Search

Teiji Yagasaki,1,2 Yoshimi Yokoyama,2 Ayaka Yagasaki,2,3 Makiko Tsukui2 1Yagasaki Eye Clinic, Ichinomiya, Aichi, Japan; 2Department of Ophthalmology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Aichi, Japan; 3Department of Ophthalmology, Gifu Prefectural General Medical Center, Gifu, Gifu, JapanCorrespondence: Teiji Yagasaki, Yagasaki Eye Clinic, 62-6 Gonaka, Kaimei, Ichinomiya, Aichi, 494-0001, Japan, Tel +81-586-61-8787, Fax +81-586-61-9210, Email y-teiji@jb3.so-net.ne.jpPurpose: To evaluate the effects of bilateral medial rectus resection (BMRres) on motor outcomes in infantile exotropia.Methods: We evaluated 19 cases of infantile exotropia surgery. The mean age at surgical alignment was 4.8± 3.4 years (range, 1.5– 11.8 years). The surgical procedures included BMRres (5 cases), BMRres with unilateral lateral rectus recession (ULRR) (3 cases), bilateral lateral rectus recession (BLRR) (8 cases), unilateral lateral rectus recession and medial rectus resection (uniRandR) with contralateral lateral rectus recession (2 cases), and uniRandR (1 case). After dividing the cases into two groups (BMRres group, n=8; other group, n=11), the outcomes at 1 day and at 1, 3, and 6 months after surgery were compared. Surgical outcomes were defined as (1) success: distant esotropia ≤ 5 prism diopters (Δ) or exotropia ≤ 10Δ, (2) recurrence: exotropia > 10Δ, or (3) overcorrection: esotropia > 5Δ.Results: Although postoperative distant deviations at 1 day were not different between the two groups, the BMRres group showed smaller distant deviations at 1, 3, and 6 months than the other group (p=0.015, 0.019, and 0.006, respectively). Success rates of the BMRres and other groups were 88% and 73% at 1 day, 100% and 36% at 1 month, 88% and 27% at 3 months, 88% and 18% at 6 months, respectively. Although there were no significant differences between the two groups within 3 months after surgery, surgical outcomes in the BMRres group 6 months after surgery were significantly better than those in the other group (p=0.003).Conclusion: BMRres is a better procedure than others for infantile exotropia to achieve desirable motor outcomes after surgery.Keywords: infantile exotropia, strabismus surgery, bilateral medial rectus resection, motor outcome

Damon S Dierker,1 Scott G Hauswirth2 1Eye Surgeons of Indiana, Indianapolis, IN, USA; 2Department of Ophthalmology, Sue-Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USACorrespondence: Damon S Dierker, Eye Surgeons of Indiana, 9202 N Meridian St, #100, Indianapolis, IN, 46260, USA, Email damon.dierker@esi-in.comSignificance: Meibomian gland dysfunction (MGD) is among the most common causes of dry eye disease worldwide. Few studies have compared treatment options, and the basis for an evidentiary approach to MGD management is lacking. We have conducted a non-randomized trial evaluating the additive benefit of a recently developed therapy.Purpose: To compare the efficacy of thermal pulsation therapy alone or combined with the dexamethasone intracanalicular insert (Dextenza) on the signs and symptoms of MGD.Methods: This was a prospective, patient-masked, sham-controlled, non-randomized trial. All subjects underwent thermal pulsation therapy using the LipiFlow system. The dexamethasone intracanalicular insert was placed in the inferior canaliculus of the more symptomatic eye (DEX group), while sham punctal dilation of the fellow eye was performed to preserve patient masking (SHAM group). Key outcomes were improvement in meibum expressibility at 1, 4, and 12 weeks and patient treatment preference at week 12.Results: Nineteen subjects underwent thermal pulsation therapy and received the DEX insert. Meibomian gland expressibility scores improved significantly in both groups at 1, 4, and 12 weeks, with significantly greater improvement in DEX eyes than SHAM eyes at 12 weeks (P=0.027). Improvement from baseline in TBUT was significant at all time points in DEX eyes and only at week 4 in SHAM eyes, with significantly greater improvement in DEX eyes over SHAM eyes at week 12 (P=0.028). Mean best-corrected visual acuity and intraocular pressure remained unchanged from baseline throughout follow-up in both groups, and no adverse events were noted. Combined therapy with DEX was preferred by 61% of subjects.Conclusion: This study demonstrated a significant benefit of combining thermal pulsation therapy with the dexamethasone intracanalicular insert on signs of MGD including TBUT and meibomian gland expressibility score. Consequently, a majority of patients preferred combination therapy to thermal pulsation therapy alone.Keywords: Dextenza, dexamethasone, LipiFlow, thermal pulsation therapy, meibomian gland dysfunction

Katarzyna Ewa Nowik,1 Kamil Nowik,1 Piotr Kanclerz,2,3 Jacek Paweł Szaflik1 1Department of Ophthalmology, Public Ophthalmic Clinical Hospital (SPKSO), Medical University of Warsaw, Warsaw, Poland; 2Department of Ophthalmology, Hygeia Clinic, Gdańsk, Poland; 3Helsinki Retina Research Group, University of Helsinki, Helsinki, FinlandCorrespondence: Katarzyna Ewa Nowik, Tel +48 509 873 680, Email lek.katarzynaolejnik@onet.euPurpose: Extended depth of focus intraocular (EDOF) IOLs form a bridge between single- and multifocal IOL design. This study aimed to compare clinical outcomes obtained after implanting two different optical designs of EDOF IOLs: the Mini Well Ready (SIFI Medtech, Catania, Italy) and Tecnis Symfony (Abbott Laboratories, Illinois, USA).Methods: The retrospective observational study included 61 patients (122 eyes) who underwent bilateral implantation of the Mini Well Ready IOL (32 patients) or the Tecnis Symfony IOL (29 patients). The following preoperative and postoperative parameters were evaluated: spherical equivalent, anterior astigmatism, pupil size, monocular and binocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), monocular and binocular uncorrected intermediate visual acuity (UIVA) and distance-corrected intermediate visual acuity (DCIVA), monocular and binocular uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA). In the 6 months postoperative period, defocus curve, contrast sensitivity, photopic phenomena, and posterior capsule opacification were assessed.Results: The patients receiving the Tecnis Symfony had slightly better monocular and binocular UDVA and CDVA than with the Mini Well Ready IOL, the differences were not statistically significant. Whereas the UIVA, DCIVA, UNVA, DCNVA, UNVA and DCNVA values were higher in the Mini Well Ready group, the differences were not significant. There were no significant between-group differences regarding the defocus curve for the vast majority of tested vergences. Dysphotopsias postoperatively were assessed at 6 months.Conclusion: Patients receiving both the Mini Well Ready and Symfony IOLs had excellent visual acuity outcomes and spectacle independence.Keywords: cataract, extended depth of focus, defocus curve, intraocular lens

Mohamed Salah El-Din Mahmoud, Ahmed Shawkat AbdelHalim, Hosny Ahmed Zein Ophthalmology Department, Faculty of Medicine, Minia University, Minia, EgyptCorrespondence: Mohamed Salah El-Din Mahmoud, Ophthalmology Department, Faculty of Medicine, Minia University, Minia, Egypt, Tel +20 1003321802, Email Mohamed_Zaki@mu.edu.eg; drmsalah1982@yahoo.comPurpose: To investigate the dynamic pupil and vault changes in eyes with implantable phakic contact lens (IPCL) under photopic and scotopic settings, as well as during accommodation using the anterior segment optical coherence tomography (AS-OCT).Methods: A prospective observational study included consecutive 36 eyes of myopic patients who underwent IPCL V2.0 implantation. Under photopic and scotopic light settings, as well as during accommodation, all patients were scanned using CASIA OCT (CASIA2; TOMEY, Nagoya, Japan). The pupil size, the vault (distance between the back surface of the IPCL and the anterior lens capsule), ACD-lens (distance between the posterior corneal surface and the anterior lens surface), IPCL-lens (distance between the posterior corneal surface and the anterior IPCL surface), and lens thickness (LT) were the study parameters.Results: The vault was significantly lower under photopic conditions (p-value< 0.001). The pupil size was significantly smaller in photopic conditions (p-value< 0.001). LT (p-value=0.975) and ACD-lens (p-value=0.917) were not significantly different between scotopic and photopic conditions, while the ACD-IPCL was significantly larger during photopic conditions (p-value=0.013). There were significant changes in all parameters between accommodative and non-accommodative conditions.Conclusion: The IPCL vault decreased significantly under photopic light conditions and accommodation.Keywords: IPCL, photopic light, scotopic light, lens accommodation, vault, AS-OCT

Jeffrey K Luttrull,1 Gerry Gray2 1Ventura County Retina Vitreous Medical Group, Ventura, CA, USA; 2Regulatory Pathways, Inc, Laguna Beach, CA, USACorrespondence: Jeffrey K Luttrull, Ventura County Retina Vitreous Medical Group, 3160 Telegraph Road, Suite 230, Ventura, CA, 93003, USA, Tel +1 805-6500664, Fax +1 805 650-0865, Email jkluttrull@gmail.comPurpose: To access the impact of regular periodic subthreshold diode micropulse laser (SDM) as Vision Protection Therapy on the rate of neovascular conversion of dry age-related macular degeneration (AMD).Methods: Patient unidentified clinical data aggregated by Vestrum Health, LLC (VH) from 300 retina specialists across the United States was analyzed to examine the effect of a program of regular periodic panmacular low-intensity/high-density subthreshold diode micropulse laser as vision protection therapy (VPT) compared to standard care alone, on the incidence of neovascular conversion in patients with dry age-related macular degeneration (AMD), between January 4, 2016, and September 30, 2020, producing 392,250 eyes for study.Results: After applying inclusion and exclusion criteria, eyes were matched by propensity scoring for key risk factors. This produced 830 eyes managed by standard care plus VPT, performed on average every 108 days per eye; and 8300 eyes managed with standard care alone (SCA) in a 1/10 ratio for comparison. Comparison found that VPT eyes had a markedly lower rate of neovascular conversion than SCA eyes (hazard ratio 13.04) overall, and for each propensity score matched quintile. VA worsened over time in the SCA group but improved in the VPT group.Conclusion: Our findings suggest that, compared to standard care alone, VPT may markedly reduce the rate of neovascular conversion in AMD, the main cause of irreversible visual loss worldwide.Keywords: age-related macular degeneration, dry, neovascular, neuroprotection, prevention, real-world data, reset, subthreshold micropulse laser, vision protection therapy

Robert Edward T Ang,1– 3 Neiman Vincent R Bargas,1 Gladness Henna A Martinez,1 George Michael N Sosuan,3 Maria Isabel Nabor-Umali2 1Department of Ophthalmology, Cardinal Santos Medical Center, San Juan City, Metro Manila, Philippines; 2Cornea and Refractive Surgery Service, Asian Eye Institute, Makati City, Metro Manila, Philippines; 3Glaucoma Service, Asian Eye Institute, Makati City, Metro Manila, PhilippinesCorrespondence: Robert Edward T Ang, Cornea and Refractive Surgery and Glaucoma Services, Asian Eye Institute, Makati City, Metro Manila, Philippines, Email angbobby@hotmail.comObjective: To compare the intraocular pressure (IOP) obtained by Goldmann applanation tonometer (GAT), correcting applanation tonometer surface (CATS) and biomechanically corrected IOP (bIOP) of Corvis ST tonometer (CVS); and to determine the effects of manifest refraction spherical equivalent (MRSE), central corneal thickness (CCT) and mean corneal curvature (Km) on the IOP measurements of corneal refractive patients.Methods: This was a single-center, retrospective, cross-sectional study of 120 eyes of 64 patients from May 1, 2020 to June 1, 2021 who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). The level of agreement between the three tonometers was evaluated, and correlation between parameters was calculated using Pearson correlation.Results: Mean preoperative to postoperative IOP in LASIK and PRK was 15.1 ± 3 to 11.3 ± 2.1 and 14.4 ± 2.6 to 12.1 ± 3 using GAT, 16.4 ± 2.8 to 13.1 ± 2.3 and 15.9 ± 2.6 to 13.7 ± 3 using CATS and 14.8 ± 2.4 to 12.9 ± 1.5 and 14.2 ± 2.4 to 12.6 ± 1.9 using CVS-bIOP. Preoperative IOP correlation between each tonometer pair showed that the lowest mean difference was between GAT and CVS-bIOP (0.32 in LASIK, 0.15 in PRK). Preoperative to postoperative IOP correlation of each tonometer resulted in a difference of 3.77, 2.30 in GAT; 3.32, 2.28 in CATS and 1.88, 1.62 in CVS-bIOP in the LASIK and PRK groups, respectively. Percentage change in CCT and Km was not correlated while change in MRSE had a weak relationship with percentage change in CVS-bIOP.Conclusion: Preoperatively, GAT and CVS-bIOP had the best agreement in IOP measurements. CATS recorded the highest IOP preoperatively and postoperatively. IOP decreased in the three tonometers after LASIK and PRK with GAT having the largest decrease. CVS-bIOP had the lowest change between preoperative and postoperative IOP measurements. Only percentage change in MRSE was correlated with percentage change in CVS-bIOP in the LASIK group.Keywords: IOP, GAT, CATS, CVS, LASIK, PRK

