Prospective Randomized Clinical Trial Evaluating Efficacy and Safety of A New Ophthalmic Viscosurgical Device In Patients Undergoing Cataract Surgery

PURPOSE

To evaluate the efficacy and safety of Bio-Hyalur LVD compared to Viscoat® ophthalmic viscosurgical device (OVD) in patients undergoing routine cataract surgery.

SETTING

Two tertiary eye care hospitals in Italy.

DESIGN

Prospective randomized clinical trial.

METHODS

This study compared the outcomes of Bio-Hyalur LVD versus Viscoat® ophthalmic viscosurgical device in patients undergoing standard cataract surgery with phacoemulsification and intraocular lens implantation from January 2021 to April 2022. The primary outcome was mean change in IOP at 6 hours. Secondary outcomes included 1-, 7-, 30- and 90-day mean intraocular pressure (IOP), 7-, 30- and 90-day best corrected visual acuity, endothelial cell density (ECD), change in central corneal thickness (CCT) and complications including intraocular inflammation.

RESULTS

A total of 84 eyes of 84 patients (n = 41 in the Bio-Hyalur LVD group and n = 43 in the Viscoat group) were screened, enrolled, randomized, and included in the analysis. Mean change in IOP was significantly higher in the Viscoat group than in the Bio-Hyalur LVD group 6 hours (p = 0.034), 7 days (p < 0.001), 30 days (p < 0.001) and 90 days (p = 0.003) postoperatively. Mean change in UDVA and CDVA was significantly higher in the Bio-Hyalur LVD group 30 and 90 after surgery. No significant differences in ECD, CCT and complication rates were observed between groups at any time point.

CONCLUSION

Bio-Hyalur LVD OVD is safe and effective for use in patients undergoing routine cataract surgery. Bio-Hyalur LVD OVD did not confer a higher risk of postoperative increase in IOP.

Deep Anterior Lamellar Keratoplasty Using Dehydrated versus Standard Organ Culture-Stored Donor Corneas: Prospective Randomized Trial

PURPOSE

To compare the outcomes of deep anterior lamellar keratoplasty (DALK) using dehydrated versus standard organ culture-stored donor corneas for eyes with keratoconus.

DESIGN

Prospective, randomized, single-center trial conducted in Italy.

PARTICIPANTS

Adult patients (age ≥ 18 years) with keratoconus scheduled for elective DALK.

METHODS

Patients undergoing successful type 1 bubble pneumatic dissection using a standard DALK technique were randomized during surgery to receive either dehydrated (n = 30) or standard organ culture-stored (n = 30) donor corneas.

MAIN OUTCOME MEASURES

The primary study outcome was best spectacle-corrected visual acuity (BSCVA) 12 months after surgery. Secondary outcomes were refractive astigmatism (RA), endothelial cell density (ECD), and complication rates.

RESULTS

Postoperative BSCVA did not significantly differ between groups at both time points: mean difference at 6 months was 0.030 logarithm of the minimum angle of resolution (logMAR; 95% confidence interval [CI], -0.53 to 0.10 logMAR; P = 0.471) and at 12 months was -0.013 logMAR (95% CI, -0.10 to 0.08 logMAR; P = 0.764). No significant differences between groups were observed in terms of postoperative RA and ECD at all time points. In the first 3 days after DALK, an epithelial defect was present in 10 patients (33%) in the organ culture cornea group and in 29 patients (97%) in the dehydrated cornea group. Complete re-epithelialization was achieved by day 7 in all patients (100%) in both groups.

CONCLUSIONS

The study provides evidence that the use of dehydrated corneas is noninferior to the use of standard organ culture donor corneas for DALK. Corneal tissue dehydration represents a viable solution that can allow long-term cornea preservation and avoid wastage of unused corneas.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Iatrogenic ophthalmic artery occlusion after platelet-rich plasma dermal filler documented with ultra-widefield imaging

PURPOSE

To report a case of iatrogenic ophthalmic artery occlusion (OAO) secondary to platelet-rich plasma (PRP) dermal filler injection for facial rejuvenation documented with ultra-widefield imaging.

METHODS

Case report.

RESULTS

A 45-year-old woman developed a sudden and painful vision loss in the left eye (LE) after a dermal filler injection of PRP in the left glabellar region. She immediately received intravenous corticosteroids with no improvements. Two weeks later a complete ophthalmological examination including visual acuity (VA), fundus examination, ultra-widefield fundus autofluorescence and fluorescein angiography, and optical coherence tomography was performed. A diagnosis of iatrogenic OAO in the LE with profound ocular ischemia was made and VA remained no light perception. Monthly follow-up visits were scheduled to ascertain the onset of any ocular complication.

