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Stalmans I, Lim KS, Oddone F, Fichtl M, Belda JI, Hommer A, Laganovska G, Schweitzer C, Voykov B, Zarnowski T, Holló G. MERCURY-3: a randomized comparison of netarsudil/latanoprost and bimatoprost/timolol in open-angle glaucoma and ocular hypertension. Graefes Arch Clin Exp Ophthalmol 2024; 262:179-190. [PMID: 37615697 PMCID: PMC10806046 DOI: 10.1007/s00417-023-06192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
PURPOSE : To compare the efficacy and safety of the fixed-dose combination (FDC) of netarsudil 0.02%/latanoprost 0.005% ophthalmic solution (NET/LAT; Roclanda®) with bimatoprost 0.03%/timolol maleate 0.5% (BIM/TIM; Ganfort®) ophthalmic solution in the treatment of open-angle glaucoma (OAG) and ocular hypertension (OHT). METHODS MERCURY-3 was a 6-month prospective, double-masked, randomized, multicenter, active-controlled, parallel-group, non-inferiority study. Patients (≥ 18 years) with a diagnosis of OAG or OHT in both eyes that was insufficiently controlled with topical medication (IOP ≥ 17 mmHg in ≥ 1 eye and < 28 mmHg in both eyes) were included. Following washout, patients were randomized to once-daily NET/LAT or BIM/TIM for up to 6 months; efficacy was assessed at Week 2, Week 4, and Month 3; safety was evaluated for 6 months. Comparison of NET/LAT relative to BIM/TIM for mean IOP at 08:00, 10:00, and 16:00 h was assessed at Week 2, Week 6, and Month 3. Non-inferiority of NET/LAT to BIM/TIM was defined as a difference of ≤ 1.5 mmHg at all nine time points through Month 3 and ≤ 1.0 mmHg at five or more of nine time points through Month 3. RESULTS Overall, 430 patients were randomized (NET/LAT, n = 218; BIM/TIM, n = 212), and all received at least one dose of study medication. Efficacy analyses were performed at Month 3 on 388 patients (NET/LAT, n = 184; BIM/TIM, n = 204). NET/LAT demonstrated non-inferiority to BIM/TIM, with a between-treatment difference in IOP of ≤ 1.5 mmHg achieved at all time points and ≤ 1.0 mmHg at the majority of time points (six of nine) through Month 3. Mean diurnal IOP during the study ranged from 15.4 to 15.6 mmHg and 15.2 to 15.6 mmHg in the NET/LAT and BIM/TIM groups respectively, with no between-group statistically significant difference. No significant differences were observed in key secondary endpoints. No serious, treatment-related adverse events (AEs) were observed, and AEs were typically mild/moderate in severity. The most common treatment-related AEs were conjunctival hyperemia (NET/LAT, 30.7%; BIM/TIM, 9.0%) and cornea verticillata (NET/LAT, 11.0%; BIM/TIM, 0%). CONCLUSIONS Once-daily NET/LAT was non-inferior to BIM/TIM in IOP reduction in OAG and OHT, with AEs consistent with previous findings. NET/LAT offers a compelling alternative FDC treatment option for OAG and OHT.
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Affiliation(s)
- Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Louvain, Belgium.
- Research Group of Ophthalmology, Department of Neurosciences, Catholic University KU Leuven, Louvain, Belgium.
