Search

Purpose: To describe a case of well-documented corneal stroma transparency improvement following the intrastromal implantation of autologous adipose-derived mesenchymal stem cells (ADASC) in a keratoconic patient with established stromal scars. Observations: ADASC were isolated by elective liposuction, and a solution composed of 3x106 ADASC contained in 1mL saline was used to soak a corneal intrastromal pocket created with femtosecond laser at mid-depth. No signs of inflammation or rejection were observed. One year after surgery, we observed a complete restoration of the pre-existing corneal stroma scars, observed both clinically and by anterior segment OCT. The rest of the visual and topographic parameters did not show relevant changes except for the patient's refractive sphere. OCT showed a thin new layer of neocollagen deposited at the surgical plane. Total stroma optical density (OD) improved from 51.5 to 41.2 GSU, anterior stroma OD improved from 55.9 to 42.8 GSU, and posterior stroma OD improved from 46.9 to 39.6 GSU. Conclusions and importance: This clinical case provides new clinical evidence supporting the use of intrastromal mesenchymal stem cell implantation to solve or alleviate established corneal scars.

Abstract Purpose This study aimed to investigate the association between variants in the interleukin (IL)-1 gene cluster and susceptibility to keratoconus (KC) in an Iranian population. Methods In the case group, there were 188 KC patients diagnosed by clinical findings and corneal tomography. The control group included all 205 healthy controls with no personal or family history of eye-related, metabolic, or immune system-related disease. Using the standard salting out extraction procedure, genomic DNA was isolated from peripheral blood leukocytes. The genotypes were determined by applying agarose gel electrophoresis for the IL-1RN 86 bp VNTR and polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) for rs16944 and rs1143634. Results The results showed a significant association between the IL-1β rs1143634 (rs1143634 T allele, P = 0.008) and IL-1RN 86 bp VNTR polymorphisms (LL and LS genotype, P = 0.048 and 0.012 respectively) and susceptibility to KC in the Iranian population. The genotype distributions of rs1143634 (P = 0.004) and rs2234663 (P = 0.042) significantly differed between case and control groups, with certain genotypes demonstrating a protective effect against KC. Logistic regression analysis revealed a protective effect of the IL-1RN L allele [odds ratio (OR) = 0.367, 95% confidence interval (CI): 0.240–0.562; P = 0.000] and certain haplotypes (OR = 0.628, 95% CI: 0.447–0.884; P = 0.007) against KC. However, no significant association was found for the IL-1β rs16944 polymorphism. Conclusion This study provides evidence for an association between variants in the IL-1 gene cluster and susceptibility to KC in an Iranian population. Further research on larger and more diverse populations is warranted to validate these findings and explore the underlying mechanisms involved.

AIM: To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty (t-DSEK) and tectonic Bowman layer transplant (t-BLT) as an alternative to tectonic penetrating keratoplasty (t-PKP). METHODS: Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included. The technique for DSEK was modified depending on individual requirements. The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture. Success was measured by the ability of this procedure to close a corneal perforation. RESULTS: All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period. Reinterventions were relatively common: 2 cases required amniotic membrane transplant for persistent epithelial defects. One case required DSEK rebubbling. One case developed angle closure glaucoma requiring surgical peripheral iridectomy. CONCLUSION: Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.

Abstract Background To compare and contrast morpho-volumetric features between Down syndrome (DS) cornea and non-DS keratoconic cornea by three-dimensional (3D) modelling. Methods Forty-three subjects (43 eyes) with DS and 99 patients matching their age and sex (99 eyes) with keratoconus (KC) were included in this single-center cross-sectional study. Main outcome measures were high-order aberrations (HOA), central corneal thickness (CCT), spherical equivalent refraction, and morpho-volumetric parameters established using a 3D corneal model, such as deviation of anterior and posterior corneal apices (Dapexant/Dapexpost) and minimum thickness points (Dmctant/Dmctpost) from corneal vertex, areas of the anterior and posterior surfaces (Aant/Apost), sagittal area passing through the anterior and posterior corneal apices (Aapexant/Aapexpost) and minimum thickness point (Amctpost) and corneal volume of the complete cornea (Vtotal). Results Age, gender, spherical equivalent refraction, CCT and Vtotal were similar between the net on-DS KC and DS groups (P > 0.05), while non-DS KC group had higher HOA than the DS group (P

