Eye & Contact Lens-Science and Clinical Practice最新文献

Objectives: To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on corneal anterior segment parameters compared with body mass index (BMI)-matched and polysomnography (PSG)-negative healthy controls.

Methods: This cross-sectional case-control study included 42 patients with OSAS and 25 age-sex BMI-matched and PSG-negative healthy volunteers. Obstructive sleep apnea syndrome was diagnosed by the polysomnographic sleep test, and the control subjects were determined from a negative overnight PSG. Maximum keratometry (Kmax), central corneal thickness, corneal symmetry index (SI), keratoconus vertex (KV), Baiocchi-Calossi-Versaci (BCV), anterior chamber volume (ACV), anterior chamber angle (ACA), and anterior chamber depth (ACD) values from topographic measurements and endothelial cell density (ECD), coefficient of variation, and hexagonality percentage (Hex) values from specular microscopic measurements were recorded.

Results: In our study, 48 eyes of 24 patients with mild-moderate OSAS (Group 1) and 36 eyes of 18 patients with severe OSAS (Group 2) and 50 eyes of 25 BMI-matched and PSG-negative volunteers (Group 3) were evaluated. Among the keratoconus index values, front and back KV values were significantly higher in the OSAS group compared with the control group (P=0.001, P:0.003, respectively), while there was no significant difference in SI and BCV values (P>0.05). Central corneal thickness was statistically lower in the severe OSAS group compared with the control group. There was no statistically significant difference between patients with OSAS and controls in Kmax, ACD, ACA, and ACV values. Among the specular microscopic measurements, the ECD value was significantly lower in the severe OSAS group (P<0.05).

Conclusion: In the study comparing age-sex and BMI-matched groups, some abnormal changes in corneal endothelial morphology and topographic keratoconus screening indices were observed in patients with OSAS. We assume that these corneal changes are due to intermittent hypoxia and hypoxia-induced inflammatory response during apnea-hypopnea episodes in OSAS.

Objectives: To investigate the long-term changes in corneal power in young patients with keratoconus (KC) and compare corneal power between eyes with and without progression by Fourier analysis using anterior segment optical coherence tomography (OCT).

Methods: Clinical records containing OCT data were retrospectively reviewed in patients with KC younger than 25 years at the first visit with a minimum follow-up duration of 2 years and at least one eye with abnormal KC findings. Eyes were divided into progressive (P) and nonprogressive (NP) groups using the ABCD grading system of Scheimpflug-based tomography. Baseline values and changes in Fourier components (spherical, regular astigmatism, asymmetry, and higher-order [HO] irregularity components) from the anterior and posterior corneal surfaces between the initial and last visits obtained with OCT were compared between both groups. Multivariate logistic regression analysis with stepwise selection was performed for baseline values to determine predictive baseline factors.

Results: Twenty-three and 16 eyes were assigned to the P and NP groups, respectively. Changes in the anterior spherical and HO irregularity and posterior spherical components were significantly greater in the P group than in the NP group (P<0.05). Baseline HO irregularity, regular astigmatism, and asymmetry components from the posterior cornea were predictive of KC progression, with the highest areas under the receiver operating characteristic curve of 0.796, 0.760, and 0.740, respectively.

Conclusions: Indices of regular and irregular astigmatism (asymmetry and HO irregularity) from the posterior corneal surface component can be potential prognostic indicators of KC progression in young patients.

Objectives: The purpose of this study was to analyze the size of the effective optical zone (EOZ) and its related influencing factors in small incision lenticule extraction.

Methods: Calculation of the horizontal EOZ (Y1: H-EOZ), vertical EOZ (Y2: V-EOZ), and average EOZ (Y3: A-EOZ) using corneal topographic difference maps. Multivariate linear regression analysis was used to establish a multivariate linear equation for the dependent variable EOZ. Receiver operating characteristic (ROC) curves were constructed based on the experimental cohort and were validated in the validation cohort.

