ASCRS News
December 2021
Selective transepithelial ablation with simultaneous accelerated corneal cross-linking for corneal regularization of keratoconus: the STARE-X protocol
Miguel Rechichi, MD, Cosimo Mazzotta, MD, Giovanni William Oliverio, MD, Vito Romano, MD, Davide Borroni, MD, Marco Ferrise, MD, Simone Bagaglia, MD, Soosan Jacob, MS, FRCS, Alessandro Meduri MD
An accelerated corneal collagen crosslinking protocol called STARE-X combined with topography-guided PRK was evaluated in central and paracentral keratoconus cases. The study included 100 eyes of 100 patients who underwent this protocol; 50 eyes had the cone located within the central 3-mm zone and 50 eyes had the cone located outside the central 3-mm zone. At 2 years postop, the CDVA improved, and sphere, cylinder, and K-max were reduced in both groups. There was a statistically significant reduction in total higher order aberrations root main square (RMS), coma RMS, and spherical aberration RMS. CDVA improved more in the group with a cone in the central 3 mm, the authors reported. The authors suggested longer follow-up studies to determine the long-term flattening effect of this procedure, which they deemed effective at stopping progression and improving corneal regularity.
Safety of phakic intraocular collamer lens (Visian ICL) implantation in 95 highly myopic special needs children
Margaret Reynolds, MD, James Hoekel, OD, Lawrence Tychsen, MD
Clinical data from 95 highly myopic (mean –11.2±3.9 D) children with special needs who received ICLs with a mean follow-up of 2.0±1.4 years (up to 5.2 years) were analyzed in this retrospective case series from a single center. The average age at implantation, which was conducted under general anesthesia, was 9.3±5.2 years. Sixty-two of the children had a neurodevelopmental disorder. A minor adverse event occurred in 2% (3 eyes) of cases. The most common major adverse event was postop pupillary block that required peripheral iridotomy (7 eyes, 4%). One child with self-injurious behavior experienced wound leak that required repair, another child with Down syndrome developed a cataract within 3 years of surgery, and one child with severe autism spectrum disorder experienced traumatic retinal detachment after about a year postop. Over 2 years, endothelial cell loss averaged 8.1%, which the authors stated is comparable to ICLs in adults. The authors concluded that the rate of adverse events associated with intraocular collamer lenses was low in this higher risk population.
Visual outcome after rhegmatogenous retinal detachment repair surgery in patients with multifocal versus monofocal intraocular lenses
Sigrid Freissinger, MD, Efstathios Vounotrypidis, MD, Eva Stetzer, Iris Bayer, MD, Mehdi Shajari, MD, Thomas Kreutzer, MD, Leonie Keidel, MD, Christoph Kern, MD, Siegfried Priglinger, MD, Armin Wolf, MD
Retinal detachment repair in eyes with multifocal IOLs can be successful with functionality of the IOL restored, according to a single-center case control study. The research evaluated 52 eyes of 48 pseudophakic patients who had successful retinal detachment repair with 23-gauge vitrectomy with gas tamponade. Twenty-one of these eyes with multifocal IOLs were matched and compared to 21 eyes that had monofocal IOLs. The patients’ mean CDVA (logMAR) improved in both groups and remained stable out to 12 months. There was no significant difference in CDVA at 6 weeks or 12 months postop for either IOL type or for preoperative macular status.
Repeatability and agreement of wavefront aberrations of Pentacam AXL Wave—a new hybrid topographer and aberrometer—with iTrace in healthy eyes
Rohit Shetty, MD, Divya Trivedi, MD, Reshma Ranade, MD, Spriha Arun, MD, Pooja Khamar, MD, Gairik Kundu, MD
This prospective, cross-sectional study assessed the repeatability and agreement of the new Pentacam AXL Wave (Oculus) compared to the iTrace aberrometer (Tracey Technologies). The study included 100 eyes of 100 patients who had three sets of measurements taken during one visit with each of the devices. The Pentacam AXL Wave showed repeatability estimates for wavefront aberrations that were significantly better than the iTrace, according to the authors. They reported an intraclass correlation coefficient from 0.84 for higher order aberrations to 0.92 for lower order aberrations. The within-subject standard deviation, test-retest variability, and within-subject coefficient of variation was lower with the Pentacam AXL Wave than iTrace. The authors noted that both devices “showed excellent correlations for total ocular aberrations.”
Trifocal intraocular lens implantation in eyes with previous corneal refractive surgery for myopia and hyperopia
Rosario Cobo-Soriano, MD, Julio Ortega-Usobiaga, MD, Beatriz Rodríguez-Gutiérrez, DOO, Víctor Tejerina, DOO, Fernando Llovet, MD, Bruno Casco, MD, Julio Baviera, MD
Patients who’ve had prior refractive surgery might want to continue their spectacle independence with cataract surgery. This retrospective comparative case study evaluated the visual and refractive outcomes of a trifocal IOL in patients who had myopic or hyperopic laser refractive surgery. The sample included 868 eyes, 319 of which had myopic corrections and 549 that had hyperopic corrections. At 3 months post-cataract surgery, eyes that had hyperopic corrections had poorer visual outcomes than those in the myopic group, but the authors noted that precision outcomes were worse in the myopic group. Magnitude of the patients’ prior refractive laser treatment correlated with poorer visual outcomes and safety results in a high-hyperopia subgroup (more +3 D), and poor precision was observed in the high-myopia subgroup (more than –5 D).
Efficacy and complications of cataract surgery in high myopia
Yunqian Yao, BSc, Qiang Lu, BSc, Ling Wei, BSc, Kaiwen Cheng, BSc, Yi Lu, MD, Xiangjia Zhu, MD
A comprehensive literature search from January 2000–August 2020 was conducted to evaluate the efficacy and complications of cataract surgery in patients with high myopia. The search yielded 19,586 eyes from 28 studies for analysis. The authors concluded that while cataract surgery is efficacious and can significantly improve visual acuity in these eyes, there are complications that occur more frequently in this population, including posterior capsule rupture, retinal detachment, progressed myopic traction maculopathy, capsular contraction syndrome, IOL dislocation, and transient IOP elevation. The authors advocated for precautions to be taken to reduce risk of some of these complications as well as sufficient follow-up visits.