Olga Furashova,1 Joerg Thalwitzer,2 Egbert Matthé3 1Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany; 2Department of Neuroradiology, Klinikum Chemnitz gGmbH, Chemnitz, Germany; 3Department of Ophthalmology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyCorrespondence: Olga Furashova, Department of Ophthalmology Klinikum Chemnitz gGmbH, Flemmingstrasse 2, Chemnitz, 09116, Germany, Tel +49 371 333 33230, Fax +49 371 333 33223, Email fur.olga@gmail.comPurpose: To report on four cases of central retinal artery occlusion (CRAO) treated with intra-arterial thrombolysis with early onset neovascular glaucoma in the further disease course.Patients and Methods: Retrospective analysis of the medical records of six consecutive patients treated with intra-arterial thrombolysis for CRAO of which four developed neovascular glaucoma.Results: All six patients were diagnosed with acute CRAO and treated with intra-arterial thrombolysis 4.5– 6 hours after symptom onset. The patients had no significant carotid artery stenosis and unremarkable ophthalmic history. No visual improvement could be achieved after treatment. Four to seven weeks after CRAO onset, four of these patients developed severe painful neovascular glaucoma.Conclusion: Early onset of aggressive neovascular glaucoma following intra-arterial thrombolysis for CRAO might be a complication of CRAO itself, still possible association with intra-arterial thrombolysis in our patients should be discussed.Keywords: neovascular glaucoma, retinal artery occlusion, intra-arterial thrombolysis

Keyvan Koushan,1,2 Arshia Eshtiaghi,3 Pauline Fung,2 Alan R Berger,1,2 David R Chow1,2 1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; 2Toronto Retina Institute, Toronto, Ontario, Canada; 3Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Keyvan Koushan, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto Retina Institute, Toronto, Ontario, Canada, Tel +1 416 356-4355, Email keyvan.koushan@uToronto.caPurpose: To investigate the safety and efficacy of micropulse (MP) macular laser in combination with intravitreal aflibercept for the treatment of center-involved diabetic macular edema (CI-DME).Methods: A single-blind prospective randomized controlled pilot trial was performed. In total, 30 eyes of 30 patients with CI-DME and best corrected visual acuity (BCVA) between, and including, 20/30 and 20/400 were enrolled. Enrolled eyes were randomized to 2 groups. Group 1 received intravitreal aflibercept injections (IVT-AFL) with sham laser. Group 2 received IVT-AFL with MP laser. Both groups were followed every 4 weeks for 48 weeks and retreatment was performed on pro re nata basis according to preset criteria. The main outcome measure was the average number of intravitreal injections for each group at 48 weeks. Secondary outcome measures included changes in BCVA and central macular thickness (CMT) at 24 and 48 weeks.Results: The average number of intravitreal injections at 48 weeks was similar between the groups (8.5± 3.3 in Group 1 vs 7.9± 3.6 in Group 2, p=0.61). After 48 weeks, both groups demonstrated an improvement in BCVA and CMT. However, the difference in improvement between the groups was not statistically significant (p=0.18 for BCVA and p=0.57 for CMT).Conclusion: Intravitreal injections of aflibercept led to improvements in BCVA and CMT at 24 and 48 weeks. Addition of MP laser to eyes in group 2 did not offer additional benefit in reducing treatment burden or improving CMT. Eyes that received MP laser showed a numerically greater improvement in BCVA, although this was not statistically significant.Clinicaltrials.gov Identifier: NCT03143192 March 8, 2017.Keywords: anti-VEGF, diabetic macular edema, micropulse laser, visual acuity

Helga P Sandoval,1 Richard Potvin,2 Kerry D Solomon1 1Carolina Eyecare Physicians, LLC, Mt. Pleasant, SC, USA; 2Science in Vision, Bend, OR, USACorrespondence: Kerry D Solomon, Carolina Eyecare Physicians, LLC, 1101 Clarity Road, Suite 100, Mt Pleasant, SC, 29464, USA, Email ksolomon@cepmd.comPurpose: To objectively determine if angle kappa materially influenced clinical outcomes or patient-reported satisfaction and visual quality of patients implanted with a trifocal intraocular lens (IOL).Methods: This was a non-interventional study of clinical outcomes. Subjects were patients choosing to be bilaterally implanted with a trifocal IOL (PanOptix®) who were then evaluated 3 months postoperative. Angle kappa (AK) was measured before surgery and at the 3-month visit. The 3-month visit included a manifest refraction, and measurement of uncorrected and distance corrected acuity at 4 m, 60 cm and 40 cm. Visual quality and satisfaction questionnaires were also administered.Results: Data from 56 eyes of 28 subjects were analyzed; 26 eyes had an AK magnitude < 0.3 mm, 14 had an AK from 0.3 mm to less than 4 mm and 16 had an AK ≥ 0.4 mm. Neither visual disturbances (eg, glare, halos, starbursts), satisfaction nor spectacle dependence were correlated to the magnitude of angle kappa. The magnitude of postoperative AK was significantly lower than preoperative (0.24 ± 0.12 mm vs 0.30 ± 0.16 mm, p < 0.01).Conclusion: The magnitude of preoperative Angle Kappa had no apparent effect on the refractive, visual acuity or subjective (visual disturbances, quality of vision, satisfaction) clinical outcomes with this trifocal IOL. The magnitude of angle kappa was significantly lower after surgery.Keywords: angle kappa, trifocal IOL, cataract surgery

Mark J Gallardo,1 Mark F Pyfer,2 Steven D Vold,3 Steven R Sarkisian Jr,4 Anita Campbell,5 Inder Paul Singh,6 Brian Flowers,7 Kavita Dhamdhere8 On behalf of the GEMINI study group1El Paso Eye Surgeons, PA, El Paso, TX, USA; 2Northern Ophthalmic Associates, Jenkintown, PA, USA; 3Vold Vision, Fayetteville, AR, USA; 4Oklahoma Eye Surgeons, PLLC, Oklahoma City, OK, USA; 5Grene Vision Group, Wichita, KS, USA; 6Eye Centers of Racine & Kenosha, Racine, WI, USA; 7Ophthalmology Associates, Fort Worth, TX, USA; 8Clinical Development, Sight Sciences, Menlo Park, CA, USACorrespondence: Kavita Dhamdhere, Email kdhamdhere@sightsciences.comPurpose: To report 12-month efficacy outcomes of 360° canaloplasty and 180° trabeculotomy using the OMNI surgical system in combination with phacoemulsification in patients with mild-moderate open-angle glaucoma (OAG) and visually significant cataract.Setting: Fifteen multi-subspecialty ophthalmology practices and surgery centers located in 14 US states.Design: Prospective, multicenter, IRB approved study of patients treated with canaloplasty (360°) and trabeculotomy (180°). Eligible patients had cataract and mild-moderate OAG with intraocular pressure (IOP) ≤ 33 mmHg on 1 to 4 hypotensive medications. Unmedicated post-washout mean diurnal IOP (DIOP) ≥ 21 and ≤ 36 mmHg.Methods: Medication washout preoperatively and prior to month 12 DIOP. Effectiveness outcomes were IOP and IOP lowering medication use. Safety outcomes included adverse events and secondary surgical interventions (SSIs). Evaluations at 1, 3, 6, and 12 months.Results: A total of 149 subjects underwent surgery and 120 were included in the final effectiveness analysis. Mean (standard deviation) unmedicated diurnal IOP was reduced from 23.8 (3.1) mmHg at baseline to 15.6 (4.0) at month 12 (− 35%) and medications (before washout) were reduced from 1.8 (0.9) at baseline to 0.4 (0.9) at month 12 (− 80%). At month 12, 84.2% of eyes achieved IOP reductions > 20% from baseline, 80% of eyes were medication-free, and 76% of eyes achieved IOP between 6– 18 mmHg inclusive. Adverse events were uncommon. Most were mild and self-limited including transient hyphema (9 of 149; 6%) and transient IOP elevations (3 of 149; 2.0%). No eyes required SSIs or experienced loss of VA that was attributable to the device or procedure.Conclusion: Canaloplasty and trabeculotomy performed with the OMNI surgical system at the time of phacoemulsification significantly reduces unmedicated mean diurnal IOP and medication use 12 months postoperatively, with an excellent safety profile. This procedure should be considered for eyes with mild-moderate OAG to reduce IOP, medication burden, or both.Keywords: viscodilation, MIGS, open-angle glaucoma, glaucoma surgery, canaloplasty, trabeculotomy, OMNI

Elizabeth Yeu,1,2 Omar Hashem,3 Hosam Sheha3– 5 1Virginia Eye Consultants, Norfolk, VA, USA; 2Eastern Virginia Medical School, Norfolk, VA, USA; 3Research Institute of Ophthalmology, Cairo, Egypt; 4Florida International University Herbert Wertheim College of Medicine, & Glaucoma Research Organization, Miami, FL, USA; 5Manhattan Eye, Ear and Throat Hospital, Hofstra Northwell School of Medicine, New York, NY, USACorrespondence: Hosam Sheha, Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, 210 E 64 Street, New York, NY, 10065, USA, Tel +1 917-810-9555, Email hoss88@gmail.comPurpose: To assess the effectiveness of cryopreserved amniotic membrane (CAM) after debridement in treating epithelial basement membrane dystrophy (EBMD) prior to cataract surgery.Methods: This pilot study included 2 treatment groups: a prospective study group of 9 subjects with significant EBMD who received debridement followed by self-retained CAM, and a retrospective, control group of 10 consecutive subjects who received debridement followed by a bandage contact lens (BCL). Slit-lamp photography after fluorescein staining were used to monitor healing. Corneal topography and IOL calculation were compared at baseline and 1 month after the procedure. Refraction and ocular surface stability were also compared after cataract surgery.Results: Corneal reepithelialization after debridement occurred in 4.6 ± 0.8 days in the study group and 6.8 ± 0.6 days in the control (p < 0.05). Corneal topography showed changes in curvature from 43.5 ± 1.2D at baseline to 44.6 ± 1.2D at 1 month in the study group and from 45.0 ± 0.6D to 45.7 ± 0.8D in the control (p = 0.38). Average change in IOL calculation was 1.56 D in the study group, compared to 0.95 D in control (p = 0.29). Post-cataract refraction in both groups was within ± 0.5 Diopter of the anticipated, and corneal surface remained stable without EBMD recurrence.Conclusion: Management of ocular surface disorders prior to cataract surgery stabilizes IOL calculation and reduces postoperative refractive surprises. CAM relatively accelerated healing after debridement; however, it was not better than BCL in stabilizing the ocular surface and improving visual outcome. The use of CAM in cases of EBMD remains speculative.Keywords: amniotic membrane, cataract, EBMD, ocular surface

Nisa Silva,1,&ast; Catarina Castro,1,&ast; Filipa Caiado,1 Sofia Maia,1 Vasco Miranda,1,2 Ricardo Parreira,1 Pedro Menéres1,2 1Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal; 2Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal&ast;These authors contributed equally to this workCorrespondence: Nisa Silva, Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto, 4099-001, Portugal, Tel +35 1918367661, Fax +35 1222077500, Email nisapinhosilva@gmail.comBackground: Understanding how strabismus impacts a child’s quality of life, as well as their families, should be an important key to guide treatment, not only from the ophthalmological point of view but also regarding psychological and social aspects, which are fundamental for a healthy and harmonious development.Methods: A cross-sectional study was performed to evaluate the functional vision and eye-related quality of life (ER-QOL) in a population of children with strabismus submitted or not to corrective surgery, using the recently developed Pediatric Eye Questionnaire (PedEyeQ) and to compare with age and gender-matched visually normal children. The PedEyeQ was applied to non-operated children with strabismus (n = 18), operated children with strabismus (n = 24), and visually normal children (n = 21). This instrument is composed of 3 components (Child, Proxy, and Parent) and has different versions according to the child’s age (0– 4, 5– 11, or 12– 17 years-old versions). Clinical data such as age, type of strabismus, angle of deviation, amblyopia, occlusion treatment, and surgical outcome were also recorded.Results: All PedEyeQ domain scores were significantly lower in children with strabismus compared with visually normal children, except the Child “functional vision” domain. Children with strabismus with successful corrective surgery had significantly lower scores in many domains of the Child, Proxy, and Parent components, compared with visually normal children.Conclusion: This study showed that strabismus has an important impact on affected children and their families, as assessed by PedEyeQ. Interestingly, children with prior successful corrective strabismus surgery had worse PedEyeQ scores compared to visually normal children. Educational programs and psychosocial rehabilitation interventions should be implemented in children with strabismus and their families.Keywords: strabismus, PedEyeQ, pediatric, parents, quality of life

