Comparison of corneal topography maps obtained using the IOLMaster 700® and the Anterion® in candidates for toric IOL implantation

OBJECTIVES

To compare central corneal topography (CT) obtained using the IOLMaster 700® biometer to corneal topography obtained using a Swept-Source OCT-based predicated topographer (PT), in candidates for toric intraocular lens (IOL) implantation.

METHODS

A retrospective comparative study was conducted in consecutive patients undergoing a routine cataract surgery assessment with significant astigmatism on keratometry. Each patient was examined using both the IOLMaster 700® (Carl Zeiss Meditec, Jena, Germany) and the Anterion® (Heidelberg Engineering, Heidelberg, Germany) for routine preoperative measurements. The corneal axial anterior power map obtained with each device was then anonymized and analysed independently by two ophthalmologists using a reading grid. The reading grid assessed the usual parameters describing astigmatism and evaluated if a toric IOL was indicated or a second topography examination was needed to confirm the indication.

RESULTS

In total, 169 eyes of 120 patients were included. The inter-examination agreement for the astigmatism description ranged from 56 to 85% depending on the reader and parameter. The decision to implant a toric IOL based on the axial map was the same in 59-60% of cases depending on the examiner. A second examination was needed in 18-25% and 8-14% of cases after CT and PT, respectively. The IOLMaster 700® central anterior axial map allowed toric IOL implantation in 58-70% of cases with no need for second corneal examination.

CONCLUSION

The agreement between the anterior axial maps obtained using both devices was good. However, in about a quarter of the cases, dedicated topography had to be performed to confirm the surgical indication.

Long Intervals between Intravitreal Injections Using a Treat-and-Extend Protocol in a Real-Life Context in AMD: The LIRE Study

INTRODUCTION

The aim of the study was to assess the outcome of long treat-and-extend (TE) anti-VEGF intravitreal injection (IVI) intervals (≥every 12 weeks [Q12W]) in neovascular age-related macular degeneration (nAMD). The aims of this retrospective study were to determine the proportion of nAMD eyes treated ≥ Q12W, to analyze their longitudinal, functional, and anatomical outcomes, and to compare functional and anatomical outcomes between eyes that rapidly versus slowly reached a Q12W regimen and between eyes directly treated with versus initiating lately the TE regimen.

METHODS

All patients receiving IVIs for nAMD were screened. The longitudinal, functional, and anatomical characteristics of Q12W-treated eyes were reported at different timepoints.

RESULTS

Ninety-one eyes were included (38% of our total nAMD cohort). The mean TE regimen time to reach a Q12W interval was 20.1 ± 16.2 months. During this time, a mean number of 12.1 ± 9.3 IVIs were needed. The mean best-corrected visual acuity was 68 letters at the time of diagnosis and was maintained (p > 0.05). Eyes that rapidly reached a Q12W interval had a shorter follow-up before TE regimen initiation (p = 0.04) and received fewer IVIs (p = 0.02) than eyes that slowly reached a Q12W interval. Eyes directly treated with the TE regimen reached a Q12W interval more rapidly than eyes with late TE initiation. The neovascularization subtype was not a predictor of outcome in TE-treated eyes.

CONCLUSION

≥Q12W eyes represent an important part of the nAMD population in our real-life study. No baseline anatomical characteristics were associated with the outcome under a TE regimen, although early TE regimen initiation allowed extending more rapidly the IVI interval.

[Late steroid-induced ocular hypertension after intravitreal dexamethasone implants: A series of 20 cases]

INTRODUCTION

Steroid-induced ocular hypertension (OHT) occurs in approximately one third of cases after dexamethasone implant (DEXi) injection. Among these, more than one fifth occur after the third DEXi intravitreal injection (IVI). Our goal was to analyze the clinical profiles of these late responders.

MATERIAL AND METHODS

A real-life, retrospective, observational study was conducted to assess demographic characteristics and intraocular pressure (IOP) responses in late responders (IOP ≥ 21mmHg, n DEXi ≥ 4). The following parameters were analyzed: IOP 2 months after IVI and number of glaucoma medications needed. The IOP response compared to baseline was defined as low (< +6mmHg), moderate (≤ +15mmHg) or high (> 15mmHg).

