Bruna Vieira Ventura

Effects of blue light–filtering intraocular lenses on the macula, contrast sensitivity, and color vision after a long-term follow-up

PURPOSE: To evaluate the possible side effects and potential protection 5 years after implantation of an intraocular lens (IOL) with a blue‐light filter (yellow tinted). SETTING: Ophthalmology Department, University of São Paulo, São Paulo, Brazil. DESIGN: Prospective randomized clinical study. METHODS: Patients with bilateral visually significant cataract randomly received an ultraviolet (UV) and blue light–filtering IOL (Acrysof Natural SN60AT) in 1 eye and an acrylic UV light–filtering only IOL (Acrysof SA60AT) in the fellow eye. The primary outcome measures were contrast sensitivity, color vision, and macular findings 5 years after surgery. RESULTS: The study enrolled 60 eyes of 30 patients. There were no significant clinical or optical coherence tomography findings in terms of age‐related macular degeneration in any eye. There were no statistically significant differences in central macular thickness between the 2 IOL groups (P=.712). There were also no significant between‐group differences under photopic or scotopic conditions at any spatial frequency studied. No statistically significant differences in the color discrimination test were found between the 2 IOL groups (P=.674). CONCLUSIONS: After 5 years, there were no significant differences in color perception, scotopic contrast sensitivity, or photopic contrast sensitivity between the blue light–filtering (yellow‐tinted) IOL and the IOL with a UV‐light filter only (untinted). The potential advantage of the tinted IOL in providing protection to macular cells remains unclear. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Role of optical coherence tomography on corneal surface laser ablation.

This paper focuses on reviewing the roles of optical coherence tomography (OCT) on corneal surface laser ablation procedures. OCT is an optical imaging modality that uses low-coherence interferometry to provide noninvasive cross-sectional imaging of tissue microstructure in vivo. There are two types of OCTs, each with transverse and axial spatial resolutions of a few micrometers: the time-domain and the fourier-domain OCTs. Both have been increasingly used by refractive surgeons and have specific advantages. Which of the current imaging instruments is a better choice depends on the specific application. In laser in situ keratomileusis (LASIK) and in excimer laser phototherapeutic keratectomy (PTK), OCT can be used to assess corneal characteristics and guide treatment decisions. OCT accurately measures central corneal thickness, evaluates the regularity of LASIK flaps, and quantifies flap and residual stromal bed thickness. When evaluating the ablation depth accuracy by subtracting preoperative from postoperative measurements, OCT pachymetry correlates well with laser ablation settings. In addition, OCT can be used to provide precise information on the morphology and depth of corneal pathologic abnormalities, such as corneal degenerations, dystrophies, and opacities, correlating with histopathologic findings.

Surgical management of astigmatism with toric intraocular lenses

Correction of corneal astigmatism is a key element of cataract surgery, since post-surgical residual astigmatism can compromise the patients uncorrected visual acuity. Toric intraocular lenses (IOLs) compensate for corneal astigmatism at the time of surgery, correcting ocular astigmatism. They are a predictable treatment. However, accurate measurement of corneal astigmatism is mandatory for choosing the correct toric IOL power and for planning optimal alignment. When calculating the power of toric IOLs, it is important to consider anterior and posterior corneal astigmatism, along with the surgically induced astigmatism. Accurate toric lens alignment along the calculated meridian is also crucial to achieve effective astigmatism correction. There are several techniques to guide IOL alignment, including the traditional manual marking technique and automated systems based on anatomic and topographic landmarks. The aim of this review is to provide an overview on astigmatism management with toric IOLs, including relevant patient selection criteria, corneal astigmatism measurement, toric IOL power calculation, toric IOL alignment, clinical outcomes and complications.

Femtosecond Laser-assisted Cataract Surgery in Patients With Marfan Syndrome and Subluxated Lens.

PURPOSE To report femtosecond laser-assisted cataract surgeries in patients with Marfan syndrome with mild, moderate, and severe lens subluxation. METHODS Case reports. RESULTS Two patients with Marfan syndrome underwent femtosecond laser-assisted cataract surgery (Alcon LenSx Lasers Inc., Aliso Viejo, CA). One patient had a mild lens subluxation in one eye and a moderate lens subluxation in the fellow eye. The other patient had a severe lens subluxation in one eye. In all eyes, the laser was able to perform a circular and free-floating anterior capsulotomy and lens fragmentation. In two of the eyes it was also helpful in decreasing corneal astigmatism by making corneal intrastromal relaxing incisions. There were no postoperative complications. CONCLUSIONS Femtosecond laser-assisted cataract surgery is an effective approach for cataract surgery in patients with Marfan syndrome with mild, moderate, and even severe lens subluxation, with the benefits of causing minimal further zonular damage and being able to treat corneal astigmatism with relaxing incisions.

