2021 ASCRS Annual Meeting

Authors

Presenting Author
Mohammad Soleimani, MD    Email the author

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Paper Abstract

Purpose
To report eleven cases of keratitis following pterygium surgery.

Methods
In this retrospective study, we reviewed medical records of eleven patients with corneal ulcer following pterygium surgery referred to the ocular trauma and emergency department of Farabi Eye Hospital throughout two years.

Results
The mean age of patients was 63.6 ±8.2 (53-77) years. Eight cases were men. The mean latency period between pterygium surgery and the corneal ulcer was 49.3±41.2(25-165) days. Most of the cultures (five patients) included gram-positive bacteria. Corneal thinning was seen in eight patients, necessitating a tectonic procedure in five patients. The incidence of keratitis after pterygium surgery was 2/1000.

Conclusion
Because of the late-onset characteristic of the keratitis after pterygium surgery, long-term follow up is warranted to detect this type of the corneal infection. Ocular surface flora superinfection especially gram-positive bacteria could carry out a significant role in post pterygium keratitis.

Authors

Presenting Author
Harun UR Rashid, MS    Email the author
Authors
Faizah Priyadarshini, FCPS, Sofia Akhter, MBBS, MPH

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Paper Abstract

Purpose
To study the incidence of intraoperative complications of small incision lenticule extraction (SMILE) and their management during early learning curve.

Methods
Prospective evaluation of 200 consecutive eyes of 100 patients undergoing SMILE was performed on individuals older than 18 years with a stable refractive error ranging from -1.00D to -10.00D with astigmatism up to -5.00D. During the early learning curve, initial 100 cases were considered as group-1 and the recent 100 cases were considered as group-2. SMILE was done by 500 kHz VisuMax femtosecond laser system using same laser setting and technique. Intraoperative complications were assessed on day 1, 1 month and 3 months post-operatively.

Results
In group-1 intraoperative complications were noted in 39 eyes (39%) and in group-2 intraoperative complications were noted in 16 eyes (16%) including suction loss, opaque bubble layer, black spots, difficult lenticule dissection, difficult lenticule extraction, incisional tear, cap lenticular adhesion and epithelial defect. Intraoperative complications were encountered more in the group-1 than in group-2.

Conclusion
Intraoperative complications during SMILE which result in delayed visual recovery are mostly observed in the initial cases. As the surgeon gets experienced, the chances of complications become less. Early recognition with correct management of complications is fundamental for optimizing the final visual result and faster visual recovery.

Authors

Presenting Author
Hormoz Abdshahzadeh Sr., MD    Email the author
Authors
Reyhaneh Abrishamchi, MD, Emilio A. Torres-Netto, MD, PhD, Nikki L. Hafezi, MA, J. Bradley Randleman, MD, Farhad Hafezi, MD, PhD

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Paper Abstract

Purpose
Oxygen diffusion plays a central role in the efficiency of corneal cross-linking.Oxygen availability within a tissue increases with reduced temperatures.The aim of this study was to evaluate whether a reduction of the corneal temperature during CXL might increase oxygen availability and enhance the biomechanical effect of CXL in porcine corneas.

Methods
One hundred twelve porcine corneas with intact epithelium were divided into 4 groups and analyzed. Prior to corneal soaking with hypo-osmolaric 0.1% riboflavin, the epithelium was removed manually in all groups. Accelerated epithelium-off CXL using 9 mW/cm2 irradiance for 10 minutes was performed either at room temperature (group 1, 24°C) or in a cold room (group3, 4°C). Non-cross-linked corneas (groups 2 and 4) were subjected to the same temperatures and served as controls. The elastic modulus of 5-mm wide corneal strips was analyzed and used to determine corneal biomechanical properties.

Results
Epithelium-off CXL led to significant increases in the elastic modulus determined between 1% and 5% of strain in stress-strain extensometry when compared to non-cross-linked controls, both at 24°C (p<0.001) and 4°C (p=0.006) . However, no significant difference was found between corneas treated with CXL at 24°C and 4°C (p = 0.384).

Conclusion
While oxygen plays a central role in corneal cross-linking, the potentially increased diffusion of oxygen in lower tissue temperatures does not appear to play a significant role in the biomechanical efficiency of epithelium-off CXL accelerated protocols in ex vivo porcine corneas.

