Begoña Baamonde

Posterior chamber collagen copolymer phakic intraocular lenses to correct myopia : five-year follow-up

PURPOSE: To evaluate the long‐term safety and efficacy of posterior chamber collagen copolymer phakic intraocular lens (pIOL) implantation to correct myopia. SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Cohort study. METHODS: Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, pIOL vault, endothelial cell loss, and adverse events were evaluated for 5 years after implantation of the Visian Implantable Collamer Lens pIOL for moderate to high myopia. RESULTS: The mean spherical equivalent (188 eyes) decreased from −11.17 diopters (D) ± 3.40 (SD) preoperatively to −0.88 ± 0.72 D 5 years postoperatively. The mean change in refraction from 1 month to 5 years was −0.65 ± 0.65 D. The mean UDVA and CDVA (Snellen decimal) were 0.69 ± 0.26 and 0.83 ± 0.15, respectively. The mean safety and efficacy indices were 1.27 ± 0.33 and 0.89 ± 0.35, respectively. No eye lost more than 2 lines of visual acuity; 70% achieved 0.80 or better CDVA. Three eyes (1.6%) developed late anterior subcapsular cataract that was clinically significant in 1 case, leading to pIOL removal and phacoemulsification. Of the 3 eyes (1.6%) with a mild transient increase in intraocular pressure (up to 27 mm Hg), none required a second surgical procedure or prolonged topical medication. The total endothelial cell loss (considered cumulatively at consecutive intervals through 5 years) was 7.7%. There was a tendency toward decreased pIOL vault decrease over time. No vision‐threatening complications occurred. CONCLUSION: Implantation of the collagen copolymer pIOL for moderate to high myopia was safe and effective and provided long‐term predictable, stable refractive results. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Collagen copolymer toric posterior chamber phakic intraocular lenses to correct high myopic astigmatism

PURPOSE: To assess the safety, efficacy, stability, and predictability after implantation of a toric intraocular copolymer (Collamer) lens (pIOL) to correct high myopic astigmatism. SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. METHODS: This study evaluated eyes that had implantation of a toric pIOL. Outcome measures were the uncorrected (UDVA) and corrected (CDVA) distance visual acuities (Snellen decimal), refraction, and postoperative complications. RESULTS: The study included 15 eyes of 12 patients (9 women). Preoperatively, the mean manifest spherical refraction was −1.98 diopters (D) ± 1.32 (SD) (range −0.50 to −5.50 D) and the mean refractive cylinder, −4.85 ± 0.83 D (range −6.50 to −4.00 D). At 12 months, the mean refractive cylinder was −0.55 ± 0.52 D (range −1.50 to 0.00 D), with 93.3% of eyes having less than 1.00 D of cylinder. The mean spherical equivalent was −0.31 ± 0.42 (range −1.00 to 0.75 D), with more than 70% of eyes within ±0.50 D of the target. For the astigmatic components, 93.3% of eyes were within ±1.00 D of J0 (r2 = 0.98) and all eyes were within ±1.00 D of J45 (r2 = 0.98). The mean UDVA was 0.70 ± 0.20 and the mean CDVA, 0.83 ± 0.12. The overall efficacy index was 0.90. Postoperatively, all eyes had unchanged CDVA or gained 1 or more lines. CONCLUSION: The refractive outcomes and improvement in UDVA and CDVA were rapidly achieved and remained fairly consistent throughout the follow‐up period, supporting the use of toric pIOLs in eyes with high astigmatism. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Refractive lens exchange with spherical diffractive intraocular lens implantation after hyperopic laser in situ keratomileusis

PURPOSE: To assess the safety, efficacy, and predictability in eyes that had refractive lens exchange (RLE) with implantation of a spherical diffractive intraocular lens (IOL) after previous hyperopic laser in situ keratomileusis (LASIK). SETTING: Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. METHODS: This prospective study evaluated eyes that had RLE and implantation of an AcrySof ReSTOR SN60D3 IOL after hyperopic LASIK. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), distance‐corrected near visual acuity (DCNVA), and residual refractive errors were analyzed using vector analysis and recorded preoperatively and 6 months postoperatively. RESULTS: The study evaluated 41 eyes of 23 patients. The mean UDVA was 0.189 logMAR ± 0.175 (SD) preoperatively and 0.113 ± 0.101 logMAR 6 months postoperatively (P = .009) and the mean CDVA, 0.049 ± 0.071 logMAR and 0.046 ± 0.063 logMAR, respectively (P = .44). At 6 months, the efficacy index was 0.87 and the safety index, 1.00. The mean UNVA was 0.014 ± 0.026 logMAR, with an efficacy index of 1.00. There were no differences in corrected near visual acuity between preoperatively (with spectacle addition) and postoperatively (P = .3); the safety index was 1.01. All eyes were within ±1.25 diopters (D) of the targeted refraction and 73.17% were within ±0.50 D. The mean postoperative spherical equivalent was −0.064 ± 0.513 D. CONCLUSION: Implantation of a spherical multifocal IOL after hyperopic LASIK was safe, effective, and predictable.