Daniel Laroche,1,2 Melanie Scheive3 1Department of Ophthalmology, New York Eye and Ear Infirmary, Icahn School of Medicine of Mount Sinai, New York, NY, USA; 2Advanced Eyecare of New York, New York, NY, USA; 3Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USACorrespondence: Daniel Laroche, Department of Ophthalmology, New York Eye and Ear Infirmary and Advanced Eyecare of New York, 49 West 127th Street, New York, NY, 10027, USA, Tel +1 212663-0473, Email dlarochemd@aol.comAbstract: Glaucoma continues to be a leading cause of blindness worldwide for the same reasons as in the past several decades, including the lack of early detection, improper treatment, and non-adherence to therapy. Medical therapy continues to be the first-line therapy even as surgical techniques are improving in their safety and efficacy. To turn the tide in preventing blindness from glaucoma, attention must be focused on targeted patient education, screening, effective treatment, and addressing health disparities. To achieve this, early safer cataract surgery and microinvasive glaucoma surgery must be considered as a first-line therapy in addition to medical therapy to best lower both intraocular pressure and the medication burden.Keywords: glaucoma, prevention, cataract surgery, lensectomy, MIGS

Hani M Gharieb Ibrahim Ophthalmology Department, Ain Shams University, Cairo, EgyptCorrespondence: Hani M Gharieb IbrahimOphthalmology Department, Ain Shams University Faculty of Medicine, Ramsees Street, Abbaseya, Cairo, Egypt, Email hani.gharieb@med.asu.edu.eg; extrahany@yahoo.comAim: To test the effect of pharmacological mydriasis on intraocular pressure (IOP) in eyes with functioning blebs compared with normal eyes.Patients and Methods: The cross-sectional study included 39 eyes, of which 19 eyes had filtering trabeculectomy blebs (group A), and 20 eyes with no previous surgeries (group B). IOP was measured using the Goldmann applanation tonometer before, and 30 min after the application of tropicamide 1% eye drops.Results: In group A eyes, the IOP level changed from 13.68 ± 3.4 mmHg before pupillary dilatation, to achieve a level of 11.95 ± 3.03 mmHg following mydriasis, with an average IOP drop of 1.73 mmHg (p < 0.0001). On the other hand, the pre-dilatation IOP in group B eyes was 15.9 ± 3.00 mmHg, had increased after mydriasis to 18.4 ± 2.9 mmHg, with an average rise of 2.5 mmHg (p < 0.0001). The difference in IOP change following mydriasis between both groups was significant (p < 0.0001).Conclusion: Surprisingly, pharmacological pupillary dilatation resulted in a reduction of IOP in eyes with successful trabeculectomy, which is different from the usual effect of raising the IOP as in the control group. This effect has not been previously studied.Keywords: mydriasis, intraocular pressure, trabeculectomy, filtering bleb

Nenita Maganti,1 Natalie Squires,1 Shubhendu Mishra,1 Prithvi Bomdica,1 Divya Nigam,2 Arthur Shapiro,2 Manjot K Gill,1 Alice T Lyon,1 Rukhsana G Mirza1 1Department of Ophthalmology, Northwestern University, Chicago, IL, USA; 2Department of Psychology and Department of Computer Science, American University, Washington, DC, USACorrespondence: Rukhsana G Mirza, Department of Ophthalmology, Northwestern University, Chicago, IL, USA, Tel +1 312-908-8152, Email r-mirza@Northwestern.eduPurpose: This study was performed to characterize changes in contrast sensitivity (CS) that occur in patients with age-related macular degeneration (AMD) using a novel test, the motion diamond stimulus (MDS).Methods: This was a cross-sectional study in which 20 subjects with unilateral exudative AMD (eAMD) and contralateral dry AMD received 3 assessments: the Pelli-Robson (PR) CS Chart, the MDS test, and a visual function questionnaire-25 (VFQ-25). CS results from the PR, and MDS tests were compared across 3 groups: eyes with eAMD vs dry AMD, eAMD vs control, dry AMD vs control. Healthy, undilated eyes from another study served as the control group. Significance was determined using ANOVA analysis for the MDS output parameters (α: overall contrast threshold, β: adaptability of the visual system) and PR logCS. Patients were also administered the VFQ-25 to assess vision-related quality of life.Results: The ANOVA of the MDS data demonstrated a significant difference in visual function according to the β parameter of the 3 groups, but no significant difference in the α parameter. PR CS results for the 3 groups were significantly different, further supporting the MDS results. Post-hoc analysis showed a significant difference in β and PR log CS between the eAMD and control eyes.Conclusion: The MDS test is valuable in discerning CS impairments in patients with AMD. It can provide further insight into the visual changes experienced by patients with AMD and has potential to quantify visual function changes that are not found on visual acuity testing alone.Keywords: age-related macular degeneration, AMD, motion diamond stimulus, MDS, contrast sensitivity, CS

Hisataka Fujimoto,1,&ast; Shintaro Ochi,2,&ast; Yasushi Inoue,2 Junichi Kiryu1 1Department of Ophthalmology, Kawasaki Medical School, Kurashiki, 701-0192, Okayama, Japan; 2Inoue Eye Clinic, Tamano, 706-0011, Okayama, Japan&ast;These authors contributed equally to this workCorrespondence: Hisataka FujimotoDepartment of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan, Tel +81-86-462-1111, Fax +81-86-462-1199, Email fujimoto-h@med.kawasaki-m.ac.jpYasushi InoueInoue Eye Clinic, 1-14-31 Uno, Tamano, 706-0011, Okayama, Japan, Tel +81-86-331-1030, Fax +81-86-331-1114, Email inoue@oka.urban.ne.jpPurpose: To evaluate perioperative dry eye (DE) syndrome and meibomian gland (MG) dysfunction parameters associated with cataract surgery-induced DE symptoms.Patients and Methods: This retrospective, single-centered, observational study included 82 eyes of 43 patients without previous subjective DE symptoms, treatment, ocular comorbidities, and previous use of ophthalmic treatment, except for anti-allergic eye drops, who underwent uncomplicated cataract surgery. MG dropout, lid margin abnormality, meibum quality, meibum expressibility, MG orifice obstruction, ocular surface disease index, non-invasive tear break-up time, tear meniscus height, and Schirmer test score were measured at baseline and 1 month postoperatively. Multivariable logistic regression with generalized estimating equation models was used to determine the risk factors for cataract surgery-induced DE symptoms.Results: Twenty-one patients had subjective DE symptoms 1 month following the cataract surgery. Preoperative and postoperative parameters, preoperative upper eyelid MG loss, and female sex (odds ratio [OR] 6.72, P = 0.012; OR 4.20, P = 0.037, respectively) were identified as risk factors for cataract surgery-induced DE symptoms.Conclusion: Ocular parameters, including upper eyelid MG findings at baseline, were considered important in predicting persistent DE symptoms following cataract surgery.Keywords: meibomian gland dysfunction, dry eye syndrome, retrospective, ocular surface disease index

Ibrahim Abdelkalek Elsaadani, Abdelmonem Mahmoud Hamed, Ahmed Elshahat, Mohamed Amin Heikal Ophthalmology Department, Benha College of Medicine, Benha University, Benha, Qalyopia, EgyptCorrespondence: Abdelmonem Mahmoud HamedOphthalmology Department, Benha College of Medicine, Benha University, Alansar Tower, Science of College St, Benha, Qalopia, Egypt, Tel +201221640288, Email abdelmonem.abdelmonem@fmed.bu.edu.egPurpose: To retrospectively compare the refractive outcomes between two groups of small-incision lenticule extraction (SMILE), one with a single incision and the second one with dual-incisions.Setting: Ebsar Eye Center, Benha, Qalyopia, Egypt.Design: A retrospective cohort study.Methods: This study was made up of two groups (162 eyes each): all eyes in group 1 had one SMILE cut at 120°, and all eyes in group 2 had double SMILE incisions, the first incision at 120° and the second one at 270°. Refractive outcomes between the two groups were compared at 3, 6, and 12 months after surgery.Results: The mean preoperative refractive spherical equivalent (MRSE) was − 5.75 ± 2.59 D and − 6.38 ± 2.18 D in group 1 and 2, respectively (P = 0.73), and a cylinder of 1.25 ± 0.83 D and 0.75 ± 0.81 D, respectively (P = 0.85). At 12 months postoperatively, in group 1, 162 eyes (100%) achieved a UCVA of 20/25, 154 eyes (95.06%) achieved a UCVA of 20/20, and 110 eyes (67.90%) achieved 20/16. In group 2, 162 eyes (100%) achieved a UCVA of 20/25, 156 eyes (96.29%) achieved a UCVA of 20/20, and 113 eyes (69.75%) achieved 20/16. The mean MRSE at 12 months postoperatively was − 0.25 ± 0.33 D in group 1 and − 0.5 ± 0.33 D in group 2 (P = 0.62).Conclusion: Dual-incision SMILE is safe and effective as single-incision SMILE, with a predictable and stable effect in correcting myopia and myopic astigmatism.Keywords: ReSMILE, ReLEX, SMILE, SMILE technique, kerato-refractive, LASER vision correction, small incision lenticule extraction

Robert Arnold,1 David Silbert,2 Heather Modjesky2 1Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, Anchorage, Alaska, USA; 2CONESTOGA EYE, Lancaster, PA, USACorrespondence: Robert Arnold, Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA, Tel +1 907 561-1917, Fax +1 907 563-5373, Email eyedoc@Alaska.netBackground: The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) issued a 2021 update of Uniform Validation Guidelines for instrument-based pediatric vision screeners. With each update it is important for each manufacturer to update the Instrument Referral Criteria (IRC) programed into their devices in order to optimize sensitivity and specificity to detect AAPOS criteria.Methods: De-identified data comparing photoscreening with simultaneous confirmatory examinations constituted separate cohorts for the development of IRC via receiver operating characteristic (ROC) curves. The refractions of the devices were also compared.Results: This study defines three sets of refractive IRC (Sensitive, Medium, and Specific) for three leading infrared photoscreening devices, PlusoptiX A12, Welch-Allyn SPOT, and Adaptica 2WIN for children < 4 and ≥ 4 years in order to better target the 2021 AAPOS guidelines. The cohorts were similar but the SPOT group (n=755, mean age 9) was older with more astigmatism and the 2WIN (n=1362, mean age 7) was younger with more hyperopia and anisometropia compared to the cohort for PlusoptiX A12 (n=616, mean age 8). The age-based, medium magnitude IRC for anisometropia, hyperopia, astigmatism and myopia for SPOT were: < 4y: 1.5, 1.75, 3.25, 3.5 and ≥ 4y: 1.5, 1.75, 2.25, 2.0; for PlusoptiX: < 4y: 1.75, 3.0, 3.5, 3.5 and ≥ 4y: 1.75, 3.0, 2.5, 2.5; and for 2WIN: < 4y: 1.75, 2.5, 3.5, 3.5 and ≥ 4y: 1.5, 2.0, 2.5, 2.0. The mean ABCD ellipsoid spectacle matches differed; SPOT: 1.8± 1.3 (better) versus PlusoptiX: 1.9± 1.6 and 2WIN: 2.2± 1.4 (p< 0.001).Conclusion: The 2021 AAPOS exam guidelines foster early specificity before age 4 and sensitivity after age 4. These evidence-based IRC for current SPOT, PlusoptiX, and 2WIN photoscreeners should allow device manufacturers the data necessary to adjust their device IRC to maximize specificity, sensitivity or a medium between the two. This paper provides practical suggestions for better validation. Improved early screening combined with thorough treatment should reduce life-long vision impairment due to amblyopia.Keywords: amblyopia, vision screening, infrared autorefractor, refraction, amblyopia risk factors, visually significant refractive errors

