Jose L. Güell

Phacoemulsification of the crystalline lens and implantation of an intraocular lens for the correction of moderate and high myopia: four- year follow-up

Purpose: To assess the safety of lens extraction and intraocular lens (IOL) implantation in patients with high myopia treated for initial lens opacity and/or refractive indications. Setting: Instituto de Microcirugía Ocular de Barcelona, Barcelona, Spain. Methods: This retrospective nonrandomized case series study comprised 44 eyes of 30 consecutive myopic patients who had surgery because of initial lens opacity and/or refractive indications during a 2‐year period. In each case, phacoemulsification was performed using an ultrasonic technique and an IOL was implanted in the capsular bag. The patients were seen preoperatively to evaluate retinal pathology. They also had a complete ophthalmologic evaluation that included detailed indirect ophthalmoscopy. All patients were followed at regular intervals. The main outcome measures were preoperative and postoperative spherical equivalent (SE), the incidence of posterior capsule opacification (PCO) and the need for capsulotomy, and the incidence of retinal complications. Results: In all eyes, the surgery was uneventful. The mean patient age at surgery was 42.83 years; the mean preoperative SE was −15.77 diopters (D) and the mean postoperative SE, −1.05 D. No eye required preoperative peripheral retinal photocoagulation. Twenty‐five eyes (56.8%) had PCO and had a neodymium:YAG laser capsulotomy. One eye had a retinal tear 14 months after surgery and was treated with focal photocoagulation. The mean endothelial cell loss was 2.1% during the first postoperative year. Two eyes had an immediate postoperative intraocular pressure (IOP) rise, 1 with an inflammatory membrane and the other with corneal edema; both resolved with topical treatment. One eye with elevated IOP and a bad response to medical treatment had argon laser trabeculoplasty. No eye had a retinal detachment during the follow‐up. Conclusion: With a thorough preoperative ophthalmologic evaluation and uneventful surgery, patients who have phacoemulsification and IOL implantation for the correction of myopia have a satisfactory chance of obtaining good visual results with few complications.

Histologic findings after amniotic membrane graft in the human cornea

OBJECTIVEnTo describe the histopathologic findings in the human cornea several months after a stromal amniotic membrane graft. To show the clinicopathologic correlation after the graft in two cases with different follow-up times.nnnDESIGNnTwo interventional case reports with clinicopathologic correlation.nnnPARTICIPANTSnTwo patients with neurotrophic corneal ulcer unresponsive to medical treatment (one with stromal vascularization and the other without stromal vascularization).nnnINTERVENTIONnAmniotic membrane graft was performed in both patients to treat the neurotrophic ulcer. Three and 7 months after amniotic membrane grafting, a penetrating keratoplasty was needed, and the removed corneas were analyzed.nnnMAIN OUTCOME MEASURESnClinical and histopathologic examinations, including routine histopathologic and immunohistochemical studies.nnnRESULTSnComplete epithelialization was observed on histologic examination over the basement membrane of the amniotic membrane graft. The amniotic membrane was slowly reabsorbed in the cornea without stromal vascularization with no inflammatory reaction produced. In the cornea that had stromal vascularization the amniotic membrane was rapidly reabsorbed because of the presence of abundant inflammatory cells. Once reabsorbed, the amniotic membrane was replaced by new fibrotic stroma, that was different from that found in the rest of the cornea but that helped to maintain corneal thickness.nnnCONCLUSIONSnThe amniotic membrane graft allows for correct epithelialization in cases of neurotrophic corneal ulcer. Once the amniotic membrane is reabsorbed, it is replaced by a new fibrotic stroma, which can reduce corneal transparency. In corneas that have no stromal vascularization, the graft may remain in the stroma for many months, compromising corneal transparency during this period.