Inferior Intrastromal Corneal Ring Segments in Paracentral Keratoconus With No Coincident Topographic and Coma Axis

PURPOSE To assess the visual and refractive outcomes of implantation of intrastromal corneal ring segments (ICRS) in keratoconic eyes with no coincident topographic and comatic axes. METHODS Forty-one keratoconic eyes of 39 patients with no coincident topographic and comatic axes were implanted inferiorly with a Ferrara-type ICRS (Keraring SI6; Mediphacos Inc., Belo Horizonte, Brazil) of 150° of arc with a thickness of 150, 200, and 250 μm. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal coma-like root mean square, and residual refractive errors analyzed using vector analysis were recorded before and 6 months after the ICRS implantation. RESULTS Mean UDVA was 0.76 ± 0.41 logMAR before and 0.53 ± 0.46 logMAR after surgery (P = .0006). CDVA was 0.13 ± 0.14 logMAR before and 0.07 ± 0.09 logMAR after surgery (P = .0007). Two eyes (4.9%) lost two lines or more of CDVA, 3 eyes (7.32%) lost one line, 16 eyes (39.02%) had no change in CDVA, 9 eyes (21.95%) gained one line, and 11 eyes (26.83%) gained two lines or more of CDVA. The safety index was 1.10. Spherical equivalent was significantly reduced after ICRS implantation (P < .001). Corneal coma-like root mean square changed from 0.80 ± 0.53 μm before surgery to 0.61 ± 0.59 μm after surgery (P = .02) for 4.5 mm of pupil size. CONCLUSIONS One Ferrara-type ICRS of 150° of arc with a thickness of 150, 200, or 250 μm implanted inferiorly may reduce both astigmatism and corneal coma-like aberrations in keratoconic eyes with no coincident topographic and comatic axes, providing an improvement of UDVA and CDVA values.

Visual and Refractive Outcomes in Hyperopic Pseudophakic Patients Implanted with the Acri.LISA 366D Multifocal Intraocular Lens

PURPOSE To assess the visual quality after bilateral implantation of the Acri.LISA 366D intraocular lens (IOL; Carl Zeiss Meditec, Jena, Germany) in patients with hyperopia. DESIGN Prospective, nonrandomized study. METHODS One hundred and seventy eyes of 85 patients had bilateral implantation of the Acri.LISA 366D IOL. The patients were divided into 2 groups: low to moderate hyperopia (IOL power, 21 to 24.5 diopters [D]) and high hyperopia (IOL power, 25 to 36 D). Monocular and binocular best spectacle-corrected visual acuity (BSCVA), best distance-corrected near visual acuity (BCNVA), binocular best distance-corrected intermediate visual acuity (VA), and distance contrast sensitivity (CSF) under photopic (85 cd/m(2)) and mesopic (5 cd/m2) conditions were determined. RESULTS At the 6-month postoperative visit, there were no statistically significant differences in monocular and binocular BSCVA (P = .06 and P = .09, respectively). Monocular and binocular BCNVA were comparable between both groups (P = .24 and P = .42, respectively). The mean binocular best distance-corrected intermediate VA changed significantly as a function of the distance of the test (P < .01) in both groups, and there were no statistically significant differences between groups at any distance. Differences were not found between groups in binocular CSF under mesopic and photopic conditions. CONCLUSIONS Bilateral implantation of the Acri.LISA 366D in patients with high hyperopia provided a satisfactory full-range of vision comparable with that obtained in patients with low to moderate hyperopia.

Refractive lens exchange with Acri.LISA bifocal intraocular lens implantation.

Purpose TO assess efficacy, safety, and predictability after refractive lens exchange (RLE) in patients who had bilateral implantation of an Acri.LISA 366D diffractive bifocal intraocular lens (IOL). Methods Sixty-six eyes of 33 consecutive patients were examined after RLE who had bilateral implantation of an Acri.LISA bifocal 366D IOL. Eyes were divided into myopic and hyperopic groups. Monocular uncorrected distance visual acuity, best-corrected distance visual acuity (BCVA), uncorrected distance near visual acuity, and best distance-corrected near visual acuity (BCNVA) were recorded preoperatively and 6 months after surgery. Results Efficacy indexes were 0.73 for myopic and 0.85 for hyperopic eyes at 6 months postoperatively. For the myopic group, 2 eyes lost 1 line, 4 eyes gained 1 line, and 6 eyes gained ≥2 lines; for the hyperopic group, 11 eyes lost 1 line, 8 eyes gained 1 line, and 7 eyes gained 2 lines. Safety indexes were 1.07 and 1.03 for myopic and hyperopic eyes, respectively. Safety indexes at near were 1.03 for myopic and 1.00 for hyperopic eyes. Efficacy indexes at near were 1.00 for myopic and 0.99 for hyperopic eyes. Conclusions Bilateral implantation of an Acri.LISA 366D bifocal IOL after RLE is an effective procedure for correcting ametropia and presbyopia.