Results: The EOZ was smaller than the programmed optical zone (POZ) (p<0.001), and the spherical (Sp) and astigmatism (As) were positively correlated with H-EOZ (pSp<0.001, pAs<0.001), whereas average K-value (Km) and horizontal corneal diameter (WTW) were negatively correlated with H-EOZ (pKm<0.001, pWTW<0.002). The corresponding multivariate linear regression equation was Y1=5.246+0.168X1-0.278X2+0.027X3-0.131X4. Spherical, As, the asphericity of cornea (Q-value), and POZ were positively correlated with V-EOZ (pAs<0.000, pQ<0.001, and pPOZ<0.05, respectively) and Y2=3.032+0.102X1+0.175X2+0.642X5+0.415X6. Spherical, astigmatism, and POZ were positively correlated with A-EOZ (pSp<0.000, pAs<0.05, pPOZ<0.05, respectively), whereas WTW was negatively correlated with A-EOZ (pWTW<0.004) as follows: Y3=4.384+0.132X1+0.023X3-0.117X4+0.294X6. The H-EOZ model had the largest area under the ROC curve, 0.853 (95% confidence interval: 0.807-0.767).

Conclusions: The preoperative intended correction of spherical lesions may be the main factor affecting the size of the postoperative EOZ, and this study has strong predictability for the horizontal EOZ.

Objectives: This study investigated the safety of rigid corneal lenses in children with unilateral aphakia after cataract surgery and observed the visual rehabilitation longitudinally.

Methods: This retrospective cohort study performed a 3-year follow-up of 21 infants (age 5.9±3.3 months) with unilateral congenital cataracts who started wearing rigid corneal contact lenses after cataract surgery. The basic presurgical patient information included chief complaint, intraocular pressure (IOP), axial length, corneal width, anterior segment, and fundus examination. The postsurgical visual acuity, IOP, and anterior segment were examined during regular postoperative follow-up visits. Keratometry was performed when contact lenses had to be changed.

Results: Of the 21 patients, 15 were male and 6 were female. Before surgery, the affected and nonaffected eyes had similar IOP (9.5±3.5 vs. 9.2±2.8 mm Hg; P=0.502) and axial length (19.2±1.5 vs. 19.4±0.96; P=0.333). The corneal diameter in the affected eyes was smaller than in the nonaffected eyes (10.2±0.7 vs. 10.6±0.6 mm; P=0.002). After surgery, the logarithm of the minimum angle of resolution vision of the affected eyes improved gradually, showing values of 1.12±0.28, 0.78±0.37, and 0.62±0.38 at 1, 2, and 3 years after surgery, respectively. The respective values in the unaffected eyes were 0.58±0.14, 0.40±0.13, and 0.33±0.16. The mean keratometric astigmatism and keratometry 1 and 3 years after surgery were statistically similar (2.09±1.21 vs. 1.73±1.16 D, P=0.272; 44.82±3.15 vs. 44.39±2.75 D, P=0.324, respectively). No serious complications occurred during the follow-up.

Conclusion: The rigid corneal lens is well tolerated and safe in aphakic eyes and can effectively improve children's visual acuity after unilateral cataract surgery. For patients able to receive rigid corneal lenses, intraocular lens implantation can be delayed until after the age of three.

Objectives: To compare intraoperative and postoperative effects of applying a viscosurgical device versus balanced salt solution (BSS) during cataract surgery.

Methods: Single-center retrospective case-control pilot study. Reviewed 27 patients who received Viscoat (Alcon Laboratories, Inc. Fort Worth, TX) or BSS on the cornea during uncomplicated cataract surgery. Surgeries were analyzed for time when the microscope light reflection was indistinct on the cornea while instruments were in the eye. Postoperative data included patient pain ratings, National Eye Institute score, and Ocular Surface Disease Index (OSDI) scores.

Results: Compared with BSS, Viscoat application resulted in a significant increase in time with a clear light reflex during surgery (P<0.001). With BSS, average time without a clear light reflex while instruments were in the eye was 82.69±50.14 sec, or 17.56%±12.00% of the surgery, compared with 0% with Viscoat. There was no significant difference in postoperative pain and National Eye Institute score between groups. However, OSDI score two about grittiness was significantly lower with Viscoat application (P=0.01) and approaching significance for OSDI score three, about painful or sore eyes (P=0.09).

