Methods: EBMD pseudophakic eyes were compared with matched pseudophakic eyes free from surface disorders. At least 3 weeks after surgery we evaluated uncorrected and best-corrected distance visual acuity (UDVA and CDVA), objective aberrometry, Point Spread Function (PSF), Modulation Transfer Function (MTF), and patient complaints., Results: Twenty-five EBMD eyes and 25 control eyes (13 patients per group) were included. Nine patients per group had a monofocal IOL, and four patients had a trifocal IOL. All the EBMD patients complained of postoperative blurred vision with ocular discomfort; intensive use of lubricants induced subjective improvement only in eyes with monofocal IOLs. Postoperative mean UDVA was 0.19 ± 0.16 LogMAR in the EBMD eyes and 0.11 ± 0.04 LogMAR in the control group ( p = 0.016). Mean CDVA was 0.18 ± 0.15 LogMAR in the EBMD eyes and 0.06 ± 0.04 LogMAR in the control eyes ( p = 0.001). The PSF curve width was significantly worse in the EBMD group ( p < 0.001). The MTF cut-off value was lower in the EBMD group than in the control group ( p < 0.001)., Conclusion: After cataract removal, eyes with EBMD had significantly lower UDVA and CDVA than controls. All the aberrometric parameters were significantly worse in EBMD cases. EBMD patients complained about their postoperative visual outcome, while control patients did not.

Competing Interests: Declaration of Competing Interest The Authors declare that there is no conflict of interest. The authors received no financial support for performing, the authorship, and/or publication of this video essay.

Lens-sparing pars plana vitrectomy (PPV) is often followed by cataract development. However, there have been few prospective studies evaluating the timing of cataract progression and potential associated factors. This was an observational study conducted at the Ophthalmology Unit of the University Hospital of Parma (Parma, Italy). Patients presenting with rhegmatogenous retinal detachment (RRD), who underwent PPV with preservation of the lens, were examined according to a scheduled follow-up (3, 6 and 12 months after PPV) and then preoperatively when cataract extraction surgery (CES) was indicated, or at the end of the study follow-up period (May 2021). The primary outcome was the interval between PPV and CES indication (based on predefined refractive criteria). A total of 36 eyes of 36 patients (mean age: 52 ± 10 years) were included in the study. Nineteen eyes (53%) were indicated for CES a median of 14.5 months (IQR: 12.0-24.8) after PPV. The nuclear and posterior subcapsular forms of cataract progressed significantly starting at 6 months after PPV. Older age at the time of PPV, silicone oil tamponade and RRD without macular involvement were significantly and independently associated with an earlier indication for CES. Patient age and the use of silicone oil tamponade must be taken into consideration when evaluating the risk of cataract development after PPV., (© 2022. The Author(s).)

Background: Information on the centration and tilt of iris-claw intraocular lenses (IC-IOLs) is limited. In this study, we tested the capacity of an anterior segment optical coherence tomography (AS-OCT) instrument to measure decentration and tilt of anterior and posterior IC-IOLs through an integrated software., Methods: The present observational, cross-sectional study was conducted at University Eye Clinic of Parma (Parma, Italy). The CASIA2 swept-source AS-OCT (Tomey Corp.) was used to measure the tilt and decentration of posterior and anterior IC-IOLs in patients implanted at least 6 months in advance. After failure with full-automation, semi-manual IOL tracing was applied. In-the-bag (IB) contralateral IOLs, when present, were measured automatically. The Bland-Altman method was used to evaluate the agreement between repeated measurements (2 images for each study eye). The amount and direction of tilt and decentration were recorded and plotted into polar charts for evaluation., Results: A total of 21 patients were included: 14 with posterior and 7 with anterior IC-IOL fixation. In 17 eyes (81%), the AS-OCT provided a repeatable measurement of tilt and decentration. All contralateral eyes with IB IOL were automatically measured. The median decentration was 0.67 mm, 0.24 mm, and 0.24 mm in posterior IC-IOLs, anterior IC-IOLs, and IB IOLs group, respectively. The median tilt was 5.0°, 5.6°, and 5.6° for posterior IC-IOLs, anterior IC-IOLs, and IB IOLs, respectively. Tilt direction was mainly temporal, while decentration was inferior-temporal with posterior IC-IOLs and scattered with anterior IC-IOLs and IB IOLs., Conclusions: The semi-manual tracing function of the CASIA2 AS-OCT provides repeatable and affordable measurements of the decentration and tilt of IC-IOLs in both the anterior and posterior chamber. Data from the former group were similar to the IB group., (© 2022. The Author(s).)

Background: To compare parsplana vitrectomy (PPV) with and without phacoemulsification to treat rhegmatogenous retinal detachment (RRD)., Methods: Subjects aged 48-65 years with RRD in a phakic eye due to superior retinal tears with an overall extension of retinal breaks < 90° underwent to PPV alone (group A); or PPV plus phacoemulsification (phacovitrectomy, PCV, group B). Post-operative follow-up visits occurred at 1 week, 1 month (m1), 3 months (m3), and 6 months (m6) after surgery. The main outcome was the rate of retinal reattachment. Secondary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and cataract progression (in the lens-sparing [PPV-alone] group)., Results: In this initial phase of the study a total of 59 patients (mean age: 55 years, 59 eyes) were enrolled: 29 eyes in group A and 30 eyes in group B. Both groups had similar gas tamponade. During the follow-up there were three cases of RRD recurrence in group A and one in group B. The relative risk of recurrence in group A was 3.22 times higher but the difference was not significant (p = 0.3). The two groups were also similar in terms of BCVA and IOP variation. At m3, CMT was significantly higher in group B (p = 0.014). In group A, cataract progression was significant at m6 (p = 0.003)., Conclusions: In a cohort of RRD patients selected according to their preoperative clinical characteristics, PPV was comparable to PCV in terms of the rate of retinal reattachment after 6 months., Trial Registration: ISRCTN15940019 . Date registered: 15/01/2021 (retrospectively registered).

