Marie-José Tassignon

Multicenter study of the Artisan phakic intraocular lens.

PURPOSE To assess the Artisan intraocular lens to correct myopia in phakic eyes. SETTING European multicenter study sponsored by Ophtec BV, Groningen, The Netherlands. METHODS In this prospective multicenter clinical study, the Artisan lens was implanted in 518 eyes between September 1991 and October 1999. The power of the lenses ranged from -5.0 to -20.0 diopters (D). Follow-up examinations were performed at 6 months and 1, 2, and 3 years. Follow-up ranged from 6 months (n = 454) to 3 years (n = 249). The preoperative uncorrected visual acuity (UCVA) was not recorded but was estimated to be worse than 0.1. The preoperative mean best spectacle-corrected visual acuity (BSCVA) was 0.67 +/- 0.26 (SD). Endothelial cell counts were done at 6 months and 1, 2, and 3 years in a subgroup of 129 eyes. RESULTS A UCVA of 20/40 or better was observed in 76.8% of eyes regardless of the postoperative goal. A BSCVA of 20/40 or better was observed in 93.9% of eyes and remained stable throughout the follow-up. Of the eyes with extremely high myopia (>-15.0 D), 63.3% gained 2 or more lines of BSCVA; of those with moderate myopia (-5.0 to -10.0 D), 23.5% gained 2 or more lines. The mean endothelial cell density change was 4.8% at 6 months, 2.4% at 1 year, 1.7% at 2 years, and 0.7% at 3 years. The incidence of persistent adverse events at 3 years was relatively low. Secondary surgical interventions included repositioning of the lens because of poor initial placement and lens exchange because of preoperative power calculation errors. Glare and halo effects during night driving were noted and were related to large pupils in young patients. CONCLUSION The Artisan lens is a safe, stable, efficacious, and predictable method to correct -5.0 to -20.0 D of myopia. This study suggests that the corneal endothelial cell loss is stabilized to the physiologically normal level after 3 years.

Keratitis and corneal scarring after UVA/riboflavin cross-linking for keratoconus.

PURPOSE To report four cases of severe keratitis after standard corneal collagen cross-linking (CXL) treatment for keratoconus. METHODS Four patients with progressive keratoconus from two different centers were treated by ultraviolet A (UVA) CXL, using riboflavin as a photosensitizer. The epithelium was removed over the central 8 to 9 mm of the cornea. Riboflavin 0.1% in dextran 20% was instilled every 2 minutes for 30 minutes before UVA exposure. The UV-X light source (IROC), calibrated at 3 mW/cm(2), was applied for 30 minutes while instillation was continued every 2 minutes. At the end of the treatment, a bandage contact lens was applied and topical treatment consisting of a combination of antibiotics and/or anti-inflammatory drops was initiated. RESULTS Patients experienced delayed (after more than 24 hours) symptoms and signs of inflammation. The eyes showed pronounced ciliary redness with cells in the anterior chamber and central keratic precipitates; multiple white infiltrates had developed at the edge and within the area of CXL. High-dose topical or subconjunctival corticosteroids led to rapid initial improvement of symptoms and signs. Herpes virus could not be detected on the ocular surface or on the anterior chamber tap of one patient. CONCLUSIONS We report four cases of keratitis and corneal scarring from a total of 117 eyes treated with CXL. The location of the scarring determined the amount of loss of visual acuity: in two eyes, there was a persistent decrease in best spectacle-corrected visual acuity.

Normative Values for Corneal Densitometry Analysis by Scheimpflug Optical Assessment

PURPOSE To describe the normative data for corneal Scheimpflug densitometry based on a cohort of normal participants. METHODS A total of 445 healthy participants were recruited for assessment (794 eyes). Left and right eyes were considered separately. All participants were assessed using the corneal densitometry analysis add-on to the standard software of the Oculus Pentacam. Densitometry measurements were obtained and expressed in standardized grayscale units (GSU). RESULTS All participants were Caucasian; 42% were male and 58% were female. The mean age was 48.0 ± 15.3 years (range, 20.2-84.2 years). Mean corneal densitometry over the 12-mm-diameter area was 19.74 ± 3.89 GSU. When divided by radial zone, densitometry values were lowest in the central zone (16.76 ± 1.87 GSU) and highest in the periphery (27.36 ± 7.47 GSU). There was no difference between central zone and the surrounding 2- to 6-mm annulus (P > 0.05), though the 6- to 10-mm and the 10- to 12-mm zones displayed higher densitometry values (P < 0.001). When divided by depth, the anterior layer displayed the highest densitometry reading of 25.81 ± 5.14 GSU, which was significantly higher than that of both the central (P < 0.001) and the posterior layers (P < 0.001). Changes in corneal densitometry were correlated with age, though not within the central 6-mm-diameter ring. No sex difference was seen within the cohort. CONCLUSIONS This add-on to the standard imaging software allows rapid and objective assessment of the corneal densitometry. We provide normative data that may be used as a reference facilitating research and complementing clinical examination.

