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Jun Zhang, Li Zheng, Yixuan Zhang, Ke Wang Department of Ophthalmology, Hangzhou MSK Eye Hospital, Hangzhou, People’s Republic of ChinaCorrespondence: Jun Zhang, Department of Ophthalmology, Hangzhou MSK Eye Hospital, Hangzhou, People’s Republic of China, Tel +86-18667046602 ; +86-0571 85064148, Email zhangjun@mskyk.onaliyun.comPurpose: To analyze the corneal asphericity, longitudinal spherical aberration (LSA), and related factors in Chinese myopic adult eyes.Methods: This was a retrospective study of myopic adult patients. The corneal asphericity and LSA were measured at 3.0, 4.0, 5.0, 6.0, and 7.0 mm diameter apertures using corneal tomography. Age and refractive power were recorded for correlation analysis.Results: In total, 531 females and 384 males were included. At the above five diameter settings the corneal asphericity values (Q) of the anterior surface were − 0.09± 0.21, − 0.14± 0.16, − 0.15± 0.13, − 0.17± 0.11, and − 0.20± 0.11, and those of the posterior surface were 0.23± 0.49, 0.06± 0.29, − 0.01± 0.22, − 0.07± 0.16, and − 0.08± 0.15, respectively. The anterior corneal LSA values at these diameters were 0.39± 0.19, 0.63± 0.27, 0.97± 0.36, 0.90± 0.30, and 0.83± 0.29 D, respectively and the whole corneal values were 0.26± 0.20, 0.44± 0.27, 0.70± 0.36, 0.66± 0.30, and 0.59± 0.28 D, respectively. Corneal asphericity and peripheral LSA showed no or weak correlation with age or spherical equivalent (all r < 0.2).Conclusion: Corneal anterior and posterior Q values in myopia patients are negatively correlated with corneal diameter. Corneal anterior and whole corneal LSA increased significantly with diameter up to 5 mm, then decreased slightly with diameter. Corneal asphericity and peripheral LSA showed very weak or no correlation with age or spherical equivalent.Clinical Trial Registration Number: ChiCTR1800015985.Keywords: wavefront aberration, asphericity, longitudinal spherical aberration, myopia

Janarthanam Jothi Balaji,1 Rajiv Raman,2 Vasudevan Lakshminarayanan3 1Department of Optometry, Medical Research Foundation, Chennai, Tamil Nadu, 600006, India; 2Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Chennai, Tamil Nadu, 600006, India; 3Theoretical and Experimental Epistemology Lab, School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, CanadaCorrespondence: Janarthanam Jothi Balaji, Department of Optometry, Medical Research Foundation, 18, College Road, Nungambakkam, Chennai, Tamil Nadu, 600006, India, Tel +91 44-42271500, Email jothibalaji@gmail.comBackground: Posterior vitreous detachment (PVD) can result in serious pathologic events at the vitreoretinal interface. This study aims to assess the relationship between PVD, macular thickness (MT), and the foveal avascular zone (FAZ) in myopic eyes.Methods: This retrospective study evaluated 63 myopic subjects’ data who were examined between January 1 and June 30, 2019. The myopes were grouped on a severity scale, namely mild, moderate, high, and very high using their spherical equivalent (SE). The PVD classification was based on OCT images. The status of the PVD and MT were evaluated with the Macular Cube 200× 200 images, the FAZ with an OCTA Angioplex, and the dimensions were calculated using a customized algorithm.Results: The study population (114 eyes) had a median (range) age was 26.00 (22.00– 28.00) years and the females constituted 62.3% of the dataset. In this population, 10 eyes had no PVD in any quadrant, and 73 eyes had incomplete PVD in all four quadrants. The inferior quadrant had the maximum rate of PVD occurrences and the nasal quadrant had the least number of occurrences. High myopic eyes exhibited significantly increased low foveal volume (p = < 0.01). The inferior part of the para- and perimacular area showed a significant thinning in very high myopic eyes (p = < 0.050). The very high myopic eyes showed a significant alteration of FAZ’s circularity index (p = 0.002).Conclusion: In high and very high myopic eyes, an increasing trend of partial PVD is seen, most commonly in the inferior quadrant. A significant alteration in foveal volume and circularity index of the FAZ is seen in high and very high myopic eyes.Keywords: posterior vitreous detachment, foveal avascular zone, OCT, macular thickness, myopia

