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PURPOSE: To compare the accuracy of the Barrett Integrated K (IK) toric calculator with the standard Barrett toric calculator. METHODS: Consecutive patients who underwent cataract extraction with implantation of a toric intraocular lens at the Rabin Medical Center, Israel, were reviewed. Errors in predicted postoperative refractive astigmatism were calculated for the Barrett toric calculator using biometry measurements only and with the IK tool using biometry and tomography. Both methods were assessed with predicted and measured posterior corneal astigmatism (PPCA and MPCA, respectively). RESULTS: The study included 73 eyes of 59 patients. The mean centroid prediction error using PPCA (0.08 ± 0.80 D @ 78°) was significantly different compared with MPCA (0.07 ± 0.80 D @ 48°, P = .016). In addition, a significant difference between IK-PPCA (0.06 ± 0.80 D @ 80°) and IK-MPCA (0.05 ± 0.80 D @ 38°) was found ( P = .023). The median absolute prediction error ranged from 0.55 D using IK-PPCA to 0.60 D using PPCA, with no significant differences between the four calculation versions. No significant differences were found between the calculators in the predictability rates within ±0.50, ±0.75, and ±1.00 D. Analysis of one eye of each patient showed similar results. CONCLUSIONS: The IK calculator yielded comparable outcomes to the standard Barrett calculator. Although differences in the mean centroid errors were found, they were clinically insignificant and predominantly seen in the axis of the predicted astigmatism error. These minor differences were mainly attributed to the incorporation of the MPCA in the calculation. [ J Refract Surg . 2022;38(9):565–571.]

PURPOSE To compare the accuracy of the Barrett Universal II (BUII) five-variable formula to previous generation formulae in calculating intraocular lens (IOL) power following paediatric cataract extraction. METHODS Retrospective study of consecutive paediatric patients who underwent uneventful cataract extraction surgery along with in-the-bag IOL implantation between 2012 and 2018 in the Hospital for Sick Children, Toronto, Ontario, Canada. The accuracy of five different IOL formulae, including the BUII, Sanders-Retzlaff-Kraff Theoretical (SRK/T), Holladay I, Hoffer Q and Haigis, was evaluated. Constant optimization was performed for each IOL and for each formula separately. Mean prediction error (PE) and the mean and median absolute PE (APE) were calculated for the five different IOL formulae investigated. RESULTS Sixty-six eyes of 66 children (59% males) with a median age at surgery of 6.2 years (IQR, 3.2-9.2 years) were included in the study. The mean IOL power that was implanted was 23.3 ± 5.1 D (range; 12.0-39.0 D). Overall, the BUII had a comparable median APE to the Hoffer Q, Holladay I, SRK/T and Haigis formulae (BUII: 0.49D versus 0.48D, 0.61D, 0.74D and 0.58D respectively; p = 0.205). The BUII, together with Hoffer Q, produced better predictability within 0.5D from target refraction compared with the SRK/T formula (BUII:51.5%, Hoffer Q:51.5% versus SRK/T:31.8%, p = 0.002 for both). CONCLUSION The BUII formula had comparable accuracy to other tested formulae and outperformed the SRK/T formula, when calculating IOL power within the 0.5D range from target refraction in paediatric eyes undergoing cataract surgery with in-the-bag IOL implantation.

Purpose: To examine the clinical outcomes, efficacy, safety, and predictability of transepithelial photorefractive keratectomy (Trans-PRK) operations performed on the day of the first screening visit in comparison with operations scheduled at a following appointment. Methods: Data of consecutive patients with myopia of various degrees, who underwent Trans-PRK, were retrospectively analyzed. Findings were compared between patients who underwent Trans-PRK on the same day of first consultation to patients that underwent surgery at subsequent visits, following initial consultation on a different day. Results: The study included 599 eyes treated on the initial visit day and 1936 eyes treated on a subsequent visit. Mean final spherical equivalent was close to emmetropia in both groups ( p = 0.183). Efficacy indices were 0.928 ± 0.192 in the initial-visit group and 0.945 ± 0.163 in the second-visit group ( p = 0.152). Safety indices were 0.954 ± 0.156 and 0.955 ± 0.151 ( p = 0.707), respectively. No differences between the groups were seen in uncorrected visual acuity (UDVA) of ⩾20/20, ⩾20/25, and ⩾20/32. Only the sub-analysis of patients reaching UDVA of 20/40 or better was slightly lower in the first-visit (95.5%) compared with the second-visit group (97.9%, p = 0.001). Results of attempted correction within ±0.50 D were: 63.3% and 69.0%, respectively ( p = 0.009). Complications profiles in the two groups were comparable. Conclusions: Trans-PRK completed on the day of the first screening appointment demonstrated a similar safety outcome compared with subsequent-visits procedures, and slightly lower, yet comparable, results regarding efficacy and predictability.

Introduction: The purpose of this study is to evaluate the effect of intravitreal injection of tissue plasminogen activator (tPA) on proliferative vitreoretinopathy (PVR). Methods: PVR was induced in a rabbit model by intraocular injection of dispase (0.05 U/0.1 mL). Progression of PVR was followed by indirect ophthalmic examination. Following 6 weeks, five animals received intravitreal injection of 25 µg/0.1 mL tPA and four were injected with balanced salt solution (BSS). Animals were euthanized at 48 hours following tPA/BSS injection and eyes were enucleated for histological evaluation and staining with α-smooth muscle actin (αSMA) and Sirius Red. Results: Following tPA injection, one eye had a reduction in PVR from grade 2 to 1 and three eyes remained stable. Following BSS, PVR grade was unchanged in three eyes. In one eye in each group, the severity of PVR couldn't be assessed due to limited view. Staining with αSMA showed reduced presence of fibroblasts in eyes injected with tPA compared with those injected with BSS. Collagen type I and III, demonstrated by Sirius Red staining, was reduced in the tPA group in comparison to controls. Conclusion: Our results suggest that intravitreally injected tPA may show an inhibitory effect on PVR progression. Further exploration in clinical trials is desired.

