Paula Verdaguer

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 5 years. Minimum follow-up time was 1 year. Results One hundred twenty-eight eyes were treated. Mean age was 54.55 years (range, 1–98 years). Mean follow-up was 41.8 months (SD 23.63). Mean preoperative logarithm of the minimum angle of resolution BSCVA and spherical equivalent (SE) were 0.67 ((SD) 0.53) and 9.63 D (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 5 years. 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) cells/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 5 years of follow-up. However, a longer follow-up is required to demonstrate its long-term safety.

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

PURPOSE To study the feasibility of performing myopic femtosecond small incision lenticule extraction (SMILE) with four different cap thicknesses (130, 140, 150, and 160 μm). METHODS In 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. RESULTS Ninety-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. CONCLUSIONS No 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

UNLABELLED We 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. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

Epithelial ingrowth after LASIK: visual and refractive results after cleaning the interface and suturing the lenticule.

Purpose: The aim was to study the visual and refractive results in patients with epithelization in the corneal interface after laser in situ keratomileusis (LASIK) who were treated by cleaning the corneal interface (epithelial cyst extraction) and suturing the corneal flap. Methods: This is a retrospective, noncomparative interventional case series. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive cylinder (CYL), spherical equivalent (SE), recurrence of epithelial ingrowth, and complications. Results: From a total of 7520 LASIK refractive eyes, 13 eyes with epithelial ingrowth were treated. The mean age was 46.9 years. The mean preoperative logMAR UDVA was 0.34 (SD, 0.19). At 2 months, the mean postoperative logMAR UDVA was 0.18 (SD, 0.17) and at 1 year was 0.12 (SD, 0.18) (P = 0.01). The mean logMAR CDVA before surgery was 0.16 (SD, 0.16). Two months and 1 year postoperatively, the mean logMAR CDVA was 0.05 (SD, 0.08) and 0.03 (SD, 0.06), respectively (P = 0.03). The mean SE before surgery was 0.30 D (SD, 1.09). The mean SE 2 months and 1 year after surgery was −0.07 (SD, 0.53) and −0.004 (SD, 0.18), respectively (P = 0.04). The mean CYL before surgery was −0.92 D (SD, 1.09); and the mean CYL 2 months and 1 year after surgery was −0.60 (SD, 0.84) and −0.18 (SD, 0.75), respectively (P = 0.26). No epithelial ingrowth recurrence was observed up to 1 year after epithelial removal. Conclusions: Cleaning the corneal interface and suturing the corneal flap was effective and appeared safe in treating epithelial ingrowth after LASIK, with an extremely low rate of regrowth. However, further prospective controlled studies with a longer follow-up are needed.

Unilateral Iris-Claw Intraocular Lens Implantation for Aphakia: A Paired-Eye Comparison.

Purpose: To perform a paired-eye comparison of secondary iris-claw intraocular lens (IOL) implantation for aphakia. Methods: Retrospective, comparative, nonrandomized interventional case series of aphakic eyes, which underwent secondary iris-claw Artisan IOL (Ophtec BV) implantation for aphakia in one eye and no surgery (group 1) or cataract surgery (group 2) in the fellow eye. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent, central endothelial cell count (cECC), and complications were evaluated before surgery, and at yearly intervals up to 5 years. Results: Thirty aphakic eyes implanted with the Artisan were included, and the fellow eyes served as controls. In group 1, postoperative logMAR UDVA and CDVA was significantly higher in the Artisan-implanted eyes (P < 0.01). In group 2, no differences were found in postoperative UDVA and postoperative CDVA between the Artisan-implanted eyes and the eyes that underwent cataract surgery throughout the follow-up (P ≥ 0.05). No statistically significant differences were found in postoperative spherical equivalent between the Artisan-implanted eyes and unoperated eyes or eyes that underwent cataract surgery (P ≥ 0.05). In group 1, cECC was significantly lower in the Artisan-implanted eyes [1973 ± 822 vs. 2616 ± 481 cells per square millimeter at 2 years (P < 0.01)] throughout the follow-up (P < 0.01). In group 2, cECC was not significantly lower in the Artisan-implanted eyes (P ≥ 0.05) [1934 ± 689 vs. 2058 ± 818 cells per square millimeter at 2 years (P = 0.67)]. Conclusions: Visual rehabilitation with secondary iris-claw IOL implantation in aphakic eyes without capsular support seems to be an effective and safe procedure. As expected, uncomplicated cataract surgery with posterior chamber IOL implantation showed lower endothelial cell count loss. Close monitoring of the corneal endothelium is mandatory.