Amr A Gab-Alla Ophthalmology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt Purpose: To determine the incidence of interface fluid syndrome (IFS) secondary to steroid-induced elevation of intraocular pressure (IOP) following laser in situ keratomileusis (LASIK) in myopic Egyptian patients.Methods: This retrospective case series study was conducted at El-Gowhara Private Eye Center. The medical records of 1,807 patients (3,489 eyes), who underwent LASIK to correct myopia from April 2012 to December 2015 were included. The patients were operated on and reviewed by one surgeon (AAG) for IFS after LASIK associated with elevation of IOP (as compared to preoperative values).Results: This paper reports the incidence of 2.9% (54 patients) (102 eyes) of IFS induced by increased IOP after LASIK in Egyptian patients. The medical records of 1,807 patients (3,489 eyes) with mean age ± standard deviation (SD) 26.4±2.7 years, who presented with mean myopia ± SD -4.50±1.3 D, mean astigmatism ± SD -1.43±0.8, mean IOP ± SD 15.2±1.2 mmHg, and mean central corneal thickness ± SD 549±25.6 µm, were included. The preoperative anterior and posterior segments, corneal topography, and Schirmer’s test were unremarkable.Conclusion: Limiting topical steroids and routinely measuring the IOP post-LASIK are necessary steps to prevent IFS, especially in case of myopia. A high index of suspicion is required to make a diagnosis. High-resolution optical coherence tomography is helpful to confirm the diagnosis. Keywords: LASIK, postoperative complication, diffuse lamellar keratitis, interface fluid, myopia

Amr A Gab-Alla Ophthalmology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt Purpose: To evaluate refractive outcomes of two management approaches after suction loss during the small-incision lenticule extraction (SMILE) technique.Patients and methods: This retrospective and comparative study was conducted at the El-Gowhara Private Eye Center. It included 26 consecutive eyes of patients who experienced suction loss during the SMILE technique. Patients were divided into two groups by the technical difficulties in redocking: in group A (12 eyes) suction loss occurred after the posterior lenticular cut and the creation of side-cuts, then suction was reapplied, and the procedure was completed; in group B (14 eyes) suction loss occurred after the posterior lenticular cut and the creation of side-cuts, then the procedure was postponed for 24 hours and completed with the same parameters. Manifest refraction outcomes were measured and compared 6 months postoperatively.Results: This study included 26 eyes with suction loss during the SMILE technique: five patients with suction loss in both eyes, nine patients with suction loss in the right eye and seven patients with suction loss in the left eye. The incidence of suction loss in this study was 2.7%. At the postoperative 6-month follow-up time, there were statistically significant differences in refraction outcomes between the two groups, with a hyperopic shift in group A compared with group B.Conclusion: A good refraction outcome can be achieved with appropriate management of suction loss during the SMILE technique, and it is recommended to postpone the treatment if this happens. Keywords: diffuse lamellar keratitis, LASIK, interface fluid syndrome, myopia

Aripiprazole is an atypical, antipsychotic drug used for the treatment of schizophrenia, depression, bipolar disorder, and obsessive-compulsive disorder in adults. There are a few reports in the literature of ocular side effects of aripiprazole, such as transient myopia, diplopia, and acute angle closure. This report describes the case of a 34-year-old female patient who was referred to the clinic with painless blurred vision in both eyes. She had been diagnosed with major depression and had been using aripiprazole for a month. She experienced blurred vision after the first week of drug therapy. The uncorrected visual acuity (UCVA) was 4/10 in both eyes using a standard Snellen chart. She had a refractive error of -2.00 diopters and the best corrected visual acuity was 10/10 in both eyes. The ocular examination results were normal other than the refractive error. The patient was diagnosed with aripiprazole-induced, acute transient myopia. The UCVA was 10/10 in both eyes at the 2-week follow-up following termination of the aripiprazole therapy. It is important to be prepared to recognize aripiprazole-induced, acute transient myopia in patients complaining about blurred vision.

Topiramate is a drug used in the treatment of epilepsy, migraine, bulimia and other pathologies. We report a case of a 40-years-old woman, presented to the emergency department of ophthalmology with blurred vision in both eyes and bilateral acute angle closure. Her medications included topiramate started 6 days before Secondary angle closure glaucoma due to topiramate was diagnosed. The medication was discontinued and she was treated with topical antiglaucoma medications, intravenous mannitol and cyclopegics. At the 5-days follow-up visit, vision, intraocular pressure, and angle anatomy had returned to normal. The acute angle-closure glaucoma occurs due to edema of the ciliary body and uveal effusion that produces an anterior motion of the iris-lens diaphragm , with ocular hypertension and acute myopia .

