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PurposeTo assess the relationship between anterior chamber depth (ACD) and lens thickness (LT), as well as its three main components (anterior and posterior cortex and nucleus thickness), in cataractous and non-cataractous eyes, depending on the axial length (AxL).MethodsAnterior and posterior cortex and nucleus thickness of the crystalline lens, ACD, and AxL were measured using optical low-coherence reflectometry in cataractous and non-cataractous eyes. They were also classified into hyperopia, emmetropia, myopia, and high myopia, depending on AxL; thus, eight subgroups were created. A minimum sample size of 44 eyes (of 44 patients) for each group was recruited. Linear models were fitted for the whole sample and each AxL subgroup to assess if there were differences in the relationships between the crystalline lens variables and ACD, including age as a covariate.ResultsThree hundred seventy cataract patients (237 females, 133 males) and 250 non-cataract controls (180 females, 70 males), aged 70.5 ± 9.4 and 41.9 ± 15.5 years, respectively, were recruited. The mean AxL, ACD, and LT for the cataractous and non-cataractous eyes were 23.90 ± 2.05, 24.11 ± 2.11, 2.64 ± 0.45, and 2.91 ± 0.49, 4.51 ± 0.38, 3.93 ± 0.44 mm, respectively. The inverse relationship of LT, anterior and posterior cortex, and nucleus thickness with ACD was not significantly (p ≥ 0.26) different between cataractous and non-cataractous eyes. Further subclassification of the sample depending on AxL showed that the inverse relationship between the posterior cortex and ACD was no longer significant (p > 0.05) for any non-cataractous AxL group. LT, anterior and posterior cortex, and nucleus thickness was not significantly (p ≥ 0.43) different between cataractous and non-cataractous eyes for the whole sample, and all AxL groups after adjusting for age.ConclusionsThe presence of cataracts does not modify the inverse relationship of the LT, anterior and posterior cortex, and nucleus with ACD. And this relationship does not seem to depend importantly on AxL. Besides, the possible differences in LT, anterior and posterior cortex, and nucleus between cataractous and non-cataractous eyes may not be caused by lens opacification, but possibly by the progressive lens growth due to aging.

Introduction Characterizing lens thickness (LT) in patients with cataracts is important for better understanding the lens aging process and for designing new intraocular lens power formulas. This study aimed to analyze the influence of common senile cataract formation on the LT, anterior (ACS) and posterior (PCS) cortex space, and nuclear thickness (NT), controlling for sex, age, and axial length. Methods A cross-sectional study was performed. A consecutive sample of 603 volunteers (403 women, 200 men) aged 59.1 ± 18.8 years was recruited. The standardized Lens Opacification Classification System (LOCS)-III was used to classify eyes (randomly selected) into cataractous and non-cataractous groups. Also, they were classified according to the cataract location (presence or absence of cortical, nuclear, or posterior subcapsular cataract). Optical biometry was performed to measure LT, ACS, NT, and PCS. Propensity score was used to match participants one-to-one for sex, age, and axial length. Groups were compared using the Student’s t  test or Yuen’s test. Results The four classifications divided unmatched eyes into: 361 cataractous lenses and 242 non-cataractous, 226 cortical and 377 non-cortical cataractous, 313 nuclear and 290 non-nuclear cataractous and 242 subcapsular and 361 non-subcapsular cataractous. Before matching, cataractous eyes showed significantly higher LT (4.52 ± 0.39 vs. 3.94 ± 0.46 mm, p  < 0.001), ACS (0.75 ± 0.20 vs. 0.58 ± 0.23 mm, p  < 0.001), NT (3.34 ± 0.23 vs. 3.18 ± 0.25 mm, p  < 0.001) and PCS (0.42 ± 0.19 vs. 0.37 ± 0.19 mm, p  = 0.003). Matched lens, cortical, nuclear, and subcapsular cataract samples comprised 146, 258, 182, and 226 eyes, respectively. After matching, no significant differences were observed in LT (4.34 ± 0.37 vs. 4.33 ± 0.36 mm, p  = 0.94), ACS (0.72 ± 0.20 vs. 0.76 ± 0.19 mm, p  = 0.08), NT (3.31 ± 0.22 vs. 3.30 ± 0.23 mm, p  = 0.24) and PCS (0.42 ± 0.19 vs. 0.43 ± 0.16 mm, p  = 0.79). Conclusions The presence of senile cortical, nuclear, and posterior subcapsular cataract have no effect on LT, ACS, NT, and PCS. Confounding factors should be controlled for when measuring LT and its main components.