Abstract Background The aim of this study was to evaluate visual, refractive, quality of vision, visual function and satisfaction of multifocal intraocular lens (MF-IOL) exchange with a monofocal IOL (MNF-IOL) in dissatisfied patients following MF-IOL implantation. Methods This was a retrospective case series. Bilateral IOL exchange (MF-IOL to MNF-IOL) was performed in 13 patients (26 eyes) with neuroadaptation failure. Questionnaires including the Quality of Vision (QoV), Visual Function Index (VF-14 and Rasch-revised VF-8R version), and a satisfaction questionnaire were used. Results The mean time for IOL exchange was 15 months. The corrected distance visual acuity (CDVA) improved from 20/26 to 20/23 (P = 0.028). The uncorrected near visual acuity (UNVA) worsened after exchange from 20/47 to 20/62 (P = 0.024). QoV scores improved significantly across all three subscales after exchange. Visual function for far distance improved with a change in VF-14 score from 74.2 ± 24.8 to 90.9 ± 9.1 (P = 0.03). The VF-8R score showed worsening although not statistically significant. Near vision spectacle independence was totally or partially lost in all cases. Ten patients (77%) reported they would not repeat the lens exchange. Safety and efficacy indices changed from 1.23 to 0.85, respectively, at three months to 1.24 (P = 0.871) and 0.89 (P = 0.568), respectively, at one year. Conclusion IOL exchange (multifocal to monofocal) to solve neuroadaptation failure in this case series resulted in significant improvements in dysphotopsia and improved distance visual function. However, UNVA worsened and patient satisfaction after exchange remained suboptimal with 77% claiming they would not repeat the lens exchange, suggesting the value of near vision spectacle independence for these patients.

Abstract Background The aim of the study was to evaluate the outcomes of dissatisfied patients reporting poor visual quality following implantation of multifocal intraocular lenses (MF-IOLs), managed by IOL exchange with another multifocal optical profile. Methods This is a retrospective series of cases. MF-IOL exchange was done in 15 dissatisfied patients (30 eyes) with the perception of poor visual quality for far distance affected by neuroadaptation failure. Patients underwent a bilateral exchange of a MF-IOL with another MF-IOL of a different optical profile. Visual outcomes and complications were analyzed. Questionnaires including Quality of Vision (QoV), Visual Function Index-14 (VF-14) and its Rasch-revised version (VF-8R) and a satisfaction questionnaire were also used for outcome evaluation. Results The mean elapsed time from implantation to explantation-reimplantation was 11.8 months. The QoV scores improved significantly across all the three subscales. Visual function improved with a change in VF-14 score from 60.41 ± 24.81 to 90.16 ± 10.91 (P

AIM: To compare the visual results of non-topography-guided and topography-guided photorefractive keratectomy (PRK) applying sequential and simultaneous corneal cross-linking (CXL) treatment for keratoconus. METHODS: Interventional and comparative prospective study. Sixty-nine eyes (36 patients) suffering from keratoconus (stages 1 Amsler-Krumeich classification) were divided into four groups: sequential topography-guided photorefractive keratectomy with CXL, simultaneous topography-guided photorefractive keratectomy with CXL, simultaneous non-topography guided photorefractive keratectomy with CXL, and sequential non-topography guided photorefractive keratectomy with CXL. The main outcome measures were pre- and postoperative uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (CDVA), manifest refraction, contrast sensitivity, and keratometry. RESULTS: All analyzed visual, contrast sensitivity, and refractive parameters showed a significant improvement in the four groups (all P

Abstract Background To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer. Methods This study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group); (b) 19 Miniwell; (c) 24 LENTIS Mplus LS-313 MF30; d) 33 LENTIS Mplus LS-313 MF15; (e) 17 AkkoLens Lumina; (f) 31 AT LISA Tri 839MP; (g) 20 Precizon Presbyopic; (h) 20 AcrySof IQ PanOptix; (i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer. Results AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10; P

