International Ophthalmology

To compare the vector analysis, visual, and refractive outcomes after myopic astigmatic correction using SMILE between the right and left eyes. This is a retrospective study including 41 right and 40 left eyes that underwent SMILE for correction of myopic astigmatism greater than 0.75 diopters (D) with a follow-up of at least 3 months. Vector analysis for astigmatic correction was done. Visual and refractive parameters were compared between both groups by measuring mean postoperative logMAR uncorrected distance visual acuity, mean postoperative spherical equivalent (SE), cylinder, and refractive predictability in terms of SE and cylindrical correction. Efficacy and safety of SMILE were also determined. No significant difference was found between vector outcomes except for angle of error (AE). The right eye group yielded a negative mean AE (− 2.71 ± 5.35), while the left eye group yielded a positive mean AE (0.23 ± 9.60). Correction index, magnitude of error and refractive predictability of cylindrical correction showed undercorrection of astigmatism in both groups. The right eye group showed lower predictability for higher cylindrical correction. Visual outcomes were similar for both eyes. Rotational errors account for vectorial outcome differences between right and left eyes. Despite achieving good visual and refractive outcomes with low cylinder correction, the tendency to undercorrect between eyes due to this error may be more evident when treating higher amounts of astigmatism. More careful preoperative control for cyclotorsion is warranted for right eyes compared to left eyes.

To review the evidence supporting diabetic retinal neurodegeneration (DRN) as a form of diabetic retinopathy. Review of literature. DRN is recognized to be a part of retinopathy in patients with diabetes mellitus (DM), in addition to the well-established diabetic retinal vasculopathy (DRV). DRN has been noted in the early stages of DM, before the onset of clinically evident diabetic retinopathy. The occurrence of DRN has been confirmed in animal models of DM, histopathological examination of donor’s eyes from diabetic individuals and assessment of neural structure and function in humans. DRN involves alterations in retinal ganglion cells, photoreceptors, amacrine cells and bipolar cells, and is thought to be driven by glutamate, oxidative stress and dysregulation of neuroprotective factors in the retina. Potential therapeutic options for DRN are under evaluation. Literature is divided on the temporal relation between DRN and DRV, with evidence of both precedence and simultaneous occurrence. The relationship between DRN and multi-system neuropathy in DM is yet to be evaluated critically.

Intraocular lens (IOL) implantation with a trocar-assisted sutureless scleral fixation technique is a relatively new IOL implantation approach for aphakic eyes. During this surgery, the intrascleral position of the haptics can change the location of the IOL optic and may alter the refractive outcome. This study aimed to evaluate the refractive outcome of this surgery. The files of 22 patients who had undergone IOL implantation with the trocar-assisted sutureless scleral fixation technique were retrospectively reviewed, and the patients were invited for final examination. IOL power was calculated with optical biometry (Lenstar LS900). IOL power calculations were performed according to formulas designed for in-the-bag IOL implantation. The final refractive error was determined with an autorefractometer (Topcon KR-1/RM-1). This study included 14 patients (8 male, 6 female, mean age: 62.7 ± 18.7). There were no significant differences between the preoperative and postoperative corneal astigmatism values (p = 0.16). There were also no significant differences between the postoperative corneal and total astigmatism values (p = 0.44), confirming the absence of significant IOL tilt. The difference between the implanted IOLs and the calculated IOL power for emmetropia was 0.09 D ± 0.49 D (p = 0.52). Although emmetropia was targeted, the refractive outcome shifted to hyperopia (+ 0.85 D ± 1.15 D) and was significantly different from the refractive status calculated with optical biometry (p = 0.034). The intrascleral fixation of IOLs results in increased posterior positioning of the IOL optic and can induce approximately 0.85 D of hyperopia if proper adjustments are not performed during IOL power calculations.

To evaluate long-term surgical success and complications in pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG) after trabeculectomy or phacotrabeculectomy. 96 PEXG eyes and 114 POAG eyes who underwent primary trabeculectomy and phacotrabeculectomy were retrospectively evaluated considering intraocular pressure (IOP), the number of glaucoma medications, surgical success, and rate of complications. Two success criteria were used: Complete success comprised IOP of 5–18 mmHg and 20% reduction of baseline IOP without medication. Qualified success comprised IOP of 5–18 mmHg and 20% reduction of baseline IOP irrespective of medication. Success rates in PEXG and POAG groups, trabeculectomy and phacotrabeculectomy groups, and four groups divided according to surgery and etiology were analyzed via Kaplan–Meier survival analysis. The complete and qualified success were not different between PEXG and POAG groups. The qualified success curves show a similar pattern among the four groups throughout the follow-up of 1,2,3,5,7 and 9 years. Baseline IOP and the number of medications were similar in all four groups (p = 0.275 and p = 0.209, respectively). IOP levels and the number of medications were not statistically different between the four groups during the follow-up of 2,5 and 7 years. The total number of complications and interventions were similar between PEXG and POAG groups (p = 0.258). Phacotrabeculectomy is an effective procedure as trabeculectomy with similar surgical success rates and few surgical complications when it comes to treating PAOG and PEXG patients. Both approaches resulted in similar postoperative IOP levels and medication numbers in both groups.