To assess the accuracy of the Kane formula for intraocular lens (IOL) power calculation in the pediatric population.The charts of pediatric patients who underwent cataract surgery with in-the-bag IOL implantation with one of two IOL models (SA60AT or MA60AC) between 2012 and 2018 in The Hospital for Sick Children, Toronto, Ontario, CanFada, were retrospectively reviewed. The accuracy of IOL power calculation with the Kane formula was evaluated in comparison with the Barrett Universal II (BUII), Haigis, Hoffer Q, Holladay 1, and Sanders-Retzlaff-Kraff Theoretical (SRK/T) formulas.Sixty-two eyes of 62 patients aged 6.2 (IQR 3.2-9.2) years were included. The SD values of the prediction error obtained by Kane (1.38) were comparable with those by BUII (1.34), Hoffer Q (1.37), SRK/T (1.40), Holaday 1 (1.41), and Haigis (1.50), all p 0.05. A significant difference was observed between the Hoffer Q and Haigis formulas (p = 0.039). No differences in the median and mean absolute errors were found between the Kane formula (0.54 D and 0.91 ± 1.04 D) and BUII (0.50 D and 0.88 ± 1.00 D), Hoffer Q (0.48 D and 0.88 ± 1.05 D), SRK/T (0.72 D and 0.97 ± 1.00 D), Holladay 1 (0.63 D and 0.94 ± 1.05 D), and Haigis (0.57 D and 0.98 ± 1.13 D), p = 0.099.This is the first study to investigate the Kane formula in pediatric cataract surgery. Our results place the Kane among the noteworthy IOL power calculation formulas in this age group, offering an additional means for improving IOL calculation in pediatric cataract surgery. The heteroscedastic statistical method was first implemented to evaluate formulas' predictability in children.

Purpose To assess the accuracy of the Kane formula for intraocualr lens (IOL) power calculation in comparison with established formulas in the elderly population. Setting Shiley Eye Institute, University of California San Diego, USA. Design Retrospective cohort. Methods Retrospective data from 90 patients (90 eyes) aged 75 years or older who underwent uneventful cataract surgery with SN60WF intraocular lens (IOL) implantation were evaluated. The first operated eyes of patients with final corrected distance visual acuity 20/40 or better and axial length 22 to 26 mm were included. Prediction errors were calculated for Barrett Universal (BU) II, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas. A subgroup analysis based on age (75-84 and ≥85 years old) was performed. Results Use of both BUII and Kane formulas resulted in the highest percentage of eyes with prediction errors within ±0.50 diopters (D) (72% each) and significantly higher than Hoffer Q, Holladay 1, and SRK/T (P = .001). Rates of predictability within ±0.25 D and ±1.00 D were 31% to 38% and 87% to 92%, respectively, with no significant differences between formulas. No statistically significant difference was seen between formulas in the median absolute error. These tendencies remained consistent in both age groups when analyzed separately. Subgroup analysis showed better predictability of all formulas in the younger age group. Conclusions To the authors' knowledge, this is the first study evaluating the Kane formula exclusively in the elderly population. The Kane formula was found to be of equal accuracy to the BUII and superior to the Hoffer Q, Holladay 1, and SRK/T formulas. Very elderly patients might have reduced refractive precision using all formulas.

Objectives Our aim is to evaluate the safety, efficacy, predictability, and clinical outcome of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) procedures performed on the day of the initial consultation relative to procedures performed at subsequent visits. Methods A retrospective cohort study design was used. The study group included patients with myopia of different severities who were treated with FS-LASIK in 2013 through 2014 in an optical outpatient clinic of a large private medical service. Inclusion criteria were at least 18 years of age, a stable refraction for 12 months, no history of autoimmune disease, ocular surgery, or eye disease, and complete medical records. Background, clinical, and outcome data were collected from the patient files. Results Femtosecond laser-assisted in situ keratomileusis was performed in 80 patients (160 eyes) at the first visit and 361 patients (719 eyes) at a subsequent visit. The mean±SD spherical equivalent (SE) refraction before surgery was -3.74±2.03 D in the first-visit group and -3.73±1.87 D in the subsequent-visit group (P=0.99). Efficacy index values were 0.97±0.15 in the first-visit group and 0.98±0.13 in the subsequent-visit group (P=0.92), and corresponding safety index values were 0.99±0.15 and 0.99±0.12 (P=0.81). The final SE measured -0.09±0.58 D in the first-visit group and -0.19±0.55 D in the subsequent-visit group (P=0.05). Types and rates of complications were similar in the two groups. Conclusions There is no significant difference in the results of refractive surgery with FS-LASIK between procedures performed at the initial or subsequent visits. In both conditions, FS-LASIK surgery is associated with excellent safety, efficacy, and predictability profiles.

To describe the first clinical implantation of the CorNeat™ keratoprosthesis, which utilizes a polymeric scaffold for biointegration within ocular tissue.The CorNeat keratoprosthesis was implanted in the right eye of a patient with bilateral corneal opacification and neovascularization secondary to multiple failed grafts. The following surgical technique was used: 360 degree peritomy; epithelial scraping and corneal marking; pre-placement of three corneo-scleral sutures through the implant; central trephination using a 7 mm trephine and host cornea removal; keratoprosthesis placement and sutures tightening while fitting the corneal edge into the posterior groove of the CorNeat keratoprosthesis; and repositioning of the conjunctiva over the implant skirt and fixation with sutures and Fibrin sealant.Twelve months postoperatively visual acuity improved to 1/16 from hand movement. The keratoprosthesis was properly positioned. Tactile intraocular pressure was assessed as normal. Regional, mostly nasal, conjunctival retraction of 4-5 mm over the nano-fibre skirt was seen throughout follow-up. The anterior chamber was quiet and well-formed. No other postoperative complications were observed.This initial case may imply a potential breakthrough in the treatment of corneal disease not amenable to standard corneal transplant. Long follow-up and additional implantations are desired to prove the long-term safety and efficacy of this device.