Abstract Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking (CXL) techniques compared with standard epi-off CXL. Methods We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) and we evaluated the selected papers according to the Cochrane risk of bias tool. We considered, as primary outcomes, average Kmax flattening, changes in uncorrected and corrected distance visual acuity (UDVA and CDVA); as secondary outcomes, we considered changes in pachymetry values and endothelial cell density (ECD). We also investigated adverse events related to the treatments and treatment failure. Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference (MD) with 95% confidence interval (CI) as the effect size. Results A total of 15 studies were included and among these 15 trials, 9 were RCTs and 6 were NRSIs, but only 4 studies showed no high risk of bias and were included in this meta-analysis. Our analysis revealed significant postoperative differences in CDVA (MD = 0.07; 95% CI 0.04 to 0.10; P 0.05). Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing (P = 0.035) and persistent stromal haze (P = 0.026). Conclusion Epi-on CXL is as effective as epi-off CXL. Except for a higher significant improvement in CDVA with current epi-on protocols, our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual, topographic, pachymetric, and endothelial parameters. Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.

Abstract This short report includes 5 eyes of 5 patients (mean age 63.2 ± 12 years) who underwent a tectonic keratoplasty [deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK)] in order to rehabilitate the eye after the extrusion of the non-perforating keratoprosthesis (Kpro) KeraKlear (KeraMed, USA). The non-perforating Kpro was extruded after a mean period of 21.4 ± 21.8 months due to melting. In two cases, the keratoplasty was performed the same day of the non-perforating Kpro removal due to a severe melting, while in the other three cases it was performed one to 3 months later. Two eyes received a DALK, but in 3 eyes a macroscopic Descemet membrane perforation forced the conversion into a PK. The mean follow-up period after the keratoplasty was 16.8 ± 6.6 months. No cases of rejection were recorded. All the 5 eyes achieved “anatomical success” (transparent graft, with no signs of infection or inflammation). Two eyes showed limited “functional success” because the achievement of the best visual potential was prevented by the development of glaucomatous optic atrophy during the follow-up period. In conclusion, this short report presents an unexpected success of a keratoplasty performed with a tectonic purpose after the extrusion of the non-perforating Kpro because the corneal graft remained transparent, without neovascularization or scarring during the follow-up period. This initial evidence shows some encouraging results regarding graft survival rate and the achievement of a useful visual rehabilitation with keratoplasty after a non-perforating Kpro failure instead of repeating the Kpro implantation.

Abstract Background To analyze the clinical results of an artificial neural network (ANN) that has been processed in order to improve the predictability of intracorneal ring segments (ICRS) implantation in keratoconus. Methods This retrospective, comparative, nonrandomized, pilot, clinical study included a cohort of 20 keratoconic eyes implanted with intracorneal ring segments KeraRing (Mediphacos, Belo Horizonte, Brazil) using the ANN (ANN group) and 20 keratoconic eyes implanted with KeraRing using the manufacturer’s nomograms (nomogram group). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) (visual acuity is expressed in decimal value and in LogMAR value in brackets), manifest refraction, corneal topography, tomography, aberrometry, pachymetry and volume analysis (Sirius System. CSO, Firenze, Italy) were performed during the preoperative visit; and the two groups, ANN group and nomogram group, did not differ significantly preoperatively in all of the parameters evaluated. These preoperative values were compared with the results obtained at the third-month visit. Mann-Whitney test and Wilcoxon test were used for the statistical analyses. Results The spherical equivalent and the keratometric values decreased significantly in both groups. The CDVA improved from 0.60 ± 0.23 (0.22 LogMAR) pre-operatively to 0.73 ± 0.21 (0.14 LogMAR) post-operatively in the ANN group (p

Purpose. To evaluate the efficacy of autologous platelet-rich plasma (E-PRP) eye drops for the treatment of chronic ocular surface syndrome (OSS) following laser in situ keratomileusis (LASIK). Methods. This prospective interventional consecutive clinical study include 156 eyes of 80 patients affected by post-LASIK chronic OSS who were treated with autologous E-PRP 6 times a day as monotherapy for 6 weeks. Results. Dry eye symptoms improved in 85% of the cases. A decrease in at least one quadrant to total disappearance on CFS was observed in 89.6% of the patients who had positive CFS before treatment. Three eyes presented severe punctate keratitis (1.9%) at baseline, all of which healed completely. Conjunctival hyperemia improved in 93.3% of the patients with previous signs of ocular surface inflammation. There was a significant improvement in logMAR CDVA from 0.14 ± 0.19 to 0.06 ± 0.12 (p=0.000), and 74 (71.4%) eyes improved at least 1 line in CDVA. Conclusion. Monotherapy with autologous E-PRP is a well-tolerated, safe, and effective treatment for the management of post-LASIK ocular surface syndrome. Precis. Monotherapy with autologous platelet-rich plasma eye drops has been shown to be an adequate option for the treatment of post-LASIK chronic ocular surface syndrome. This trial is registered with NCT03322917.

