Retinal images viewed through a small aperture corneal inlay

A refractive optical device potentially masking an intraocular tumor

A 62-year-old woman was referred with reduced vision in her left eye and suspected retinal detachment. Bilateral laser in situ keratomileusis with KAMRA corneal inlay insertion was performed in the left eye 2 years earlier. On examination, a shadow from the corneal inlay limited posterior segment examination even with dilated fundoscopy, but a temporal raised lesion extending over the macula was noted. Ocular ultrasound confirmed a large tumor consistent with malignant melanoma, requiring enucleation. It is unclear whether the patient had baseline dilated fundoscopy before corneal inlay implantation; however, a pinhole effect for the patient will cause a pinhole effect for the clinician, potentially limiting the fundal view. The authors emphasize the importance of appropriate informed consent patients, including discussion of rare risks and complications, which can have profound implications. In this case, the elective refractive procedure potentially masked an intraocular tumor. Enucleation may have been avoided if the lesion had been identified at an earlier stage.

Implantation of a small-aperture intraocular lens and a partial aniridia implant in eyes with traumatic iris defects

Purpose

To report the clinical outcomes after implantation of a small-aperture intraocular lens (IOL) and a partial aniridia ring in three patients with traumatic iris defects.

Observations

The corrected distance visual acuity (CDVA), irregular astigmatism, and glare improved in all patients. In one patient, the monocular defocus curve showed a visual acuity (VA) of 0.30 logMAR or better from 1.0 to −1.5 D, and the halo size and intensity were 5 and 10 (on a scale from 0 to 100), respectively, and the glare size and intensity were 23 and 16 (on a scale from 0 to 100), respectively.

Conclusions and importance

The pinhole effect of the small-aperture IOL helped considerably decrease irregular astigmatism and improve visual acuity. The partial aniridia implant also contributed to the reduction of the glare symptoms, while allowing a sufficient fundus assessment. The combined implantation of the small-aperture IOL and the partial aniridia device, therefore, presents an effective option for improvement of the visual symptoms in patients with traumatic iris defects.

Image quality of grating target in model eye when viewed through a small-aperture corneal inlay

PURPOSE

To evaluate the quality of the image of a grating target placed in a model eye and viewed through a small-aperture corneal inlay.

SETTING

Kyorin Eye Center, Tokyo, Japan.

DESIGN

Experimental study.

METHODS

A Kamra corneal inlay was placed on the anterior surface of a fluid-filled model eye, and a United States Air Force target and a calibrated scale were placed on the inner surface of the model eye. With a flat contact lens or a contact or noncontact wide-angle viewing system, the contrast of the grating images and the field of view through the inlay were compared with those without the inlay.

RESULTS

A blurred dark ring was observed with the flat contact lens and MiniQuad wide-viewing contact lens in the model eye with the inlay. The contrast of the gratings was significantly decreased at 16 cycles/mm (P=.028), 32 cycles/mm (P=.046), and 64 cycles/mm (P=.015). With the Resight noncontact wide-angle viewing system, the field of view was reduced from 62 degrees to 32 degrees when the front lens was at 7.0 mm and slightly reduced from 75 degrees to 62 degrees at 5.0 mm with the inlay.

CONCLUSIONS

The contrast of grating images observed through the inlay was significantly reduced when viewed with the flat contact lens. The field of view through the wide-angle viewing system was also altered. However, the noncontact wide-angle viewing system may be recommended for vitreous surgeries in eyes with the inlay by adjusting the distance of the front lens from the cornea.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.