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Purpose: To report visual outcomes and corneal biomechanical changes after femtosecond-assisted Intacs SK implantation in keratoconic eyes. Methods: This prospective interventional case series is comprised of 32 keratoconic eyes of 25 patients with mean age of 23.8 ± 5.4 years. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, manifest refraction spherical equivalent (MRSE), keratometry, central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF) were measured preoperatively, and 1, 3 and 6 months postoperatively. Results: Mean UDVA improved from 0.81 ± 0.3 LogMAR preoperatively to 0.53 ± 0.2 LogMAR six months postoperatively (P < 0.001). At 6 months, MRSE was significantly reduced only in eyes with moderate KCN (mean change, +2.61 ± 0.54 diopter [D]; P< 0.001). A significant improvement in sphere (mean change, +1.92 ± 0.37 D; P< 0.001) and mean keratometry (mean change, -3.34 ± 0.47D; P< 0.001) were observed. CCT increased from 446.1 ± 38 μm preoperatively to 462.2 ± 50 μm at six months (P < .001). CRF decreased from 6.5 ± 1.6 mmHg to 5.9 ± 1.1 mmHg six months after surgery (P = 0.02). CDVA, refractive cylinder and CH did not change significantly (P = 0.48, 0.203 and 0.55, respectively). Linear regression analysis disclosed that a decrease in CCT and moderate KCN are associated with higher CRF (standardized B,-0.513 and 0.314;P= 0.004 and 0.024, respectively; Adjusted R square = 0.353). Conclusion: Visual, refractive and keratometric indices remarkably improved in a parallel fashion. CRF was inversely associated with CCT. Changes in CRF represent the trend of changes in corneal biomechanics and thickness during the early postoperative months.

To report the outcomes of cataract surgery at a large referral eye hospital and to identify factors associated with less than excellent visual outcomes. Hospital records of patients, who had undergone age-related cataract extraction (1,285 procedures) within a two-year period were sampled randomly for 353 patients (405 eyes) and baseline characteristics were recorded. Up to three causes of visual loss (contributory reasons) were considered and the principal cause of \"less than excellent outcome,\" i.e., best spectacle corrected visual acuity (BSCVA) <20/25 was defined as the primary reason. Mean age of the participants was 68.6 years, and 50.7% of enrolled subjects were female. Phacoemulsification had been performed in 92.1% of cases. Out of 405 eyes, 54%, 78%, and 97% achieved BSCVA of ≥20/25, ≥20/40, and ≥20/200, respectively. Poor visual outcomes were significantly associated with older age (OR: 4.55 for age >70 years), female gender (OR: 4.64), ocular comorbidities (OR: 7.68), surgically challenging eyes (OR: 7.33), long and short eyes (versus eyes with normal axial length, OR: 3.24), and being operated on by a novice surgeon (OR: 2.41). The leading contributory reasons for unfavorable outcome, in descending order were maculopathy (17%), posterior capsule opacification (PCO, 11.8%), corneal opacity (5.7%), and degenerative myopia (5.4%). Maculopathy, PCO, corneal opacity, degenerative myopia and ARMD may contribute to unfavorable outcomes in cataract surgery.

Purpose To compare the visual, refractive, and anatomical outcomes and incidence of complications between combined pars plana vitrectomy and phacoemulsification (phacovitrectomy) versus pars plana vitrectomy (PPV-only) in phakic eyes with rhegmatogenous retinal detachment (RRD). Methods Two independent reviewers searched MEDLINE, Cochrane Central, and Web of Science to identify relevant articles. Prospective or retrospective studies comparing PPV-only and phacovitrectomy for RRD were included. Recruited studies provided information about at least anatomical success or refractive outcomes. Meta-analysis was performed for single surgery success rate, final best-corrected visual acuity (BCVA), postoperative complications, mean predicted refractive error, and mean absolute predicted refractive error. Results Seven studies (788 eyes) were selected, including two clinical trials and five retrospective comparative case series. The single surgery success rate was similar in PPV-only and phacovitrectomy groups (risk ratio [RR] = 1.02; 95% confidence interval [CI] 0.95–1.10; P  = 0.57). Mean final BCVA was significantly better in the PPV-only group than the phacovitrectomy group (MD = 0.06; 95% CI 0.00–0.12; P  = 0.04). The risk of epiretinal membrane formation was significantly higher in eyes that underwent phacovitrectomy than PPV-only (RR = 2.85; 0.95% CI 1.5–5.41; P  = 0.001). Phacovitrectomy group showed a more myopic final mean predicted refractive error than PPV-only group (MD = −0.31; 95% CI −0.55–−0.07; P  = 0.01). Conclusion There was no significant difference between the two groups regarding the anatomical outcome. Slightly better visual and refractive results were observed in the PPV-only group. However, the results should be interpreted with caution as the majority of included studies were low-quality retrospective studies.