Corneal ectatic disorders are characterized by a progressive weakening of the tissue due to biomechanical alterations of the corneal collagen fibers. Carbon nanostructures, mainly carbon nanotubes (CNTs) and graphene, are nanomaterials that offer extraordinary mechanical properties and are used to increase the rigidity of different materials and biomolecules such as collagen fibers. We conducted an experimental investigation where New Zealand rabbits were treated with a composition of CNTs suspended in balanced saline solution which was applied in the corneal tissue. Biocompatibility of the composition was assessed by means of histopathology analysis and mechanical properties by stress-strain measurements. Histopathology samples stained with blue Alcian showed that there were no fibrous scaring and no alterations in the mucopolysaccharides of the stroma. It also showed that there were no signs of active inflammation. These were confirmed when Masson trichrome staining was performed. Biomechanical evaluation assessed by means of tensile test showed that there is a trend to obtain higher levels of rigidity in those corneas implanted with CNTs, although these changes are not statistically significant (p>0.05). Implanting CNTs is biocompatible and safe procedure for the corneal stroma which can lead to an increase in the rigidity of the collagen fibers.

Abstract Purpose To analyze the quality of vision of patients implanted bilaterally with the multifocal Precizon Presbyopic intraocular lens (IOL), as well as to evaluate the visual performance provided by the lens. Setting Vissum Miranza Alicante. Design Prospective multicenter study. Methods 56 patients (mean age 65.0 ± 8.7 years old) underwent bilateral implantation with multifocal Precizon Presbyopic IOL. The quality of vision was assessed by a quality of vision questionnaire at 6 months after the implantation procedure, a complete eye examination was also performed including visual and refractive measurements, defocus curve and contrast sensitivity assessment. Visual and refractive variables were compared in preoperative, 3-month postoperative and 6-month postoperative visits by Wilcoxon test. Results The quality of vision analysis showed the absence of severe glare and severe haloes in all evaluated patients. Likewise, non-symptoms of glare, haloes and starbursts were seen in 75%, 68%, and 55% of subjects, respectively. Efficacy and safety index was 1.26 and 1.42, respectively. The 6-month postoperative binocular uncorrected distance visual acuity and near uncorrected visual acuity were 0.00 ± 0.09 and 0.20 ± 0.13 logMAR, respectively. Mean spherical equivalent was 0.29 ± 0.45 D. Conclusions The Precizon Presbyopic NVA IOL (OPHTEC BV) provides a suitable quality of vision with a low rate of disturbance photic phenomena induction, as well as an excellent visual performance at main distances of sight accomplishing the visual demands of the majority of patients.

Abstract Background Keratoconus is an ectatic, progressive corneal disorder characterized by alterations in the morphology of the corneal tissue that leads to limitation of visual function of the patient. Intracorneal ring segments (ICRS) are small synthetic devices that are implanted in the corneal stromal in order to regularize the morphology of the tissue therefore improving the visual function and the quality of life of the patients. Main text The present narrative review summarizes the main scientific articles developed by the authors in relation to the clinical outcomes and long-term results of ICRS in the treatment of keratoconus. It was found that those patients that benefit the most from this surgical intervention are those that have the most severe form of keratoconus. Additionally, patients with good visual function, those with more than 0.9 in the decimal scale are at risk of losing visual acuity after ICRS implantation. In relation to long-term results, scientific investigations published by the authors demonstrate that ICRS is a stable procedure after long period of time in terms of vision, refraction, and topographic variables in those patients with stable keratoconus. However, in patients with keratoconus and signs of progression, ICRS may not have the capability of halting the progression of the disease. Using artificial intelligence to guide ICRS implantation provide better clinical outcomes and improvement in corneal higher-order aberrations in patients with keratoconus in comparison to those treated using the commercial nomogram of implantation. Conclusions ICRS is a safe surgical procedure in the treatment of keratoconus. Patients that benefit most from the surgery are those with a significant visual impairment. ICRS should not be considered in patients with good visual function because of the risk of losing lines of vision. Long-term follow-up demonstrate stability of the clinical outcomes in patients with stable keratoconus although ICRS may not have the ability of halting the progression of the disease. New technologies based artificial intelligence improved the indications and the clinical outcomes of keratoconus patients treated with ICRS.