Secondary iris-claw anterior chamber lens implantation in patients with aphakia without capsular support

Background/aims To evaluate the efficacy, predictability, safety and complications of secondary iris-claw intraocular lens (IOL) implantation in aphakic eyes without capsular support. Methods Retrospective, non-comparative, interventional case series of 128 aphakic eyes, which consecutively underwent secondary iris-claw Artisan IOL (Ophtec BV) implantation, were included. Manifest refraction, uncorrected visual acuity, best-spectacle corrected visual acuity, biomicroscopy, tonometry, funduscopy and central endothelial cell count (cECC) were evaluated before surgery, and at yearly intervals up to 5u2005years. Minimum follow-up time was 1u2005year. Results One hundred twenty-eight eyes were treated. Mean age was 54.55u2005years (range, 1–98u2005years). Mean follow-up was 41.8u2005months (SD 23.63). Mean preoperative logarithm of the minimum angle of resolution BSCVA and spherical equivalent (SE) were 0.67 ((SD) 0.53) and 9.63u2005D (SD 5.50), respectively. One year postoperatively, mean logarithm of the minimum angle of resolution best-spectacle corrected visual acuity improved to 0.52 (SD 0.46) (p<0.05), and remained stable up to 5u2005years. One year postoperatively, mean SE was −0.52 (SD 2.21) (p<0.05). Mean SE progressively decreased during the 1st year, and remained stable thereafter (p<0.05). Mean preoperative cECC was 2237.47 (SD 793.33)u2005cells/mm2. cECC showed a slight, though statistically significant, decrease over the years (p=0.05). Main complications were: 2 pupillary block; 3 transient increase in intraocular pressure; 1 IOL replacement; 2 penetrating keratoplasty and 4 cystoid macular oedema. Conclusions Iris-claw IOL implantation in aphakic eyes is an effective, predictable and safe procedure in the first 5u2005years of follow-up. However, a longer follow-up is required to demonstrate its long-term safety.

Femtosecond laser-assisted enhancements after laser in situ keratomileusis

UNLABELLEDnWe describe a technique of femtosecond laser-assisted enhancement after primary LASIK with a mechanical microkeratome-created flap. The vertical side-cut incision by the femtosecond laser creates a wound configuration that decreases mechanical trauma to the epithelium and prevents epithelial cell migration. These factors may decrease the risk for post-LASIK enhancement epithelial ingrowth.nnnFINANCIAL DISCLOSUREnNo author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Intrastromal corneal ring segments to correct low myopia in eyes with irregular or abnormal topography including forme fruste keratoconus: 4-year follow-up

PURPOSE: To report the 4‐year outcomes after Intacs intrastromal corneal ring segment (ICRS) implantation to correct low myopia in patients with abnormal topography. SETTING: Instituto de Microcirugia Ocular, Barcelona, Spain. METHODS: This retrospective consecutive interventional case series included eyes with myopia lower than −4.50 diopters (D) and abnormal topography that excluded excimer laser surgery. Evaluation was performed preoperatively and at yearly intervals up to 4 years postoperatively. The 4‐year outcomes measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, predictability and stability of refractive correction, the efficacy and safety indices, and complications. RESULTS: After ICRS implantation, 82.05% of 39 eyes (21 patients) were within ±1.00 diopter (D) of emmetropia and 46.15% were within ±0.50 D. Refractive correction improved during the first 6 months and remained stable up to 4 years. The UDVA was 20/40 or better in all eyes and 20/20 or better in 38.46% of eyes. Seven eyes (17.95%) lost 1 line of CDVA, and no eye lost 2 or more lines. No intraoperative complications occurred. The ICRS were exchanged for thicker ICRS in 7 eyes (17.9%) because of undercorrection. One patient requested ICRS removal due to unsatisfactory refractive results. CONCLUSIONS: The 4‐year results indicate that ICRS implantation is effective and safe in the correction of low myopia in patients for whom excimer laser surgery is contraindicated because of abnormal topography, including forme fruste keratoconus. The achieved refractive correction remained stable throughout the follow‐up. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

SMILE Procedures With Four Different Cap Thicknesses for the Correction of Myopia and Myopic Astigmatism

PURPOSEnTo study the feasibility of performing myopic femtosecond small incision lenticule extraction (SMILE) with four different cap thicknesses (130, 140, 150, and 160 μm).nnnMETHODSnIn this retrospective, comparative, non-randomized clinical trial, a refractive lenticule of intrastromal corneal tissue was cut with the VisuMax femtosecond laser system (Carl Zeiss Meditec AG, Jena, Germany) using different depths of the non-refractive lenticule cut. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and Objective Scattering Index (OSI) were evaluated. Minimum follow-up time was 1 year.nnnRESULTSnNinety-four eyes of 47 patients with myopia with (14 patients) and without (33 patients) astigmatism were treated. One year after the surgery, mean log-MAR UDVA, logMAR CDVA, SE, and OSI were 0.07 ± 0.12, 0.01 ± 0.37, 0.07 ± 0.57, and 0.88 ± 0.17, respectively (P < .05). There were no significant statistical differences in logMAR UDVA, logMAR CDVA, SE, or OSI (P > .05) variables when the different groups were compared for the same periods of time.nnnCONCLUSIONSnNo differences in visual acuity, refractive outcomes in optical visual quality, or complications were observed when using SMILE at four different depths.