BACKGROUND The purpose of this study was to examine the correlation between research productivity in the field of rheumatology and various updated economic indicators of Countries of the Organisation for Economic Co-operation and Development (OECD). METHODS The number of documents published, number of citable documents, number of citations, citations per document, and the H-index for the 36 OECD countries in the field of rheumatology between 1996 and 2017 were obtained from the The Scimago Journal and Country rank source. The recent data regarding gross domestic product (GDP) per capita, total health spending as percent of GDP, and the gross domestic expenditure on research and development as percent of GDP were collected from the World Bank, OECD, and United Nations Educational, Scientific, and Cultural Organization Web sites, accordingly. The relationship between economic indicators and scientific productivity for each of the OECD countries was analyzed. RESULTS A total of 132,314 documents were analyzed. A moderate to strong significance correlation was found between health expenditure and the number of documents published (r = 0.67, p < 0.001), number of citable documents (r = 0.68, p < 0.001), number of citation (r = 0.76, p < 0.001), and H-index (r = 0.77, p < 0.001). CONCLUSIONS This study provides a current highlight on the relationship between academic productivity in rheumatology and economic indicators of OECD countries. We showed a positive moderate to strong significant correlation between total health expenditure as percent of GDP and different bibliometric indicators, implying another possible advantage of national investment in this filed.

Background The purpose of this study was to compare the h-index, and subsequently the research productivity, among different ophthalmic subspecialties in the United States. Methods A cohort of over 15,000 academic ophthalmologists residing in the United States (US) was identified out of the physician list of the American Academy of Ophthalmology. Of them, 1000 ophthalmologists with at least one publication were randomly retrieved, 100 in each of the following 10 subspecialties: cataract, cornea/external disease, glaucoma, medical retina, neuro-ophthalmology, pediatric ophthalmology, plastic/reconstructive ophthalmology, refractive surgery, retina/vitreous surgery and uveitis. Data collected included: number of published papers, h-index score, annual increase in h-index and the mean number of authors on each paper. Results The mean h-index amongst all subspecialties was 9.87 ± 13.90, and the mean average annual increase in h-index was 0.22 ± 0.21. The mean number of papers published was 37.20 ± 80.08 and the mean number of authors on each paper was 3.39 ± 0.84. Uveitis was the most prolific subspecialty in mean number of papers (74.78 ± 131.37), in mean h-index (16.69 ± 20.00) and in mean annual increase in h-index (0.35 ± 0.28). The least fertile subspecialty with regards to research was cataract with 11.06 ± 27.65 mean number of papers, a mean h-index of 3.89 ± 5.84, and a mean annual increase in h-index of 0.11 ± 0.11. Conclusions This study describes the research productivity in each ophthalmic subspecialty in the US, thus providing information on the research performance of each field and on the expected academic accomplishments within it.

PURPOSE: To assess visual outcomes and patient satisfaction for trifocal and extended depth of focus (EDOF) intraocular lenses (IOLs) compared to monofocal IOLs with and without monovision. METHODS: Consecutive patients underwent bilateral cataract extraction surgery and implantation of either monofocal IOLs, monofocal IOLs using monovision, EDOF IOLs, or trifocal IOLs. Patients with preoperative biometric data, postoperative refraction, and visual acuity who completed a questionnaire regarding satisfaction and side effects were included. Visual outcome, spectacle independence, patient satisfaction, and subjective photic phenomena were assessed. RESULTS: Each group comprised 50 patients (100 eyes). The mean postoperative uncorrected distance, intermediate, and near visual acuities (logMAR) were: 0.17 ± 0.14 (Snellen 20/30), not applicable, and not applicable for monofocal; 0.08 ± 0.12 (Snellen 20/24), not applicable, and 0.07 ± 0.12 (Snellen 20/23) for monovision; 0.03 ± 0.08 (Snellen 20/21), 0.08 ± 0.12 (Snellen 20/24), and 0.23 ± 0.17 (Snellen 20/34) for EDOF; 0.07 ± 0.09 (Snellen 20/23), 0.08 ± 0.11 (Snellen 20/24), and 0.02 ± 0.06 (Snellen 20/21) for trifocal. Spectacle independence was reported by 36%, 70%, 74%, and 92% of patients, respectively. Postoperative halos and/or glare were experienced by 2%, 6%, 14%, and 38%, respectively, of which 2%, 0%, 6%, and 10%, respectively, were functionally disturbing. A total of 64%, 72%, 78%, and 76%, respectively, would choose the same IOL again. CONCLUSIONS: Patient satisfaction rates were high in all groups. Trifocal IOLs were more effective in improving unaided whole range of vision, but were associated with a higher rate of photic phenomena. The EDOF IOL and monovision provided partial spectacle independence with less photic phenomena. [ J Refract Surg. 2019;35(7):434–440.]

Introduction: The purpose of this study was to compare the outcomes of transepithelial photorefractive keratectomy (Trans-PRK) with femtosecond laser assisted in situ keratomileusis (FS-LASIK) for the correction of low to moderate myopia. Methods: A retrospective cohort study design was used. The study group included patients with myopia less than −6.0 D, with or without concomitant astigmatism under 2.0 D, who were treated with FS-LASIK or Trans-PRK in 2013 through 2014. Background, clinical and outcome data were collected from the patient files. A comparison between eyes treated with FS-LASIK or Trans-PRK was performed. Results: The Trans-PRK group was comprised of 1793 eyes and the FS-LASIK group of 666 eyes. Mean ± SD spherical equivalent (SE) refraction prior to surgery was −3.43 ± 1.27 D in the Trans-PRK group and −3.18 ± 1.34 D in the FS-LASIK group ( p Conclusions: Both Trans-PRK and FS-LASIK demonstrated excellent results, mostly comparable with the current literature. FS-LASIK achieved better results than Trans-PRK surgery in the efficacy and safety parameters.

