Predictors of Photic Phenomena with a Trifocal IOL

Aim

To assess predictive factors associated with glares and halos in patients undergoing cataract surgery with PanOptix trifocal IOL implantation.

Methods

Single-center retrospective study. One hundred and forty eyes from 70 patients with cataract were bilaterally implanted with a trifocal PanOptix aspherical diffractive lens between 2017 and 2019 and followed-up for six months. All patients were evaluated for refraction, corneal topography, and aberrometry pre- and post-operatively. Patients were assessed at 1 day, 6 days, 1 and 6 months after surgery. One and six months post-operatively patients were asked to complete a satisfaction questionnaire that included photic phenomena assessment. Main outcome measures were photic phenomena at 1 and 6 months of follow-up. Predictors of photic phenomena at 1 and 6 months were also analyzed.

Results

A higher corneal coma was associated with more mild halos at 6 months with no association regarding other degrees of severity. The lower the age the higher the glare or halos, the higher the lens thickness and the lower the anterior chamber depth or chord µ the less halos at 1 month. A significant proportion of patients had more none/mild compared to moderate/severe glare and halos both at 1 and 6 months post-operatively. Baseline BCVA was the only predictor of halos at 1 month and glare and halos at 6 months post-surgery.

Conclusion

On multivariate regression analyses, the only predictor of photic phenomena was baseline visual acuity, suggesting that patients that have a better visual acuity before surgery are more demanding regarding visual outcomes after surgery.

Consensus on the management of astigmatism in cataract surgery

This project was aimed at achieving consensus on the management of astigmatism during cataract surgery by ophthalmologists from Latin America using modified Delphi technique. Relevant peer-reviewed literature was identified, and 21 clinical research questions associated with the definition, classification, measurement, and treatment of astigmatism during cataract surgery were formulated. Twenty participants were divided into seven groups, and each group was assigned three questions to which they had to respond in written form, after thoroughly reviewing the literature. The assigned questions with corresponding responses by each group were discussed with other participants in round 4 – presentation of findings. The consensus was achieved if approval was obtained from at least 80% of participants. The present paper provides several agreements and recommendations for management of astigmatism during cataract surgery, which could potentially minimize the variability in practice patterns and help ophthalmologists adopt optimal practices for cataract patients with astigmatism and improve patient satisfaction.

Clinical outcomes using standard phacoemulsification and femtosecond laser-assisted surgery with toric intraocular lenses

PURPOSE

To compare the 1-month and 1-year results of toric intraocular lens (IOL) implantation with standard (manual) phacoemulsification vs femtosecond laser-assisted surgery.

PATIENTS AND METHODS

Refractive data, visual acuity data, and ocular aberration measured with a wavefront aberrometer were collected for two groups of patients from one site. The first group had standard phacoemulsification, while the second group had femtosecond laser-assisted surgery, and both groups were implanted with toric IOLs, either monofocal or multifocal. Differences in visual acuity, refractive outcomes, and higher order aberrations - total, corneal, and internal - were evaluated at 1 month and 1 year postoperatively.

RESULTS

Toric IOLs were implanted in 62 eyes using standard phacoemulsification and 53 eyes using femtosecond laser-assisted surgery. Uncorrected visual acuity and best-spectacle-corrected visual acuity at 1 month and 1 year were not statistically significantly different between the groups (P>0.05) nor was the mean cylinder or mean spherical equivalent refraction (P>0.12). Total ocular higher order aberrations were significantly different between the groups (P<0.05), but absolute differences appeared to be the same. Internal vertical coma was significantly lower in the femto group at 1 year (P=0.03). Differences in aberrations did not correlate with corrected or uncorrected visual acuity.

CONCLUSION

Patients who underwent uncomplicated lens surgery with toric IOLs in both the groups had comparable refractive outcomes in terms of visual acuity and residual refraction at 1 year. The femto group had significantly lower internal vertical coma at 1 year.

Effect of collagen implants in the reduction of high astigmatism induced by penetrating keratoplasty

PURPOSE

To evaluate the insertion of EagleVision collagen plugs as spacers between corneal relaxing incisions to correct significant residual astigmatism after penetrating keratoplasty (PKP).

