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

Objectives: To investigate the effect of cataract surgery on visual acuity, stereoacuity, balance, and falls in patients with senile cataract.

Methods: Prospective, cross-sectional study. The patients were divided into group 1 if the first surgery was performed on the dominant eye and group 2 on the nondominant eye. After a complete ophthalmologic examination, all patients underwent stereoacuity tests (Titmus and TNO test); Berg Balance Scale and the number of falls in the last 36 months were recorded. All assessments were performed at three time points: the preoperative period, 6 months after the first surgery (primary endpoint), and 24 months after the second surgery (secondary endpoint).

Results: The mean number of falls was 4.95±2.6/year in the preoperative period and 1.43±0.59/year in the postoperative period. The incidence of falls after the second surgery decreased by 53.15% compared with the preoperative period. The number of falls and preoperative stereoacuity were negatively and moderately correlated (r=-0.546) ( P =0.033). In univariate and multivariate analysis, only low preoperative corrected distance visual acuity in the dominant eye was associated with poor stereoacuity ( P =0.001) and a high number of falls ( P <0.001) in the preoperative period.

Conclusion: Cataract surgery in patients with senile cataracts not only improves visual acuity but also increases stereoacuity level, improves balance, and decreases falls. These effects should be further studied in multicenter, large-participant studies.

Abstract: The design of the prosthetic replacement of the ocular surface ecosystem (PROSE) device allows it to serve as a novel drug delivery system. In this article, we describe the off-label administration of amphotericin B and cenegermin by instillation in the PROSE device reservoir for the treatment of Candida keratitis in the setting of a persistent epithelial defect.

Objective: To determine if scleral fittings that occur before corneal cross-linking (CXL) are still successful after the procedure.

Methods: This prospective study included seven patients with keratoconus or post-laser-assisted in situ keratomileusis (LASIK) corneal ectasia who were fitted with scleral lenses then underwent CXL. Four patients (six eyes) had keratoconus and three patients (five eyes) had post-LASIK ectasia. Topographic and refractive parameters, as well as uncorrected visual acuity, best spectacle-corrected visual acuity, and scleral lens-corrected visual acuity were collected preoperatively and compared with values 1 and 3 months postoperatively.

Results: Ten eyes had no significant change in refractive parameters from baseline to 3 months ( P >0.05). Nine eyes had no significant change in Km (mean keratometry), K2 (steep keratometry), Kmax (maximal corneal curvature), or pachymetry from baseline to 3 months ( P >0.05). On average, there was no significant difference regarding scleral lens or topographic measurements preoperatively versus postoperatively ( P >0.05).

Conclusion: On average, no significant differences were observed between preoperative and postoperative corneal measurements or refractive correction. These findings suggest that scleral fittings could be introduced before CXL to expedite the process of lens prescription and future acquisition. Safe scleral lens use with a lens fit before surgery could resume 1 month postoperatively.

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.

Objective: To compare endophthalmitis rates after cataract extraction in patients with different preoperative prophylaxis: double povidone-iodine preparation with topical antibiotics versus a control group.

Methods: All cases of postoperative endophthalmitis over the last 17 years were reviewed. Incidence rates of endophthalmitis for all cataract surgeries (current procedural terminology codes 66982 and 66984) performed by 26 surgeons were calculated. Cataract surgery combined with glaucoma and corneal procedures were excluded (1,347 surgeries). Incidence rates were compared for the study group (i.e., use of double povidone-iodine preparation) versus the control group. In the study group, two standard interventions were implemented: preoperative instillation of fluoroquinolone drops every 15 min for 1 hr and preoperative irrigation of conjunctival fornices and eyelashes with 10 cc of 5% povidone-iodine. In both the study and control group, povidone-iodine preparation was performed in the operating room, and postoperative fluoroquinolone drops were used.

Results: From January 2005 to May 2022, no cases of endophthalmitis were identified out of 7,611 cataract extractions performed by three surgeons who used the double povidone-iodine preparation. Seven new cases of endophthalmitis were identified in the control group during the same time (7 out of 9,876=0.07%). Two of these cases had combined cataract surgery with endoscopic cyclophotocoagulation, and five cases had cataract surgery alone. Individual surgeon rates of endophthalmitis ranged from 0% to 0.29%.

Conclusion: A double povidone-iodine preparation may provide more robust prophylaxis against postcataract extraction endophthalmitis than a single preparation.