Purpose: To compare the outcomes of femtosecond laser assisted in situ keratomileusis (FS-LASIK) with transepithelial photorefractive keratectomy (T-PRK) for the correction of high-grade astigmatism. Methods: Medical records of patients with astigmatism of 2 diopters (D) or higher, who were treated with FS-LASIK or T-PRK in 2013 through 2014 at a private practice laser clinic, were retrospectively analyzed. Efficacy, safety, predictability and vector analysis of astigmatism correction were compared between the treatment groups. Results: The study included 93 eyes treated with FS-LASIK and 186 eyes treated with T-PRK. No significant differences in postoperative spherical equivalent (−0.10 ± 0.7 D and −0.11 ± 0.7 D, respectively, p = 0.958) and postoperative refractive astigmatism (0.79 ± 0.54 D and 0.82 ± 0.63 D, respectively, p = 0.685) were demonstrated. A significant advantage of FS-LASIK over T-PRK was seen for the efficacy (1.00 ± 0.18 and 0.86 ± 0.22, respectively, p Conclusion: Both procedures demonstrated desirable post-operative SE outcomes for high-grade astigmatism correction. However, FS-LASIK achieved better results than T-PRK in the efficacy and safety parameters.

Previous studies have demonstrated a correlation between national economic indicators and academic productivity. However, such a relationship has not been studied in the field of internal medicine (IM).The number of documents published, number of citable documents, number of citations, citations per document and the h index between 1996 and 2019 in the field of IM among the Organisation for Economic Co-operation and Development (OECD) countries were analysed. Data were derived from the The Scimago Journal and Country rank source. We analysed the correlation between these indicators to the gross domestic product (GDP) per capita, health spending as percent of GDP and gross domestic expenditure on research and development as percent of GDP (GERD). Economic data were collected from the OECD websites.A significant correlation was found between health expenditure and h index (r = 0.75, P0.001), number of citations (r = 0.72, P0.001), number of documents (r = 0.62, P0.001) and number of citable documents (r = 0.61, P0.001); between GERD and number of citations (r = 0.6, P0.001), h index (r = 0.6, P0.001), number of documents published (r = 0.53, P = 0.001) and citable documents (r = 0.51, P = 0.001); between the GDP per capita and number of citations (r = 0.46, P = 0.005), citations per document (r = 0.54, P = 0.001) and h index (r = 0.5, P = 0.002).This study demonstrated a positive correlation between academic productivity in the field of IM and economic indicators of the OECD countries, mainly health expenditure, implying the advantage of domestic investment in health.

Background: The relation between health investment and research has been portrayed previously in several medical fields, showing a positive relation between economic resources and academic yield. Purpose: To assess the relations between various economic and bibliometric parameters in otolaryngology - head and neck surgery (ORL-HNS) of the OECD countries. Methods: Data regarding bibliometric parameters in ORL-HNS; number of publications, citations, citations per document and H index, between the years 1996 and 2019, were gathered from the Scimago Journal and Country Rank source. These data were then analysed in several breakdowns – seldom county, regional and language comparisons, in order to assess variations in ORL-HNS scholar activity. Economic data regarding each OECD country; GDP per capita, total health expenditure as percent of the GDP and GERD as percent of the GDP were gathered from the OECD and World Bank websites. The correlation between economic and bibliometric indicators was analysed. Results: Among 209,949 documents analysed, a strong correlation was found between H index and health expenditure (r=0.734, p=0.000), and a moderate connection was found between H index and both GDP per capita (r=0.459, p=0.005) and GERD as percent of GDP (r=0.579, p=0.000). Health expenditure showed the strongest correlations to bibliometric parameters. Nonetheless, most data showed some degree of positive correlations between economics and scholar productivity. Conclusion: This study emphasizes the positive relation between scholar productivity and economic indicators, mostly health expenditure, in the OECD countries in the field of ORL-HNS, implying the importance of health investment to ORL-HNS research.

PURPOSE: To evaluate different calculation approaches for toric intraocular lens (IOL) calculation in cases with high posterior corneal astigmatism (PCA). METHODS: Consecutive patients who underwent cataract extraction with implantation of toric IOLs by a single surgeon were reviewed. Eyes with measured PCA of 0.80 diopters (D) or greater were included. Errors in the predicted postoperative refractive astigmatism were calculated for the Abulafia-Koch formula, vector summation of anterior keratometry with posterior tomography, and the Barrett toric calculator using predicted and measured PCA. RESULTS: One hundred seventy-three consecutive cases of toric IOL implantation were reviewed. Seventeen eyes (10%) had PCA of 0.80 D or greater and were investigated. The mean absolute error was the lowest with Barrett's measured PCA (0.55 ± 0.38) followed by Barrett's predicted PCA mean absolute error (0.65 ± 0.31), vector summation (0.69 ± 0.33), and the Abulafia-Koch formula (0.80 ± 0.36). The rate of eyes with prediction errors within 0.25 D or less was the highest for Barrett's measured PCA (29.4%) followed by Barrett's predicted PCA (5.9%) and no eyes for the Abulafia-Koch formula and vector summation. The mean centroid prediction errors were lowest for Barrett's measured PCA and Barrett's predicted PCA (0.14 ± 0.66 @70, 0.14 ± 0.73 @179, respectively), followed by vector summation (0.35 ± 0.70 @5), and the Abulafia-Koch formula (0.39 ± 0.80 @179). CONCLUSIONS: The results suggest that in cases of high PCA, the Barrett toric calculator using direct measurements of PCA may have a potential advantage over predicted PCA in toric IOL calculations and vector summation of the anterior and posterior corneal astigmatism. [ J Refract Surg . 2020;36(12):820–825.]