| | - Kin Sheng Lim
- KCL Frost Eye Research Department, St Thomas' Hospital, London, UK
| | | | - Marek Fichtl
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and University Hospital Motol in Prague, Prague, Czech Republic
| | - Jose I Belda
- Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain
- Visionker Eye Clinic, Torrevieja, Spain
| | - Anton Hommer
- Private Office for Ophthalmology and Optometry, Albertgasse 39/10, 1080, Vienna, Austria
| | - Guna Laganovska
- Riga Stradins University, P.Stradins Clinical University Hospital, Riga, Latvia
| | - Cédric Schweitzer
- CHU Bordeaux, Department of Ophthalmology, 33000, Bordeaux, France
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, 33000, Bordeaux, France
| | - Bogomil Voykov
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
| | - Tomasz Zarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University, Lublin, Poland
| | - Gábor Holló
- Tutkimusz Ltd, Solymár, Hungary
- Eye Center, Prima Medica Health Centers, Budapest, Hungary
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Gutiérrez-Ezquerro R, Salinas Martínez EM, Vidal-Oliver L, Izquierdo-Escámez R, Belda JI. The Thickness of the Retinal Nerve Fiber Layer (RNFL) as a Biomarker in Uveitis. Ocul Immunol Inflamm 2023:1-7. [PMID: 37348069 DOI: 10.1080/09273948.2023.2220787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
AIMS To study the changes of the retinal nerve fiber layer (RNFL) thickness during and following uveitis flares. METHODS This was a retrospective study of patients with uveitis diagnosed in the ophthalmology service of Torrevieja hospital. We analyzed RNFL thickness during and after the acute episode. RESULTS We included 29 patients. Most patients (55.2%) had anterior uveitis; followed by posterior, intermediate and panuveitis. Mean RNFL thickness was significantly higher during the flare (132.17±35.54μm vs 107.66±17.10μm). RNFL thickness had no difference between groups with or without macular edema. CONCLUSIONS The RNFL thickens during flares in most patients with uveitis. It can be measured by optical coherence tomography in a non-invasive way, representing an objective marker of inflammation. This can favor earlier detection of flares, resolution, and recurrence of uveitis. More studies are needed to determine the evolution of RNFL over time and in different types of uveitis.
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Affiliation(s)
- R Gutiérrez-Ezquerro
- Department of Ophthalmology, Torrevieja University Hospital, Torrevieja, Alicante, Spain
| | - Eva M Salinas Martínez
- Department of Ophthalmology, Torrevieja University Hospital, Torrevieja, Alicante, Spain
| | - L Vidal-Oliver
- Department of Ophthalmology, Torrevieja University Hospital, Torrevieja, Alicante, Spain
- Department of Ophthalmology, FISABIO Oftalmología Médica, Valencia, Spain
| | - R Izquierdo-Escámez
- Department of Ophthalmology, Torrevieja University Hospital, Torrevieja, Alicante, Spain
| | - Jose I Belda
- Department of Ophthalmology, Torrevieja University Hospital, Torrevieja, Alicante, Spain
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Teus MA, Belda JI, Lavín C, GarcÃa-Feijoà J, Falvey H, Buseghin G, Soler M, Appierto M. Cost-effectiveness analysis of iStent Inject® implantation during cataract surgery compared to cataract surgery alone for mild to moderate open-angle glaucoma patients in Spain. Expert Review of Ophthalmology 2021. [DOI: 10.1080/17469899.2021.1939685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Miguel A Teus
- Ophtalmology Department, Hospital Universitario Príncipe De Asturias, University of Alcalá, Madrid, Spain
| | - Jose I Belda
- Ophthalmology Department, Hospital Universitario Torrevieja, Alicante, Spain
| | - Cosme Lavín
- Ophthalmology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Julián GarcÃa-FeijoÃ
- Ophthalmology Unit, Hospital Clínico San Carlos, Instituto De Investigación Sanitaria Del Hospital Clínico San Carlos (Idissc), OFTARED, Madrid, Spain
| | - H Falvey
- Health Economics and Market Access Department, Glaukos, San Clemente, California, United States
| | - Giorgio Buseghin
- Health Economics and Market Access Department, Glaukos, San Clemente, California, United States
| | - María Soler
- Health Economics Department, Outcomes’10 S.L.U, Castellón De La Plana, Spain
| | - Marilena Appierto
- Health Economics Department, Outcomes’10 S.L.U, Castellón De La Plana, Spain
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Tuuminen R, Belda JI. Comment on: Posterior Capsule Opacification With Two Hydrophobic Acrylic Intraocular Lenses: 3-Year Results of a Randomized Trial. Am J Ophthalmol 2021; 223:447-449. [PMID: 33097178 DOI: 10.1016/j.ajo.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