Corneal impairment in a patient with type 2 distal arthrogryposis.

Objective: Case report of a 7-year-old male patient, diagnosed with idiopathic progressive corneal alteration developed within a period of 6 months. Methods: Description of type 2 distal arthrogryposis affecting hands and feet, a bilateral, congenital hearing loss, alterations such as keloid-like scarring, congenital heart disease, and cryptorchidism with no relevant family history. Results: Corrected visual acuity in the right eye (RE) was 0.5 and in the left eye was 1 and, in addition to that, a bilateral corneal subepithelial fibrosis that was denser in the RE without neovessels and no signs of inflammatory activity. Conclusion: This is the first publication relating arthrogryposis with corneal affectation, probably because of a collagen anomaly characteristic in these patients.

Advantages and Disadvantages of Different Cap Thicknesses

The small incision lenticule extraction (SMILE) procedure is an all-in-one technology for correcting refractive errors that has become available for intrastromal lenticule cutting and subsequent lenticule extraction. SMILE technology has exhibited excellent efficacy, safety, and predictability for the correction of myopia and astigmatism [1, 2].

Intraocular Lens Opacification After Endothelial Keratoplasty as Analyzed by Environmental Scanning Electron Microscopy

Purpose: To describe a case of hydrophilic intraocular lens (IOL) opacification based on IOL analysis after Descemet stripping automated endothelial keratoplasty. Methods: A 60-year-old woman had uneventful phacoemulsification after the implantation of a hydrophilic IOL (Akreos-Adapt; Bausch & Lomb) into both eyes. Because of postoperative corneal decompensation in the right eye, 2 Descemet stripping automated endothelial keratoplasty operations were performed within 1 year. After the second procedure, the graft was not well attached, requiring an intracameral injection of air on day 3. After 1 year, opacification was observed on the superior 2/3 of the anterior surface of the IOL, along with a significant decrease in visual acuity. The IOL was explanted 6 months after the opacification. Results: Environmental scanning electron microscopy followed by x-ray microanalysis revealed an organic biofilm on the surface of the IOL. Conclusions: To our knowledge, this is the first reported case in which the material deposited on the lens is organic rather than calcific.

Phakic Intraocular Lenses in Keratoconus

There are several circumstances where phakic intraocular lenses (IOLs) might be considered in the management of the keratoconic patient, obviously only in the case of a stable refractive situation, sometimes difficult to be defined in this setting. Taking into account that the IOLs will only correct the sphere and the regular component of the astigmatism, sometimes they will be used in combination with other surgical strategies such as collagen crosslinking and/or intracorneal ring segments. In this chapter, we will evaluate the conceptual possible indications for them and review the published data as well as our own experience during these last 15 years.

Laser Corneal Refractive Surgery: An Update

Lamellar corneal surgery for the correction of refractive errors has been evolving for more than 60 years. LASIK (laser-assisted in situ keratomileusis) is a well-known procedure for correction of different refractive defects as myopia, hyperopia and astigmatism. It is the most widely used refractive surgical technique due to its safety and effectiveness, quick visual recovery, and minimal side effects. The introduction of wavefront-guided laser technology into the field of refractive surgery in 1999 represented a significant advancement in ophthalmology, allowing an optimized correction not only of spherocylindrical errors but also of higher-order aberrations. Femtosecond lasers were introduced in the place of mechanical microkeratomes, and in the past few years have rapidly become accepted as a safe and effective way to create flaps for LASIK, various corneal transplant configurations, and intracorneal channels for treating ectatic corneal disorders. The ultimate goal has been to create an intrastromal lenticule that can be removed in one piece manually, thereby avoiding the need for photoablation by an excimer laser. The results of the first prospective trials of this technique have been reported.