We report on the case of a 17-year-old boy with clinical features compatible with Lowry-Wood syndrome: microcephaly, short stature, multiple epiphyseal dysplasia, tapetoretinal degeneration, and mental retardation. Bilateral restricted elbow extension, knock knees and hip dislocation were also present. Radiographs showed evidence of radial dislocation due to the absence of the radial heads, lateral dislocation of both patellae, multiple epiphyseal dysplasia that was more severe at the proximal femoral epiphyses, and dislocation of both hips with severe hip dysplasia. The patient developed a behavioral disorder at age 15. Conventional karyotyping was normal (46,XY). Molecular karyotyping, performed through array-based competitive genomic hybridization, showed copy number variants that were probably benign. We suggest that multiple joint dislocations, including the patellae, may be a sign of Lowry-Wood syndrome.

We report a case study of Fundus Albipunctatus (FA) due to compound heterozygous mutations in RDH5, the gene encoding for the 11-cis-retinal dehydrogenase (RDH). A 6-year old Hispanic American female with a clinical presentation suggestive of FA underwent dark-adapted full-field flash electroretinography (ERG) at 30 and 120 min. The pattern of ERG abnormalities was consistent with the working diagnosis FA. However, only ERG responses to dim stimuli were profoundly affected, and maximal ERG responses were already near normal after only 30 min of dark adaptation. The patient also demonstrated a subnormal maximal ERG response b/a-wave ratio at 30 min that resolved after 120 min of dark adaptation. When measurable, dark-adapted post-receptoral responses were normal in timing under all circumstances, and became increasingly faster after prolonged dark adaptation. Cone-driven responses were completely normal at this young age. Sequencing of the RDH5 gene revealed two distinct missense mutations, a G238W mutation, previously reported in patients with FA, and a D128N mutation, which has not been reported before but is known to cause reduced 11-cis-RDH activity. These findings confirmed the clinical and functional diagnosis of FA and excluded that of retinitis punctata albescens (RPA). The behavior of dark-adapted ERG responses in FA displays characteristics that differ from those of RPA patients, which may be useful to differentiate functionally these two conditions at their common albipunctate stages.

Purpose: To characterize the kinetics of visual field decay in Usher syndrome type II., Methods: The area of 137 Goldmann visual fields (GVFs) delimited with the I4e and V4e targets was measured in each eye of 19 patients with an established diagnosis of Usher syndrome type II, and the average interocular GVF area for each patient at each time point was calculated. The average follow-up was 5.58 years. Symptomatic disease duration was defined as years elapsed after symptoms were first noted. The data set (n = 67 for the I4e target; n = 70 for the V4e target) was analyzed with a random coefficient mixed model to identify the best-fit model describing the decay of visual field size over time. The half-life of the residual visual field area (t(0.5)) was also calculated., Results: The variable that best explained the decay of the GVF area was the duration of symptomatic disease. In an exponential model, the slope estimate for the natural log of the GVF area was -0.172 for the I4e target and -0.136 for the V4e target for each year of symptomatic disease. Accordingly, t(0.5) was approximately 4 years for the I4e target and 5 years for the V4e target. These estimates are very similar to those in previous studies of nonsyndromic retinitis pigmentosa (RP)., Conclusions: This study suggests that the kinetics of GVF decline in Usher syndrome type II are, on average, very similar to other forms of RP and that, once the disease becomes symptomatic, GVF deterioration follows stereotyped kinetics, even in patients with late-onset retinal disease.

Purpose: To report a family in which three siblings have unilateral late-onset Brown syndrome., Methods: The entire nuclear family underwent ophthalmologic evaluation. Orbital imaging and systemic workup were obtained to rule out local or systemic causes. Historic information was obtained from unavailable family members. The family's Brown syndrome trait was analyzed for linkage to the known congenital fibrosis syndrome loci and the CFEOM2 gene, ARIX, was sequenced in affected individuals., Results: All affected siblings developed left-sided Brown syndrome, worse on awakening, at 12-13 years of age. No evidence of Brown syndrome could be identified in other family members, either by exam or history. No abnormalities of the trochlear-tendon complex could be documented. Haplotype analysis of the Brown syndrome phenotype was consistent with recessive inheritance at the DURS1 locus and dominant inheritance with reduced penetrance at the DURS1, DURS2, and FEOM1 loci. No mutations were detected in CFEOM2 gene, ARIX., Conclusions: We propose that a genetically determined predisposition to Brown syndrome is likely responsible for the observed manifestations in this family and that late age of onset and intermittent manifestations do not distinguish acquired from hereditary Brown syndrome. The pattern of inheritance of the Brown phenotype in this family could be either autosomal recessive or autosomal dominant with reduced penetrance. Our analysis only permitted the exclusion of the FEOM3 locus and the FEOM2 gene, ARIX. Future genetic studies of additional Brown syndrome families should shed additional light on the genetic basis of this disorder.