Nandini Venkateswaran,1 Yandong Bian,1 Preeya K Gupta2 1Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; 2Triangle Eye Consultants, Cary, NC, USACorrespondence: Preeya K Gupta, Email preeyakgupta@gmail.comAbstract: Dry eye disease (DED) is a prevalent ocular surface disease. Like with any chronic disease, patients with DED can experience episodic flares. There are many existing and upcoming treatments for the chronic treatment of DED, yet treatments for DED flares are limited. Loteprednol etabonate 0.25% is an FDA approved treatment modality for the short-term treatment of the signs and symptoms of DED. This medication is formulated with the customized mucus-penetrating particle (MPP) technology, which has a greater ability to penetrate the ocular surface and more effectively deliver the active steroid to the ocular surface tissues as compared with conventional steroid preparations. There is also increasing utility of loteprednol etabonate 0.25% in the treatment of DED before and/or after cataract or refractive surgery or as induction therapy prior to starting chronic immunomodulatory medication for DED.Keywords: dry eye disease, dry eye disease flares, loteprednol etabonate 0.25%, mucus penetrating particle technology, ocular surface inflammation

Robert Arnold,1 Mario Angi2 1Alaska Blind Child Discovery, Alaska Children’s Eye and Strabismus, Anchorage, Alaska, 99508, USA; 2Senior Scientist, Department of Ophthalmology, University of Padua, Padua, Padua Province, ItalyCorrespondence: Robert Arnold, Alaska Blind Child Discovery, Alaska Children’s Eye and Strabismus, Office 280, 3500 Latouche Street, Anchorage, Alaska 99508, Tel +1-907 561-1917, Fax +1907 563-5373, Email eyedoc@alaska.netBackground: Novel devices target different facets of amblyopia risk factors (ARFs). Through birefringence, the Rebion blinq assesses binocular foveation. The Adaptica 2WIN is a multiradial infrared photorefractor that also estimates ocular alignment. PDI Check is a forced-choice, dynamic near-vision game for the autostereoscopic Nintendo 3DS.Methods: New and returning patients to a pediatric ophthalmology clinic had concomitant confirmatory exams after all three vision screens had been validated with ROC curves, Bland–Altman plots, and Alaska Blind Child Discovery ellipsoid grades. Exam outcomes were classified by ARF visual acuity, strabismus, binocularity, and refractive errors following the 2021 AAPOS guidelines and Bosque–Hunter rubric for the blinq.Results: A total of 202 ethnically diverse students aged 10± 4 (4– 19) years, 33% treatment-naïve, had a high (58%) prevalence of ARFs. Linear logMAR visual acuity, intereye differences, stereo and three-cone color correlated well between PDI Check and exams. Mean score on the 2WIN matched sphero-cylinder exam with ellipsoid scoring was 2.1± 1.5. For AAPOS 2021 refractive plus strabismus, sensitivity/specificity for PDI Check was 68%/59%, 2WIN 72%/95%, and blinq 87%/32%. For the amblyopia or strabismus rubric, PDI Check was 79%/68%, 2WIN 56%/65%, and blinq 94%/37%.Conclusion: Each device had advantages and disadvantages in screening this cohort of older, high-prevalence students, many of whom had already been treated. Validation methods should cover more than just refraction, as the new 2021 AAPOS guidelines do.Keywords: amblyopia, vision screening, strabismus, validation

Sneha Padidam,1,2 George Skopis,2 Michael M Lai1,2 1The Retina Group of Washington, Chevy Chase, MD, USA; 2Department of Ophthalmology, Medstar Washington Hospital Center, Washington, DC, USACorrespondence: Michael M Lai, Tel +301-656-8100, Email mlai@rgw.comObjective: To determine the prevalence and risk factors for cystoid macular edema (CME) after cataract surgery in eyes that have previously undergone macular surgery.Study Design and Methods: Retrospective consecutive interventional case series. Patient medical records and Spectral Domain Optical Coherence Tomography (SD-OCT) were reviewed for eyes that underwent vitrectomy for full thickness macular hole (FTMH), lamellar macular hole (LMH) or epiretinal membrane (ERM) and subsequent cataract surgery at a large private retina practice between 2016 and 2018.Results: Around 9.1% of eyes (22/243) developed CME post cataract surgery. The mean time from macular surgery to cataract surgery was 273 days (range: 87– 797) in eyes with CME and 289 days (range: 22– 897) in eyes without CME (p = 0.67). There was no difference in final visual acuity between eyes with CME (20/40, logMAR 0.312) and without CME (20/30, logMAR 0.206) (p = 0.101). Compared with patients with FTMH or LMH, patients with epiretinal membrane were more likely to develop post cataract CME (OR = 2.97, p = 0.031, Chi square test).Conclusion: In eyes with history of macular surgery, the prevalence of post cataract surgery CME was around 9.1%. The development of CME is not dependent on timing of cataract surgery but is more common in eyes with history of epiretinal membrane.Keywords: cystoid macular edema, macular hole, epiretinal membrane, pseudophakic cystoid macular edema

Tsaina Mahlen,1 Robert W Arnold2 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USACorrespondence: Robert W Arnold Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, 3500 Latouche #280, Anchorage, AK, 99508, USA Tel +1 907 561-1917 Fax +1 907 563-5373 Email eyedoc@Alaska.netBackground: The purpose of this paper is to validate three recent non-refractive devices that target sensory and/or strabismus risk factors for amblyopia. EyeSwift® with eye tracking and PDI Check on autostereoscopic Nintendo 3DS are video games that estimate acuity, binocularity and color. The Rebion blinq assesses foveation by birefringence.Methods: Students were consented to be screened by each device as if by a school nurse before confirmatory examination with optimized, refined refraction. Results were compared with correlation and Bland Altman plots while screening ability was compared with 2021 AAPOS Guidelines and the strabismus-amblyopia rubric proposed by David Hunter.Results: A total of 77 ethnically diverse students, aged 11± 4 (4– 19) years had a 77% prevalence of 2021 risk factors. Near visual acuity, inter-eye difference and stereopsis correlated significantly (p< 0.01) for the EyeSwift® (r2 0.14, 0.06 and 0.45) and PDI Check (r2 0.23, 0.22 and 0.32). The sensitivity/specificity to target 2021-AAPOS: Hunter-rubric for EyeSwift® was 82%/56%: 74%/62%, for PDI Check was 75/64%: 69%/69% and for blinq 75/48%: 82%/39%. Sensitivity/specificity for the seven color-deficient students was 86%/84% for EyeSwift® and 100%/81% for PDI Check. Screening time was 96± 19 s for PDI Check and 375± 102 s for EyeSwift but less than 25 s for blinq.Conclusion: Reliable near visual acuity, stereo and color testing were obtained from the two binocular and touch screen devices often with minimal coaching of the student. The blinq rapidly gives an estimate of whether both eyes are steadily fixing, and the ProVersion predicted 100% which eye is deviated or amblyopic. Non-refractive validation metrics were beneficial.Keywords: amblyopia, strabismus, validation, school nurse, pediatrician

Sara M AlHilali, Samar A Al-Swailem Cornea, External Eye Diseases and Refractive Surgery Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi ArabiaCorrespondence: Sara M AlHilali, Tel +00966114821234 ext; 2371, Fax +4821234X1250, Email shilali@kkesh.med.saAbstract: Type I Boston keratoprosthesis is implanted in patients with severely diseased eyes who are considered poor candidates for traditional keratoplasty. Glaucoma is considered a major visual comorbidity following the implantation of type I Boston keratoprosthesis (KPro). Eyes that receive a Boston KPro are at high risk of progression of pre-existing glaucoma and the development of de novo glaucoma. Both complications can limit best-corrected visual acuity postoperatively. Diagnosis and surveillance for glaucoma in KPro eyes are fundamental to mitigate the risk of visual morbidity. However, managing these patients presents several challenges. The diagnosis of glaucoma after KPro implantation is usually hindered by inaccurate intraocular pressure (IOP) measurements and unreliable ophthalmic investigations such as visual field testing and optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL). In these eyes, medical management of glaucoma with topical medications is usually insufficient, and glaucoma surgery is usually warranted either prior to or during KPro implantation. Options for glaucoma surgery include glaucoma drainage device (GDD) and cyclodestructive procedures. The aim of this article is to highlight the incidence, pathophysiology, diagnosis, and management options of glaucoma in eyes that have undergone type I Boston keratoprosthesis.Keywords: glaucoma, Boston keratoprosthesis, management, surveillance, complications

Tsaina Mahlen,1 Robert W Arnold2 1Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA; 2Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USACorrespondence: Robert W Arnold Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, 3500 Latouche #280, Anchorage, AK, 99508, USA Tel +1 907 561-1917 Fax +1 907 563-5373 Email eyedoc@Alaska.netBackground: The purpose of this paper is to validate three recent non-refractive devices that target sensory and/or strabismus risk factors for amblyopia. EyeSwift® with eye tracking and PDI Check on autostereoscopic Nintendo 3DS are video games that estimate acuity, binocularity and color. The Rebion blinq assesses foveation by birefringence.Methods: Students were consented to be screened by each device as if by a school nurse before confirmatory examination with optimized, refined refraction. Results were compared with correlation and Bland Altman plots while screening ability was compared with 2021 AAPOS Guidelines and the strabismus-amblyopia rubric proposed by David Hunter.Results: A total of 77 ethnically diverse students, aged 11± 4 (4– 19) years had a 77% prevalence of 2021 risk factors. Near visual acuity, inter-eye difference and stereopsis correlated significantly (p< 0.01) for the EyeSwift® (r2 0.14, 0.06 and 0.45) and PDI Check (r2 0.23, 0.22 and 0.32). The sensitivity/specificity to target 2021-AAPOS: Hunter-rubric for EyeSwift® was 82%/56%: 74%/62%, for PDI Check was 75/64%: 69%/69% and for blinq 75/48%: 82%/39%. Sensitivity/specificity for the seven color-deficient students was 86%/84% for EyeSwift® and 100%/81% for PDI Check. Screening time was 96± 19 s for PDI Check and 375± 102 s for EyeSwift but less than 25 s for blinq.Conclusion: Reliable near visual acuity, stereo and color testing were obtained from the two binocular and touch screen devices often with minimal coaching of the student. The blinq rapidly gives an estimate of whether both eyes are steadily fixing, and the ProVersion predicted 100% which eye is deviated or amblyopic. Non-refractive validation metrics were beneficial.Keywords: amblyopia, strabismus, validation, school nurse, pediatrician

Sneha Padidam,1,2 George Skopis,2 Michael M Lai1,2 1The Retina Group of Washington, Chevy Chase, MD, USA; 2Department of Ophthalmology, Medstar Washington Hospital Center, Washington, DC, USACorrespondence: Michael M Lai, Tel +301-656-8100, Email mlai@rgw.comObjective: To determine the prevalence and risk factors for cystoid macular edema (CME) after cataract surgery in eyes that have previously undergone macular surgery.Study Design and Methods: Retrospective consecutive interventional case series. Patient medical records and Spectral Domain Optical Coherence Tomography (SD-OCT) were reviewed for eyes that underwent vitrectomy for full thickness macular hole (FTMH), lamellar macular hole (LMH) or epiretinal membrane (ERM) and subsequent cataract surgery at a large private retina practice between 2016 and 2018.Results: Around 9.1% of eyes (22/243) developed CME post cataract surgery. The mean time from macular surgery to cataract surgery was 273 days (range: 87– 797) in eyes with CME and 289 days (range: 22– 897) in eyes without CME (p = 0.67). There was no difference in final visual acuity between eyes with CME (20/40, logMAR 0.312) and without CME (20/30, logMAR 0.206) (p = 0.101). Compared with patients with FTMH or LMH, patients with epiretinal membrane were more likely to develop post cataract CME (OR = 2.97, p = 0.031, Chi square test).Conclusion: In eyes with history of macular surgery, the prevalence of post cataract surgery CME was around 9.1%. The development of CME is not dependent on timing of cataract surgery but is more common in eyes with history of epiretinal membrane.Keywords: cystoid macular edema, macular hole, epiretinal membrane, pseudophakic cystoid macular edema