Authors

Presenting Author
Hormoz Abdshahzadeh Sr., MD    Email the author
Authors
Reyhaneh Abrishamchi, MD, Emilio A. Torres-Netto, MD, PhD, Nikki L. Hafezi, MA, Farhad Hafezi, MD, PhD

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Paper Abstract

Purpose
Keratoconus is a multifactorial disease with a genetic component.Repetitive and prolonged eye rubbing is considered a risk factor and trigger for the progression of Keratoconus.The damage threshold level must be higher than 10’500 eye rubbing movements, suggesting that occasional eye rubbing should not impact corneal biomechanics.

Methods
In a first step, we determined the average force human keratoconus patients apply to their eyelids when rubbing. Then, porcine eyes were obtained from a local slaughterhouse and divided into 2 groups. Thirty-three eyes were rubbed over their own eyelids in a specially developed eye-rubbing device. Each eye underwent 10,500 eye-rubbing movements over the eyelid (corresponds to one year of eye-rubbing, 3 times daily, 10 movements each), using a force similar to the human condition. Thirty-seven eyes served as no-rub controls. The elastic modulus of 5-mm wide corneal strips was analyzed and used to determine corneal biomechanical properties.

Results
Seventy porcine eyes were analyzed. The elastic modulus at the range of 1% and 5% of strain was 1.219 ± 0.284 and 1.218 ± 0.304 N/mm in the eye-rubbing group and the no-rub controls, respectively. Corneal stiffness was thus similar in both groups. (p=0.984)

Conclusion
We did not observe significant corneal biomechanical changes in eyes subjected to repetitive and prolonged eye-rubbing under ex vivo conditions when compared to no-rub controls.In conclusion, repetitive eye rubbing may indeed not be an etiological factor, but rather a risk factor and trigger for progression in predisposed corneas.

Authors

Presenting Author
Wesam Shamseldin Shalaby, MD    Email the author
Authors
Aakriti Garg Shukla, MD, ABO, Eric J. Shiuey, MS, Christopher J. Rapuano, MD, ABO, Zeba A. Syed, MD, ABO

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Paper Abstract

Purpose
To determine the potential impact of sociodemographic and economic factors on graft survival after penetrating keratoplasty (PK).

Methods
Retrospective chart review of PK eyes. Graft outcomes were obtained based on evaluations documented in the medical record. Only the first PK of the first eye was included. The primary outcome measure was graft failure, defined as irreversible and visually significant graft edema, haze, or scarring. Yearly regional average adjusted gross income (AGI) was determined by cross-referencing the patient’s self-reported residential zip code with the average AGI across zip codes supplied by the Internal Revenue Service. Two groups were created: 1) lower income - individuals from neighborhoods with the lowest 10% of AGI, 2) higher income – the remaining 90% of individuals.

Results
The 822 patients (822 eyes) included had a mean age of 57.1±22.1 years. Over 4.2±3.1 years, graft failure occurred in 35.3%. Mean AGI in the higher income group (N=740) was $86,900±52,200 and the lower income group (N=82) was $32,100±4,000 (P < 0.001). Age, sex, follow-up duration, time to failure, smoking, diabetes, traumatic injury or burn history were comparable between groups (all P>0.05). Black race was more common in the lower income group (50.0% vs 11.5%, P<0.001). Multivariate analysis identified ocular and sociodemographic/economic predictors of graft failure. The latter included: younger age (P=0.025), black race (P=0.014), and residing in a lower income neighborhood (P = 0.014).

Conclusion
PK graft prognosis demonstrates a strong association with sociodemographic and economic factors. Younger patients, those of black race, or lower income may be more vulnerable to graft failure after PK.

Authors

Presenting Author
Wesam Shamseldin Shalaby, MD    Email the author
Authors
Amirmohsen Arbabi, MD, Aakriti Garg Shukla, MD, ABO, Reza Razeghinejad, MD, Daniel Lee, MD, ABO, Jonathan S. Myers, MD, ABO, Natasha N. Kolomeyer, MD, ABO

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Paper Abstract

Purpose
To compare the immediate and short-term risk of intraocular pressure (IOP) spikes after micropulse (MP) versus continuous wave (CW) transscleral cyclophotocoagulation (CPC).