ABSTRACT Purpose. To evaluate a frequency of secondary cataract development in different periods of postoperative follow-up after cataract phacoemulsification depending on the degree of axial myopia and the implanted IOL design. Material and methods. A retrospective analysis of secondary cataract formation in the long-term follow-up after cataract phacoemulsification with foldable intraocular lens implantation was performed in 16575 eyes out of 8722 patients with emmetropia and axial myopia. The average age of patients was 74±7 years, and the follow-up period was 5 years. The eyes with associated pathology such as glaucoma, diabetic retinopathy etc, were excluded from the study. Depending on the design of implanted IOL all eyes were divided into 3 groups. The first group included 5527 eyes with the implanted B-lens IOL (Hanita, Israel). The second group included 5629 eyes with the implanted Idea IOL (XCELENS, Switzerland). The third group consisted of 5419 eyes with the implanted Acrysof natural, SA60AT IOL (Alcon, USA). In every case the degree of myopia was evaluated using axial length of an eye that was measured instrumentally. The incidence of secondary cataract formation was evaluated on quantity of YAG-laser posterior capsule dissection within the 5-year follow-up after phacoemulsification with IOL implantation. Conclusion. According to our results the incidence of PCO is directly dependent on the axial length of the eye, strongly increasing in eyes with high axial myopia. The design and material of implanted IOL played an important role in PCO formation too. The eyes with the Acrysof natural, SA60AT IOL (Alcon, USA) had the lowest incidence of PCO in the long-term follow-up.

Introducing the management of non traumatic rhegmatogenous retinal detachment in pediatric patient in the context of a genetic syndrome associated with failure of type 2 collagen synthesis which manifests itself in ocular , hearing , facial , bone and joint abnormalities. We describe the clinical presentation of the picture and surgical repaire technique consisted of lensectomy , vitrectomy , peeling of vitreoretinal proliferation membranes , giant retinal tear management and prolonged tamponade by silicone oil. Long term clinical follow-up was carried out. We highlight this case report to be a therapeutic challenge in a deaf and high myopic child , with motor disabilities and atypical vitreoretinal disorders have generated difficulties in surgical resolution , there is also little scientific reference in world literature and represent a clinical model of abnormal vitreoretinal interaction

To determine the efficacy, predictability, stability and safety of laserin situkeratomileusis (LASIK) in treating patients with different degrees of myopia.We enrolled 386 eyes of 200 consecutive patients who underwent LASIK and divided them into four groups according to their degree of preoperative spherical equivalent (SE). Group 1 eyes ranged between− 1.00 and− 3.99 dioptres (D) (low myopia). Group 2 eyes ranged between− 4.00 and− 5.99 D (moderate myopia). Group 3 eyes ranged between− 6.00 and− 9.99 D (high myopia). Group 4 eyes were over− 9.99 D (extreme myopia). Follow-up was at 1 day, 1 week and 1, 3, 6, 12 and 18 months postoperatively.Our study included 386 eyes of 200 patients with SE ranging from− 3.00 to− 16.00 D (mean− 7.14 ± 2.87 D). All eyes were seen at 1 day postoperatively. A total of 360 eyes (93%) were examined at 1 week, 330 eyes (85%) at 1 month, 281 eyes (73%) at 3 months, 247 eyes (64%) at 6 months, 199 eyes (52%) at 12 months and 142 eyes (37%) at 18 months. The postoperative data from 1 day to 12 months were used because of the low follow-up rate at 18 months postoperatively. Group 1 consisted of 30 eyes. The mean SE was− 3.52 ± 0.43 D preoperatively and− 0.40 ± 0.58 D at 1 month,− 0.46 ± 0.60 D at 6 months and− 0.42 ± 0.50 D at 12 months postoperatively. Uncorrected visual acuity (UCVA) was 20/40 or better in 95% of eyes at 1 day and in 100% of eyes at 6 and 12 months postoperatively. Group 2 consisted of 151 eyes. The mean SE was− 5.36 ± 0.67 D preoperatively and− 0.54 ± 0.78 D at 1 month,− 0.56 ± 0.90 D at 6 months and− 0.55 ± 0.82 D at 12 months postoperatively. Uncorrected VA was 20/40 or better in 95% of eyes at 1 day and in 100% of eyes at 6 and 12 months postoperatively. Group 3 consisted of 167 eyes. The mean SE was− 8.15 ± 0.94 D preoperatively and− 0.58 ± 0.90 D at 1 month,− 0.67 ± 1.00 D at 6 months and− 0.64 ± 0.95 D at 12 months postoperatively. Uncorrected VA was 20/40 or better in 90% of eyes at 1 day and in 98% of eyes at 6 and 12 months postoperatively. Group 4 consisted of 38 eyes. The mean SE was− 11.09 ± 1.10 D preoperatively and− 1.25 ± 1.20 D at 1 month,− 1.13 ± 1.30 D at 6 months and− 1.20 ± 1.25 D at 12 months postoperatively. Uncorrected VA was 20/40 or better in 78% of eyes at 1 day, in 94% at 6 months and in 90% at 12 months postoperatively. Intraoperative complications (free cap) occurred in two eyes and postoperative complications were observed in three eyes, making the total complications rate 1.29% (5/386). Seven eyes lost one Snellen line of BCVA, five lost two lines and two lost more than two lines (total: 3.64%, 14/386).In conclusion, LASIK is effective, predictable and safe for correcting myopia but is more accurate for correcting myopia up to−10.00 D. With more improvement in algorithms and ablation profile, we believe that LASIK can offer better results for higher myopia. [ABSTRACT FROM AUTHOR]