Prevalence and risk factors of eye diseases in adult patients with obstructive sleep apnoea: results from the SLE.E.P.Y cohort study

OBJECTIVES

To assess the occurrence of glaucoma, eyelid, corneal and macular disorders in a cohort of patients with obstructive sleep apnoea (OSA) diagnosed by overnight polysomnography and to investigate into the risk factors for the above eye diseases (EDs).

DESIGN

Cross-sectional cohort study between 2014 and 2015.

SETTING

Unit of Respiratory Medicine and Eye Clinic of the University of Verona.

PARTICIPANTS

431 consecutive patients were considered eligible. Of these, 87 declined to participate, 35 were untraceable and 13 were deceased.

INTERVENTIONS

A complete ophthalmic evaluation of both eyes for each patient.

PRIMARY AND SECONDARY OUTCOME MEASURES

Best-corrected distance visual acuity, intraocular pressure, corneal, macular and optic nerve optical coherence tomography, ocular aberrometry, optic nerve laser polarimetry, visual field test, and eyelid examination.

RESULTS

296 patients aged 64.5±12.8 years, 23% female and 77% male, underwent ophthalmic examination. There was 56% (n=166) prevalence of eyelid disorders, 27% (n=80) of corneal disorders, 13% (n=39) of macular disorders and 11% (n=33) of glaucoma. Advancing age was not associated with the severity of OSA, while significant differences were found for gender, body mass index, Oxygen Desaturation Index, smoking habit, hypertension and diabetes. Severe OSA was significantly associated with glaucoma (OR, 95% CI 1.05 to 5.93, p=0.037).

CONCLUSIONS

EDs were more prevalent in our patinets with OSA than in the general population. Severe Apnoea/Hypopnoea Index level seemed to play a role as risk factor only for glaucoma.

Refractive outcomes of penetrating keratoplasty and deep anterior lamellar keratoplasty in fellow eyes for keratoconus

PURPOSE

To compare the refractive outcomes following penetrating keratoplasty and deep anterior lamellar keratoplasty in fellow eyes in patients with keratoconus.

METHODS

This is an observational retrospective review of consecutive patients with keratoconus first managed with penetrating keratoplasty in one eye and then with lamellar keratoplasty in the fellow eye, between 2002 and 2007. Data collection was based on patients' hospital records. Information related to assessment before surgery and at 1, 3, 6, 12, 24, and 48 months after keratoplasty were retrieved and considered in the analysis. Clinical evaluations included patients' medical histories and diagnosis of keratoconus, uncorrected and best corrected visual acuity, spherical equivalent, refractive cylinder, topographic cylinder, and high-order aberrations, complications, and adverse reactions. Data on contrast sensitivity, central corneal thickness, and central residual bed thickness (only for lamellar keratoplasty) were retrieved from anterior segment optical coherence tomography observation performed at 48 months.

RESULTS

Sixteen patients (32 eyes), 7 males and 9 females, were included in the analyses. After 4 years from transplantation, at the end of follow-up, no statistically significant differences were found in visual acuity and refractive measures between the two keratoplasties. Perforating keratoplasty showed significant differences for contrast sensitivity at 6 cpd with maximum glare (p = 0.026) and without glare (p = 0.015). Deep anterior lamellar keratoplasty showed a negative correlation between central residual bed thickness and best corrected visual acuity (R = -0.414, p < 0.001).

CONCLUSIONS

The manual pre-descemetic deep anterior lamellar keratoplasty used in this study showed refractive and visual results comparable to those obtained with penetrating keratoplasty. Such results indicated that leaving healthy stroma attached to Descemet's membrane does not compromise the clinical outcome in the short and long term after surgery.

Long-term visual function and patient satisfaction after bilateral implantation and combination of two similar multifocal IOLs

PURPOSE

To evaluate the visual outcome, spectacle independence, and patient satisfaction after implantation of two Acrysof ReSTOR (Alcon Laboratories, Inc., Fort Worth, TX) intraocular lenses (IOLs) with different addition power or their combination in both eyes.

METHODS

One hundred twenty eyes of 60 patients with bilateral multifocal IOL implantation were divided into three groups of 20 consecutive patients each: the SV25T0 (the T0 group), the SN6AD1 (the D1 group), or a combination of both the SN6AD1 and SV25T0 (the combined group). Patients were observed 18 months postoperatively for visual acuity (40, 50, and 60 cm, and 4 m), defocus curves (range: +1.0 to -4.0 diopters), and contrast sensitivity. Quality of vision, patient satisfaction, and spectacle independence were evaluated by the National Eye Institute Refractive Error Quality of Life Instrument-42 questionnaire.