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Belda JI, Loscos-Arenas J, Mermoud A, Lozano E, D'Alessandro E, Rebolleda G, Rodriguez-Agirretxe I, Canut M, Rodriguez-Calvo PP. Supraciliary versus intrascleral implantation with hema implant (Esnoper V-2000) in deep sclerectomy: a multicenter randomized controlled trial. Acta Ophthalmol 2018; 96:e852-e858. [PMID: 29855167 DOI: 10.1111/aos.13749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 02/08/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare the supraciliary versus intrascleral implantation of the hema implant (Esnoper V-2000) in terms of the efficacy and safety in nonpenetrating deep sclerectomy (NPDS). PATIENTS AND METHODS Prospective, randomized, unmasked, competitive and multicenter clinical trial. Eighty-three eyes from 83 patients suffering from open-angle glaucoma (40 males, 43 females) were enrolled and followed up for 12 months. Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), perimetry (mean defect, MD and Visual Field Index, VFI), pachymetry, number of antiglaucoma medications and analysis of blebs according Moorfields Bleb Grading. RESULTS The IOP was significantly reduced in both groups from 23.74 ± 6.9 mmHg (implant sutured to the sclera, group 1) and 23.46 ± 6.47 mmHg (implant placed in the suprachoroidal space, group 2) to 15.43 ± 4.27 mmHg (p < 0.001) and 14.62 ± 3.64 mmHg (p < 0.001), respectively. There were no statistically significant differences in mean IOP values between the groups a year after the surgery (p = 0.581). BCVA did not show statistical differences in comparison with baseline (p = 0.09, group 1; p = 0.42, group 2). The mean number of antiglaucoma medications was reduced in both groups from 2.58 ± 0.04 and 2.68 ± 0.02 before the surgery to 0.32 ± 0.76 and 0.24 ± 0.66 after surgery. CONCLUSION Nonpenetrating deep sclerectomy using hema implant (Esnoper V-2000) is safe and effective regardless of the positioning of the implant. We achieved IOP decrease and reduction in antiglaucoma medications during the first year after surgery without significant differences between both techniques.
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Affiliation(s)
- Jose I. Belda
- Department of Ophthalmology; Torrevieja Hospital; Alicante Spain
| | | | | | - Esther Lozano
- Department of Ophthalmology; Torrevieja Hospital; Alicante Spain
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Myers JS, Masood I, Hornbeak DM, Belda JI, Auffarth G, Jünemann A, Giamporcaro JE, Martinez-de-la-Casa JM, Ahmed IIK, Voskanyan L, Katz LJ. Prospective Evaluation of Two iStent ® Trabecular Stents, One iStent Supra ® Suprachoroidal Stent, and Postoperative Prostaglandin in Refractory Glaucoma: 4-year Outcomes. Adv Ther 2018; 35:395-407. [PMID: 29476443 PMCID: PMC5859115 DOI: 10.1007/s12325-018-0666-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Indexed: 12/01/2022]
Abstract
Introduction This study evaluates long-term outcomes of two trabecular micro-bypass stents, one suprachoroidal stent, and postoperative prostaglandin in eyes with refractory open angle glaucoma (OAG). Methods Prospective ongoing 5-year study of 80 eligible subjects (70 with 4-year follow-up) with OAG and IOP ≥ 18 mmHg after prior trabeculectomy and while taking 1–3 glaucoma medications. Subjects received two iStent® trabecular micro-bypass stents, one iStent Supra® suprachoroidal stent, and postoperative travoprost. Postoperative IOP was measured with medication and annually following medication washouts. Performance was measured by the proportion of eyes with ≥ 20% IOP reduction on one medication (the protocol-specified prostaglandin) versus preoperative medicated IOP (primary outcome); and the proportion of eyes with postoperative IOP ≤ 15 and ≤ 18 mmHg on one medication (secondary outcome). Additional clinical and safety data included medications, visual field, pachymetry, gonioscopy, adverse events, visual acuity, and slit-lamp and fundus examinations. Results Preoperatively, mean medicated IOP was 22.0 ± 3.1 mmHg on 1.2 ± 0.4 medications, and mean unmedicated IOP was 26.4 ± 2.4 mmHg. Postoperatively, among eyes without later cataract surgery, mean medicated IOP at all visits through 48 months was ≤ 13.7 mmHg (≥ 37% reduction), and annual unmedicated IOP was ≤ 18.4 mmHg (reductions of ≥ 30% vs. preoperative unmedicated IOP and ≥ 16% vs. preoperative medicated IOP). At all postoperative visits among eyes without additional surgery or medication, ≥ 91% of eyes had ≥ 20% IOP reduction on one medication versus preoperative medicated IOP. At month 48, 97 and 98% of eyes achieved IOP ≤ 15 and ≤ 18 mmHg, respectively, on one medication. Six eyes required additional medication, no eyes required additional glaucoma surgery, and safety measurements were favorable throughout follow-up. Conclusion IOP control was achieved safely with two trabecular micro-bypass stents, one suprachoroidal stent, and postoperative prostaglandin. This microinvasive, ab interno approach introduces a possible new treatment option for refractory disease. Trial Registration NCT01456390. Funding Glaukos Corporation. Electronic supplementary material The online version of this article (10.1007/s12325-018-0666-4) contains supplementary material, which is available to authorized users.