To evaluate the short-term effects of a single subconjunctival injection of triamcinolone acetonide as an adjunct to subconjunctival bevacizumab for prevention of corneal neovascularization in rats. Chemical cauterization was performed in the central cornea of the right eye in 48 male Sprague-Dawley rats (4 eyes were excluded due to perforation and/or infection). Immediately after the injury, the rats were randomly assigned to four treatment groups: controls (n=10), received subconjunctival injection of 0.02 mL balanced salt solution; group 1 (n=12), received 0.02 mL bevacizumab (25 mg/mL); group 2 (n=11), were treated with 0.02 mL triamcinolone acetonide (40 mg/mL); and group 3 (n=11), received both bevacizumab and triamcinolone acetonide. On days 7 and 14 after cauterization, digital photographs of the corneas were taken and the area of neovascularization was calculated and compared among the study groups. The area of corneal neovascularization in all three treatment groups was less than the controls (P<0.05 for all comparisons). On day 7, the corneal avascular area was largest in group 3 (63%). On day 14, the area of corneal neovascularization in groups 2 and 3 was smaller than that in group 1 (P=0.031 and 0.011, respectively), but the difference between groups 2 and 3 was not statistically significant (P=0.552). Microscopic evaluation of the cornea was compatible with gross findings; inflammation and the number of new vessels was the least in group 3. Triamcinolone acetonide was more effective than bevacizumab in inhibiting corneal neovascularization. Its adjunctive administration to bevacizumab resulted in even better prevention of corneal neovascularization. However, the produced combined effect was less than the sum of their separate effects and did not match additive or synergistic interactions.

To devise and evaluate a screening algorithm for glaucoma in clinical settings. Screening included examination of the optic disc for vertical cupping (≥0.4) and asymmetry (≥0.15), Goldmann applanation tonometry (≥21 mmHg, adjusted or unadjusted for central corneal thickness), and automated perimetry. In the diagnostic step, retinal nerve fiber layer imaging was performed using scanning laser polarimetry. Performance of the screening protocol was assessed in an eye hospital-based program in which 124 non-physician personnel aged 40 years or above were examined. A single ophthalmologist carried out the examinations and in equivocal cases, a glaucoma subspecialist's opinion was sought. Glaucoma was diagnosed in six cases (prevalence 4.8%; 95% confidence interval, 0.01-0.09) of whom five were new. The likelihood of making a definite diagnosis of glaucoma for those who were screened positively was 8.5 times higher than the estimated baseline risk for the reference population; the positive predictive value of the screening protocol was 30%. Screening excluded 80% of the initial population. Application of a formal screening protocol (such as our algorithm or its equivalent) in clinical settings can be helpful in detecting new cases of glaucoma. Preliminary performance assessment of the algorithm showed its applicability and effectiveness in detecting glaucoma among subjects without any visual complaint.