Sónia Torres-Costa,1 António Benevides Melo,1,2 Sérgio Estrela-Silva,1,2 Fernando Falcão-Reis,1,2 João Barbosa-Breda1– 4 1Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal; 2Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal; 3UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal; 4Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, BelgiumCorrespondence: Sónia Torres-CostaOphthalmology Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernani Monteiro, Porto, 4200, Portugal, Tel +351 225 512 100, Fax +351 225 025 766, Email sonia.torres.costa@gmail.comPurpose: To evaluate whether previous clear-cornea phacoemulsification surgery affects the surgical outcomes of trabeculectomy in open-angle glaucoma (OAG).Methods: We performed a retrospective cohort study, which included 82 patients with OAG that underwent trabeculectomy between January 1, 2010, and December 31, 2017. The primary outcome was the probability of surgical failure. Failure was defined as IOP > 21 mmHg or reduced < 20% from baseline, IOP ≤ 5 mmHg in three consecutive visits, need for further glaucoma surgery, phthisis or loss of light perception vision due to glaucoma.Results: Eighty-two eyes (58 phakic and 24 pseudophakic) were included. Phakic group patients were younger than those in the pseudophakic group, 65.8 ± 11.7 vs 76.2 ± 7.9 years (p < 0.001). The most common type of glaucoma was primary OAG [59% (n = 34) phakic vs 63% (n = 15) pseudophakic], followed by exfoliative and pigmentary glaucomas. The mean preoperative IOP was not significantly different between groups nor was the number of preoperative hypotensive medications. The rate of surgical failure was not significantly different between groups at year 1 [17% (n = 10) phakic vs 29% (n = 7) pseudophakic; p = 0.361] nor at year 2 [28% (n = 16) phakic vs 46% (n = 11) pseudophakic; p = 0.110]. No significant differences were observed regarding the postoperative IOP or any secondary outcome measures at year 1 or 2.Conclusion: Previous clear-cornea phacoemulsification surgery does not lead to statistically significant differences in the rate of trabeculectomy failure. Despite not being significant, clinically relevant differences were observed between groups. Future studies with a larger sample and/or randomized are needed to clarify this association.Keywords: trabeculectomy, phacoemulsification, surgical failure, intraocular pressure

Mithila Negalur,1 Virender Sachdeva,2 Ramesh Kekunnaya1 1Jasti V Ramanamma Children’s Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India; 2Nimmagadda Prasad Children’s Eye Care Centre, Child Sight Institute, L V Prasad Eye Institute, Vizag, IndiaCorrespondence: Ramesh Kekunnaya Tel +91-40-68102645Fax +91-40-23548271Email rameshak@lvpei.orgAbstract: Various surgical approaches have been described for the management of Duane retraction syndrome (DRS), a type of congenital cranial dysinnervation disorder (CCDD), the goals of which include correcting the primary position deviation and abnormal head posture (AHP), minimizing globe retraction and overshoots and improving the ocular rotations. Vertical rectus transposition (VRT) is one such technique, found more effective in improving abduction and thereby expanding the field of binocular vision, as compared to horizontal muscle surgery. VRT, however, is associated with the risk of inducing vertical deviations and also poses a risk for development of anterior segment ischemia. To overcome these concerns, transposition of only the superior rectus to the lateral rectus was proposed and evaluated to reveal improvement in alignment, AHP and motility comparable to VRT but with lesser surgical time and fewer post-operative complications. With promising results in the management of DRS, superior rectus transposition (SRT) has been extensively studied and has evolved over the last decade with several modifications to further increase the efficiency and reduce the risk of post-operative complications. This article focusses on the pre-operative considerations while planning SRT in DRS, various approaches and surgical techniques described, and the outcomes and complications of SRT in DRS. The role of SRT in the management of other CCDDs may be explored with further studies.Keywords: Duane syndrome, SRT, transposition surgery

Sergio Zaccaria Scalinci,1 Nicola Valsecchi,2 Elena Pacella,3 Edoardo Trovato Battagliola3 1Ophthalmology Unit, DIMEC (Department of Medical and Surgical Sciences), Department of Ophthalmology, Alma Mater Studiorum University of Bologna, Bologna, Italy; 2Ophthalmology Unit, DIMES (Department of Experimental, Diagnostic and Specialty Medicine), Department of Ophthalmology, Alma Mater Studiorum University of Bologna, Bologna, Italy; 3Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, ItalyCorrespondence: Nicola ValsecchiOphthalmology Unit, DIMES (Department of Experimental, Diagnostic and Specialty Medicine), Department of Ophthalmology, Alma Mater Studiorum University of Bologna, Via Pelagio Pelagi 9, Bologna, 40138, ItalyTel +39 3407783914Email nicola.valsecchi2@studio.unibo.itPurpose: Stargardt disease (STGD1) is the most common hereditary macular degeneration and currently no treatments have been approved to interrupt the progression of the disease. The aim of this study was to evaluate the efficacy of photo-biomodulation in patients with Stargardt disease 1 year after treatment, considering as primary outcomes improvements in best corrected visual acuity (BCVA), microperimetry, and pattern electroretinography (PERG) amplitude.Materials and Methods: Ninety eyes of 45 patients with a diagnosis of Stargardt disease stage 1 were prospectively recruited at the University of Bologna. Selected patients were treated with photo-biomodulation therapy for 1 year for 10 minutes a day, twice a day, and 5 days per week for 12 months. A light emitting diode (LED) of 10 Hz and wavelength 650 nm was used. BCVA and microperimetry were assessed before treatment and 1 year after photo-biomodulation, whereas PERG was assessed at baseline, 1, 3, 6, and 12 months after treatment.Results: BCVA improved from 0.7 [interquartile range (IQR)=0.6– 0.9)] to 0.4 (IQR=0.2– 0.5)] after treatment (95% CI=− 0.3, − 0.35; p=< 0.001) and PERG negative wave at 35 ms (N35)-positive wave at 50 ms (P50) amplitude improved from 0.9 (IQR=0.74– 1.21) to 2.12 (95% CI=1.11, 1.28; p< 0.001). MP-1 Microperimetry improved from 26.5% (IQR=16.75– 40) of median preferred retinal loci (PRL) within an area of 2° of diameter to 38% (IQR=29– 50.25; 95% CI=10.50, 14.50; p=< 0.001); on the other hand, PRL within 4° of diameter raised from 72% (IQR=51.5– 80) to 80% (IQR=76– 87) after photo-biomodulation (95% CI=4.50, 7.50; p< 0.001). Also, patients with an improvement of more than 1.205 PERG N35-P50 ratio amplitude at 3 months and more than 1.29 at 6 months tended to present an improvement of more than 0.2 logMar in BCVA at 12 months (p=0.28, AUC=0.630; p=0.30, AUC=0.636).Conclusion: BCVA, PERG, and MP-1 significantly improved 1 year after treatment. Also, improvement of PERG N35-P50 amplitude at 3 and 6 months was correlated to BCVA improvement at 1 year, suggesting that PERG could be useful in predicting visual outcome after photo-biomodulation.Keywords: Stargardt disease, PERG, microperimetry, LED, photo-biomodulation

Wissam Aljundi,1 Shady Suffo,1 Cristian Munteanu,1 Achim Langenbucher,2 Berthold Seitz,1 Alaa Din Abdin1 1Department of Ophthalmology, Saarland University Medical Center UKS, Homburg, Saar, Germany; 2Institute of Experimental Ophthalmology, Saarland University, Homburg, Saar, GermanyCorrespondence: Wissam Aljundi, Tel +4968411622387, Fax +4968411622400, Email wissam.aljundi@uks.euPurpose: To detect the impact of intravitreal injection (IVI) therapy with sole anti-vascular-endothelial-growth-factor (VEGF) or combined with steroids treating diabetic macular edema (DME) on activity of proliferative diabetic retinopathy (PDR) based on total number of panretinal photocoagulation (PRP) spots needed within 2 years.Patients and Methods: A retrospective study of 102 eyes with primary-onset PDR and minimum follow-up of 24 months divided into 2 groups: Group 1 (G1) 40 eyes received only PRP and did not develop DME. Group 2 (G2) 62 eyes received additional IVI-therapy due to concomitant DME, with anti-VEGF only (subgroup 2a, G2a) or in combination with steroids (subgroup 2b, G2b). Main outcomes: central macular thickness (CMT, μm), best-corrected visual acuity (BCVA, LogMAR) and total number of needed PRP spots and IVI after 24 months.Results: CMT was significantly higher in G2 compared to G1, initially (p < 0.01) and after 24 months (p = 0.01). CMT was significantly higher in G2b compared to G2a, both initially (p = 0.01) and after 24 months (p < 0.01). BCVA was significantly higher in G1 compared to G2, initially and after 24 months (p = 0.01). BCVA was not significantly different between the two subgroups, initially (p = 0.54) and after 24 months (p = 0.29). The total number of PRP spots was significantly higher in G1 compared to G2 (p < 0.01) but not significantly different between the subgroups (p = 0.8).Conclusion: Regardless of severity of concomitant DME, IVI with sole anti-VEGF or combined with steroids reduced the total number of PRP spots needed within 2 years significantly indicating a favorable effect on activity of PDR.Keywords: proliferative diabetic retinopathy, diabetic macular edema, intravitreal injection, panretinal photocoagulation, anti-VEGF, steroids

Marwa A Khairy, Said Kenawy, Khaled Mohamed Fawzi, Haitham Y Al-Nashar Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptCorrespondence: Marwa A KhairyOphthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptTel +20-1111801956Fax +20-552353738Email ma_kh87@yahoo.comPurpose: To evaluate different pre-operative variables on the success of combined trabeculotomy–trabeculectomy (CTT) surgery in patients with primary congenital glaucoma (PCG) to predict those at higher risk for surgical failure and for proper parent counseling.Patients and Methods: Sixty-three eyes of patients with PCG were treated either with CTT without augmentation, or CTT augmented with mitomycin-C (0.2 mg/mL) in both subconjunctival space and under scleral flap for 3 minutes, or with CTT augmented with a collagen implant under both the scleral flap and the conjunctiva. Cases showed surgical failure was reported and evaluated in relation to different pre-operative variables.Results: Complete success (IOP ≤ 21 mmHg) was achieved in 52 cases (82.5%). Cumulative success probability was calculated using Kaplan-Meier survival analysis, proving that higher pre-operative intraocular pressure (IOP) was associated with higher failure rates (28.6% for pre-operative IOP ≥ 30 mmHg versus 4.8% for IOP < 30 mmHg), with P value = 0.007.Conclusion: CTT is an effective surgical intervention in PCG patients without sight threatening complications. Univariate survival analysis showed higher rates of surgical failure in patients with higher pre-operative IOP, while other pre-operative variables were irrelevant.Keywords: buphthalmos, Kaplan–Meier survival analysis, surgical failure

Marwa A Khairy, Said Kenawy, Khaled Mohamed Fawzi, Haitham Y Al-Nashar Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptCorrespondence: Marwa A KhairyOphthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptTel +20-1111801956Fax +20-552353738Email ma_kh87@yahoo.comPurpose: To evaluate different pre-operative variables on the success of combined trabeculotomy–trabeculectomy (CTT) surgery in patients with primary congenital glaucoma (PCG) to predict those at higher risk for surgical failure and for proper parent counseling.Patients and Methods: Sixty-three eyes of patients with PCG were treated either with CTT without augmentation, or CTT augmented with mitomycin-C (0.2 mg/mL) in both subconjunctival space and under scleral flap for 3 minutes, or with CTT augmented with a collagen implant under both the scleral flap and the conjunctiva. Cases showed surgical failure was reported and evaluated in relation to different pre-operative variables.Results: Complete success (IOP ≤ 21 mmHg) was achieved in 52 cases (82.5%). Cumulative success probability was calculated using Kaplan-Meier survival analysis, proving that higher pre-operative intraocular pressure (IOP) was associated with higher failure rates (28.6% for pre-operative IOP ≥ 30 mmHg versus 4.8% for IOP < 30 mmHg), with P value = 0.007.Conclusion: CTT is an effective surgical intervention in PCG patients without sight threatening complications. Univariate survival analysis showed higher rates of surgical failure in patients with higher pre-operative IOP, while other pre-operative variables were irrelevant.Keywords: buphthalmos, Kaplan–Meier survival analysis, surgical failure