Conclusions: Viscoat provided greater optical clarity during surgery with a single application and was associated with less sensation of grittiness compared with BSS.

Purpose: To evaluate the short-term influence of scleral lenses (SL) with different diameters on intraocular pressure (IOP) and corneal biomechanics. A secondary objective was to investigate the relationship between fluid reservoir (FR) thickness and IOP and biomechanical parameters.

Methods: Thirty healthy subjects were randomly fitted with L1 (diameter of 15.80 mm) and L2 (diameter of 16.80 mm) on the right eye and worn for 2 hr. On IOP and corneal biomechanical parameters were measured with the CORVIS ST before and after SL removal. Fluid reservoir thickness at 0 and 2 hr of wear was measured using anterior segment optical coherence tomography.

Results: Biomechanical parameters decreased after removal of L1 (-1.04±1.47 mm Hg) (P<0.01) and L2 (-0.80±1.74 mm Hg) (P=0.02). The biomechanical parameters A1T (-0.11±0.18 ms) (P=0.01) and SP-A1 (-4.29±9.97 mm Hg/mm) (P=0.02) decreased after L1 removal, whereas a decrease in highest concavity time (-0.21±0.50 m/s) (P=0.03) and an increase in highest concavity radius (+0.17±0.43 mm) (P=0.04) were observed after L2 removal. A significant, negative, and moderate correlation was found between highest concavity deformation amplitude and FR thickness with L1 (r=-0.42, P=0.02).

Conclusions: The small changes in corneal biomechanical parameters and IOP values induced by short-term SL wear have no significant clinical impact and were not influenced by the diameter of the SL.

Purpose: To report interim results of a single center, randomized, double-blind, crossover-controlled clinical trial comparing wavefront-guided (wfg) scleral lenses (SLs) to traditional scleral lenses (tSLs) for patients with a history of irregular corneal astigmatism (ICA).

Methods: Thirty-one ICA eyes of 18 participants were reviewed, 23 with keratoconus, six postcorneal refractive ectasia, and two postpenetrating keratoplasty. Patients with corneal or lens opacities were not excluded from participating. Participants underwent a diagnostic lens-based fitting with a tSL with standard spherocylindrical optics. Once the tSL was finalized, a comprehensive wavefront aberrometer-based system was used to capture the residual aberration of the tSL under scotopic conditions without pharmacologic dilation, and these data were used to create a wfgSL. Once the tSL and wgfSL were finalized, a double-blinded, randomized, crossover was conducted where the participants received lens A (tSL or wgfSL) or lens B (the alternative), each worn for a 4±1 week interval. Measurements of the visual acuity (VA) and total higher-order root mean squared (HORMS) were recorded at each interval under controlled lighting conditions. At the final visit, patient subjective preference for lens A or lens B was recorded.

Results: The average HORMS for a fixed 5-mm pupil was 0.68±0.31 μm for tSL and 0.29±0.18 μm for wfgSL. Wavefront-guided SL provided an average HORMS improvement of 56% ( P <0.001). All eyes showed a reduction in HORMS, ranging from 18% to 83%. Wavefront-guided SL provided an average VA improvement of 0.12±0.11 logMAR ( P <0.01). Seventy-one percent of eyes showed one line or greater improvement, 26% showed no improvement, and 3% showed a reduction of VA with the wfgSL. The average VA with tSL was 0.14±0.16 logMAR and 0.03±0.11 logMAR for wfgSL. Seventeen of 18 patients subjectively preferred wfgSL.

Conclusion: In eyes with ICA, wfgSL reduced HORMS and improved VA when compared with tSL. Patients subjectively preferred wfgSL to tSL. These interim results demonstrate the feasibility and generalizability of wfgSL in a typical clinical practice environment.

Objective: To review the current literature describing corneal changes observed with orthokeratology (ortho-k) use and to formulate preliminary recommendations for these patients seeking corneal refractive surgery.