Posterior capsule management in congenital cataract surgery.

&NA; Management of the posterior capsule significantly affects the outcome of pediatric cataract surgery. Posterior capsule opacification (PCO) is rapid and virtually inevitable in very young children when adult‐style cataract surgery is performed and the posterior capsule is left intact. In eyes with pediatric cataract, primary posterior capsulotomy and vitrectomy are considered routine surgical steps, especially in younger children. The site of intraocular lens (IOL) fixation and the surgical technique used also affect the prevalence of PCO. The present systematic review evaluates the options available to prevent PCO or ensure a clear central visual axis after pediatric cataract surgery. Newer approaches to posterior capsule management such as pars plicata posterior capsulorhexis, sutureless vitrectomy, sealed‐capsule irrigation, and bag‐in‐the‐lens IOL are discussed. Management of the posterior capsule in the presence of a preexisting posterior capsule defect and posterior capsule plaque and options to treat PCO are also reviewed. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Continuous positive airway pressure therapy is associated with an increase in intraocular pressure in obstructive sleep apnea

PURPOSE Several reports have demonstrated an association between glaucoma and obstructive sleep apnea (OSA), though the origin of this association remains unknown. In the present study, the influence of OSA and continuous positive airway pressure (CPAP) therapy on intraocular pressure (IOP) and ocular perfusion pressure (OPP) was examined. METHODS IOP, blood pressure, and pulse rate were measured every 2 hours during 24-hour sessions in 21 patients with newly diagnosed OSA. A first series of measurements was performed before CPAP therapy, and a second series was performed 1 month after the initiation of CPAP therapy. OPP was then calculated. RESULTS Baseline measurements showed a significant nycththemeral fluctuation in the average IOP, with the highest IOPs at night. After 1 month of CPAP therapy, the average IOP was significantly higher than baseline. The increase in overnight IOP was also significantly higher. A 24-hour IOP fluctuation of > or =8 mm Hg was found in 7 patients at baseline and in 12 patients during CPAP therapy. The mean difference between trough and peak IOP was 6.7 +/- 1.5 mm Hg at baseline and 9.0 +/- 2.0 mm Hg during CPAP therapy. Thirty minutes after CPAP cessation a significant decrease in IOP was recorded. There was a statistically significant decrease in mean OPP during CPAP therapy. CONCLUSIONS Patients with OSA demonstrated significant 24-hour IOP fluctuations, with the highest values at night. CPAP therapy causes an additional IOP increase, especially at night. Regular screening of visual fields and the optic disc is warranted for all patients with OSA, especially those treated with CPAP.

Secondary closure of posterior continuous curvilinear capsulorhexis in normal eyes and eyes at risk for postoperative inflammation

Purpose: To observe the posterior continuous curvilinear capsulorhexis (PCCC) after cataract surgery in control eyes and eyes with an increased risk for postoperative inflammation. Setting: Department of Ophthalmology, University Hospital Antwerp, Belgium. Methods: After phacoemulsification, a PCCC was performed before intraocular lens (IOL) implantation in 20 eyes of 18 patients with ocular or systemic conditions that predisposed them for increased postoperative inflammation; e.g., diabetes, uveitis, retinitis pigmentosa (inflammation group). These eyes were compared with 20 eyes of 16 patients who had the same surgical procedure but did not present a history of medical or ocular pathology (control group). The postoperative follow‐up was 6 months to 3 years. Reclosure of the PCCC was evaluated by anterior segment photographs. The reclosure was classified as partial when newly formed tissue was present at the PCCC margin and total when the proliferation covered the entire PCCC area. Results: Three types of PCCC reclosure were found: fibrotic, Elschnig pearl or multilayer, and monolayer. All 3 were seen within or at the margin of the PCCC area. Reclosure (total and partial) occurred in 8 eyes (40%) in the control group and 10 (50%) in the inflammation group. Total reclosure was more frequent in the inflammation group (4 eyes [20%]) than in the control group (1 eye [5%]). Monolayered or multilayered cellular proliferation was present in 8 eyes (40%) in the control group and 4 eyes (20%) in the inflammation group; fibrotic proliferation was found in the inflammation group only (7 eyes [35%]). Conclusion: Reclosure of the PCCC occurred in both groups, although the frequency of reclosure was slightly higher in the inflammation group. Although PCCC does not prevent posterior capsule opacification in all cases, it is useful in specific situations.