RESULTS

The D1 group achieved better results for near vision (P < .01), whereas the T0 group achieved better intermediate vision (P = .01). The combined group showed a wider range of spectacle independence at all distances evaluated (P < .05). The contrast sensitivity was similar within the groups. The incidence of glare was lower for the T0 group (P = .054). The combined group had better results in terms of expectation (P = .021) and activity limitation (P = .003).

CONCLUSION

Although the bilateral implantation of the same multifocal IOL can maximize the vision for near or intermediate distances, the combination of these IOLs in both eyes can increase the range of spectacle independence without compromising the contrast sensitivity and quality of vision.

Comparison of two multifocal intraocular lens designs that differ only in near add

PURPOSE

To evaluate monocular functional outcomes after the implantation of the AcrySof ReSTOR SN6AD2 intraocular lens (IOL) (+2.5 diopters [D] near add) (Alcon Laboratories, Inc., Fort Worth, TX) and the AcrySof ReSTOR SN6AD1 IOL (+3.0 D near add) (Alcon Laboratories, Inc.).

METHODS

This prospective, comparative, nonrandomized single-blind observational study comprised 62 eyes of 62 patients that underwent phacoemulsification and implantation of a multifocal IOL: SN6AD2 (31 eyes) (+2.5 group) and SN6AD1 (31 eyes) (+3.0 group). Twelve months after surgery, monocular near (30 and 40 cm), intermediate (50, 60, and 70 cm), and distance (4 m) visual acuity were evaluated with the internal root mean square and modulation transfer function. Both parameters were evaluated at the 4- and 6-mm pupil sizes.

RESULTS

No statistical differences at 4 m were found between the groups. The +2.5 group obtained better performances at all intermediate distances (50 cm, 0.23 ± 0.14 vs 0.32 ± 0.13; 60 and 70 cm, 0.21 ± 0.10 vs 0.41 ± 0.14 and 0.24 ± 0.10 vs 0.53 ± 0.17, respectively), whereas the near visual acuity was better for the +3.0 group (30 and 40 cm, 0.36 ± 0.18 vs 0.14 ± 0.09 and 0.36 ± 0.19 vs 0.17 ± 0.07, respectively). The root mean square was lower for the +2.5 group compared to the +3.0 group, whereas the modulation transfer function showed overlapping results between the two models.

CONCLUSIONS

Both IOL models showed good results in distance vision; the +2.5 D IOL seemed to provide better intermediate vision than the +3.0 D IOL. For near vision, the +3.0 D model performed better than the +2.5 D model.

A case of Beauveria bassiana keratitis confirmed by internal transcribed spacer and LSU rDNA D1-D2 sequencing

We describe a case of fungal keratitis due to Beauveria bassiana in a farmer with Fuchs' dystrophy, treated with amphotericin B. Surgery with penetrating keratoplasty was necessary to resolve the lesions. Susceptibility testing and molecular sequencing permitted the identification and treatment of this rare aetiological agent of invasive fungal disease.

Long-term effectiveness of autologous cultured limbal stem cell grafts in patients with limbal stem cell deficiency due to chemical burns

BACKGROUND

Chemical burns cause depletion of limbal stem cells and eventually lead to corneal opacity and visual loss. We investigated the long-term effectiveness of autologous cultured limbal stem cell grafts in patients with limbal stem cell deficiency.

DESIGN

Prospective, non-comparative interventional case series.

PARTICIPANTS

Sixteen eyes from 16 patients with severe, unilateral limbal stem cell deficiency caused by chemical burns.

METHODS

Autologous ex vivo cultured limbal stem cells were grafted onto the recipient eye after superficial keratectomy.

MAIN OUTCOME MEASURES

Clinical parameters of limbal stem cell deficiency (stability/transparency of the corneal epithelium, superficial corneal vascularization and pain/photophobia), visual acuity, cytokeratin expression on impression cytology specimens and histology on excised corneal buttons.

RESULTS

At 12 months post-surgery, evaluation of the 16 patients showed that 10 (62.6%) experienced complete restoration of a stable and clear epithelium and 3 (18.7%) had partially successful outcomes (re-appearance of conjunctiva in some sectors of the cornea and instable corneal surface). Graft failure (no change in corneal surface conditions) was seen in three (18.7%) patients. Penetrating keratoplasty was performed in seven patients, with visual acuity improving up to 0.8 (best result). For two patients, regeneration of the corneal epithelium was confirmed by molecular marker (p63, cytokeratin 3, 12 and 19, mucin 1) analysis. Follow-up times ranged from 12 to 50 months.

CONCLUSIONS

Grafts of autologous limbal stem cells cultured onto fibrin glue discs can successfully regenerate the corneal epithelium in patients with limbal stem cell deficiency, allowing to perform successful cornea transplantation and restore vision.