SETTING

Ambulatory Clinic of the Department of Ophthalmology, Rhode Island Hospital, and Rhode Island Eye Institute, Providence, Rhode Island, USA.

METHODS

This study comprised 8 patients meeting the following criteria: had previous PKP, had at least 5.0 diopters of residual keratometric astigmatism with all the sutures removed, were free from eye infection, and were at least 21 years old. All 8 patients had unilateral high astigmatism after PKP. Four eyes were randomly assigned to the control group of astigmatic keratectomy (AK) incisions without the collagen implants and 4 eyes to the experimental group of AK incisions with collagen implants.

RESULTS

Best corrected visual acuity 1 day, 3 weeks, and 1, 2, and 6 months after AK showed decreased astigmatism in all the patients who had the relaxing incisions. The amount of astigmatism was lower in patients who received AK incisions with collagen implants (P < .28). Minimal adverse effects were noted.

CONCLUSION

Implanting a biocompatible material into AK incisions to correct post-PKP astigmatism appears to be safe and may enhance astigmatic correction.

Preservation of vision through Weiss ring after dense vitreous hemorrhage

PURPOSE

To report an unusual case of retained vision through a Weiss ring in the setting of dense vitreous hemorrhage.

METHOD

Case report of a 55-year-old woman with a 23-year history of type 1 diabetes mellitus who presented with new onset of blurred vision in the left eye as a result of a dense vitreous hemorrhage.

RESULTS

The patient had received full scatter laser photocoagulation for proliferative diabetic retinopathy in the right eye several years earlier and reported previous resolving episodes of vitreous hemorrhage in the left eye. Best-corrected visual acuity in the left eye was hand motions at 3 feet. However, with careful head positioning visual acuity improved to 20/40 through a small clear central island. Examination of the left fundus showed a dense vitreous hemorrhage with a clear, mobile opening in the posterior hyaloid corresponding to the Weiss ring. The retina could be partially visualized only through the area of the Weiss ring.

CONCLUSIONS

This unusual case demonstrates the anatomical relationship between the posterior hyaloid and Weiss ring.

Cataracts, bilateral macular holes, and rhegmatogenous retinal detachment induced by lightning

PURPOSE

To report ocular injuries, including a unilateral rhegmatogenous retinal detachment, induced by lightning.

METHOD

Case report. A 30-year-old man was injured by lightning.

RESULTS

The patient developed a severe decrease in visual acuity in both eyes, an afferent pupillary defect in his left eye, bilateral cataracts, posterior vitreous detachments, macular holes, and an inferotemporal retinal detachment with an associated flap retinal tear in his left eye.

CONCLUSIONS

This is a case of bilateral cataracts, posterior vitreous detachments, macular holes, and a unilateral retinal detachment associated with lightning. We postulate that the heating of the retinal surface, the concussive forces on the eye, and a sudden lateral contraction of the attached vitreous resulted in bilateral posterior vitreous detachments and a unilateral peripheral retinal break.

Expression of fibronectin isoforms in rat cornea after an epithelial-scrape wound

The polymerase chain reaction (PCR) technique was used to analyze the presence or absence of the EIIIB and V region fibronectin (FN) mRNA isoforms, generated by alternative splicing of the FN primary mRNA transcript during epithelial wound healing, in a rat cornea wound model. A central 4mm area of the cornea was denuded of epithelium. At 5, 15, 30, 45 minutes, 1, 2, 4, 8, 24, 48 hours, and 4 days post-wounding, the rats were euthanized and a 6mm diameter full thickness corneal biopsy was performed. cDNA was synthesized from extracted RNA, and specific FN sequences were amplified by PCR as directed by different sets of 5' and 3' primers specific for the alternatively spliced EIIIB and V region domains. Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA expression was used to normalize the data. PCR products were analyzed by agarose gel electrophoresis and the identity of the bands were confirmed by direct nucleotide sequencing. The alternatively-spliced EIIIB and all three alternatively spliced isoforms of V domain FN mRNA were observed post-wounding. Similarly, in normal tissue, EIIIB and all three V region alternatively spliced FN isoforms were expressed. These findings suggest that in situ synthesis of cellular associated EIIIB FN and FN V domain may play a role in corneal wound healing.