Binocular vision impairment after refractive surgery

Purpose: To illustrate the need for an accurate preoperative orthoptic examination to prevent postoperative changes in binocular vision. Setting: Department of Ophthalmology, University Hospital Antwerp, Edegem, Belgium. Methods: Five patients presenting major subjective complaints after refractive surgery were analyzed. Results: In 1 patient, a latent N IV palsy decompensated after laser in situ keratomileusis (LASIK) in the more myopic eye to achieve monovision. A second patient, operated on for N IV palsy 10 years earlier, presented a recurrence of the palsy after bilateral LASIK for myopia. The third patient complained of discomfort in binocular vision caused by aggravation of a preexisting intermittent esotropia that worsened after LASIK for hyperopia. The fourth patient complained of diplopia after LASIK in the highly anisometropic and exotropic eye. The fifth patient experienced a decrease in fusion and stereopsis at the time he became anisometropic after bilateral LASIK. Conclusions: Special care should be taken of patients who have a preoperative history of strabismus surgery, an overcorrection or undercorrection in 1 or both eyes, or anisometropia and of those who are unhappy with contact lenses. An orthoptic examination should be done with and without spectacle correction to detect underlying vertical phorias. Intended monovision should be examined initially using contact lenses.

Bag-in-the-lens intraocular lens implantation in the pediatric eye

PURPOSE: To study the efficacy, safety, and feasibility of implantation of a bag‐in‐the‐lens intraocular lens (IOL) in children and babies. SETTING: Departments of Ophthalmology, University Hospital, Antwerp, Belgium, and the University Hospital, Ljubljana, Slovenia, and a private ophthalmology practice, Oudenaarde, Belgium. METHODS: Thirty‐four eyes of 22 children had implantation of a bag‐in‐the‐lens IOL. The ages ranged from 2 months to 14 years. Congenital cataract was present in 26 eyes, and persistent fetal vasculature (PFV) was concomitantly present in 4 eyes. Fifteen patients had bilateral cataract, and 6 had unilateral cataract. RESULTS: In 3 eyes, the IOL could not be properly implanted. In these cases, secondary intervention was necessary because of early posterior capsule opacification. The mean postoperative follow‐up was 17.45 months ± 17.12 (SD) (range 4 to 68 months). None of the children except those presenting with PFV had anterior vitrectomy during surgery. The optical axis remained clear during the follow‐up in all patients who had successful IOL implantation. CONCLUSIONS: The bag‐in‐the‐lens implantation technique in children and babies was safe and kept the visual axis clear after cataract surgery. In the near future, 4.0 or 4.5 mm IOLs will be available that may improve the success rate of IOL implantation in the small eyes of babies.

Retinal Straylight as a Function of Age and Ocular Biometry in Healthy Eyes

PURPOSE To determine the dependency of straylight on ocular biometry. METHODS This prospective study included 518 eyes of 277 volunteers of diverse ethnic backgrounds with healthy eyes of various iris colors. The eyes had retinal straylight tested using a commercial psychophysical device. Ocular axial length and refraction were also measured with an ocular biometer and an autorefractometer, respectively. RESULTS The measured retinal straylight was validated by comparing data with the age model described in the literature as log(s) = P(1) + log[1 + (age/65)(4)], where P(1) is the logarithm of the average straylight for the eyes of a newborn. The data agreed well with this model, although P(1) was slightly higher (0.931 vs. 0.87). When this model was subtracted from the measured straylight values, a quadratic increase was found in the function of axial length, L: log(s) = 0.931 + log[1 + (age/65)(4)] + (0.01089L(2) - 0.4820L + 5.330). A similar model was defined for the spherical equivalent refraction SE. This corresponds to an increasing amount of straylight for increasing degrees of myopia. No correlation was found with keratometry and corneal astigmatism or with iris color. CONCLUSIONS Retinal straylight increases not only with age, but also with axial length. Further study is needed to identify the cause of this dependency.

Surgical outcomes of intraocular lens exchange : Five-year study

PURPOSE: To report the indications, surgical complications, and outcomes of intraocular lens (IOL) exchange procedures performed over 5 years and to correlate the incidence of perioperative anterior vitrectomy in eyes previously treated by neodymium:YAG (Nd:YAG) laser capsulotomy. SETTING: Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. METHODS: In this prospective study, all IOL exchange procedures performed between October 2002 and December 2007 were included. Surgical outcomes were correlated with indications, IOL position, targeted versus achieved refraction, preoperative Nd:YAG laser capsulotomy, and surgical complications. RESULTS: One hundred twenty‐eight eyes (113 patients) had IOL exchange because of IOL opacification (31%), IOL decentration (19%), IOL dislocation (18%), capsule phimosis (14%), corneal endothelial cell decompensation (8%), IOL miscalculation (6%), damaged IOL (2%), or IOL‐related chronic uveitis (2%). Before and after IOL exchange, respectively, the IOL was capsule fixated in 82% and 45% of eyes, iris fixated in 4% and 39% of eyes, and sulcus fixated in 7% and 15% of eyes. Iris‐fixated IOLs had the lowest predictability of refractive outcome (mean 1.55 diopters). Intraocular lenses implanted using the bag‐in‐the‐lens technique had the highest refractive outcome predictability (mean 0.51 D). CONCLUSIONS: Decentration of pseudoaccommodating IOLs accounted for 14% of all IOL exchanges. Vitreous loss necessitating anterior vitrectomy was strongly correlated with preoperative Nd:YAG laser capsulotomy. Postoperative visual acuity improved in all cases without preoperative ocular comorbidity.