To evaluate the effect of primary posterior continuous curvilinear capsulorrhexis (PPCCC) on the positional stability of IOLs. This study is a prospective intra-individual comparative randomized controlled trial including 31 patients (62 eyes). Eyes of the same patient were randomly assigned to the PPCCC group (18 right eyes and 13 left eyes) or group without PPCCC (NPCCC group). Eyes in both groups were implanted with a one-piece foldable hydrophobic acrylic IOL via routine cataract surgery. Patients in the PPCCC group underwent additional manual PPCCC before IOL implantation. Examinations were performed 1 day, 1 week, 1 month and 3 months postoperatively. IOL tilt (x, y), decentration (x, y), anterior chamber depth (z) and refractive prediction error data were collected and analyzed with Pentacam. Postoperatively, the range of IOL position change over 3 months in PPCCC group was comparable to NPCCC group, which indicated smaller value in every tilt and decentration index. PPCCC eyes showed comparable tilt and decentration with NPCCC eyes in this study endpoint: mean tilt (x, y), decentration (x, y) and anterior chamber depth (ACD) were 1.04 ± 0.56°, 0.90 ± 0.64°, 0.239 ± 0.140 mm, 0.233 ± 0.133 mm and 4.01 ± 0.32 mm, respectively, in the PPCCC group vs. 1.09 ± 0.76°, 1.10 ± 0.82°, 0.252 ± 0.153 mm, 0.244 ± 0.155 mm and 4.01 ± 0.38 mm, respectively, in the NPCCC group. Refractive prediction error in the PPCCC group demonstrated a mild hyperopic shift vs. the NPCCC group (0.13 ± 0.50 vs. 0.05 ± 0.39; p = 0.208), and corrected distance visual acuity (CDVA) did not differ between the two groups (0.027 ± 0.014 vs. 0.059 ± 0.185; p = 0.377). Comparable IOL tilt, decentration, ACD and refractive prediction error were observed in PPCCC eyes with that underwent routine cataract surgery. Little IOL position fluctuation and good visual acuity were shown in PPCCC group over time. Trail registration: The study was registered at the Chinese Clinical Trial Register Center on May 27th, 2020 (protocol code ChiCTR2000033304, 27/05/2020).

Necrobiosis lipoidica diabeticorum (NLD) is a relatively common manifestation of diabetes mellitus that is thought to be related to immune-complex vasculitis. The legs are the most common site for NLD, but other locations, such as the forearms or hands, have been reported. We describe a case of periorbital NLD that was diagnosed on the basis of histopathology.

To describe the clinical and imaging features in a series of patients diagnosed with macular coloboma (MC) and intrachoroidal cavitation (ICC). Patients diagnosed with MC based on clinical examination between June 2017 and July 2021 were retrieved from the electronic medical record system and were included in the study. Colour fundus photographs, optical coherence tomography (OCT) and Multicolour® imaging scans of these patients were analysed. We identified 16 eyes of 11 patients with MC on fundus examination. Based on OCT imaging features, conforming variant of MC was seen in 9 (56%) eyes and non-conforming variant in 7 (44%) eyes. No eyes with MC in the study showed features of both conforming and non-conforming varieties simultaneously. In the non-conforming variety of MC with presence of intercalary membrane break, ICC was identified in 5 (71%) of these eyes. ICC in MC appeared as flat, dark greenish areas with or without an orange-coloured boundary abutting the margin of the coloboma on Multicolour® imaging. In 31% eyes, ICC was seen in non-conforming type of MC and was well-identified on Multicolour® imaging. It appears that presence of intercalary membrane break and detachment are prerequisites for developing ICC.

The aim of this study is to examine and analyze the contribution of corneal and lenticular components of total astigmatism (TA) in infants and young children and to determine whether there is any compensation for astigmatism by the lenticular component or not. The study was conducted on 614 eyes of 307 infants and young children. Cycloplegic refraction and keratometric measures using the Hand-held Autokeratometer (Nidek Co. Ltd., Hiroishi, Japan) were done for the study group under general anesthesia in Paediatric Ophthalmology Center, Sohag City, Egypt. We divided the sample into high astigmats (total cylinder ≥ 1.00 D; mean, 1.99 ± 0.89 D; n = 431 eyes; 70 %) and normal astigmats (total cylinder ≤ 0.75 D; mean, 0.55 ± 0.22 D; n = 183; 30 %). The prevalence of corneal astigmatism (CA) ≥ 1.00 D was (73 %), any degree of lenticular astigmatism (LA) was (85 %), (LA > 0.25 D = 72 %) TA was predominantly with the rule (n = 499 eyes, 81 %). Eyes with against the rule astigmatism were (n = 33 eyes, 5.3 %) and eyes with oblique astigmatism were (n = 82 eyes; 13.3 %). Gender or age differences in TA, CA, LA, or type of astigmatism were not significant. The prevalence of astigmatism found in this population of newlyborn infants and young children was relatively high, primarily corneal, and WTR astigmatism with high prevalence of oblique astigmatism. LA was much less than previous reports (mean = −0.0044 D), associated with more hyperopic eyes and eyes with high TA. The data suggest that a compensatory process exists between CA and LA to decrease the amount of TA.