Nisa Silva,1 André Ferreira,1,2 Pedro Manuel Baptista,1 Ana Figueiredo,1 Rita Reis,1 Isabel Sampaio,1 João Beirão,1,3 Riccardo Vinciguerra,4,5 Pedro Menéres,1,3 Maria João Menéres1,3 1Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal; 2Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal; 3Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal; 4Ophthalmology Department, Humanitas San Pio X Hospital, Milan, Italy; 5The School of Engineering, University of Liverpool, Liverpool, UKCorrespondence: Nisa SilvaOphthalmology Department, Centro Hospitalar Universitário do Porto, Portugal Largo do Prof. Abel Salazar, Porto, 4099-001, PortugalTel +351918367661Fax +351222077500Email nisapinhosilva@gmail.comBackground: To evaluate biomechanical parameters of the cornea provided by Corvis ST in patients with ocular hypertension, primary open-angle glaucoma, and amyloidotic glaucoma and to compare with healthy controls.Methods: This was a cross-sectional study of patients with ocular hypertension, primary open-angle glaucoma, and amyloidotic glaucoma that underwent Corvis ST imaging. Primary outcome was the comparison of corneal biomechanical parameters between study groups after adjusting for age, gender, Goldmann intraocular pressure (GAT-IOP), and prostaglandin analogues medication. Secondary outcome was the comparison of different IOP measurements in each group.Results: One hundred and eighty-three eyes from 115 patients were included: 61 with primary open-angle glaucoma, 32 with amyloidotic glaucoma, 37 with ocular hypertension and 53 were healthy controls. Amyloidotic glaucoma group had smaller radius (p=0.025), lower deflection amplitude at highest concavity (p=0.019), and higher integrated radius (p=0.014) than controls. Ocular hypertension group had higher stiffness parameter at first applanation (p=0.043) than those with primary open-angle glaucoma, and higher stress–strain index (p=0.049) than those with amyloidotic glaucoma. Biomechanically corrected intraocular pressure was significantly lower than Goldmann intraocular pressure in group with primary open-angle glaucoma (p=0.005) and control group (p=0.013), and Goldmann intraocular pressure adjusted for pachymetry in group with primary open-angle glaucoma (p=0.01).Conclusion: Eyes with amyloidotic glaucoma have more deformable corneas, while eyes with ocular hypertension have less deformable corneas. These findings may be linked to the susceptibility to glaucomatous damage and progression. There were significant differences between Goldmann applanation tonometry and biomechanically corrected intraocular ocular pressure provided by Corvis ST.Keywords: corneal biomechanics, ocular hypertension, glaucoma, amyloidosis, Goldmann tonometry

Mutsuko Kato, Michie Namba, Sachika Shimoyama, Mayumi Inoue, Chihiro Ouchi, Takehiro Shimizu Department of Ophthalmology, Japan Red Cross Okayama Hospital, Okayama, JapanCorrespondence: Mutsuko KatoDepartment of Ophthalmology, Japan Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ward, Okayama, 700-8607, JapanTel +81 86 222 8811Fax +81 86 222 8841Email mutsukato@okayama-med.jrc.or.jpPurpose: To report our modified simple technique for optic capture and the clinical results of intrascleral IOL fixation preserving the lens capsule, without vitrectomy, in cases of cataract with insufficient zonular support to stabilize the intraocular lens (IOL).Patients and Methods: In 37 eyes of 25 patients with phacodonesis and two or more risk factors for progressive zonular insufficiency, we inserted a CTR to support the capsule and zonules during cataract surgery and IOL fixation; an optic was inserted into the lens capsule, and a haptic was fixed in the scleral tunnel without vitrectomy. In all cases, anterior or total vitrectomy was not needed.Results: The postoperative mean (± standard deviation) tilt and decentration of the implanted IOL did not change from 6 to 12 months (6.77 ± 3.15° to 6.33 ± 3.38° and 0.60 ± 0.30 to 0.61 ± 0.35 mm, respectively). We encountered no late IOL dislocation and no retinal complications, including retinal breaks or cystoid macular oedema, postoperatively (follow-up = 21.1 ± 5.2 months).Conclusion: Our modified techniques preclude the need for vitrectomy. If the lens capsule can be preserved using a CTR, our modified technique can be used to stabilize IOL.Keywords: insufficient zonular support, phacodonesis, lens capsule, capsular tension ring, intrascleral IOL fixation

T Hunter Newsom,1 Richard Potvin2 1Newsom Eye & Laser Center, Sebring, FL, USA; 2Science in vision, Bend, OR, USACorrespondence: T Hunter Newsom, Email hunter@newsomeye.netPurpose: To assess the visual outcomes and quality of vision of patients receiving the AcrySof® IQ Vivity™ non-diffractive extended vision intraocular lens (NDEV IOL) after uneventful cataract surgery when the non-dominant eye is targeted for slight myopia.Design: Single site, prospective, single-arm study.Methods: Eligible subjects interested in reducing their dependence on spectacles over a range of working distances were enrolled and followed for 3 months after the second eye surgery. Subjects were bilaterally implanted with this NDEV IOL, with a target of emmetropia in the dominant eye and a myopic refraction of − 0.75D in the non-dominant eye. At 3 months postoperative, the uncorrected and distance-corrected (with monovision) visual acuity at 40 cm, 66 cm and 4 m were recorded, along with the manifest refraction. Questionnaires related to spectacle independence, patient satisfaction and quality of vision were also administered.Results: Data from 33 subjects were analyzed. The mean difference between eyes by subject was 0.80 ± 0.37 D. Twenty-nine of 33 (88%) subjects had a binocular uncorrected near VA of 0.2 logMAR or better. Twenty-five of 33 eyes (76%) had a binocular distance-corrected (− 0.75 D in the non-dominant eye) VA of 0.2 logMAR or better at all three test distances. Satisfaction with vision at all distances was high. The reported level of spectacle independence was higher than for the same lens without monovision. Visual disturbances were higher than has been previously reported for this lens but were not correlated to the level of monovision.Conclusion: A target of − 0.75 D of myopia in the non-dominant eye of patients bilaterally implanted with this NDEV IOL improved near vision, increasing the rate of spectacle independence in patients relative to those targeted for bilateral emmetropia, with no correlated increases in visual disturbances.Keywords: wavefront shaping, spectacle independence, presbyopia correction, EDOF, extended depth of focus, extended depth of vision, non-diffractive, monovision

Sameh G Taher,1 Mahmoud A Rageh,1 Omar Hashem2 1Department of Pediatric Ophthalmology and Strabismus, Research Institute of Ophthalmology, Giza, Egypt; 2Department of Cornea and Refractive Surgery, Research Institute of Ophthalmology, Giza, EgyptCorrespondence: Omar HashemDepartment of Cornea and Refractive Surgery, Research Institute of Ophthalmology, 2 El Ahram St, Giza, EgyptTel +201222422032Email hashemomar@yahoo.com; omar.hashim004@gmail.comPurpose: This study aimed to evaluate the efficacy and safety of fenestration in comparison to the classic muscle recession as a weakening maneuver to horizontal and vertical extra ocular muscles in the surgical management of strabismus.Patients and Methods: This is a pilot single blind parallel group randomized controlled trial with 1:1 allocation ratio. Male or female patients aged 1- to 60-years-old who were admitted to the Pediatric Ophthalmology and Strabismus Department for surgical correction of horizontal or vertical strabismus. Patients were randomly allocated by the envelop method to either group 1 (muscle fenestration, N=9) or group 2 (classic muscle recession, N=9). All participants were assessed at the first post operative day, at one week, and one month after the surgery for the outcomes.Results: Postoperative ocular alignment evaluated at the first day, one week, and one month following the operation showed comparable results with no significant differences between both groups (p> 0.05). The median postoperative pain score evaluated at the first day following the operation was significantly higher in fenestration group than recession group (the medians were 2.0 and 1.0, respectively, p=0.014). Alternatively, the medians of the pain score were equal in both groups at one week and one month postoperatively (p> 0.999). One patient in the fenestration group developed progressive subconjunctival hemorrhage. In contrast, there was no postoperative complications in the recession group (p> 0.999).Conclusion: Efficacy and safety of muscle fenestration for correcting horizontal or vertical strabismus was comparable to the classic muscle recession.Keywords: adults, children, fenestration, recession, strabismus, surgery

Manoj Motwani Motwani LASIK Institute, San Diego, CA, 92121, USACorrespondence: Manoj MotwaniMotwani LASIK Institute, 4520 Executive Dr., Suite 230, San Diego, CA, 92121, USATel +1 858 554-0008Email drmmlj@gmail.comPurpose: To demonstrate the treatment of radial keratotomy-induced corneal irregularity with topographic-guided ablation (WaveLight Contoura).Methods: Thirty-two eyes of 18 patients were treated for corneal irregularity post-radial keratotomy with WaveLight Contoura topographic-guided ablation utilizing LASIK and PRK and the San Diego Protocol for reconstructing corneas. These eyes were followed for six-months. Outcomes included: measurements of vision, refraction, residual higher-order aberrations, residual lower-order and higher-order aberrations, as well as loss or gains of lines of best-corrected visual acuity.Results: All eyes had decreased corneal irregularity as evidenced by topographic analysis and reduction in manifest astigmatism, Contoura-measured astigmatism, higher-order aberrations, and higher-order aberrations grouped with lower-order aberrations excluding tilt (Grouped). The eyes of 5 sample patients are included in this manuscript to demonstrate the procedure, protocol, and outcomes.Conclusion: Treatment with WaveLight Contoura whether as LASIK or PRK appears to be an effective treatment for corneal irregularity associated with radial/astigmatic keratotomy.Keywords: WaveLight Contoura, topographic-guided ablation, LASIK, PRK, uniform cornea, measured astigmatism, radial keratotomy

Nisa Silva,1,&ast; André Ferreira,1,2,&ast; Natália Ferreira,1 Bernardete Pessoa,1,3 Angelina Meireles1,3 1Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal; 2Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal; 3Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal&ast;These authors contributed equally to this workCorrespondence: Nisa SilvaDepartment of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto, 4099-001, PortugalTel +351 22 207 7500Email nisapinhosilva@gmail.comBackground: The main options for intraocular lens (IOL) placement without capsular bag support and/or zonular weakness are iris-fixated IOL and scleral-fixated IOL (SFIOL).Purpose: To describe the surgical technique and the outcomes of intrascleral knotless zigzag suture fixation of Akreos AO60 foldable IOL.Methods: Retrospective cohort study of consecutive cases.Results: Ninety-nine eyes of 92 patients were retrospectively studied. The mean age was 72.1± 15.2 years (range 18– 94), and the median follow-up duration was 19.5 months (range 3– 81). The best-corrected visual acuity improved from a mean±SD of 1.34± 0.70 logarithm of the minimum angle of resolution (logMAR) units at baseline to 0.49± 0.56 logMAR at the end of follow-up (p< 0.001). The mean±SD final SE was − 1.24± 1.82 diopters. The mean±SD prediction error was − 0.51± 1.16 diopters. The overall perioperative complications rate was 44.4% (n=44). The rate of complications requiring invasive treatment was 19.2% (n=19). The most common perioperative complications were ocular hypertension (OHT, 20.2%, n=20), and cystoid macular edema (CME, 15.2%, n=15). The rate of IOL dislocation was 7% (n=7).Conclusion: This knotless technique avoids the risks of haptics fixation but is more prone to IOL dislocation in cases of suture deterioration. Past ophthalmic history needs to be carefully considered in candidates who underwent SFIOL implantation.Keywords: intraocular lens, scleral fixation, knotless, cataract, lens luxation

John A Hovanesian,1 Michael Jones,2 Quentin Allen3 1Harvard Eye Associates, Laguna Hills, CA, USA; 2Quantum Vision Centers, Swansea, IL, USA; 3Florida Vision Institute, Stuart, FL, USACorrespondence: John A HovanesianHarvard Eye Associates, 23961 Calle De La Magdalena, #300, Laguna Hills, CA, 92653, USATel +1 949 951 2020Fax +1 949 951 9244Email jhovanesian@harvardeye.comPurpose: To compare patient-reported outcomes (PROs) after intraocular lens (IOL) implantation with the AcrySof IQ Vivity IOL or Vivity Toric IOL to those achieved with other multifocal IOLs.Patients and Methods: Prospective, open-label, multicenter analysis of PROs, including spectacle independence, dysphotopsia, and overall satisfaction among patients who underwent cataract surgery at least 1 month previously with bilateral Vivity or Vivity Toric lenses (n=60). Results were compared to outcomes from two similar prospective studies of bilateral AcrySof IQ PanOptix or PanOptix Toric trifocal IOLs (n = 59), blended AcrySof ReSTOR 2.5/3.0 IOLs (n=72) or bilateral ReSTOR ActiveFocus 2.5 D IOLs with a mini-monovision target [n = 95]).Results: Patients in the Vivity cohort were significantly less likely to notice glare and halo in dim light (85% “none” or “just a little”) compared to PanOptix (69%, p< 0.03), 2.5 mini-monovision (75%, p< 0.05) or 2.5/3.0 (71%, p< 0.05) patients. Complete spectacle independence for all visual activities combined (never need glasses) with Vivity was comparable to the mini-monovision and 2.5/3.0 groups (33%, 36%, and 31%, respectively) but significantly lower than in the PanOptix cohort (83%, p < 0.0001). Satisfaction was high across all groups. There were no statistically significant differences in best-corrected visual acuity, and no new safety concerns were reported.Conclusion: The AcrySof IQ Vivity extended depth of focus IOL offers an expanded range of vision and better spectacle independence than has typically been achieved with traditional monofocal IOLs, with high rates of satisfaction and a favorable dysphotopsia profile compared to diffractive multifocal IOLs.Keywords: cataract surgery, spectacle independence, glare, multifocal intraocular lens