Different Use of Cell Surface Glycosaminoglycans As Adherence Receptors to Corneal Cells by Gram Positive and Gram Negative Pathogens

The epithelium of the cornea is continuously exposed to pathogens, and adhesion to epithelial cells is regarded as an essential first step in bacterial pathogenesis. In this article, the involvement of glycosaminoglycans in the adhesion of various pathogenic bacteria to corneal epithelial cells is analyzed. All microorganisms use glycosaminoglycans as receptors, but arranged in different patterns depending on the Gram-type of the bacterium. The heparan sulfate chains of syndecans are the main receptors, though other molecular species also seem to be involved, particularly in Gram-negative bacteria. Adherence is inhibited differentially by peptides, including heparin binding sequences, indicating the participation of various groups of Gram-positive, and -negative adhesins. The length of the saccharides produces a major effect, and low molecular weight chains inhibit the binding of Gram-negative microorganisms but increase the adherence of Gram-positives. Pathogen adhesion appears to occur preferentially through sulfated domains, and is very dependent on N- and 6-O-sulfation of the glucosamine residue and, to a lesser extent, 2-O sulfation of uronic acid. These data show the differential use of corneal receptors, which could facilitate the development of new anti-infective strategies.

Relationship between breast arterial calcifications seen on screening mammograms and age-related macular degeneration.

the inferior quadrant. The Spectralis OCT classic glaucoma application and the Nsite Axonal Analytics application revealed significant thinning in the inferior and inferotemporal RNFL in patients with AD compared with controls. There is histopathologic evidence of retinal ganglion cell loss and optic nerve degeneration in patients with AD (Blanks et al. 1996). Thus, we postulate that axonal loss secondary to other pathologic changes that occur in the brain can be detected by scanning the RNFLand the optic nerve, as these nonmyelinated axons form the optical path that culminates in the occipital cortex. Although we believe the OCT could potentially provide a biomarker of AD, it should take into account a series of limitations: the relatively small sample size (despite being larger than that in previous studies) and the exclusion of subjects with mild cognitive impairment (preclinical stage of AD) or advanced dementia. Future prospective studies should attempt to segment the RNFL and macula to know which retinal layers are predominantly affected and should investigate Age Macular Disease-AD associations (by calculating amount of druse; measuring thickness of Bruch’s membrane and auto-fluorescence of retina in AD cases, etc.) (Ohno-Matsui 2011).We think this is an interesting and promising research field in an unfortunately increasingly common dementing disorder in the elderly. Time will tell whether we are onlymeasuring and comparing different parameters with the latest technologies or whether we are facing a new and accessible biomarker of disease.

Five-year functional outcomes and vault of −20 diopter myopic phakic intraocular lens implantation

Purpose To evaluate refractive and visual outcomes and complications associated with phakic intraocular lens (pIOL) implantation to correct high myopia. Settings Fernández‐Vega Ophthalmological Institute, Oviedo, Spain. Design Retrospective observational case series. Methods Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refraction, vault, and adverse effects were evaluated after 5 years with Visian ICMV4 pIOL. Results Mean spherical equivalent (SE) dropped from −18.32 ± 2.37 diopters (D) preoperatively to −0.88 ± 0.52D 5 years postoperatively; 61% of eyes were within ±0.75 D of the target. The mean Snellen decimal CDVA and UDVA were 0.73 ± 0.23 and 0.55 ± 0.26, respectively. More than 50% of eyes achieved 20/25 or better CDVA postoperatively. Four eyes had lost 2 or 1 lines of CDVA, 10 eyes had not lost any lines from preoperatively, and 46 eyes had gained 1 or more lines of CDVA 5 years postoperatively. The safety index was 1.26 ± 0.32. Forty eyes had UDVA of 20/40 or better postoperatively. The efficacy index was 0.99 ± 0.42. At 5‐year follow‐up, the mean central vault was 475.28 ± 216.38 &mgr;m. No eyes showed central contact between the pIOL and crystalline lens. Nevertheless, 10 eyes showed peripheral contact with a central vault between 150 and 260 &mgr;m. Two eyes developed anterior subcapsular cataract, although only 1 eye required cataract surgery. Conclusions Predictability, safety and effective outcomes of posterior pIOL of (− were good, as well as postoperative complications over the long term. A central vault of 260 &mgr;m was enough to prevent the peripheral contact between the pIOL and crystalline lens in eyes with high myopia. Financial Disclosure The authors have no proprietary interest in any of the materials mentioned in this article.