Background: We aimed to compare the safety and efficacy of two techniques for the correction of subluxated posterior intraocular lens (IOL): scleral fixation (SFIOL) and iris fixation of IOL (IFIOL). Methods: 112 eyes of 105 patients that underwent SFIOL or IFIOL at the Kaplan Medical Center between 2008 and 2018 were retrospectively included, 73 eyes had SFIOL and 39 eyes had IFIOL. The main outcome measures were: operation time, postoperative visual acuity and intra and post-operative complications. Results: There was no significant difference in the mean operation time between SFIOL and IFIOL. The mean follow-up time was significantly longer for the IFIOL compared with the SFIOL (34 ± 31 vs. 14 ± 20 months, respectively [p>0.001]).Postoperative distance corrected visual acuity (DCVA) at the last follow-up was significantly better than the preoperative DCVA in both groups (SFIOL: 0.52 ± 0.49 vs. 1.20 ± 0.84, [p

PURPOSE: To compare ocular measurements of three optical biometry devices and their application in intraocular lens (IOL) power calculations. METHODS: One hundred and forty eyes which had undergone cataract extraction surgery with preoperative biometry with OA­-2000, IOLMaster-500, and Lenstar-LS900 were enrolled. Biometry measurements of the three devices were compared. The deviation of the postoperative refraction from the preoperative refractive target was calculated with different formulas (Barrett Universal II, Hoffer Q, Holladay I, and SRK/T). Errors in the predicted astigmatism using the Barrett toric calculator were calculated for the toric IOLs. Additional 6465 eyes in which the IOLMaster-500 failed to measure axial length (AL) were reviewed. The percentage of successful measurements using the OA-2000 in those eyes was calculated. RESULTS: High agreement was found between the three devices for AL, anterior chamber depth, and average keratometry measurements (interclass correlation confidents: 1.000, 0.970, and 0.998, respectively, P

To compare the accuracy of intraocular lens power prediction for eyes with average keratometry (K) readings greater than 46.00 diopters (D) and lower than 42.00 D.Ein-Tal Eye Center, Tel-Aviv, Israel.Retrospective case series.Eyes having cataract extraction surgery with steep and flat preoperative corneal curvatures determined with the Lenstar-LS900 device were enrolled. Refractive prediction errors for the Barrett Universal II, Haigis, Hill-RBF, Hoffer-Q, Holladay 1, Holladay 2, Olsen, and SRK/T formulas were compared. Optimized K values for the SRK/T formula were back-calculated for each group. Validation was performed using an additional dataset.The study comprised 171 eyes (79, K reading46.00 D; 92, K reading42.00 D). For K readings greater than 46.00 D, myopic errors were noted using the SRK/T and Hill-RBF formulas and hyperopic errors using the Olsen C-constant and Haigis (-0.31 D, -0.17 D, 0.18 D, and 0.17 D, respectively). The percentage of eyes with an absolute error within ±0.50 D from target refraction ranged from 60.8% (SRK/T) to 83.0% (Hill-RBF). For K readings lower than 42.00 D, myopic errors were seen using the Haigis, Hill-RBF, Hoffer-Q, and Olsen-C formulas (-0.31 D, -0.14 D, -0.22 D, and -0.17 D, respectively) and a hyperopic error using the SRK/T formula (0.16 D). The refractive prediction within ±0.50 D ranged between 75.0% (Haigis) and 96.7% (Barrett Universal II).Power calculation for eyes with flat corneas and steep corneas requires the use of specific formulas for accurate postoperative results. An adjustment method of the SRK/T formula is proposed.

OBJECTIVE The aim of this study was to compare the effect of biologic agents and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) on the psychologic status of patients with psoriatic arthritis (PsA) in remission or with low disease activity. METHODS This is a case-control study of PsA patients in remission or with low disease activity treated at a single-center combined rheumatologic-dermatologic clinic between 2015 and 2017. Patients were assigned to 2 comparison groups according to their treatment (1) biologic drugs and (2) csDMARDs therapy. Psoriatic arthritis disease activity was evaluated by disease activity score-28. Anxiety, somatization, and depression were evaluated by patient health questionnaires (PHQ): generalized anxiety disorder-7, PHQ-15, and PHQ-9, respectively. Disability was assessed by the health assessment questionnaire disability index (HAQ-DI). RESULTS Thirty PsA patients on biologic treatment (BT) and 14 PsA patients in csDMARDs were enrolled. No significant differences in disease duration and treatment duration between the 2 groups were found. Disease activity score-28 was significantly better in the BT group compared with the csDMARDs group (1.8 ± 0.4 vs 2.1 ± 0.4, respectively, p = 0.028). A nonsignificant tendency toward higher scores in psychologic questionnaires was seen among the non-BT group. Moderate to high correlations between all mental questionnaires and HAQ-DI were found in both groups (0.567 ≤ r ≤ 0.850, p < 0.05). Patients with mental disturbance (generalized anxiety disorder-7/PHQ-15/PHQ-9 ≥ 5) showed significant poorer performance in their HAQ-DI in comparison with patient without physiological comorbidities in both groups. CONCLUSIONS Tight disease control in PsA patients, achieved with BT, may offer an improvement in psychological outcomes in addition to relieving clinical symptoms.

Purpose To compare the accuracy of different methods that consider posterior corneal curvature in toric intraocular lens (IOL) calculations. Setting Ein-Tal Eye Center, Tel-Aviv, Israel. Design Retrospective comparative case series. Methods Consecutive cases of toric IOL implantation and preoperative measurements by optical biometry with optical low-coherence reflectometry (OLCR) (Lenstar LS 900) and a Scheimpflug camera (Pentacam) were retrospectively reviewed. Five methods of toric IOL calculation were compared as follows: (1) anterior corneal astigmatism using OLCR, (2) application of the Baylor nomogram, (3) posterior tomography combined with anterior corneal measurements using vector summation, (4) the Scheimpflug camera's true net power, and (5) total corneal refractive power. Toric IOL astigmatic power and axis, aiming for the lowest residual astigmatism, were selected according to these methods. Simulated residual refraction was calculated for each method based on manifest refraction and measured IOL alignment more than 3 weeks after surgery. Results The study included 115 eyes of 92 patients. The median simulated residual astigmatism was lower when based on vector summation of anterior and posterior astigmatisms than with calculations based on anterior corneal measurements only, application of the Baylor nomogram, true net power, and total corneal refractive power readings (0.49 diopters [D] versus 0.70 D, 0.60 D, 0.64 D, and 0.76 D, respectively) (P Conclusions Residual astigmatism after toric IOL implantation can be reduced by appropriate consideration of the posterior corneal astigmatism. Using methods that take into account the effect of the posterior cornea in toric IOL calculations is suggested. Financial Disclosures Drs. Assia and Kleinmann are consultants to Hanita Lenses, Israel. Dr. Abulafia received a speaker's fee from Haag-Streit AG. No other author has a financial or proprietary interest in any material or method mentioned.