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Fea AM, Belda JI, Rękas M, Jünemann A, Chang L, Pablo L, Voskanyan L, Katz LJ. Prospective unmasked randomized evaluation of the iStent inject (®) versus two ocular hypotensive agents in patients with primary open-angle glaucoma. Clin Ophthalmol 2014; 8:875-82. [PMID: 24855336 PMCID: PMC4019628 DOI: 10.2147/opth.s59932] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to compare outcomes of subjects with open-angle glaucoma (OAG) not controlled on one medication who underwent either implantation of two iStent inject (®) trabecular micro-bypass devices or received medical therapy consisting of a fixed combination of latanoprost/timolol. PATIENTS AND METHODS Of 192 subjects who qualified for the study and were enrolled, 94 were randomized to surgery with implantation of two iStent inject(®) devices in the treated eye and 98 to receive medical therapy. RESULTS At the month 12 visit, 94.7% of eyes (89/94) in the stent group reported an unmedicated intraocular pressure (IOP) reduction of ≥20% versus baseline unmedicated IOP, and 91.8% of eyes (88/98) in the medical therapy group reported an IOP reduction ≥20% versus baseline unmedicated IOP. A 17.5% between-group treatment difference in favor of the iStent inject group was statistically significant (P=0.02) at the ≥50% level of IOP reduction. An IOP ≤18 mmHg was reported in 92.6% of eyes (87/94) in the iStent inject group and 89.8% of eyes (88/98) in the medical therapy group. Mean (standard deviation) IOP decreases from screening of 8.1 (2.6) mmHg and 7.3 (2.2) mmHg were reported in the iStent inject and medical therapy groups, respectively. A high safety profile was also noted in this study in both the iStent inject and medical therapy groups, as measured by stable best corrected visual acuity, cup-to-disc ratio, and adverse events. CONCLUSION These data show that the use of iStent inject is at least as effective as two medications, with the clinical benefit of reducing medication burden and assuring continuous treatment with full compliance to implant therapy as well as having a highly favorable safety profile.
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Affiliation(s)
- Antonio M Fea
- Università degli Studi di Torino, Clinica Oculistica, Torino, Italy
| | - Jose I Belda
- Hospital Torrevieja Salud, UTE, Servicio de Oftalmologia, Alicante, Spain
| | - Marek Rękas
- Military Institute of Medicine, Department of Ophthalmology, Warsaw, Poland
| | | | - Lydia Chang
- Hinchingbrooke Hospital NHS Trust and Moorfields Bedford Hospital NHS Trust, United Kingdom
| | - Luis Pablo
- Hospital Universitario Miguel Servet, Servicio Oftalmologico, Zaragoza, Spain
| | | | - L Jay Katz
- Wills Eye Institute, Jefferson Medical College, Philadelphia, PA, USA
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Schargel K, Placeres-Daban J, Garcia-Conca V, Belda JI, Aguirre Balsalobre F. [Improving the visualization of non-absorbable T-Flux(®) implants in deep sclerectomy. Colouring technique]. ACTA ACUST UNITED AC 2013; 89:226-8. [PMID: 24269463 DOI: 10.1016/j.oftal.2012.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 11/15/2012] [Accepted: 11/29/2012] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe a staining technique that will enhance the visualization of non-absorbable T-Flux implants. METHODS The technique was applied to non-absorbable T-Flux implants. The implants were submerged for 5 to 10 minutes in a sodium fluorescein solution, and dried with a sponge when removed from the solution. DISCUSSION This is a very simple and easy procedure that uses a common fluorescein solution to enhance the contrast between the surgical field and a transparent implant used in deep sclerectomy. This colour technique will decrease the risk of loss of the implant in the surgical field.