Abstract Purpose This study investigates immune cell (ICs) infiltration in advanced keratoconus patients undergoing autologous adipose-derived adult stem cell (ADASC) therapy with recellularized human donor corneal laminas (CL). Methods A prospective clinical trial included fourteen patients divided into three groups: G-1, ADASCs; G-2, decellularized CL (dCL); and G-3, dCL recellularized with ADASCs (ADASCs-rCL). Infiltrated ICs were assessed using in vivo confocal microscopy (IVCM) at 1,3,6, and12 months post-transplant. Results Infiltrated ICs, encompassing granulocytes and agranulocytes, were observed across all groups, categorized by luminosity, structure, and area. Stromal ICs infiltration ranged from 1.19% to 6.62%, with a consistent increase in group-related cell density (F = 10.68, P 300μm2, presumably macrophages, notably in G-3, indicating a potential role in tissue repair and remodeling, explaining reductions in cells remnants

This review explores contemporary challenges in penetrating keratoplasty (PK), focusing on technical intricacies, technological advancements, and strategies for preventing graft rejection. A systematic literature search from January 2018 to July 2023 was conducted across PubMed, Cochrane, Web of Science, Scopus, and EMBASE. The inclusion criteria comprised studies on PK and its comparison with other corneal pathologies, with emphasis on keratoconus (KC). Two independent reviewers screened studies, extracting relevant data. The review covers PK evolution, highlighting infra-red femtosecond lasers' impact on graft shapes, minimizing astigmatism, and enhancing wound healing. Graft rejection, a primary complication, is examined, detailing risk factors and preventive measures. Preoperative considerations, diagnostic techniques for rejection, and PK in KC are discussed. Postoperative care's significance, including intraocular pressure monitoring and steroid administration, is emphasized. The paper concludes with a comprehensive approach to prevent graft rejection, involving topical and systemic medications. An outlook on evolving monoclonal antibody research is presented. As the field progresses, personalized approaches and ongoing therapeutic exploration are expected to refine strategies, enhancing PK outcomes.

The purpose of this study was to describe a case and clinical course of simultaneous anterior chamber phakic intraocular lens (AC-pIOL) removal, implantation of a posterior chamber phakic intraocular implantable collamer lens (ICL), and Descemet membrane endothelial keratoplasty (DMEK). This was a case report of a 44-year-old male with a unilateral decompensated cornea from a displaced Duet–Kelman lens on his left eye that underwent pIOL extraction and implantation of a posterior chamber phakic intraocular ICL and simultaneous DMEK. After 6 months, the cornea of the left eye had regained clarity, the Descemet membrane was graft stable, and the ICL implanted was centered with good vault. Postoperative anisometropia was avoided. There was no development of cataracts or other complications. The simultaneous pIOL extraction, ICL implantation, and DMEK in our case showed good results with full restoration of anterior segment anatomy and return of transparency of the cornea. The current case shows the feasibility of the simultaneous approach instead of sequential as an alternative for patients with endothelial disease associated with AC pIOLs, restoring vision and anatomy and also avoiding postoperative anisometropia.

Abstract Background Prevalence of high myopia is continuously increasing, thus, patients affected with staphyloma are abundant worldwide. Assessment of the quality of vision in these patients is mandatory for a proper clinical counselling, specially when undergoing surgical procedures that require intraocular lenses implantation. Thus, the purpose of the study was to assess monochromatic higher order aberrations (HOAs) in highly myopic eyes with staphyloma with or without a dome-shaped macula. Methods Participants underwent spectral-domain optical coherence tomography, ocular axial biometry, dual Scheimpflug photography and integrated Placido disk topography, and Hartmann-Shack wavefront analysis. Five groups were evaluated: a low-moderate myopia control group (