Background Noninvasive or minimally invasive cosmetic dermatologic procedures are considered safe with low parentage of reported adverse events. However, reliable prevalence data regarding adverse event of such cosmetic procedures among patients with systemic autoimmune diseases are insufficient. Objectives To assess the occurrence of adverse events and disease exacerbation associated with noninvasive or minimally invasive cosmetic dermatologic procedures, including those involving hyaluronic acid fillers, botulinum toxins and laser application among patients with systemic autoimmune diseases. Methods Consecutive cases of patients suffering from autoimmune diseases and attending the rheumatology clinic for regular follow-ups, were asked about receiving cosmetic procedures during the last two years. Medical history, including clinical and laboratory signs of disease exacerbation after the date of the procedure, was retrospectively obtained from medical files of the patients included in the study. Patients were also asked about subjective disease exacerbation and local adverse events after the procedure. Results During the three months of study period, 148 patients were inquired. Nineteen patients (89% females) underwent 23 cosmetic procedures in total. Thirty-nine percent had Rheumatoid arthritis (RA), 39% had Ankylosing spondylitis (AS) and 22% had other systemic connective tissue disease. Sixty seven percent were treated by Disease-modifying antirheumatic drugs (DMARDs), 28% by Biologic treatment and 5% did not receive any specific treatment. All patients were in remission during the cosmetic procedures. Forty three and a half percent of patients underwent hyaluronic acid injection, 21.7% botulinum toxin injection, 21.7% laser application, 8.7% mesotherapy and 4.3% silicon injection. None of the patients suffered from subjective disease exacerbation after the procedure. No changes in antibody titer and level of acute phase reactants (C-reactive protein and erythrocyte sedimentation rate) were noticed. Two patients (10.5%) experienced local oedema after filler injections. Both patients received Hydroxychloroquine treatment (one patient with RA and one with AS). Conclusions Our results suggest that noninvasive or minimally invasive cosmetic dermatologic procedures, including energy, neurotoxin, and filler procedures, may be safe among rheumatological patients, and do not cause autoimmune systemic disease exacerbation when performed in periods of remission. Hydroxychloroquine may predispose to a higher occurrence rate of local site injection adverse events. Further studied are desired to investigate this phenomena. Disclosure of Interest None declared

Prasugrel has proved its superiority over clopidogrel for reducing ischemic events among patients with ST elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). Data on switching of antiplatelet therapy in acute coronary syndrome patients in clinical practice are very limited. Importantly, the safety of in-hospital switching from clopidogrel to prasugrel following thrombolysis has not been addressed.We reviewed consecutive STEMI patients from February 2011 to April 2014 who were transferred to a tertiary center after receiving thrombolysis and a loading dose of clopidogrel in a non-PCI-capable center. If not contraindicated, these patients were reloaded and treated with prasugrel. A control group, three times larger, was selected from patients who underwent primary PCI and were initially treated with prasugrel. In-hospital outcomes were examined.Cases (n=45, 13% female, mean age 56 years) and controls (n=135, 11% female, mean age 54 years) did not differ significantly with respect to MI location, left ventricular systolic function, and extent of coronary artery disease. Mean time from thrombolysis to prasugrel loading was 32±19 hours. No significant differences were found between cases and controls in TIMI major or minor bleeding (0% vs. 3%), overall mortality (0% vs. 1.5%), and hospitalization length (4.8 vs. 5.5 days).In-hospital reloading and subsequent maintenance therapy with prasugrel in patients who received thrombolysis and a loading dose of clopidogrel appears to be as safe as in STEMI patients managed by primary PCI; however, larger studies are needed to verify these results.

PURPOSE: To compare the findings of three corneal measuring devices for calculating surgically induced astigmatism (SIA) during cataract extraction. METHODS: Patients’ records were retrospectively reviewed to identify patients who had corneal astigmatism measurements before and at least 1 month after cataract surgery through 2.4-mm corneal incisions by all three tested devices (Lenstar LS900, Haag-Streit, Koeniz, Switzerland; IOLMaster 500, Carl Zeiss Meditec, Dublin, CA; and Atlas topographer, Carl Zeiss Meditec). Vector analysis was used to calculate the SIA for each measuring device. RESULTS: Seventy eyes of 49 patients were included. All three measuring devices had similar SIA results: the median SIAs were 0.45 diopters (D) for the Lenstar, 0.41 D for the IOLMaster, and 0.47 D for the Atlas topographer ( P = .884). CONCLUSIONS: The three evaluated anterior corneal measuring devices produced similar results in measuring SIA. [ J Refract Surg. 2015;31(4):244–247.]