Background/Aims: Obesity is believed to accelerate age-related cataractogenesis through various biomechanisms. On the contrary, there are also studies advocating the protective role of obesity against the cataract formation process. We investigate the correlation of body mass index (BMI) as a measure for obesity with crystalline optical lens density and opacity in a healthy adult population. Methods: In a cross-sectional setting, 93 consecutive disease-free adult individuals who were working staff of a university-based hospital were assessed for the association between crystalline lens density and opalescence [measured by the objective Pentacam HR lens densitometry and subjective Lens Opacity Classification System III (LOCS III), respectively] with the degree of obesity as defined by BMI. Results: LOCS III and crystalline lens density readings were positively correlated [Spearman rho CC (p value) = 0.224 (0.034)]. However, we found neither LOCS III nor crystalline lens density to be correlated with BMI [Spearman rho CC = −0.008 (p = 0.943) and −0.062 (p = 0.560), respectively]. Conclusions: Results from the present study indicate a lack of association between obesity and densitometry of the crystalline in the adult population group. Further studies are required to confirm the order of causality and pathogenesis of this finding.

There is no specific agreement which surgical approach leads to the best outcome. [...]a major challenge of surgical management of corneal cysts is their frequent recurrence after the operation. [...]the lesion was 5 and 8 mm in diameter [Figure 1]a. Other findings of ocular examination were otherwise unremarkable. Because the corneal cyst had threatened patient's visual axis, surgical intervention was planned.

Steroids are still the mainstay of management of nephrotic syndrome (NS). It was shown that steroids could impair growth and development of children. However, other clinical studies have shown conflicting results. Hospital records of 147 children with diagnosis of NS who were followed during 1988-2008 are reviewed relating to height measurements. All patients were treated with prednisolone and had been followed for at least five years. Height measures were transformed into standard deviation score (SDS). Information on dose and duration of prednisolone therapy, histological findings of biopsy as well as concomitant use of steroid-sparing agents (SSA) were also analyzed. Mean age at onset of NS was 5.94 years and at last follow-up visit 15.08 years. All patients had normal renal function during entire duration of the study. Analysis of the whole population did not show any significant alterations in the height SDS (Ht(SDS)) between the first and the last follow-up visit (P=0.5; -0.76±2.0 vs. -0.89±2.05 respectively). The patients were divided into two subgroups. Subgroup A, which achieved growth improvement, was composed of 62 children (initial Ht(SDS) -1.63; final Ht(SDS) -0.08; P<0.001) and subgroup B, that showed growth retardation, included 85 children (initial Ht(SDS) -0.13; final Ht(SDS) -1.59; P<0.001). No statistically significant retardation of linear growth was observed in the study population as a group following treatment with prednisolone according to the guidelines of ISKDC. Although about 62 subjects had growth retardation, children treated with prednisolone were not different from those who had increased growth.

Background: To compare the effect of different dosages of subconjunctival bevacizumab with its topical administration on preventing the development of corneal neovascularization (CNV) in a rat model of corneal chemical injury. Methods: Neovascularization was induced by pressing a 2-mm diameter alkaline-coated applicator on the central cornea of the right eye of 50 anesthetized male rats. Immediately after cauterization, rats were divided randomly into 5 groups. Groups 1–4 received a subconjunctival injection of 0.02 ml of normal saline (control) or 1, 5 and 25 mg/ml of bevacizumab, respectively. In the fifth group, topical bevacizumab was instilled daily for 7 consecutive days. After 7 days, digital photographs of the cornea were taken and the area of the neovascularized cornea was calculated. Results: Analysis of digital photographs showed that, compared with the controls, a single subconjunctival injection of at least 0.1 mg of bevacizumab (5 mg/ml) – immediately after corneal cauterization – effectively decreased CNV after 7 days. Injection of 25 mg/ml of bevacizumab in the fourth group increased the avascular area more than twofold, compared with the saline-treated group (32.2% compared with 15%, p < 0.001). This difference between groups 4 and 2 was statistically significant (p = 0.04). Although topical delivery of 25 mg/ml bevacizumab was effective to inhibit CNV (p = 0.004), the results were similar to those of the third group. Qualitative microscopic evaluation of the cornea was compatible with the gross findings, as bevacizumab-treated groups had less intense corneal vessel channels and inflammation. Conclusion: Both subconjunctival and topical bevacizumab can prevent CNV in rats.