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Affiliation(s)
- K Schargel
- Sección de Glaucoma, Servicio de Oftalmología, Hospital de Torrevieja, Alicante, España.
| | - J Placeres-Daban
- Sección de Retina, Servicio de Oftalmología, Hospital de Torrevieja, Alicante, España
| | - V Garcia-Conca
- Servicio de Oftalmología, Hospital Universitario de San Juan, Alicante, España
| | - J I Belda
- Sección de Glaucoma, Servicio de Oftalmología, Hospital de Torrevieja, Alicante, España
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Miranda M, Bosch-Morell F, Belda JI, García-Manzanares MD, Barcia J, Alió JL, Romero FJ. Protective Effect of Viscoelastics against Retina Lipid Peroxidation. Ophthalmic Res 2007; 39:260-4. [PMID: 17851266 DOI: 10.1159/000108119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Accepted: 04/08/2007] [Indexed: 11/19/2022]
Abstract
Viscoelastics or ophthalmic viscosurgical devices are routinely used during anterior segment surgery and also in posterior segment surgery. Studies of the harmful effects of phacoemulsification on corneal endothelial cells suggest that much of this damage is mediated by free radicals. In this study, we compare the possible effects against lipid peroxidation in the retina of three different viscoelastic substances: Viscoat, Healon and Visiol. Herein we demonstrate for the first time that viscoelastics are effective to protect the retina against lipid peroxidation, as can be seen by the slight increase of malondialdehyde in the homogenates incubated with viscoelastic exposed to light and to a temperature of 37 degrees C when compared with the control homogenates.
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Affiliation(s)
- M Miranda
- Universidad Cardenal Herrera - CEU, Valencia, España
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Alió JL, Belda JI, Osman AA, Shalaby AMM. Topography-guided Laser in situ Keratomileusis (TOPOLINK) to Correct Irregular Astigmatism After Previous Refractive Surgery. J Refract Surg 2003; 19:516-27. [PMID: 14518740 DOI: 10.3928/1081-597x-20030901-06] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess whether topography-driven laser in situ keratomileusis (LASIK) can correct induced corneal irregular astigmatism. METHODS A prospective non-comparative case series of 41 eyes (38 patients) with irregular astigmatism following corneal refractive surgery, included two groups: Group 1 (26 eyes) with a defined topographic pattern and Group 2 (15 eyes) with no pattern. Ablation was performed using the Technolas 217C excimer laser with a software ablation program (TOPOLINK) based on corneal topography. Uncorrected and best spectacle-corrected visual acuity, manifest and cycloplegic refraction, corneal topography, superficial corneal surface quality, and image distortion were measured. RESULTS At 6 months follow-up in Group 1 eyes (defined topographic pattern) mean preoperative BSCVA improved from 0.16 +/- 0.11 LogMAR (0.4 to 0) to 0.09 +/- 0.10 LogMAR (0.2 to 0) (P = .001) (safety index of 1.1). In Group 2 eyes (no pattern), mean preoperative BSCVA was 0.18 +/- 0.11 LogMAR (0.4 to 0), similar to the postoperative BSCVA of 0.17 +/- 0.10 LogMAR (0.3 to 0) (safety index of 0.98). Mean postoperative UCVA was > or = 0.3 LogMAR in 25 eyes (96.2%) in Group 1 (efficacy index of 0.8) and 7 eyes (46.6%) in Group 2 (efficacy index of 0.5). Both superficial corneal surface quality and image distortion significantly improved in Group 1; there were no significant changes in Group 2. We reoperated nine eyes (21.9%). CONCLUSIONS Topographic-assisted LASIK was helpful in selected cases where irregular astigmatism showed a pattern. It was ineffective in undefined irregular astigmatism. Partial correction of the irregularity and regression of the obtained effect was common.