Purpose To evaluate and compare the accuracy of formulas and methods for calculating the intraocular lens (IOL) power for eyes with an axial length (AL) greater than 26.0 mm. Setting Ein-Tal Eye Center, Tel-Aviv, Israel. Design Retrospective case series. Methods The postoperative refraction results in myopic eyes with an AL over 26.0 mm were compared with the predicted refractions calculated using standard formulas (Holladay 1, SRK/T, Hoffer Q, and Haigis) with optical IOL constants, User Group for Laser Interference Biometry constants, and an AL-adjustment method and using new-generation formulas (Barrett Universal II, Holladay 2, and Olsen). Results In 76 (71.7%) of 106 eyes, the IOL was 6.0 diopters (D) or more (Group A) and in 30 eyes (28.3%) was less than 6.0 D (Group B). In Group A, the SRK/T, Hoffer Q, Haigis, Barrett Universal II, Holladay 2, and Olsen methods met the benchmark criteria of having a prediction error of ±0.5 D in at least 71.0% of eyes and ±1.0 D in 93.0% of eyes. In Group B, only the Barrett Universal II formula and the Holladay 1 and Haigis formulas using the AL-adjusted method met those criteria. Conclusion When selecting IOLs for high and extreme myopia, choosing appropriate formulas and methods can yield accurate refractive results that meet benchmark criteria. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Background To evaluate the accuracy of predicted refraction using multifocal intraocular lenses (IOLs) with power calculation based on two biometric devices and multiple IOL power calculation formulas. Design A retrospective study conducted in a private practice ophthalmology clinic. Participants Seventy-three eyes of 48 patients were evaluated. Methods Consecutive cases of eyes that had undergone successful cataract surgery with an implantation of a multifocal IOL (SN6AD1, Alcon Laboratories, Inc., Fort Worth, TX, USA) by a single surgeon were enrolled. Patients were meticulously screened for suitability for a multifocal IOL implantation according to our clinic guidelines. Two biometric measurement devices (IOLMaster-500 [Carl Zeiss Meditec AG, Jena, Germany] and Lenstar-LS900 [Haag-Streit AG, Koeniz, Switzerland]) were used under strict validation criteria to evaluate the predicted refraction errors for the Holladay 1, SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal II and Olsen formulas. Main Outcome Measures Predicted refractive sphere equivalent (RSE) errors. Results The measurements obtained from the two biometric devices were highly correlated. The standard deviation of the error in predicted RSE and the median absolute error were similar for the IOLMaster and the Lenstar devices using all formulas, ranging from 0.27 dioptres (D) to 0.31D and from 0.15D to 0.21D, respectively. A high percentage of eyes had an error in predicted RSE within ±0.5D from target refraction, ranging from 86.3% to 93.2%. Conclusions High accuracy can be achieved in multifocal IOL power calculations by appropriate patient selection, precise biometry and appropriate IOL calculation formulas.

Intraocular power calculation is challenging for patients who have previously undergone corneal refractive surgery. The sources of prediction errors for these eyes are well known; however, the numerous formulas and methods available for calculating intraocular lens power in these cases are eloquent testimony to the absence of a definitive solution. This review discusses some of the available methods for improving the accuracy for predicting the refractive outcome for these patients. It focuses mainly on the methods available on the American Society of Cataract and Refractive Surgery (ASCRS) online calculator and provides some practical guidelines for cataract surgeons who encounter these challenging cases.

Background: Combined therapy of weight loss and exercise provide today the best treatment for Knee Osteoarthritis. Most studies evaluating the effect of this therapy focus on the active intervention phase or immediately after the end of the treatment. Objectives: To describe the of long term effectiveness of weight loss and exercise treatment on Knee Osteoarthritis. Methods: Medical charts of 10 overweight women who suffered from Knee Osteoarthritis and had been treated for six months with a combined treatment of weight loss with Orlistat in the recommended dose, aerobic exercise and muscle mass strengthening, were retrospectively reviewed. Knee Osteoarthritis symptoms were assessed before treatment, at the end of treatment and following 6 months using the Western Ontario and McMaster Universities Osteoarthritis Index. Results: In comparison to baseline, we documented a statistically significant improvement in pain, stiffness, and function at the end of the treatment (37.0 vs. 21.0, P=0.007, 44.5 vs. 28.3, P=0.037 and 45.5 vs. 27.1, P=0.005, respectively) together with reduction in BMI (32.9 vs. 29.5, P=0.007). Six months later, although the mean BMI had returned to its baseline (31.1, P=0.126), the improvement in all parameters still existed (23.9, P=0.028, 27.1, P=0.028 and 32.9, P=0.037, respectively). Conclusions: Weight reduction together with muscle strengthening can improve function, stiffness, and pain symptoms in women with knee Osteoarthritis. Our case series suggest that this combined intervention may potentially maintain clinical improvement even when patients return to their baseline weight.

Case series Patient: Female, 56 • Male, 64 Final Diagnosis: Neutropenia after Rituximab Symptoms: Cough • diarrhea • fever • headache Medication: Rituximab Clinical Procedure: — Specialty: Rheumatology Objective: Unusual or unexpected effect of treatment Background: We describe here 2 patients who developed late-onset neutropenia after Rituximab treatment. While this phenomenon is well described among patients suffering from hematological malignancies, such adverse effects are rare among patients with rheumatic diseases. Case Report: Two patients, the first with rheumatoid arthritis and the second with granulomatosis with polyangiitis, were treated by Rituximab after all previous treatments failed. The patients developed late-onset neutropenia after several courses of treatment. The first patient, with symptomatic neutropenia, recovered after a single dose of granulocyte macrophage stimulating factor, and the second patient’s neutrophils increased spontaneously. Both patients were retreated by rituximab in their scheduled time without further complications. Conclusions: Our case series is unique because the same phenomenon appeared in patients with different rheumatic diseases. This case series confirms the possibility of continuing the treatment without further adverse effects.

To evaluate the accuracy of predicted refraction using multifocal intraocular lenses (IOLs) with power calculation based on two biometric devices and multiple IOL power calculation formulas.A retrospective study conducted in a private practice ophthalmology clinic.Seventy-three eyes of 48 patients were evaluated.Consecutive cases of eyes that had undergone successful cataract surgery with an implantation of a multifocal IOL (SN6AD1, Alcon Laboratories, Inc., Fort Worth, TX, USA) by a single surgeon were enrolled. Patients were meticulously screened for suitability for a multifocal IOL implantation according to our clinic guidelines. Two biometric measurement devices (IOLMaster-500 [Carl Zeiss Meditec AG, Jena, Germany] and Lenstar-LS900 [Haag-Streit AG, Koeniz, Switzerland]) were used under strict validation criteria to evaluate the predicted refraction errors for the Holladay 1, SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal II and Olsen formulas.Predicted refractive sphere equivalent (RSE) errors.The measurements obtained from the two biometric devices were highly correlated. The standard deviation of the error in predicted RSE and the median absolute error were similar for the IOLMaster and the Lenstar devices using all formulas, ranging from 0.27 dioptres (D) to 0.31D and from 0.15D to 0.21D, respectively. A high percentage of eyes had an error in predicted RSE within ±0.5D from target refraction, ranging from 86.3% to 93.2%.High accuracy can be achieved in multifocal IOL power calculations by appropriate patient selection, precise biometry and appropriate IOL calculation formulas.