Purpose: Symptom management in Ocular Cicatricial Pemphigoid (OCP) is challenging because of the progressive factors of dry eye, scarring, trichiasis, and vision impairment. We set out to evaluate the benefits and therapeutic effects of scleral contact lenses in the management of OCP.

Methods: A retrospective review was performed over a database of 20 patients (36 eyes) fitted with scleral lenses (SL) at the Department of Ophthalmology, Emory University from May 2018 to April 2021. The fitting indications, time required for ocular surface stabilization, vision rehabilitation success, and ocular complications were evaluated.

Results: The mean age was 67.4 (range, 43-81) years, with four to one female to male predominance. The mean duration of the follow-up was 16.5 months (range, 1.5-35). The mean wearing time was 9.0±1.9 hr a day, with no overnight wear permitted. All fitted patients reported a subjective improvement in ocular comfort after initiations of SL wear. The mean keratopathy grading improved from 2.1±0.8 to 1.4±0.7 at the last documented visit. The mean visual acuity improved from 0.56±0.51 (logMAR) to 0.34±0.45; in 46% of patient eyes, visual acuity improved by two or more lines. And 96% of fitted eyes responded well to therapy and continued scleral lens wear. Patients who initially presented with fornix shortening, symblepharon, and trichiasis remained stable.

Conclusions: SL offer ocular surface preservation, symptom relief, and improved visual acuity in patients with ocular pemphigoid. They should be strongly considered as ancillary therapy in patients with OCP.

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.

Objective: To determine changes in tear film characteristics and dry eye symptoms in patients who underwent primary pterygium excision with conjunctival autograft.

Methods: A prospective, descriptive, analytic study was performed. Patients with primary pterygium who underwent surgical excision with conjunctival autograft were included. Ocular surface disease index (OSDI) test, noninvasive break-up time (NIBUT), lipid layer interferometry, tear meniscus height, and meibomian gland dropout were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively.

Results: Thirty-three eyes of 31 patients were included, 16 were right eyes, 20 patients were female, and with the average age of 51±9 years. The tear film and dry eye symptom findings before surgery were as follows: OSDI test 36.34±22.04, NIBUT 8.30±1.17 sec, interferometry 53.03±32.32 nm, tear meniscus height 29.90±10.01 mm, superior meibomian gland dropout 24.78%±9.86%, and inferior meibomian gland dropout 22.57%±14.62%. There was a significant decrease in the postop OSDI score to 23.12, as well as tear meniscus height to 24.36 at 3 months postop, and significant improvement in superior (21.03%) and inferior (15.06%) meibomian gland dropout in the final visit.

Conclusion: Primary pterygium excision with conjunctival autograft seems to help improve dry eye-related symptoms and tear film characteristics, with a statistically significant change in postop OSDI scores, tear meniscus height, and meibomian gland dropout. Changes in other objective evaluations of tear film characteristics were not as evident.

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 (p Sp <0.001, p As <0.001), whereas average K-value (Km) and horizontal corneal diameter (WTW) were negatively correlated with H-EOZ (p Km <0.001, p WTW <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 (p As <0.000, p Q <0.001, and p POZ <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 (p Sp <0.000, p As <0.05, p POZ <0.05, respectively), whereas WTW was negatively correlated with A-EOZ (p WTW <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.

Background: Orthokeratology (OK) lenses are used to control myopia progression in children. Few studies have described the changes in stereoacuity scores and fusion ranges in OK-treated children.

Objectives: This study sought to investigate the effects of short-term OK lens wearing on binocular visual function, including fusion and stereoacuity, in children successfully fit with OK lenses.

Methods: This prospective study included 36 children with ideal lens fitting (treatment zone decentration <1 mm) and was conducted between September 2020 and December 2021. Thirty-six patients were assessed before treatment, after 3 months of follow-up, and after 6 months of follow-up for contrast sensitivity (CS), fusion function, and stereopsis and calculation of the accommodative convergence/accommodation (AC/A) ratio.

Results: Compared with those at baseline, the stereoacuity score and convergence amplitude were significantly improved after 3 months of OK lens wear ( P <0.05) but did not further increase after 6 months of lens wear. By contrast, the CS and AC/A ratio did not significantly change from baseline to either follow-up date ( P >0.05).

Conclusions: The CS and AC/A ratio remained unchanged after OK lens wear, while the stereoacuity score and fusion range improved in the pediatric population. These findings suggest that OK lens wearing improves or maintains binocular vision function in myopic children who achieve good visual performance with OK lenses (ChiCTR2000038600, registered September 24, 2020).September 24, 2020).