G. Tassinari

Posterior capsule opacification after phacoemulsification: silicone CeeOn Edge versus acrylate AcrySof intraocular lens.

Purpose: To compare the rates and morphologic features of posterior capsule opacification (PCO) after small‐incision phacoemulsification and in‐the‐bag implantation of 2 foldable intraocular lenses (IOLs) over an 18‐month follow‐up. Setting: Departments of Ophthalmology, Hospital of Conegliano, Conegliano, and Maggiore Hospital of Bologna, Bologna, Italy. Methods: In an open clinical study, 78 cataract patients were randomly selected to have implantation of a silicone CeeOn® Edge (Pharmacia) or acrylate AcrySof® (Alcon) IOL after phacoemulsification cataract surgery. All the patients were operated on using a standard technique and in‐the‐bag IOL implantation. One eye in each patient was studied. Morphologic evaluation of PCO was performed using Evaluation of Posterior Capsule Opacification software. Results: At 18 months in the CeeOn Edge group, 36 eyes (90%) had a clear posterior capsule and 4 (10%) had PCO that did not affect visual acuity. In the AcrySof group, 26 eyes (68%) had a clear posterior capsule, 11 (29%) had PCO that did not affect visual acuity, and 1 (3%) had PCO with a decrease of 2 or more lines of visual acuity that required a neodymium:YAG laser capsulotomy. No eye developed Elschnig pearls or stretched folds in the bag. The postoperative best corrected visual acuity ranged from 0.8 to 1.0 in 96% in the CeeOn Edge group and in 92% in the AcrySof group. No IOL haze or discoloration was observed in the CeeOn Edge group. Mild IOL decentration and tilting occurred in 4 AcrySof eyes; however, no glistenings were found any AcrySof IOL. Conclusions: Both the CeeOn Edge and AcrySof groups had a low incidence of PCO after an 18‐month follow‐up. The CeeOn Edge group had significantly less PCO than the AcrySof group. These results confirm that IOLs with square truncated edges create a barrier effect at the optic edge, reducing the overall incidence of PCO.

Two-step LASIK with topography-guided ablation to correct astigmatism after penetrating keratoplasty.

PURPOSE To assess the efficacy, predictability, stability, and safety of a two-step LASIK procedure using topography-guided ablation to correct astigmatism after penetrating keratoplasty. METHODS Fifteen eyes of 15 patients underwent a two-step LASIK procedure at the Maggiore Hospital of Bologna, Italy. In the first step, a flap was created using the Hansatome microkeratome. In the second step, topography-guided ablation using the LaserSight LSX was planned with interactive software (CIPTA) once topographical and refractive stabilization had been obtained. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cylindrical correction, gain of lines of BSCVA, spherical equivalent refraction, and complications were analyzed. RESULTS Minimum follow-up was 12 months (range: 12 to 30 months). Uncorrected visual acuity improved in all 15 (100%) eyes. At the last postoperative examination, 11 (73%) eyes had UCVA > or = 20/40. Nine (60%) eyes were within 1.0 diopter (D) of the attempted correction. Mean postoperative astigmatism was -1.67 (range: -3.5 to 0; standard deviation: 1.26). Index of success of astigmatic correction was 0.26. No patient lost Snellen lines of BSCVA. Intraoperative complications included two buttonhole flaps, and postoperative complications included one flap retraction. No further laser treatment was needed. CONCLUSIONS The two-step LASIK procedure using topography-guided ablation reduces spherical and cylindrical refractive error due to penetrating keratoplasty. Topography-guided ablation also proved to be effective in correcting irregular astigmatism.

Induced astigmatism after near-clear hinge incision

Purpose: To evaluate astigmatism induced by the near‐clear hinge incision. Setting: Casa di Cura Villa Toniolo, Bologna, and Day Hospital Nuova Ricerca, Rimini, Italy. Methods: The results in 100 eyes having phacoemulsification with a 3.2 or 4.1 mm temporal near‐clear hinge incision were evaluated for a maximum of 6 months. Corneal curvature was measured using computerized videokeratography, and surgically induced astigmatism was computed by vector analysis. Surgically induced corneal topographic changes were also evaluated. Results: Mean induced cylinder in the 3.2 mm incision group was 0.4 diopter (D) ± 0.2 (SD) 6 months after surgery; there was no significant difference in the values at 4 days and 6 months. Mean induced cylinder in the 4.1 mm incision group was similar at 1 and 6 months (0.47 and 0.45 D, respectively). However, it was significantly higher at 4 days (0.56 D). Vector decomposition analysis showed that the with‐the‐rule component was prevalent and remained constant over 6 months. Topographic analysis showed localized wound‐related flattening with minimal central corneal changes. Conclusion: The near‐clear hinge incision was almost astigmatically neutral and resulted in self‐sealing incisions that did not leak.