Methods: The literature search was conducted through the PubMed, Scopus, and Ovid databases through June 4, 2024, for articles regarding corneal physiological, tomographic, and biomechanical changes secondary to ortho-k use.

Results: Forty-one articles were found describing several changes associated with ortho-k use, including higher corneal staining, central corneal epithelial thinning and midperipheral thickening, increased higher-order aberrations, decreased contrast sensitivity, reduced corneal hysteresis and corneal resistance factor, and alterations in the tear proteome. The majority of these parameters returned to baseline after ortho-k lens discontinuation, with timing potentially dependent on the amount of myopic correction, duration of ortho-k use, and age of lens fitting.

Conclusions: Despite the paucity of articles describing prior ortho-k patients undergoing corneal refractive surgery, it is evident that ortho-k use may potentially cause various corneal physiological, tomographic, and biomechanical changes in patients. Therefore, clinicians are advised to serially monitor ortho-k patients' refraction, tomography, pachymetry, and corneal biomechanics until stability is achieved before considering surgery.

Objectives: To investigate the referral and management patterns of patients with keratoconus among primary eye care practitioners in Ghana and Nigeria.

Methods: A questionnaire adapted from previous studies was modified and created using Google Forms. The online survey was distributed to prospective participants using e-mails and other social media platforms. Data were analyzed using the Statistical Product and Service Solutions software (version 25.0; IBM Corp, Armonk, NY; Released 2017).

Results: One hundred and sixty-nine optometrists responded to the survey (61.54% from Nigeria and 38.46% from Ghana). Most (88.6%) practiced without corneal topographers. Most respondents (77.7%, n=136) reported not fitting rigid gas-permeable (RGP) contact lenses in a year and 68% were willing to refer for contact lens fitting to another practitioner. The major barriers to RGP fitting were lack of experience (44.4%, n=72), cost to practice (15.4%, n=25), and other reasons (12.4%), whereas 27.8% (n=45) preferred not to answer. Seventy-six percent of respondents (n=133) were willing to fit RGPs if the respondents received the training to do so. About half of the respondents (53.8%) reported progression of cornea signs as the reason for referral to an ophthalmologist. Half of the respondents (n=51.4%) did not have a cornea surgeon in the area the respondents practiced, and 76.3% reported not comanaging patients at all with ophthalmologists.

Conclusion: This study highlights the current standard of care of patients with keratoconus in West Africa. The findings from this study suggest that clinical guidelines and further training of eye care practitioners in West Africa are needed to better manage patients with keratoconus.

Objectives: The aim of this study was to evaluate the combined effect of dual-focus soft contact lenses (CLs) and 0.05% atropine in the control of myopia.

Methods: A retrospective study was conducted on 142 myopic children aged 7 to 13 years. A single nightly instillation of 0.05% atropine at bedtime was prescribed if the rate of myopia progression exceeded -1.00 D/year. After 1 year of treatment, patients who exhibited myopia progression of more than 0.75 D/year or an increase in axial length of more than 0.25 mm/year were additionally treated with dual-focus soft CLs (MiSight) alongside 0.05% atropine (Combination group, n=71). By contrast, patients who showed myopia progression of less than 0.50 D/year and axial elongation of less than 0.20 mm/year continued treatment with 0.05% atropine only (Monotherapy group, n=71). Subjects in the combination group were further divided into high myopia and low/moderate myopia subgroups, using a cutoff of -6 D.

Results: Myopia progression and axial elongation were significantly slower after the addition of dual-focus soft CLs to 0.05% atropine in the combination group ( P =0.001 and P =0.012, respectively). The combination group exhibited statistically significantly faster myopia progression than the monotherapy group before the addition of dual-focus soft CLs (both P <0.001), but no significant difference in myopia progression between the two groups was observed afterward ( P =0.504 and P =0.479, respectively). The inhibition of axial elongation was more pronounced in the low/moderate myopia group compared with the high myopia group ( P =0.028).

Conclusions: The combination of dual-focus soft CLs and 0.05% atropine is an effective treatment strategy for controlling myopia in children with rapidly progressing myopia. The additive effect was greater in children with low/moderate myopia than in those with high myopia.