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Affiliation(s)
- Jorge L Alió
- Instituto Oftalmológico de Alicante, Alicante - Miguel Hernández University, Alicante, Spain
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Abstract
PURPOSE To demonstrate the usefulness of excimer laser surgery assisted by sodium hyaluronate for the correction of irregular astigmatism after previous corneal refractive surgery. DESIGN Prospective noncomparative case series. PARTICIPANTS Fifty eyes with surgically induced irregular astigmatism. All the patients had been subjected previously to one or more of the following: laser in situ keratomileusis (LASIK), incisional keratotomy, photorefractive keratotomy, phototherapeutic keratotomy, laser thermokeratoplasty, and corneal trauma. Irregular astigmatism developed thereafter. METHODS Stability of the corneal topography pattern before surgical decision was observed for at least 6 months with the C-SCAN corneal topography with Ray Tracing (Technomed GmbH, Germany) and the Eye-Sys 2000 Corneal Analysis System (Eye Sys Co., Houston, TX). The lowest pachymetry value was 310 microm in the thinnest portion of the cornea. Ablation was performed with the Technolas 217 C-LASIK excimer laser (Bausch and Lomb Chiron Technolas GmbH, Dornach, Germany), in phototherapeutic keratectomy mode, assisted by a mask of 0.25% sodium hyaluronate. We performed our ablation either on the surface or under a flap, whether elevated or newly cut. MAIN OUTCOME MEASURES Uncorrected and best-corrected visual acuity, manifest and cycloplegic refraction, superficial corneal surface quality, image distortion, and predicted corneal visual acuity. RESULTS At 3 months of follow-up, the irregular corneal surface was significantly improved in all cases (n = 50). The superficial corneal surface quality improved from 70.5% +/- 9.16% to 75.6% +/- 10.38 (P < 0.0001). Six eyes lost 1 line of best-corrected visual acuity, three eyes lost 2 lines, and five eyes lost 3 or more lines. The real corneal ablation depth obtained was equal to 63% of that programmed because of the influence of masking substance. Mean uncorrected visual acuity improved from 20/80 +/- 20/125 to 20/63 +/- 20/100 (P = 0.01). Predicted corneal visual acuity improved from a mean of 20/32 +/- 20/80 to 20/25 +/- 20/63 (P = 0.004). Image distortion improved from a mean of 13.95 +/- 3.64 to 12.16 +/- 3.92 (P < 0.0001). We obtained a hyperopic shift in 56% and myopic shift in 40% of eyes. After 6 months of follow-up the irregular corneal surface continued to improve in all cases (n = 32). The superficial corneal surface quality improved from 69.38% +/- 9.48% to 73.13% +/- 8.87 (P = 0.002). Two eyes lost 2 lines of best-corrected visual acuity, and 3 eyes lost 1 line. Ray tracing was significantly improved in all cases at the end of follow-up regarding superficial corneal surface quality (P = 0.002) and the image distortion (P = 0.05). Improvement of predicted corneal visual acuity was not significant (P = 0.11). The procedure proved to be safe, with a safety index of 1.1. Differences between the surface and stromal treatments and between pattern and nonpattern irregular astigmatism were not statistically significant. CONCLUSION It is possible to produce a more regular corneal surface and to improve best-corrected visual acuity in patients with irregular astigmatism using plano-scan excimer laser assisted by viscous masking solution of 0.25% sodium hyaluronate.
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Affiliation(s)
- J L Alió
- Instituto Oftalmológico De Alicante, Alicante, Spain.
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Belda JI, Romá J, Vilela C, Puertas FJ, Díaz-Llopis M, Bosch-Morell F, Romero FJ. Serum vitamin E levels negatively correlate with severity of age-related macular degeneration. Mech Ageing Dev 1999; 107:159-64. [PMID: 10220044 DOI: 10.1016/s0047-6374(98)00144-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Age-related macular degeneration (AMD) pathogenesis has been related to UV radiation and other factors that may promote increased oxidative damage to the retina. Patients with different AMD grading (n = 25) were compared with an age-matched group of AMD-free subjects (n = 15), both groups older than 60 years. A modification of the AMD grading system is proposed that allows patient grading and not single eye grading. AMD patients showed statistically significant lower serum levels of vitamin E and Zn than AMD-free subjects. Moreover, a negative correlation (Spearman's correlation coefficient r = -0.815, P < 0.001) could be established between AMD grading of both the patients' eyes and serum vitamin E levels. Sun exposure index (SEI) was also compared and found to be significantly higher in the AMD group. The results presented establish the importance of antioxidants in AMD, and set the basis for further studies on adjuvant therapies with antioxidants for AMD. Finally, the results also confirm the pathogenic role of UV radiation in AMD.
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Affiliation(s)
- J I Belda
- Department of Physiology, School of Medicine & Dentistry, University of Valencia, Spain
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