Abstract Background To evaluate the safety, efficacy, refractive outcomes and causes for bilensectomy (phakic intraocular lens – pIOL – explantation with cataract surgery and pseudophakic intraocular lens implantation) in patients previously implanted with posterior chamber pIOLs. Methods This multi-center retrospective study included 87 eyes of 55 patients who underwent bilensectomy for posterior chamber pIOL with a follow up time of 12 months. The uncorrected and best corrected distance visual acuities (UDVA, CDVA), endothelial cell density before and after bilensectomy were assessed, as well as the cause of bilensectomy and intra or postoperative complications. Results There was a statistically significant improvement in uncorrected and best corrected visual acuities after bilensectomy (p = 0.00). The main reason for bilensectomy was cataract development (93.1% of the cases), followed by miscalculation of lens size, and corneal edema. The endothelial cell count remained stable without a statistically significant change after surgery (p = 0.67). The refractive efficacy index was 0.8, none of the patients lost lines of CDVA after surgery, 73% of the patients were within ±1 D (spherical equivalent) of the target refraction. Intraoperative complications were one posterior capsule rupture with the intraocular lens (IOL) implanted in the sulcus, and 3 eyes required the use of pupil expanders for adequate pupil dilation. Postoperatively, one eye developed retinal detachment. The three pIOLs models explanted were the Implantable Collamer Lens (ICL), Implantable Phakic Contact Lens (IPCL) and the Phakic Refractive Lens (PRL). Conclusions Good safety and visual outcomes were observed 1 year after bilensectomy for posterior chamber phakic intraocular lenses (PC pIOLs). There were few intra and postoperative complications and there was no significant endothelial cell loss after the bilensectomy procedure.

Abstract Purpose To evaluate the clinical and visual outcomes, quality of near vision and the influence of photic phenomena in patients bilaterally implanted with a new Precizon Presbyopic multifocal intraocular lens (IOL). Methods In this prospective consecutive case series, 20 eyes of 10 patients were included (mean age 63.80 ± 12.55 years). Uncorrected and corrected visual acuity (far, intermediate and near), subjective refraction, binocular defocus curve, contrast sensitivity (CSV-1000) and quality of vision and satisfaction questionnaires were measured. The follow-up was 12 months after surgery. Results At 12 months after surgery, uncorrected distance visual acuity (UDVA) improved with surgery (p = 0.001) with a value of 0.08 ± 0.08 logMAR. Uncorrected near visual acuity (UNVA) was 0.22 ± 0.12 logMAR and distance corrected near visual acuity (DCNVA) was 0.16 ± 0.13 logMAR. Intermediate distance visual acuity (UIVA) was 0.22 ± 0.10 logMAR. Contrast sensitivity outcomes were similar to normal population in photopic conditions and slightly reduced in mesopic conditions of lighting. Defocus curve showed that this multifocal IOL was able to provide a visual acuity (VA) equal or better to 0.16 logMAR between defocus levels of + 1.00 to − 2.50 D. Good patient satisfaction was obtained in quality of vision and satisfaction questionnaires outcomes. Conclusions The Precizon Presbyopic NVA IOL (OPHTEC BV) provides good visual outcomes. This multifocal IOL provides a high percentage of spectacle independence due to good VA at far, intermediate and near distances and satisfactory contrast sensitivity. High patient satisfaction was observed in quality of vision and satisfaction questionnaires with a low percentage of patients manifesting photic phenomena.

Abstract The worldwide outbreak of the severe and acute respiratory coronavirus disease (COVID-19) caused by the coronavirus strain SARS-CoV-2 is currently the focal point of discussion due to the suffering this syndrome is causing to humanity. However, the ophthalmological implications of this syndrome has not yet been well described. Both eyes and tears as portals of entry and sources of contagion have been the subject of debate by many authors. The purpose of this review is to summarize the evidence currently available on COVID-19 and its ocular implications and manifestations, in both animals and humans, with the aim to facilitate prevention and educate the ophthalmological community on this subject. A review of the literature revealed that the results of some studies suggest that ocular symptoms commonly appear in patients with severe COVID-19 pneumonia and that it is possible to isolate the virus from the conjunctival sac of these patients. Conjunctivitis is not a common manifestation of the disease, but contact with infected eyes could be one route of transmission. Consequently, ophthalmologists need to have correct prevention strategies in place. Some guidelines regarding the prevention and management of ophthalmology clinics are reviewed. However, well-designed trials should be conducted to rule out other ocular manifestations that may result from COVID-19 infection and to understand the transmission of the virus through the eyes.