Summary Background: Tumor necrosis factor-alpha inhibitors treatment is accosiated with several side effects. The most common are injection side reactions, headache, nausea and infections. The more rare are development of systemic autoimmune diseases. Case Report: We describe two patients, who developed ANCA associated vasculitis during Tumor necrosis factor alpha inhibitors treatment. The diagnosis was confirmed by appropriate tissue picture, CT scan and laboratory findings. Conclusions: Our case series are unique, because vasculitis appeared after many years of the treatment and during complete patient’s remission of there main illness.

Background Reactivation of latent tuberculosis (TB) is a major complication of tumor necrosis factor alpha inhibitors (TNF-i). Therefore, screening for latent TB is recommended before initiation of this treatment. Currently, the cut-off size of a positive Tuberculosis skin test (TST) among immunosuppressed patients is 5 mm. It is vastly described in the literature that Prednisone treatment along with chronic inflammatory disease depresses TST reaction. Nevertheless, few studies reject this hypothesis. Objectives To assess the correlation between Prednisone treatment duration and dosing with the size of a TST reaction among Rheumatoid Arthritis (RA) patients. To compare the size of a TST reaction among RA patients with and without Prednisone therapy. Methods Consecutive cases of RA patients candidate for TNF-i therapy were retrospectively reviewed. TST measurements, Prednisone and Methotrexate doses and treatment durations were recorded. Active tuberculosis (TB) was excluded by chest X-ray and patient9s history. A control group, was randomly selected from healthy patients who had a TST at the pulmonology clinic in our institution. We compared the results of the mean TST reaction size between the following three groups: RA patients with current prednisone treatment, RA patients without history of prednisone treatment and healthy individuals. Oneway ANOVA test was used to compare the differences between the groups. We then calculated a score of Prednisone and Methotrexate unit-years (u-y) by multiplying the dosage of the medication divided by it9s minimal unit (5 mg/day and 2.5 mg/week, respectively) by the number of treatment years. A correlation between this score and the size of the TST reaction was assessed using Pearson9s correlation coefficient (r). A value of p Results 43 (mean age 57.8±13.1 years, 86% female) RA patients with prednisone treatment, 20 (mean age 59.0±10.5 years, 70% female) prednisone naive patients and 137 (mean age 32.7±13.0 years, 62% female) healthy subjects were enrolled in the study. There was no significant difference in mean TST between these three groups (5.3±6.8, 7.4±6.3, 4.2±6.0, respectively, p=.079). No correlation was noted between TST size and Prednisone u-y (mean u-y =5.2±5.7, r=.235, p=.130), and Methotrexate u-y in patients with and without Prednisone therapy (mean u-y =14.4±28.5, r=.220, p=.156; mean=32.3±34.4, r=-.351, p=.130 respectively). Conclusions Our results showed that TST reaction distribution among RA patients isn9t affect by Prednisone therapy. In addition, RA patients may present TST reaction similar to healthy individuals. Therefore, we conclude that the criterion of 5 mm TST reaction defining latent TB infection in our population should be re-evaluated. It may be more appropriate to substitute the traditional TST for newer diagnostic tools as the QuantiFERON assay. Larger studies are needed to verify our results. Disclosure of Interest None declared

We herewith report the rare case of a patient with juvenile rheumatoid arthritis who developed on 2 occasions the clinical picture of an isolated unilateral palsy of the inferior oblique muscle—Brown’s syndrome, following pregnancies, each time in a different eye. Although the eye is frequently involved in rheumatoid arthritis (RA), the Brown’s syndrome is seldom reported in literature with regards to RA.

Background In our clinical practice, we noticed that individuals with symptomatic knee osteoarthritis (OA) frequently complain on pain or swelling above Achilles tendon. We found no studies that evaluated association between knee OA and Achilles tendon pathology. Objectives To explore the association between knee OA and changes in Achilles tendon. Methods Cross-sectional observational cohort study was performed in Rheumatology Unit, Barzilai Medical Center, Ashqelon, Israel. The convenience sample of 30 knee OA (Kellgren-Lawrence (K-L) score ≥2) female patients complaining on unilateral pain was recruited. For each patient, demographic data, K-L score, sonographic evaluation of femoral cartilage thickness and Achilles tendon width, and Western Ontario and McMaster Osteoarthritis (WOMAC) Index were collected. To evaluate the association between femoral cartilage thickness, K-L score, WOMAC parameters, and Achilles tendon width we used Pearson9s correlation and linear regression analysis. Results Significant association was found between Achilles tendon width and WOMAC total score (r=0.490, p=0.006), pain (r=0.416, p=0.022), and functional (r=0.452, p=0.012) scores (but not stiffness score (r=0.242, p=0.198)) in the affected side. Associations remained significant after adjustment for age and body mass index. No associations between similar parameters were found in the unaffected side. No associations were found between K-L score, cartilage thickness and Achilles tendon thickness in affected and in unaffected sides. No associations were found between K-L score or cartilage thickness (at affected or unaffected side) and any parameters of WOMAC. Conclusions This is a first study that evaluated the association between knee OA parameters and Achilles tendon width. There are previous studies that found that weakness of quadriceps muscle is associated with knee OA. It is possible that gastrocnemius muscle whose attachments are also proximate the knee joint participates in knee stabilization. Stress forces that are implied on the muscle to stabilize osteoarthritic knee may cause structural changes in Achilles tendon. Interestingly, the Achilles tendon width was associated with pain and function of ipsilateral OA knee, but not with radiographic OA severity score (K-L) and not with cartilage thickness. Therefore, the sense of pain in the affected joint may be not only due to cartilage changes in the affected joint, but also because of simultaneous changes in Achilles tendon. Comprehensive assessment of Achilles tendon should probably be part of routine knee OA evaluation. The findings of this research provide a basis for further studies with larger sample size, and using different study designs. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1619