Julianna E Murray, Aaron S Gold, Azeema Latiff, Timothy G Murray Private Practice, Miami Ocular Oncology & Retina, Miami, FL, USACorrespondence: Timothy G MurrayMiami Ocular Oncology & Retina, 6705 Red Road Suite 412, Miami, FL, 33143, USAEmail tmurray@murraymd.comObjective: To report a consecutive series of compassionate, off-label use of intravitreal brolucizumab as a rescue therapy for complex, non-responsive macular edema. This report delineates primary diagnosis, indications for treatment, adverse events, and visual and anatomic outcomes after intravitreal brolucizumab.Methods: A retrospective review of a consecutive clinical case series of 110 eyes treated with intravitreal brolucizumab between January 1st and March 1st. 2020. All patients were included if they received intravitreal brolucizumab in an off-label delivery and had ongoing macular edema in the setting of prior, multiple intravitreal anti-VEGF and/or intravitreal triamcinolone acetonide. All patients had spectral domain OCT documented before, at the time of, and in serial follow-up after intravitreal brolucizumab.Results: Ninety-eight of 98 patients had marked decrease in macular edema. Indications for treatment were assigned to the primary etiologic diagnosis leading to the macular edema secondary to radiation retinopathy, complex epiretinal membrane, or complex diabetic retinopathy. In this series, sdOCT central point thickness decreased by an average of 71.5 microns, subretinal fluid resolved, and visual acuity was improved in 40% (greater than two Snellen lines) and stable in 60% (within two Snellen lines). No patient experienced a severe adverse event to specifically include vitritis and/or vasculitis.Conclusion: In this series, brolucizumab intravitreal injection was associated with significant improvement in macular edema in each diagnostic category. No serious complications to treatment were found in this series. Brolucizumab, though associated with known intraocular inflammation and vasculitis, demonstrated marked benefit in these complex eyes previously unresponsive to aggressive intravitreal pharmacotherapy.Keywords: brolucizumab, off-label usage, retinal vasculitis, vitreous inflammation, intraocular inflammation, macular edema

Martin Fus, Sarka Pitrova Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech RepublicCorrespondence: Martin Fus Tel +420 725 713 921Email martin.fus@cvut.czPurpose: The aim of this study was to develop software for the universal objective evaluation of factors influencing intraocular correction of astigmatism, such as decentration, tilt, axial position and angular orientation the toric intraocular lens (IOL).Patients and Methods: Software was developed using the MS Visual Studio environment. The analysis was presented using images of 67 eyes with an implanted IOLs of the SN6ATx model series. Decentration and angular position of the lens were obtained from images of the anterior segment of the eye, using a Visucam unit. Tilt was measured on tomographic images from OCT Avanti (in meridian of highest tilt and perpendicular meridian) and preoperative biometry parameters of eye (axial length, anterior chamber depth – ACD, ocular lens thickness – LT, limbus diameter and mean keratometry value) including postoperative anterior chamber depth (pACD) were measured using Lenstar LS900.Results: Applying the software methodology to the evaluation of individual toric IOL parameters, the following results were obtained: mean decentration 0.25 ± 0.17 mm which was observed in 61.19% of eyes, mean misalignment to the planned axis equal to 3.8 ± 3.6 degrees, mean highest inclination equal to 3.7 ± 1.2 degrees and mean difference of pACD and ACD was equal to 1.46 ± 0.31 mm. There was only a weak nonsignificant correlation between preoperative ACD versus decentration and tilt of IOL or a weak significant correlation between preoperative LT and both decentration and misalignment of IOL.Conclusion: The use of the presented methodology for determining the positional parameters of the toric IOL provided comparable results with the results of recent studies. Software design can be considered as a suitable alternative to previously published techniques, with the significant advantage of the possibility of using universal input images, their graphical editing and especially the possibility of comprehensive analysis of all parameters.Keywords: astigmatism and cataract, toric IOL centration, toric IOL tilt, toric IOL axis misalignment

Majid Moshirfar,1– 3 Austin J Waite,4 James H Ellis,5 Rachel Huynh,5 John Placide,6 Matthew R Barke,6 Shannon E McCabe,1,7 Yasmyne C Ronquillo,1 Phillip C Hoopes Jr,1 Michael J Bradley,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4A.T. Still University College of Osteopathic Medicine in Arizona, Mesa, AZ, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA; 7Mission Hills Eye Center, Pleasant Hill, CA, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, 11820 S. State Street Suite #200, Draper, UT, 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comPurpose: To assess visual outcomes over time of femtosecond laser-assisted cataract surgery compared to standard phacoemulsification cataract surgery.Design: A retrospective, single-center comparative study.Methods: Patient data including demographics, ocular biometry, pre- and postoperative visual acuity, postoperative complications, primary (uncorrected distance visual acuity over time) and secondary visual outcomes (uncorrected near visual acuity, best distance visual acuity, patient complaints, satisfaction, and postoperative surgery) were gathered and statistically analyzed. Demographic differences between patients receiving femtosecond-laser assisted cataract surgery (FLACS) versus standard phacoemulsification cataract surgery (PCS) were corrected for outcome comparison. Safety, efficacy, predictability, and stability were analyzed for each procedure and compared.Results: A total of 155 eyes in PCS and 143 eyes in FLACS were analyzed at 1 week, 3 months, and 1 year using odds ratio. The odds ratio of being 20/20 or better and 20/40 or better at the specified time periods were similar and statistically insignificant at all time periods analyzed except 20/20 or better for uncorrected distance visual acuity (UDVA) at 1 year (p=0.0001) and uncorrected near visual acuity (UNVA) at 1 week (p=0.02). In both cases, the odds of being 20/20 or better favored FLACS. Mean UDVA, UNVA, and best distance visual acuity (BDVA) were all similar and statistically insignificant between the two groups. Postoperative patient complaints, safety, efficacy, predictability, and stability between the two groups showed no statistical significance.Conclusion: Despite the odds ratio of being 20/20 or better favoring FLACS for UDVA at 1 year and UNVA at 1 week, the mean logMAR UDVA, BDVA, and UNVA were similar and statistically insignificant between the FLACS and PCS groups at 1 week, 3 months, and 1 year. Differences in visual acuity were likely due to differences other than surgical approaches. While both FLACS and PCS are appropriate approaches to cataract surgery, one does not appear to be superior when assessing longitudinal markers for visual acuity, safety, efficacy, predictability and stability.Keywords: cataract surgery, cataracts, femtosecond-laser assisted cataract surgery, phacoemulsification cataract surgery, uncorrected distance visual acuity, best distance visual acuity, uncorrected near visual acuity

Umesh Chandra Behera, Pratima Singh Thakur Retina-Vitreous Service, L V Prasad Eye Institute, Bhubaneswar, 751024, Odisha, IndiaCorrespondence: Umesh Chandra BeheraRetina-Vitreous Service, L V Prasad Eye Institute, Patia, Bhubaneswar, 751024, Odisha, IndiaTel +91-674-3987100Fax +91-674-398 7130Email umeshcbehera@gmail.comPurpose: To study the efficacy and safety of a modified trans-scleral intraocular lens (IOL) fixation technique in aphakic eyes when performed by ophthalmologists in training.Methods: The study was conducted in an institutional setting that included 43 surgeries performed by surgeons training in small incision cataract surgeries. The data were analyzed for stability and position of IOL, refractive changes, best-corrected vision, and associated complications.Results: Mean age of the subjects was 53.8 ± 18.5yrs (range 6– 81yrs). Surgical aphakia (58.14%) was the most common cause. The corrected distance visual acuity improved significantly at six weeks (p = 0.0003). The mean residual spectacle correction was +0.74 ± 1.2D spherical equivalent (cylinder − 1.6± 1.5D at 84 ± 50°) at the 6th-month follow-up (24.35 ± 6.71wks). Lens tilt on ultrasound biomicroscopy (kappa 0.762; p < 0.001) and the IOL centration (kappa 0.411; p = 0.001), assessed by two independent masked observers, were satisfactory at the 6th-month visit. Transient postoperative vitreous hemorrhage was the most common complication (46.5%). Cellular deposits on the IOL surface (18.6%), cystoid macular edema (11.6%), subconjunctival haptic exposure (4.66%), and haptic slippage (2.33%) were the other complications.Conclusion: This method of trans-scleral IOL fixation is an effective rescue procedure for eyes with deficient capsular support when ophthalmologists perform in training.Keywords: aphakia, intraocular lens, posterior capsular rent, trans scleral lens fixation, lens deposits

Eilidh Farquhar,&ast; Umiya Harley,&ast; Alan Rotchford, Kanna Ramaesh Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK&ast;These authors contributed equally to this workCorrespondence: Umiya HarleyTennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, United KingdomEmail umiya.harley@nhs.netPurpose: Current guidance states that access to cataract surgery should not be restricted by visual acuity (VA); nevertheless, 6/12 is used as a cut-off criterion in some health institutions. This study aims to determine the benefits of performing cataract surgery in patients with VA of 6/9 or better in both eyes; determine whether these benefits change over time; and compare the benefit observed between early first eye and second eye surgery.Patients and Methods: Fifty adults with VA at least 6/9 in the worst eye and no ocular comorbidity were recruited. The Visual Function Index (VF-14) and Impact of Visual Impairment (IVI) questionnaires were conducted pre-operatively, 4 months post-operatively, and 12 months post-operatively. The t-test or a non-parametric equivalent was used to compare averages between groups.Results: The mean change in VF-14 from baseline to 4 months was 16.43 (95% CI 12.49– 20.50, p < 0.001) and the median change in IVI was 6.5 (IQR 9.75, p < 0.001). There was no significant difference between 4-month and 12-month follow-up (p > 0.05). There was no significant difference in the change in visual function between the first and second eye surgery (p > 0.05).Conclusion: This study provides evidence that visual function improves after cataract surgery in patients with pre-operative VA of 6/9 or better. The improvement observed was clinically significant and unchanged a year after surgery. Visual function improved after second eye as much as after first eye surgery. Assessing patient reported visual function may give a more realistic indication of the benefit of early cataract surgery than relying on VA alone.Keywords: visual function, cataract surgery, patient reported outcomes

Francesco Saverio Sorrentino Department of Surgical Sciences, Unit of Ophthalmology, Ospedale Maggiore, Bologna, ItalyCorrespondence: Francesco Saverio Sorrentino Email dr.fsorrentino@gmail.comAim: To deeply analyze quantitative and qualitative changes of corneal endothelium after longitudinal phacoemulsification.Methods: In this prospective interventional case series study, 50 eyes with age-related cataract have been evaluated preoperatively, intraoperatively and postoperatively. The measured parameters were surgically induced endothelial cell loss (ECL), average endothelial cell area (AVG) and hexagonality (HEX).Results: The relationship among the measured parameters and the energy dissipated during the two phases of phacoemulsification, sculpting and quadrant removal, has been analyzed with regard to the 5-score harm scale, a new method suggested to categorize cataracts. Two phases of phacoemulsification are linearly related (r = 1.5, P < 0.001, r2 = 79%). Plus, a quadratic model described the correlation between the percentages of ECL and AVG (P < 0.0001), while there was no specific model for the correlation between ECL and HEX.Conclusion: The 5-score harm scale allows to predict the mean changes in percentages of ECL, AVG and HEX of endothelial cells after longitudinal phacoemulsification. Also, this study confirms that the main damage on corneal endothelium is due to the energy delivered in the second phase of phacoemulsification.Keywords: phacoemulsification, cataract, endothelial cell loss, average cell area, hexagonality