RESULTS

Late steroid-induced OHT occurred in 20.8% of cases. Twenty eyes (18 patients) were included. The mean duration of follow-up was 3.8±1.9 years. They received a mean number of 9.5±4.2 IVI. The first OHT peak, measured at 25.3±3.2mmHg (21-31), occurred after 6.8±2.3 IVI. Approximately 65% of OHT spikes occurred between the fourth and sixth IVI; 35% occurred later. At maximum, 1.7±1.0 glaucoma medications and 0.75±0.79 SLT procedures were required to control the OHT, with no filtering surgery required. The ratio of "low," "moderate," and "high" responders was 5%, 85% and 10% respectively.

CONCLUSION

Late steroid-induced OHT occurs after at least 3 DEXi in one fifth of multi-injected patients, requiring long-term IOP monitoring. This case series identifies mostly moderate responder profiles, whose IOP rise often remains well-controlled with medical management or laser treatment (SLT).

Impact of Total Corneal Astigmatism Estimated With the Abulafia-Koch Formula Versus Measured With a SS-OCT Biometer on the Refractive Outcomes of a Toric Intraocular Lens in Cataract Surgery

PURPOSE

To compare the impact of total corneal astigmatism (TCA) estimated with the Abulafia-Koch formula (TCA^ABU) versus measured by Total Keratometry (TK), swept-source optical coherence tomography (OCT) coupled with telecentric keratometry (TCA^TK) on the refractive outcomes after cataract surgery with toric intraocular lens (IOL) implantation.

METHODS

Two hundred one eyes of 146 patients who underwent cataract surgery with toric IOL implantation (XY1AT; HOYA Corporation) were included in this single-center, retrospective study. For each eye, TCA^ABU (estimated from the anterior keratometry values measured with the IOLMaster 700 [Carl Zeiss Meditec AG]) and TCA^TK (measured using TK IOLMaster 700) were entered into the HOYA Toric Calculator. Patients were operated on based on TCA^ABU. For each eye, centroid and mean absolute error in predicted residual astigmatism (EPA) were calculated according to TCA used (TCA^ABU or TCA^TK). The cylinder power and the axis of the posterior chamber IOL were compared.

RESULTS

The mean uncorrected distance visual acuity was 0.07 ± 0.12 logMAR, the mean spherical equivalent was 0.11 ± 0.40 D, and mean residual astigmatism was 0.35 ± 0.36 D. Mean centroid EPA was 0.28 D at 132° with TCA^ABU and 0.35 D at 148° with TCA^TK (P(x) < .001; P(y) < .01). Mean absolute EPA was 0.46 ± 0.32 D with TCA^ABU and 0.50 ± 0.37 D with TCA^TK (P < .01). In the with-the-rule astigmatism subgroup, a deviation from the target of less than 0.50 D was achieved in 68% of eyes with TCA^ABU versus 50% of eyes with TCA^TK. The proposed posterior chamber IOL was different depending on the calculation methods used in 86% of cases.

CONCLUSIONS

Both calculation methods showed excellent results. However, the predictability error was significantly reduced when TCA^ABU was used compared to TCA^TK measured with the IOLMaster 700 in the whole cohort. Finally, TCA was overestimated by TK in the with-the-rule astigmatism subgroup. [J Refract Surg. 2023;39(3):171-179.].

Evaluation of the Correlation between Regional Retinal Ganglion Cell Damage and Visual Field Sensitivity in Patients with Advanced Glaucoma