Outcomes of congenital cataract surgery: Intraoperative intracameral triamcinolone injection versus postoperative oral prednisolone

Purpose To compare the outcomes of congenital cataract surgery using intraoperative intracameral triamcinolone versus postoperative oral prednisolone to modulate ocular inflammation. Setting Department of Congenital Cataract, Altino Ventura Foundation, Recife, Brazil. Design Randomized clinical trial. Methods Children younger than 2 years were randomly divided into 2 groups. The study group received an intraoperative intracameral injection of 1.2 mg/0.03 mL of triamcinolone acetonide. The control group (29 eyes) received 1 mg/kg per day of prednisolone syrup for 15 days postoperatively, which was then tapered over the following 2 weeks. Intraocular pressure (IOP), central corneal thickness (CCT), cell deposits on the intraocular lens (IOL), posterior synechiae, visual axis obscuration, additional surgical procedures, and IOL centration were assessed 12 months postoperatively. Results The mean patient age at surgery was 10.45 months ± 6.22 (SD) in the study group (31 eyes) and 10.0 ± 6.15 months in the control group (29 eyes) (P = .779). In both groups, the mean IOP and CCT did not change significantly postoperatively (study group P = .922 and P = .149, respectively; control group P = .483 and P = .416, respectively). The groups had similar incidences of cell deposits (P = .517) and posterior synechiae (P = .247). No eye developed visual axis obscuration or had additional surgical procedures. All eyes had a clinically centered IOL. Conclusion One year postoperatively, the outcomes were similar with intraoperative intracameral triamcinolone injection and postoperative oral prednisolone for modulating inflammation after congenital cataract surgery. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Visual outcomes of eyes implanted with a toric multifocal intraocular lens.

PURPOSE To investigate the predictability, efficacy, and safety of a ReSTOR multifocal intraocular lens (IOL) (Alcon Laboratories, Inc., Fort Worth, TX). METHODS This retrospective, noncomparative case study included 70 eyes of 44 patients implanted with a ReSTOR toric multifocal IOL (Alcon Laboratories, Inc., Fort Worth, TX). Patients were examined preoperatively and approximately 3 months postoperatively. Uncorrected and distance-corrected distance and near visual acuities were measured. Refractive and topographic astigmatism were recorded. Improvement, number of lines gained and lost, and correlation of attempted and achieved astigmatic correction values were also investigated as measurements of efficacy, safety, and predictability. RESULTS Mean follow-up time was 2.3 ± 1.2 months. Postoperative values of uncorrected distance and near visual acuity were 0.02 ± 0.05 logMAR (20/21 ± 20/22 Snellen) and 0.01 ± 0.04 logMAR (20/20 ± 20/22 Snellen), respectively. Statistical analyses revealed a significant improvement when comparing preoperative and postoperative values of manifest refraction spherical equivalent (P < .0001), uncorrected distance visual acuity (P < .0001), and astigmatism (P < .0001); 95.7% of eyes were 20/25 or better and 100% of eyes were 20/30 or better. At the last follow-up visit, none of the examined eyes had lost any lines. One hundred percent of the eyes remained unchanged or improved after surgery. Mean postoperative manifest refraction spherical equivalent was -0.06 ± 0.27 at the last follow-up visit. The residual manifest astigmatism was 0.22 ± 0.21. There was a highly significant correlation between preoperative attempted topographic astigmatism and postoperative achieved refractive astigmatism. CONCLUSIONS The study provides clinical evidence that the new toric multifocal IOL seems to be predictable, safe, and effective, providing satisfactory visual acuity for far and near and correcting astigmatism.

Profile of ocular and systemic characteristics in Möbius sequence patients from Brazil and Italy

PURPOSE To compare the profiles and clinical findings of a series of patients with Möbius sequence from Brazil with a series from Italy. METHODS This is a multicenter study, which includes 46 Möbius sequence patients from Brazil and 20 from Italy. Socio-demographic, gestational, and neonatal profile characteristics were collected from interviews with the guardians of the Möbius sequence patients and compared. The Möbius sequence patients were submitted to an ophthalmologic examination and systemic malformations were also evaluated. RESULTS Misoprostol was used in the first trimester of pregnancy by 26 (56.5%) of the mothers of the Möbius sequence patients in the Brazilian series and was not used by any of the Italian mothers. The mean age of the Brazilian Möbius sequence patients was 89.95 ± 7.79 months and the mean age of the Italian patients was 102.6 ± 22.94 months (P=0.6105; Mann-Whitney test). Brazilian mothers had a significantly lower education level (P=0.0002; Fishers exact test) and Italian mothers had significantly more stable relationships (p=0.0002; Fishers exact test). The frequency of ocular and systemic abnormalities was similar in both series. CONCLUSION Adverse events during pregnancy varied between both groups. A history of misoprostol use during early pregnancy was present only in Brazilian mothers, who had lower levels of education and less frequent stable marital statuses. Clinical findings were similar between both groups of patients.