Julianna E Murray, Aaron S Gold, Azeema Latiff, Timothy G Murray Private Practice, Miami Ocular Oncology & Retina, Miami, FL, USACorrespondence: Timothy G MurrayMiami Ocular Oncology & Retina, 6705 Red Road Suite 412, Miami, FL, 33143, USAEmail tmurray@murraymd.comObjective: To report a consecutive series of compassionate, off-label use of intravitreal brolucizumab as a rescue therapy for complex, non-responsive macular edema. This report delineates primary diagnosis, indications for treatment, adverse events, and visual and anatomic outcomes after intravitreal brolucizumab.Methods: A retrospective review of a consecutive clinical case series of 110 eyes treated with intravitreal brolucizumab between January 1st and March 1st. 2020. All patients were included if they received intravitreal brolucizumab in an off-label delivery and had ongoing macular edema in the setting of prior, multiple intravitreal anti-VEGF and/or intravitreal triamcinolone acetonide. All patients had spectral domain OCT documented before, at the time of, and in serial follow-up after intravitreal brolucizumab.Results: Ninety-eight of 98 patients had marked decrease in macular edema. Indications for treatment were assigned to the primary etiologic diagnosis leading to the macular edema secondary to radiation retinopathy, complex epiretinal membrane, or complex diabetic retinopathy. In this series, sdOCT central point thickness decreased by an average of 71.5 microns, subretinal fluid resolved, and visual acuity was improved in 40% (greater than two Snellen lines) and stable in 60% (within two Snellen lines). No patient experienced a severe adverse event to specifically include vitritis and/or vasculitis.Conclusion: In this series, brolucizumab intravitreal injection was associated with significant improvement in macular edema in each diagnostic category. No serious complications to treatment were found in this series. Brolucizumab, though associated with known intraocular inflammation and vasculitis, demonstrated marked benefit in these complex eyes previously unresponsive to aggressive intravitreal pharmacotherapy.Keywords: brolucizumab, off-label usage, retinal vasculitis, vitreous inflammation, intraocular inflammation, macular edema

Bobby Saenz,1 Tanner J Ferguson,2 Noelle Abraham,1 Brett H Mueller,1 Gregory D Parkhurst1 1Parkhurst NuVision, San Antonio, TX, USA; 2Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USACorrespondence: Bobby SaenzParkhurst NuVision, 9725 Datapoint, Suite 106, San Antonio, TX, 78229, USATel +1-210-585-2020Email bobbysaenz@gmail.comPurpose: To evaluate the safety and efficacy of a sustained-release intracanalicular dexamethasone insert for postoperative inflammation and pain implanted in a clinical setting preoperatively or on postoperative day 1.Methods: Single-site, retrospective, contralateral eye study of patients undergoing cataract surgery. Included were subjects with a dexamethasone intracanalicular insert implanted in the clinic immediately prior to surgery in one eye (same-day) and on postoperative day 1 (POD1) in the contralateral eye. The primary outcome measure was the resolution of anterior chamber inflammation at 1 week postoperative. Secondary outcome measures included proportion of eyes requiring additional therapy for pain and inflammation through 1 month as well as the number of eyes with IOP spikes above baseline. Safety measures included adverse events through 1 month postoperative.Results: Sixty-two eyes of 31 subjects were included in the case series. At 1 week postoperative, 52% of the eyes (n = 16) achieved complete resolution of inflammation in the same-day group and 58% (n = 18) met this endpoint at 1 week in the POD1 group. One subject in the same-day group required additional therapy for rebound inflammation and no eyes required additional therapy in the POD1 group. There were no reports of pain at 1 week or 1 month in either group. There were no implant-related adverse events in either group.Conclusion: The favorable results of this study indicate that the sustained-release dexamethasone insert can be safely implanted in the clinic either preoperatively on the day of surgery or on postoperative day 1 for the control of pain and inflammation following cataract surgery.Keywords: cataract surgery, dexamethasone, intracanalicular, ocular inflammation, ocular pain

Napaporn Tananuvat,1,2 Pawara Winaikosol,2 Muanploy Niparugs,1,2 Winai Chaidaroon,1,2 Chulaluck Tangmonkongvoragul,1,2 Somsanguan Ausayakhun1,2 1Chiang Mai University LASIK Center, Center for Medical Excellence, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandCorrespondence: Napaporn TananuvatDepartment of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, ThailandTel +66-53935512Fax +66-53936121Email ntananuvat@gmail.comPurpose: To evaluate the 12-months outcomes of photorefractive keratectomy (PRK) in patients with high myopia (≥ 6.0 diopters, D) compared with low-to-moderate myopia (< 6.0 D).Patients and Methods: Records of 46 patients (69 eyes) who underwent PRK for myopic and astigmatic correction between October 2015 and December 2018 were reviewed. High myopic eyes (29 eyes) were compared with low-to-moderate myopic eyes (40 eyes). All surgeries were adjunct with 0.02% mitomycin C intraoperatively. Measured outcomes included postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent, corneal haze rate, and any complications.Results: At 12 months post-PRK, 26 eyes (89.7%) in the high myopia and 39 eyes (97.5%) in the low-to-moderate myopia group had UDVA ≥ 20/20, (p=0.30). Average postoperative logMAR UDVA at 12 months was − 0.04 (20/18) and − 0.11 (20/15) for the high myopia and low-to-moderate myopia groups, respectively. No eyes in either group had residual refractive errors > 1 D. No eyes in both groups developed significant corneal haze at month 12. No eyes had a loss of greater than two Snellen lines of CDVA at 12 months post-surgery. The efficacy and safety indices at 12 months post-surgery were not significantly different between groups (1.06± 0.26 vs.1.14± 0.27, p =0.25 and 1.14± 0.27 vs 1.17± 0.26, p=0.60 for low-to-moderate myopia vs high myopia groups, respectively).Conclusion: PRK with high myopic correction provides excellent refractive outcomes and is safe, compared to those of low-to-moderate myopic correction.Keywords: corneal haze, high myopia, PRK, refractive surgery, wavefront-optimized

Ryo Kurobe, Yoshio Hirano, Shuntaro Ogura, Tsutomu Yasukawa, Yuichiro Ogura Department of Ophthalmology & Visual Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, JapanCorrespondence: Yoshio HiranoDepartment of Ophthalmology & Visual Science, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, JapanTel +81-52-8538251Fax +81-52-8419490Email yoshio.hirano@gmail.comPurpose: To investigate whether ultra-widefield (UWF) swept-source optical coherence tomography (SSOCT) system (Silverstone, Nikon Healthcare Japan, Inc, Tokyo, Japan) can obtain OCT images of peripheral retinal degenerations and breaks.Methods: Thirty-seven eyes of 31 consecutive cases (16 men, 15 women; mean age 51 years) who had peripheral retinal degenerations and underwent a UWF-SSOCT imaging were enrolled. The convenience and usefulness were investigated.Results: In all eyes, OCT images were capable and interpretable without any special techniques. The respective findings on OCT were retinal degeneration in 16 eyes: lattice degeneration in 8 eyes, paving stone degeneration in 4 eyes, and unclassified in 4 eyes, retinal tear in 12 eyes, and retinal hole in 9 eyes. The respective locations of the retinal degenerations or breaks were the posterior pole in 0 eyes, mid-periphery in 23 eyes, and far-periphery in 14 eyes. Fifteen eyes had a rhegmatogenous retinal detachment (RRD), one of which was preoperative and the other 14 eyes were postoperative. A buckle was placed in 8 eyes for RRD repair. Subretinal fluid was observed in 9 of 21 eyes with retinal break or retinal hole. Vitreoretinal traction was observed in 10 of 27 eyes without a history of vitrectomy. Inverted artifacts on OCT images were observed in 20 of 37 eyes, which were not related to the location or axial length, but were supposed to be due to the limited scan depth.Conclusion: The UWF-SSOCT system could capture the OCT images of peripheral retinal degenerations and breaks without any special technique.Keywords: ultra-widefield, swept-source optical coherence tomography, peripheral retinal degeneration, retinal break, rhegmatogenous retinal detachment

Majid Moshirfar,1– 3 Austin J Waite,4 James H Ellis,5 Rachel Huynh,5 John Placide,6 Matthew R Barke,6 Shannon E McCabe,1,7 Yasmyne C Ronquillo,1 Phillip C Hoopes Jr,1 Michael J Bradley,1 Phillip C Hoopes1 1Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA; 2Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4A.T. Still University College of Osteopathic Medicine in Arizona, Mesa, AZ, USA; 5University of Utah School of Medicine, Salt Lake City, UT, USA; 6McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA; 7Mission Hills Eye Center, Pleasant Hill, CA, USACorrespondence: Majid MoshirfarHoopes Vision Research Center, 11820 S. State Street Suite #200, Draper, UT, 84020, USATel +1 801-568-0200Fax +1 801-563-0200Email cornea2020@me.comPurpose: To assess visual outcomes over time of femtosecond laser-assisted cataract surgery compared to standard phacoemulsification cataract surgery.Design: A retrospective, single-center comparative study.Methods: Patient data including demographics, ocular biometry, pre- and postoperative visual acuity, postoperative complications, primary (uncorrected distance visual acuity over time) and secondary visual outcomes (uncorrected near visual acuity, best distance visual acuity, patient complaints, satisfaction, and postoperative surgery) were gathered and statistically analyzed. Demographic differences between patients receiving femtosecond-laser assisted cataract surgery (FLACS) versus standard phacoemulsification cataract surgery (PCS) were corrected for outcome comparison. Safety, efficacy, predictability, and stability were analyzed for each procedure and compared.Results: A total of 155 eyes in PCS and 143 eyes in FLACS were analyzed at 1 week, 3 months, and 1 year using odds ratio. The odds ratio of being 20/20 or better and 20/40 or better at the specified time periods were similar and statistically insignificant at all time periods analyzed except 20/20 or better for uncorrected distance visual acuity (UDVA) at 1 year (p=0.0001) and uncorrected near visual acuity (UNVA) at 1 week (p=0.02). In both cases, the odds of being 20/20 or better favored FLACS. Mean UDVA, UNVA, and best distance visual acuity (BDVA) were all similar and statistically insignificant between the two groups. Postoperative patient complaints, safety, efficacy, predictability, and stability between the two groups showed no statistical significance.Conclusion: Despite the odds ratio of being 20/20 or better favoring FLACS for UDVA at 1 year and UNVA at 1 week, the mean logMAR UDVA, BDVA, and UNVA were similar and statistically insignificant between the FLACS and PCS groups at 1 week, 3 months, and 1 year. Differences in visual acuity were likely due to differences other than surgical approaches. While both FLACS and PCS are appropriate approaches to cataract surgery, one does not appear to be superior when assessing longitudinal markers for visual acuity, safety, efficacy, predictability and stability.Keywords: cataract surgery, cataracts, femtosecond-laser assisted cataract surgery, phacoemulsification cataract surgery, uncorrected distance visual acuity, best distance visual acuity, uncorrected near visual acuity

Bobby Saenz,1 Tanner J Ferguson,2 Noelle Abraham,1 Brett H Mueller,1 Gregory D Parkhurst1 1Parkhurst NuVision, San Antonio, TX, USA; 2Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USACorrespondence: Bobby SaenzParkhurst NuVision, 9725 Datapoint, Suite 106, San Antonio, TX, 78229, USATel +1-210-585-2020Email bobbysaenz@gmail.comPurpose: To evaluate the safety and efficacy of a sustained-release intracanalicular dexamethasone insert for postoperative inflammation and pain implanted in a clinical setting preoperatively or on postoperative day 1.Methods: Single-site, retrospective, contralateral eye study of patients undergoing cataract surgery. Included were subjects with a dexamethasone intracanalicular insert implanted in the clinic immediately prior to surgery in one eye (same-day) and on postoperative day 1 (POD1) in the contralateral eye. The primary outcome measure was the resolution of anterior chamber inflammation at 1 week postoperative. Secondary outcome measures included proportion of eyes requiring additional therapy for pain and inflammation through 1 month as well as the number of eyes with IOP spikes above baseline. Safety measures included adverse events through 1 month postoperative.Results: Sixty-two eyes of 31 subjects were included in the case series. At 1 week postoperative, 52% of the eyes (n = 16) achieved complete resolution of inflammation in the same-day group and 58% (n = 18) met this endpoint at 1 week in the POD1 group. One subject in the same-day group required additional therapy for rebound inflammation and no eyes required additional therapy in the POD1 group. There were no reports of pain at 1 week or 1 month in either group. There were no implant-related adverse events in either group.Conclusion: The favorable results of this study indicate that the sustained-release dexamethasone insert can be safely implanted in the clinic either preoperatively on the day of surgery or on postoperative day 1 for the control of pain and inflammation following cataract surgery.Keywords: cataract surgery, dexamethasone, intracanalicular, ocular inflammation, ocular pain