Purpose To evaluate the demographic, clinical, and histopathologic characteristics of periocular inverted follicular keratosis (IFK), a very rare lesion with poorly defined characteristics. Study design Retrospective case series. Methods We evaluated 11 patients with clinically diagnosed IFK confirmed by histologic analysis. Data were collected on the patients’ demographics, clinical presentation and course of the disease, signs and symptoms, location of the lesion, and outcomes of treatment. Results The patients’ mean age was 71 years (range, 32–91 years). Seven (64%) of the patients were female. Eight of the patients (72.7%) had no symptoms, two (18.2%) reported itching, and one (9.1%) had edema and bleeding of the lesion. The lesion affected the upper eyelid in 4 of the patients (36%), the lower lid in 3 of the patients (27%), and the inner canthus in 4 of the patients (36%). Conclusions IFK has no specific clinical characteristic and thus requires histologic confirmation for its diagnosis and appropriate management.

Purpose: To evaluate the changes on the position of the lower lid after phacoemulsification surgery using objective methods. Methods: This prospective study evaluated the lower lid position of cataract carriers who underwent to phacoemulsification surgery from January to May 2017. Data were collected on demographics, type of anesthesia, duration of the surgical procedure, and duration of the speculum remained in place. Standardized digital photographs of the patient's face in primary gaze position were obtained preoperatively and 1, 30, 90, and 180 days, postoperatively. The data were analyzed on the distraction test, distance of the lower lacrimal punctum from the inner canthus, and margin reflex distance 2 (MRD2). Comparative and correlation statistical analyses involving preoperative and postoperative measurements were performed. Results: One hundred twelve cataract patients comprised the study sample. There were 68 (60.7%) females with a median age of 74 (interquartile range, 70-81) years old. The mean distraction test value before surgery was 7 ± 2 mm and 6.8 ± 1.8 mm 180 days postoperatively (P = 0.02). The mean lacrimal lower punctum distance changed from 5 ± 1.1 mm preoperatively to 5.4 ± 1 mm at 180 days postoperatively (P = 0.06). The mean MRD2 preoperatively was 5 ± 1 mm and increased to 5.4 ± 0.9 mm 180 days after surgery (P = 0.02). The duration of surgery and the duration that speculum remained in place were not correlated to MRD2 (P = 0.7; P = 0.98). Conclusions: There is a mild lower lid laxity after phacoemulsification reflected by slight increased lacrimal lower punctum distance to the inner canthus and MRD2. Lacrimal lower punctum distance and MRD2 vary along the study and remained altered at 180 days after surgery, while distraction test tends to recover to similar preoperative levels. Although lid laxity is common in elderly cataract carriers, even a short procedure as phacoemulsification can mildly increase flaccidity.

Purpose: To define the incidence, characteristics, and management of eyelid basal cell carcinoma (BCC) in Central Spain. Methods: This retrospective study investigates the characteristics and the outcome of eyelid BCC from 2000 to 2016 in a central region of Spain. Data were collected on demographics, skin phenotype, location of the eyelid lesion, clinical and histological diagnosis, surgery, commitment of surgical margins, and recurrence rate. Results: Primary eyelid BCC occurred in a mean of 20.6 lesions a year or 9.4/100,000 inhabitants/year. The mean age of BCC carriers was 69.4 ± 16.2 years, with no gender difference (P = 0.479), predominantly affecting Fitzpatrick II-III skin (81.3%) (P < 0.001). The most common location was the inner canthus (154/45.7%) (P < 0.001) and type nodular (215 cases/63.8%) (P < 0.001). The surgical margins were affected in 69 (20.5%) individuals, and the recurrence rate was 5.6 (95% confidence interval, 3.2-8.3) significantly higher in affected margins (P < 0.001). The most common location for recurrence was the inner canthus (P = 0.003), and the most common histological type for recurrence was sclerosing (16.7%), then multinodular (12.5%), and infiltrating (10.4%) with no significant difference (P = 0.27). Conclusions: The frequency of occurrence of eyelid BCC is much less than the estimated crude incidence for skin tumors involving all areas of the body in the Spanish population. Eyelid BCC is more common in the seventh decade of life, with no predilection for gender. Nodular histological type is the most common. The recurrence rate is 5.6%, depending on site and affected margins, even though clear free margins also can present with recurrence.