Repeatability and comparability of corneal power and corneal astigmatism obtained from a point-source color light-emitting diode topographer, a Placido-based corneal topographer, and a low-coherence reflectometer.

Purpose To assess the repeatability and agreement of corneal power and astigmatism obtained from the Cassini point‐source color light–emitting diode (LED) topographer, Humphrey Atlas 9000 Placido–based corneal topographer, and Lenstar LS‐900 low‐coherence reflectometer in normal eyes. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Design Evaluation of diagnostic test or technology. Methods Consecutively enrolled patients with normal corneas were enrolled. Three sets of measurements were obtained using the color‐LED topographer, the Placido topographer, and the reflectometer. Vector analysis was used in the astigmatism analysis. The repeatability was evaluated using the within‐subject standard deviation, coefficient of variation (CoV), and intraclass correlation coefficient (ICC). Agreement was verified using Bland‐Altman plots. The paired Student t test was used to assess statistical significance. Results Thirty‐two eyes (32 patients) were evaluated. All devices provided highly repeatable corneal power and astigmatism measurements (ICC > 0.9) except for the Placido topographer with regard to J45 (ICC = 0.721). The color‐LED topographer and the reflectometer obtained similar mean values of corneal power, astigmatism magnitude, J0, and J45 (P > .05), which was also true when comparing the color‐LED topographer and the Placido topographer, except for the mean corneal power (P = .0007). The Bland‐Altman plots showed a wide data spread for all analyzed variables. Conclusions The color‐LED topographer provided highly repeatable corneal power and astigmatism measurements. Even though it obtained values similar to those of the reflectometer and the Placido topographer, the wide data spread discourages their interchangeable use to assess corneal power and astigmatism. Financial Disclosure Drs. Wang, Koch, and Weikert are consultants to Ziemer USA, Inc. Dr. Koch is a consultant to Abbott Medical Optics, Inc., Alcon Surgical, Inc., and i‐Optics, Corp. Drs. Ventura and Al‐Mohtaseb have no financial or proprietary interest in any material or method mentioned.

Microscopic analysis of opacification in Ioflex® hydrophilic acrylic intraocular lenses

Five cases of intraocular lens (IOL) opacification in patients implanted with the Mediphacos Ioflex® IOL are described. Clinical data in each case was obtained from the patients medical record. The five explanted IOLs underwent gross and light microscopic analysis. Selected lenses were processed for further evaluation and multiple sagittal cuts were stained with the alizarin red and von Kossa methods. Light microscope analysis confirmed the presence of deposits on and within the lens, which stained positive for calcium. The reason why calcification has occurred in these cases remains unclear, but surgeons should be aware of this potential late postoperative complication.

Comparison of corneal power, astigmatism, and wavefront aberration measurements obtained by a point-source color light-emitting diode–based topographer, a Placido-disk topographer, and a combined Placido and dual Scheimpflug device

Purpose To evaluate and compare the performance of a point‐source color light‐emitting diode (LED)–based topographer (color‐LED) in measuring anterior corneal power and aberrations with that of a Placido‐disk topographer and a combined Placido and dual Scheimpflug device. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas USA. Design Retrospective observational case series. Methods Normal eyes and post‐refractive‐surgery eyes were consecutively measured using color‐LED, Placido, and dual‐Scheimpflug devices. The main outcome measures were anterior corneal power, astigmatism, and higher‐order aberrations (HOAs) (6.0 mm pupil), which were compared using the t test. Results There were no statistically significant differences in corneal power measurements in normal and post‐refractive surgery eyes and in astigmatism magnitude in post‐refractive surgery eyes between the color‐LED device and Placido or dual Scheimpflug devices (all P > .05). In normal eyes, there were no statistically significant differences in 3rd‐order coma and 4th‐order spherical aberration between the color‐LED and Placido devices and in HOA root mean square, 3rd‐order coma, 3rd‐order trefoil, 4th‐order spherical aberration, and 4th‐order secondary astigmatism between the color‐LED and dual Scheimpflug devices (all P > .05). In post‐refractive surgery eyes, the color‐LED device agreed with the Placido and dual‐Scheimpflug devices regarding 3rd‐order coma and 4th‐order spherical aberration (all P > .05). Conclusions In normal and post‐refractive surgery eyes, all 3 devices were comparable with respect to corneal power. The agreement in corneal aberrations varied. Financial Disclosure Drs. Wang, Koch, and Weikert are consultants to Ziemer Ophthalmic Systems AG. Dr. Koch is a consultant to Abbott Medical Optics, Inc., Alcon Surgical, Inc., and i‐Optics Corp.