Abstract Cellular therapy of the corneal stroma, with either ocular or extraocular stem cells, has been gaining a lot of interest over the last decade. Multiple publications from different research groups are showing its potential benefits in relation to its capacity to improve or alleviate corneal scars, improve corneal transparency in metabolic diseases by enhancing the catabolism of the accumulated molecules, generate new organized collagen within the host stroma, and its immunosuppressive and immunomodulatory properties. Autologous extraocular stem cells do not require a healthy contralateral eye and they do not involve any ophthalmic procedures for their isolation. Mesenchymal stem cells have been the most widely assayed and have the best potential to differentiate into functional adult keratocytes in vivo and in vitro. While embryonic stem cells have been partially abandoned due to ethical implications, the discovery of the induced pluripotent stem cells (iPSC) has opened a new and very promising field for future research as they are pluripotent cells with the capacity to theoretically differentiate into any cell type, with the special advantage that they are obtained from adult differentiated cells. Cellular delivery into the corneal stroma has been experimentally assayed in vivo in multiple ways: systemic versus local injections with or without a carrier. Encouraging preliminary human clinical data is already available although still very limited, and further research is necessary in order to consolidate the clinical applications of this novel therapeutic line.

Abstract Introduction To report the outcomes in near vision, optical quality and pupil diameter of a new pharmacological therapy (FOV tears) for presbyopia. Methods This was a prospective, consecutive, interventional, non-comparative clinical study in which 117 presbyopic patients were given one drop of the novel therapy (FOV tears) in each eye, followed 2 h after the instillation of the eye drop by an evaluation of the binocular uncorrected near visual acuity (UNVA) and uncorrected distance visual acuity. The objective scatter index and pupil diameter under photopic and scotopic conditions before and after instillation were also assessed. The patients were divided into two groups according to their age, with group 1 patients being 41 and 50 years old and group 2 patients, between 51 and 65 years old. Results The mean age of the patients was 50.2 years. The mean UNVA before the use of the eye drop was 0.35 LogMAR, which improved to 0.16 LogMAR at 2 h after the use of the eye drop (p = 0.000). Nine patients did not show an improvement in UNVA, but no patient showed a loss of lines. Fourteen patients (11.9%) reported headaches as a side effect of the therapy. Conclusion This pharmacological therapy improved near vision by one or more lines (mean improvement 0.18 lines) in 92.3% of the patients at 2 h following the instillation of the eye drops. The group with the youngest patients gained more lines than the group with the oldest patients.

Abstract Small Incision Lenticule Extraction (SMILE) is a flap-free intrastromal technique for the correction of myopia and myopic astigmatism. To date, this technique lacks automated centration and cyclotorsion control, so several concerns have been raised regarding its capability to correct moderate or high levels of astigmatism. The objective of this paper is to review the reported SMILE outcomes for the correction of myopic astigmatism associated with a cylinder over 0.75 D, and its comparison with the outcomes reported with the excimer laser-based corneal refractive surgery techniques. A total of five studies clearly reporting SMILE astigmatic outcomes were identified. SMILE shows acceptable outcomes for the correction of myopic astigmatism, although a general agreement exists about the superiority of the excimer laser-based techniques for low to moderate levels of astigmatism. Manual correction of the static cyclotorsion should be adopted for any SMILE astigmatic correction over 0.75 D.

Abstract Presbyopia still remains the last frontier of refractive surgery. Its surgical management is under constant evolution due to the limitations that exist today with respect to its management, which is probably in relation with the multifactorial basis in which presbyopia is clinically developed in the human. Until currently, virtually all surgical techniques that have been proposed for its correction are based on the induction of pseudoaccommodation in the presbyopic eye, including multifocality. However, the real restoration of accommodation is more complex, and it has been tried by the use of different, so called, “accommodative” pseudophakic intraocular lenses (AIOL). Overall, the reported results with these lenses by independent authors have been modest in relation with the restoration of the accommodative power of the eye and these modest benefits are usually lost with time due to the long term changes in the capsular bag. This fact made these lenses to be almost abandoned in the last few years, but there are currently other AIOL models being used with innovative mechanisms of action and different anatomical support outside the capsular bag that offer encouraging preliminary results that could bring a new potential of application to these types of lenses. In this article, we will update the modern refractive surgeon about the fundamentals and provide updated information about the outcomes of AIOLs by reviewing the concept of accommodation, the different attempts that have been accomplished in the past, their demonstrated published results in human clinical trials, and the future alternatives that may arrive in the near future.

