Current Issue : January - March Volume : 2019 Issue Number : 1 Articles : 6 Articles
Purpose: To evaluate the early clinical outcomes of a new diffractive extended\ndepth-of-focus (EDOF) intraocular lens (IOL). Methods: Prospective case series\nenrolling patients undergoing cataract surgery with implantation of the\nEDOF IOL AT LARA (Carl Zeiss Meditec, Jena, Germany). Distance, intermediate\nand near visual acuity were evaluated during a follow-up of 1 month.\nLikewise, defocus curve, binocular mesopic contrast sensitivity, perception of\nphotic phenomena, patient satisfaction and spectacle independence were assessed.\nResults : The study enrolled 38 eyes of 19 patients with a mean age of\n69.5 years. A significant reduction of manifest refraction and improvement in\ncorrected distance visual acuity (CDVA) was observed with surgery (p <\n0.001). All eyes achieved a 1-month postoperative binocular CDVA of 20/20\nor better. Likewise, all eyes achieved a DCIVA of 20/30 or better at 1 month\npostoperatively, and a total of 92.1% achieved DCNVA of 20/40 or better.\nConcerning refractive predictability, 97.4% of eyes had a 1-month postoperative\nspherical equivalent within ±0.50 D. The level of patient satisfaction with\ndistance, intermediate and near vision was high, with 95% of patients reporting\nthat they would have the same surgical procedure with the same IOL\nagain. Difficulties in night driving or associated to halos were low. A total of\n89% of patients reported to be spectacle independent postoperatively. Conclusions:\nThe EDOF IOL AT LARA is able to provide a functional restoration of\nthe visual function across distances after cataract surgery, with very high levels\nof patient satisfaction and minimal incidence of photic phenomena....
a...
Purpose. To evaluate retinal functional improvement by means of visual acuity and retinal sensibility examination after intravitreal\ndexamethasone implant in patients affected by cystoid macular edema secondary to retinal vein occlusion. Methods. Twenty-six\nconsecutive patients affected by retinal vein occlusion complicated by cystoid macular edema were enrolled in this prospective\ninterventional study. All patients underwent a baseline complete ophthalmological evaluation as well as retinal angiography, OCT\nexamination, and microperimetry evaluation. Each patient was treated with intravitreal injection of a long-term steroid implant\n(Ozurdex, Allergan). Follow-up evaluations were performed at months 1, 3, and 6 and completed by OCT and MP1 examination.\nClinical data underwent statistical analysis. Results. Baseline functional evaluation showedmean visual acuity of 0,63±0,42 LogMAR\nand retinal sensitivity of 7,93±4,73 dB (mean±standard deviation); after treatment, at day 30 we found, respectively, 0,43±0,38\nLogMAR (p<0.05, compared to baseline) and 10,15±4,410 dB (p<0.05); at day 90, we found 0,44±0,32 (p<0.05) and 9.61±4,29 dB\n(p<0.05); at day 180, we found 0,41±0,31 (p<0.05) and 9,95±3,79 dB (p<0.05). Fixation pattern improved significantly (p<0.05),\nshowing a stable fixation in 30% of patients at baseline, increasing to 77% of patients at day 180. Baseline morphological evaluation\nshowed a central retinal thickness (CRT) of 398,21±181,65 ... after treatment; we found a CRT of 222,64±95,21 ... at day 30\n(p<0.05, compared to baseline), 307,50±120,25 ... (p<0.05) at day 90, and 294,93±135,86 ... (p<0.05) at day 180. About 15,3%\npatients showed already atmonth 3 a recurrence ofmacular edema.They underwent a retreatment beforemonth 6 as for treatment\nguidelines. Conclusion. Our detailed analysis showed the significative increase in retinal function in the early phases of the followup.\nRetinal sensibility showed a stronger correlation than VA in macular edema reabsorption, better underlying the progressive\nfunctional recovery and increase in quality of vision and life for the patients. This trial is registered with ClinicalTrials.gov\nNCT03559491....
Background: To improve accuracy of IOLMaster (Carl Zeiss, Jena, Germany) in corneal\npower measurement after myopic excimer corneal refractive surgery (MECRS) using\nmultivariate polynomial analysis (MPA).\nMethods: One eye of each of 403 patients (mean age ....) was subjected\nto MECRS for a myopic defect, measured as spherical equivalent, ranging from ........(.....) Each patient underwent a complete eye\nexamination and IOLMaster scan before surgery and at 1, 3 and 6 months follow up.\nAxial length (AL), flatter keratometry value (K1), steeper keratometry value (K2), mean\nkeratometry value (KM) and anterior chamber depth measured from the corneal\nendothelium to the anterior surface of the lens (ACD) were used in a MPA to devise a\nmethod to improve accuracy of KM measurements. Results: Using AL, K1, K2 and ACD measured after surgery in polynomial degree 2\nanalysis, mean error of corneal power evaluation after MECRS was ....... Conclusions: MPA was found to be an effective tool in devising a method to improve\nprecision in corneal power evaluation in eyes previously subjected to MECRS, according\nto our results....