CONCLUSIONS

Dermal filler injections of PRP can lead to rare but devastating side effects with permanent visual loss. Considering that there is currently no validated treatment strategy, prevention could be the real key of iatrogenic OAO management.

Combined photorefractive keratectomy and corneal collagen cross-linking for treatment of keratoconus: a 2-year follow-up study

Background:

Corneal collagen cross-linking (CXL) is considered an effective procedure for slowing down or eliminating the progression of keratoconus. New techniques, in combination with CXL, have been proposed to stop the evolution of keratoconus and improve the visual function.

Objective:

To evaluate the effectiveness of combined photorefractive keratectomy (PRK) with mitomycin-C (MMC) application and CXL in the management of grade 1–2 keratoconus over a 2-year follow-up.

Methods:

Fifteen eyes underwent topography-guided PRK with 0.02% MMC application immediately followed by standard CXL.

Results:

Best corrected visual acuity improved from 0.15 ± 0.11 logMAR to 0.08 ± 0.09 logMAR at 24 months (p < 0.0001) in treated eyes. Mean steepest meridian keratometry reduced from 48.79 ± 3.22 D at baseline to 46.16 ± 3.11 D at 24 months (p < 0.0001). Mean flattest meridian keratometry reduced from 45.18 ± 2.17 D preoperatively to 44.35 ± 2.19 D at 24 months (p < 0.0001).

Conclusion:

Simultaneous topography-guided PRK with MMC 0.02% application and standard CXL is a safe, promising and effective procedure in the treatment of mild and moderate keratoconus.

Classification Tree to Analyze Factors Connected with Post Operative Complications of Cataract Surgery in a Teaching Hospital

Background: Artificial intelligence (AI) is becoming ever more frequently applied in medicine and, consequently, also in ophthalmology to improve both the quality of work for physicians and the quality of care for patients. The aim of this study is to use AI, in particular classification tree, for the evaluation of both ocular and systemic features involved in the onset of complications due to cataract surgery in a teaching hospital. Methods: The charts of 1392 eyes of 1392 patients, with a mean age of 71.3 ± 8.2 years old, were reviewed to collect the ocular and systemic data before, during and after cataract surgery, including post-operative complications. All these data were processed by a classification tree algorithm, producing more than 260 million simulations, aiming to develop a predictive model. Results: Postoperative complications were observed in 168 patients. According to the AI analysis, the pre-operative characteristics involved in the insurgence of complications were: ocular comorbidities, lower visual acuity, higher astigmatism and intra-operative complications. Conclusions: Artificial intelligence application may be an interesting tool in the physician’s hands to develop customized algorithms that can, in advance, define the post-operative complication risk. This may help in improving both the quality and the outcomes of the surgery as well as in preventing patient dissatisfaction.

Classification Tree to Analyze Factors Connected with Post Operative Complications of Cataract Surgery in a Teaching Hospital

BACKGROUND

Artificial intelligence (AI) is becoming ever more frequently applied in medicine and, consequently, also in ophthalmology to improve both the quality of work for physicians and the quality of care for patients. The aim of this study is to use AI, in particular classification tree, for the evaluation of both ocular and systemic features involved in the onset of complications due to cataract surgery in a teaching hospital.

METHODS

The charts of 1392 eyes of 1392 patients, with a mean age of 71.3 ± 8.2 years old, were reviewed to collect the ocular and systemic data before, during and after cataract surgery, including post-operative complications. All these data were processed by a classification tree algorithm, producing more than 260 million simulations, aiming to develop a predictive model.

RESULTS

Postoperative complications were observed in 168 patients. According to the AI analysis, the pre-operative characteristics involved in the insurgence of complications were: ocular comorbidities, lower visual acuity, higher astigmatism and intra-operative complications.

CONCLUSIONS

Artificial intelligence application may be an interesting tool in the physician's hands to develop customized algorithms that can, in advance, define the post-operative complication risk. This may help in improving both the quality and the outcomes of the surgery as well as in preventing patient dissatisfaction.