Abstract The main purpose of this review is to compare and analyze the results of the main PresbyLASIK approaches; central and peripheral. Summary A comprehensive research was conducted in PUBMED using keywords like “presbyopia correction”, “PresbyLASIK”, “Corneal multifocality”, “Laser blended vision”. We reviewed the PresbyLASIK technique, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), and corrected near visual acuity (CNVA), and compared the differences between the techniques.

Purpose. To assess anterior corneal surface stability 12 months following hyperopic LASIK correction with a light propagation algorithm. Setting. Vissum Instituto Oftalmológico de Alicante, Universidad Miguel Hernández, Alicante, Spain. Methods. This retrospective consecutive observational study includes 37 eyes of 37 patients treated with 6th-generation excimer laser platform (Schwind Amaris). Hyperopic LASIK was performed in all of them by the same surgeon (JLA) and completed 12-month follow-up. Corneal topography was analyzed with a light propagation algorithm, to assess the stability of the corneal outcomes along one year of follow-up. Results. Between three and twelve months postoperatively, an objective corneal power (OCP) regression of 0.39 D and 0.41 D was found for 6 mm and 9 mm central corneal zone, respectively. Subjective outcomes at the end of the follow-up period were as follows: 65% of eyes had spherical equivalent within ±0.50 D. 70% of eyes had an uncorrected distance visual acuity 20/20 or better. 86% of eyes had the same or better corrected distance visual acuity. In terms of stability, 0.14 D of regression was found. No statistically significant differences were found for all the study parameters evaluated at different postoperative moments over the 12-month period. Conclusions. Light propagation analysis confirms corneal surface stability following modern hyperopic LASIK with a 6th-generation excimer laser technology over a 12-month period.

PURPOSE: To verify corneal biomechanical changes, poststromal augmentation using myopic small-incision lenticule extraction's (SMILEs) lenticules in advanced keratoconus (KCN) through Corvis ST (Oculus, Wetzlar, Germany). MATERIALS AND METHODS: A clinical trial enrolled 22 advanced KCN patients. We implanted lenticules exceeding 100 μ according to a nomogram and evaluated biomechanical factors through Corvis ST at 3-, 6-, and 24-month postimplantation. We examined parameters during the first applanation (A1), second applanation (A2), highest concavity (HC)/max concavity events, and Vinciguerra screening parameters, as recently established criteria derived from the ideal blend of diverse biomechanical and ocular factors and formulated through the application of logistic regression. Regression analyses explored relationships with age, mean keratometry value, thickness, sphere, cylinder, and best-corrected visual acuity. RESULTS: Patients were well matched for age, intraocular pressure, and central corneal thickness (CCT). The mean spherical equivalent decreased from −13.48 ± 2.86 Diopters (D) to −8.59 ± 2.17 D (P < 0.007), and mean keratometry decreased from 54.68 ± 2.77 D to 51.95 ± 2.21 D (P < 0.006). Significant increases were observed in HC time (HCT), Radius–central curvature radius at the HC state–, peak distance (PD) during HC state, CCT, first applanation time, and stiffness parameter (A1T and SP-A1), whereas HC deformation amplitude, maximum deformation amplitude ratio at 2 mm, Corvis Biomechanical Index (CBI), integrated radius (IR), second applanation deformation amplitude (A2DA), first applanation velocity and deflection amplitude (A1V and A1DeflA) significantly decreased postlenticule implantation. Multivariable regression revealed age positively correlated with SP-A1 (P = 0.003) and negatively with HC delta Arc length (P = 0.007). Mean K positively correlated with CCT (P = 0.05) and negatively with CBI (P = 0.032). Best-corrected visual acuity positively correlated with HCT (P = 0.044), and the cylinder positively correlated with PD (P = 0.05) and CCT (P = 0.05) whereas negatively with IR (P = 0.025). CONCLUSIONS: Stromal augmentation using myopic SMILE lenticules induces significant corneal biomechanical changes in KCN.