Proton beam therapy (PBRT) is an essential tool in the treatment of certain\nocular tumors due to its characteristic fall-off and sharp beam parameters at\ncritical structures. Review of clinical cases in our ocular PBRT program identified\npatients with silicone oil used as an intraocular tamponade following\npars plana vitrectomy for repair of retinal detachment. Patientâ??s eye may be\nfilled with silicone oil prior to PBRT for an ocular tumor. The objective of\nthis study was to extend our knowledge of the physical characteristics of proton\nbeams in silicone oil by measuring dose within a silicone tank itself,\nhence better representing the surgical eye, as well as applying the range\nchanges to EYEPLAN software to estimate clinical impact. The relevant proton\nbeam physical parameters in silicone oil were studied using a 67.5 MeV\nun-modulated proton beam. The beam parameters being defined included: 1)\nresidual range; 2) peak/plateau ratio; 3) full width at half maximum (FWHM)\nof the Bragg peak; and 4) distal penumbra. Initially, the dose uniformity of\nthe proton beam was confirmed at 10 mm and 28 mm depth, corresponding\nto plateau and peak region of the Bragg peak using Gefchromic film. Once the\nbeam was established as expected, three sets of measurements of the beam\nparameters were taken in: a) water (control); b) silicone-1000 oil and water;\nand c) silicone-1000 oil only. Central-axis depth-ionization measurements\nwere performed in a tank (â??main tankâ?) with a 0.1cc ionization chamber\n(Model IC-18, Far west) having walls made of Shonka A150 plastic. The tank\nwas 92 mm (length) Ã? 40 mm (height) Ã? 40 mm (depth). The tank had a 0.13\nmm thick kapton entrance window through which the proton beam was incident.\nThe ionization chamber was always positioned in the center of the circular field of diameter 30 mm with the phantom surface at isocenter. The\nionization chamber measurements were taken at defined depths in increments\nof 2 mm, from 0 to 35 mm. To define the effect of silicone oil on the\nphysical characteristics of proton beam, the above-defined three sets of measurements\nwere made. In the first run (a), the Bragg-peak measurements were\nmade in the main tank filled with water. In the second run (b), a second\nsmaller tank filled with 10 mm depth silicone oil was placed in front of the\nwater tank and the measurements were repeated in water. In the third run (c),\nthe water in the main tank was replaced with silicone oil and the measurements\nwere repeated in silicone directly (no second tank in runs â??aâ? and â??câ?).\nFinally, the effects of change in range on dose distribution based on the\nEYEPLAN® treatment planning software of patients with lesions in close\nproximity to the disc/macula as well as ciliary body tumors were studied. The\nuniformity of the radiation across the treatment volume shows that the radiation\nfield was uniform within ± 3% at 10 mm depth and within ±4% at 28\nmm depth. Parameters evaluated for the three runs (a, b, c) included: 1) residual\nrange; 2) peak/plateau ratio; 3) FWHM of the Bragg curve; and 4) distal\npenumbra. The measured data revealed that the un-modulated Bragg peak\nhad a penetration at the isocenter of: a) 30 mm in water; b) 31.5 mm in silicone\nand water; and c) 32 mm range in silicone oil. The peak/plateau ratio of\nthe depth dose curve is 3.1:1 in all three set-ups. The FWHM is: a) 9 mm in\nwater; b) 10 mm in silicone and water; and c) 11 mm in silicone oil. The distal\npenumbra (from 90% to 20%) was: a) 1.1 mm; b) 1.4 mm; and c) 2 mm. Clinical\nrelevance of the extended distal range in silicone was studied for impact\nin EYEPLAN treatment software, including cases in which tumors were in\nclose proximity to the optic disc/nerve and macula as well as cases in which\nanterior ciliary body tumors were treated. The potential change of range by 2\nmm in silicone would impact the dose-volume histograms (DVH) importantly\nfor the posterior structures. In ciliary body/anterior tumors, an increase\nin distal range in silicone could result in optic disc/macula dose and\nlength of optic nerve treated, compared with original EYEPLAN model\nDVHs. The use of silicone oil as a surgical tamponade in the treatment of retinal\ndetachments has important implications for PBRT treatment planning.\nIn patients with intraocular silicone oil, the physical parameters of the beam\nshould be closely examined and DVHs for posterior structures should be\nanalyzed for potential increased doses to the macula, disc, and length of optic\nnerve in the field. The change in beam parameters due to silicone oil is essential\nto consider in treatment planning and DVH interpretation for ocular patients\nwith posterior as well as anterior ocular tumors....
Purpose. To assess the simulated keratometry (Sim K) and the total corneal refractive power (TCRP) in eyes undergoing\nconventional corneal cross-linking (CXL). Methods. This study comprised 20 eyes of 20 keratoconic patients (14men and 6 women;\nmedian age (25th and 75th percentile), 26.5 (21.8, 38.0) years) who underwent CXL. The Sim K and TCRP were measured with\na rotating Scheimpflug system (Pentacam HR, Oculus), preoperatively and 1, 3, 6, and 12 months postoperatively. Results. The\nvalues of Sim K were 52.65 (46.00, 55.70), 52.45 (45.85, 56.88), 51.70 (45.78, 55.83), 51.40 (45.68, 56.80), and 51.25 (46.08, 56.15) D\npreoperatively and 1, 3, 6, and 12months postoperatively, respectively.Thecorresponding figures of TCRP were 52.10 (45.48, 55.08),\n51.30 (45.18, 55.20), 50.95 (45.15, 54.50), 50.00 (45.18, 55.08), and 49.80 (45.48, 54.15) D, respectively.The variances of the SimK and\nTCRP data were not statistically significant (p=0.994 and p=0.970, respectively, Kruskalâ??Wallis test). The Sim K was significantly\nlarger than the TCRP before CXL and at 1, 3, 6, and 12months after CXL (p<0.001, Wilcoxon signed-rank test). Conclusions. Not\nonly the SimK but also TCRP was decreased by approximately 1 D after CXL.TheSimK readingsmay overestimate the TCRP, even\nafter CXL for progressive keratoconus....
Loading....