Analysis of Corneal Distortion after Myopic PRK

The purpose of the study is to evaluate the corneal biomechanical properties (CBP) and their behaviors after myopic refractive surgery both with Ocular Response Analyzer (ORA) and Corvis ST (CST). This retrospective study included 145 eyes of 145 patients with a mean age of 33.13 ± 9.24 years, who underwent myopic photorefractive keratectomy (PRK) for a refractive defect, measured as spherical equivalent, of mean −4.69 ± 2.04 D and have been evaluated before surgery and at 1, 3 and 6 months follow-up. Corneal hysteresis (CH) and corneal resistance factor (CRF) values significantly decreased after 1 month and remained statistically stable during further follow-ups. CST parameters had a different evolution: only second applanation time (AT2) differences showed a significant variation after 1 month that did not statistically change over time. Highest concavity deformation amplitude (HCDA), highest concavity peak distance (HCPD), first applanation time (AT1) and velocity (AV1) showed continuous significant differences both after 3 and after 6 months. This study suggests that after central surface ablation surgery, such as myopic PRK, corneal shape is remodeling, and its deformation parameters are going to change even at 6 months follow-up. This indicates that it should be important to evaluate refractive surgery patients during a longer follow-up because this could allow earlier diagnosis and better management of late-onset complications.

Standard, transepithelial and iontophoresis corneal cross-linking: clinical analysis of three surgical techniques

BACKGROUND

To evaluate the clinical results of standard, transepithelial (TE) and iontophoresis (I) corneal cross-linking (CXL), in patients with progressive keratoconus.

METHODS

Thirty eyes of 30 patients with progressive keratoconus treated by CXL (10 by standard-CXL, 10 by TE-CXL and 10 by I-TE-CXL) with 12 months of follow-up. Pre- and postoperative ophthalmologic testing were: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive examination (spherical error, spherical equivalent), corneal topography (corneal astigmatism, simulated maximum, minimum and average keratometry), aberrometry (coma and spherical aberration), pachymetry and endothelial cell density.

RESULTS

In all groups, UDVA and CDVA improved significantly after treatment. Furthermore, a significant improvement in spherical error, spherical equivalent, topographic and aberrometric outcomes was observed in 3 groups at 1 year posttreatment. No significant variations were recorded in corneal thickness and endothelial cellular density.

CONCLUSION

Our results showed efficacy, clinical and refractive stability after standard-CXL, TE-CXL and iontophoresis-CXL.

Customized photorefractive keratectomy to correct high ametropia after penetrating keratoplasty: A pilot study

PURPOSE

To evaluate preliminarily the safety and efficacy of customized photorefractive keratectomy (PRK) to correct ametropia and irregular astigmatism after penetrating keratoplasty (PK).

METHODS

This pilot study included five eyes of five patients with a mean spherical equivalent of -5.1±1.46D (range from -2.75 to -6.50D). In all cases, ametropia and irregular astigmatism was corrected with topography-guided customized PRK. Ocular examinations with topographic analysis were performed preoperatively as well as at 1, 3 and 6 months after surgery.

RESULTS

All eyes gained postoperatively at least three Snellen lines of uncorrected visual acuity. Mean refractive spherical equivalent was 0.62±0.63D (range from -0.25 to -1.75D) at 6 months postoperatively.

CONCLUSION

Our pilot study suggests that customized PRK can be a safe and effective method for treating ametropia and irregular astigmatisms after PK. Future studies with larger samples and longer follow-ups should be performed to confirm these results.

Feline perforating dermatitis resembling human reactive perforating collagenosis: clinicopathological findings and outcome in four cases

The clinicopathological findings of perforating dermatitis in two young and two adult cats are described. In all cases, the lesions were characterized by single or multiple papules and plaques, 0.5-3.0 cm in diameter, each containing a central, firm, exophytic, cone-shaped, yellow-orange keratotic plug, tightly adherent to the underlying skin. Removal of the protruding material was associated with bleeding and left the ulcerated surface exposed. In one case, the lesions showed a linear configuration and identical lesions occurred on the suture sites following biopsy. Histopathologically, the diagnosis was straightforward because of the presence of vertically orientated collagen bundles extruded from ulcerated, concave-shaped invaginations of the skin. In two cases, vitamin C administration failed to resolve the disease. In two cases, methyl-prednisolone acetate was used to manage relapsing episodes and vitamin C helped to reduce glucocorticoid requirements. In one case, treatment with methyl-prednisolone acetate only appeared to be curative. The fourth case was lost to follow-up immediately after the diagnosis.