Acute corneal hydrops after intrastromal corneal ring segment implantation for keratoconus

UNLABELLEDnWe present a 14-year-old boy with a history of advanced keratoconus in the left eye. Two 400 μm intrastromal corneal ring segments (ICRS) (Intacs) were implanted on the 140-degree meridian at a depth of 400 μm in the left eye using the suction-guided manual dissection technique. While the temporal segment was being implanted, a probable break in Descemet membrane occurred, allegedly opening during the hours after surgery; acute corneal hydrops was observed on the following day. We have no knowledge of an ICRS implantation case that experienced acute hydrops due to a break in Descemet membrane without perforation of the anterior chamber; ie, without allowing aqueous humor through the corneal internal incision.nnnFINANCIAL DISCLOSUREnNo author has a financial or proprietary interest in any material or method mentioned.

Preliminary results with posterior lamellar keratoplasty for endothelial failure.

We describe the technique and the results of three cases where we performed a posterior lamellar keratoplasty.nnThe following surgical technique was performed in all cases. The donor posterior button was obtained from an entire fresh globe. We made sure that intraocular pressure was adequate by injecting BSS (balanced salt solution, Alcon) in the vitreous cavity. With a Moria ONE microkeratome, an anterior cap of 250 μm was cut and lifted. A Barron trephine 7 mm in diameter was used to obtain the posterior button, covered afterwards with viscoelastic to protect it and to avoid desiccation.nnWith our microkeratome an 8.5 mm in diameter, nasal hinge and 250 μm flap was obtained. The trephination was made with a 7 mm Barron trephine and completed with corneal scissors, under viscoelastic protection.nnAfter the intraocular injection of acetylcholine the posterior donor button was placed on the recipient eye under viscoelastic protection. Six 10-0 Nylon interrupted sutures were used to secure and close the wound. Immediately after, the flap was put back and fixated with six interrupted 10-0 Nylon sutures and the knots were buried. The viscoelastic anterior chamber was exchanged with …

Suggested guidelines for reporting keratoprosthesis results: Consensus opinion of the cornea society, Asia Cornea Society, EuCornea, PanCornea, and the KPRO study group

Purpose: To propose a series of standardized guidelines for reporting keratoprosthesis (KPRO) results. Methods: At the most recent KPRO Study Group Meeting (Barcelona, 2015), representatives of the 4 multinational corneal societies (Cornea Society, Asia Cornea Society, EuCornea, and PanCornea) and the KPRO Study Group agreed to propose consistent terminology for reporting KPRO results, especially in describing the length of follow-up and in the description of the KPRO itself. Consensus was reached for minimal reporting guidelines. Results: The 4 multinational corneal societies and the KPRO Study Group agreed to standardized terminology for reporting the length of follow-up, preoperative diagnosis grouping, and data stratification based on the KPRO type used. Conclusions: Guidelines suggesting minimal reporting standards will assist in both data collection and reporting and will allow for better comparative analysis and pooling of the available data.

Transient myopic shift after phakic intraocular lens implantation.

UNLABELLEDnThree patients presented with spontaneous myopic shift 6 weeks to 6 months after implantation of the Artiflex phakic intraocular lens (pIOL). The corrected distance visual acuity (CDVA) was maintained in all cases. Cyclopentolate drops successfully reverted the myopic shift in all cases; however, 2 cases required surgical reenclavation of the pIOL haptics to achieve long-term refractive stability. At the last follow-up, all patients had returned to emmetropia, with uncorrected distance visual acuities of 20/20. A slight decrease in objective optical quality was observed. No eye lost a line of CDVA. In 1 eye, optical coherence tomography scans showed slight posterior positioning of the pIOL. These cases show that spontaneous myopic shift is a potential complication of iris-claw pIOL implantation. That cyclopentolate drops and/or reenclavation of the haptics were effective in reverting the situation suggests a mechanical mechanism related to iris and ciliary body dynamics.nnnFINANCIAL DISCLOSUREnDr. Güell is a consultant to Ophtec. No author has a financial or proprietary interest in any material or method mentioned.