(1) Background: to investigate the correlation between structural (retinal ganglion cells and retinal nerve fibers) and functional alterations analyzed point-by-point in the central 10 degrees of the visual field of patients with advanced glaucoma using Humphrey 10-2 visual field tests. (2) Methods: Single-center prospective cohort study carried on from October 2018 to February 2019 at the Croix-Rousse hospital, Lyon, France. The primary outcome measure was the point-by-point correlation between retinal sensitivity (Humphrey 10-2) and retinal ganglion cell complex (GCC) thickness. (3) Results: 29 eyes of 27 patients were examined. Of these, 15 eyes had a mean deviation (MD) less than −20 dB. There were statistically significant linear relationships between GCC thickness and 10-2 visual field sensitivity for several points in the lower part of the visual field, with lower retinal sensitivity being associated with thicker GCC layers. There were no strong linear relationships or statistically significant correlations in the other regions of the visual field. For the patients with MD < −20 dB, there were statistically significant linear relationships between GCC thickness and 10-2 visual field sensitivity for several points in the superior nasal region. Retinal sensitivity was not correlated with retinal nerve fibre layer thickness. (4) Conclusions: In this study of patients with advanced glaucoma, GCC thickness was linearly associated with 10-2 visual field sensitivity in certain regions, negatively for patients with less-severe glaucoma. The initial thickening raises questions about the apoptosis mechanism, while the thinning observed in the most severe cases is consistent with the ganglion cell death identified on visual field tests.

Toward quantitative and reproducible clinical use of OCT-Angiography

Optical coherence tomography angiography (OCT-A) is an ophthalmic imaging technique which has recently been introduced to clinical use. OCT-A provides visualization of the retinal vascularization in three dimensions, without injection of contrast agents. OCT-A could thus replace the current standard of opthalmic imaging, which is 2D only and requires contrast agents. However, quantitative studies remain to be carried out to assess the full potential of OCT-A. In this context, the present work proposes a methodology to perform OCT-A in a more reproducible and precise way. We introduce a procedure to automatically extract the area of interest in avascular regions, which we demonstrate on various avascular areas with a focus on the optic nerve extracted in 2-dimensional images for a selected depth. We then study the repeatability of OCT-A with our segmentation technique when implemented on various clinical devices. For illustration, we apply this segmentation to healthy control group and to patients presenting different stages of glaucoma, a disease of clinical interest. The variability observed between these two cohorts compares favorably to the variability due to instrumental limitations or the segmentation algorithm. Our results thus constitute a significant step toward a more quantitative use of OCT-A in a clinical context.

Macular toxicity and blind spot enlargement during a treatment by voriconazole: A case report

Purpose:

To report a case of macular toxicity and blind spot enlargement during voriconazole treatment.

Methods:

This is a case report.

Results:

We describe a 77-year-old man treated by voriconazole for pulmonary aspergillosis, who complained of visual disorders such as dyschromatopsia and visual hallucinations 3 days after voriconazole initiation. Initial ophthalmological examination found no loss of visual acuity. The anterior and posterior segments presented no anomalies. The chromatic vision evaluated with the Lanthony 15-Hue Desaturated Test demonstrated dyschromatopsia in the left eye along the tritan axis, and the Goldmann visual field examination found a blind spot enlargement in both eyes. The multifocal electroretinogram found a global decrease in the foveal peak in both eyes. Visual evoked potential showed asymmetric data and lower amplitudes of the P(100) wave on the left eye. No anomalies were observed on spectral domain macular optical coherence tomography. As a first step, based on presumed dose-dependent toxicity, voriconazole dose was reduced. No improvements were noted. The voriconazole treatment was then discontinued and replaced with itraconazole. After 1 month, visual field and multifocal electroretinogram had improved and visual hallucinations had disappeared.

Conclusion:

Voriconazole can cause potentially serious visual side effects. Adapting treatment based on plasma concentrations of voriconazole did not prevent the appearance of visual side effects in this case. Therapeutic drug switching within the same drug family seems to be an effective alternative to preserve ocular function.

Self-talk in a basketball-shooting task

This study examined the effectiveness of two different types of self-talk on the performance of a basketball-shooting task. 60 physical education and sports sciences students were organized into one control and two treatment groups which used self-talk. During the experiment, the control group performed with the general instructions, whereas the self-talk groups used the cue-words "relax" and "fast," respectively, Analysis showed that only the participants of the self-talk group who used the word "relax" improved their performance significantly as compared to the other two groups. It appears that self-talk can positively affect performance if its content is appropriate for the task performed.