Methods
Prospective comparative non-randomized study at single tertiary care center included patients with refractory glaucoma planned for MP or CW-CPC. Patients with prior CPC or significant corneal opacity were excluded. IOP was measured using iCare immediately before, immediately after, and 1 hour after the CPC, then at postoperative day 1. The average of 3 consecutive IOP measurements at each time point were used for analysis. The primary outcome measure was the rate of IOP spikes after MP and CW-CPC defined as 30% IOP elevation with preoperative IOP≥30 mmHg, and 40% elevation with preoperative IOP<30 mmHg. Patients with IOP spikes received IOP lowering agents (topical or oral).

Results
22 eyes (12 CW and 10 MP) of 22 patients were included with a mean age of 64.4±16.2 years. At baseline, mean±SD logMAR visual acuity was 1.4±1.1, IOP was 28.9±11.6 mmHg, and medications number was 3.8±1.4 with no difference between groups. IOPs (CW vs MP, mmHg) were 30.8±9.1 vs 23.5±7.5 immediately before CPC, 23.9±11.0 vs 16.5±6.5 immediately after, 26.8±11.9 vs 25.1±7.7 1hour after, and 17.5±5.5 vs 21.1±7.3 1 day later (all P>0.05). 3 eyes (13.6%; 1 CW, 2 MP) experienced IOP spikes (P=0.571) at 1-hour post-CPC and responded to topical and/or oral medications. At day 1, mean mmHg IOP reduction as compared to baseline was 16.0±14.3 in CW eyes (P=0.01), and 4.3±9.1 in MP eyes (P=0.193).

Conclusion
MP and CW-CPC have similar risk of early postoperative IOP spikes. Significant early IOP reduction was better achieved after CW-CPC. In certain patients, early postoperative IOP spikes may be detrimental; there may be a role for prophylactic acetazolamide or IOP monitoring in such cases.

Authors

Presenting Author
Cristobal Loezar Hernandez, MD    Email the author
Authors
Javier I Peña, MD, Felipe A. Valenzuela, MD, Juan Stoppel Sr., MD, René A. Moreno, MD, Marco A Casas, MD, Mauricio A. Perez, MD

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Paper Abstract

Purpose
To describe the causes of repositioning and explantation of different models of Implantable Collamer Lens phakic intraocular lenses (pIOL).

Methods
Retrospective analysis of patients who underwent implantations of different models of Implantable Collamer Lenses (ICL) between August 2006 and October 2019. The medical records of patients with pIOLs explantations and repositionings were evaluated and clinical data was retrieved for the analysis. The main outcome of the study was to describe the causes of repositioning and explantation with different models of ICL pIOL.

Results
Twenty five eyes of 24 patients were included, 12 repositions and 13 explantations. In all cases, the cause of reposition was >10º of misalignment and decreased visual acuity in toric models and just 3 of them had recent traumatic history. Explantations were due to hyper-vaulting (n=5), cataract (n=4), traumatic retinal detachment (n=1), low corneal endothelial cell density (n=1), labeling error (n=1) and inability to rotate the lens to the proper axis (n=1). Seven explantations were followed by implantation of another ICL. The time from the implantation to the repositioning/explantation procedure will be reported as median (range). The ICL models will also be reported in the final version.

Conclusion
Misalignment of toric Implantable Collamer Lens is a complication that could require repositioning of the pIOL when visual acuity is affected. In our study, the main causes of explantation were hyper-vaulting and cataract, so patients should be informed of this possibility before implantation.

Authors

Presenting Author
Marius A Scheepers, BM BCh, MRCOphth, MM, FRCSC    Email the author

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Paper Abstract

Purpose
This study analyzes patient reported visual disturbances (% not bothered by starbursts, halos, etc.) recorded via a validated questionnaire and collected from both groups. Secondary outcomes will report on binocular best distance corrected distance, intermediate and near visual acuities, and postoperative refractive results.

Methods
Prospective, randomized, patient masked study of 32 eyes of 16 patients (8 per group) that underwent cataract surgery with bilateral implantation of either Vivity or Symfony IOLs. A validated questionnaire was used to determine visual disturbances 3 months post-op. Binocular distance corrected visual acuities were measured at near (40cm), intermediate (60cm), and distance (6M). Contrast acuity (10%) was measured at distance. Postoperative manifest refraction spherical equivalent (MRSE) was recorded and refractive accuracy was analyzed as % of eyes with an absolute prediction error of ≤0.50D. Finally, postoperative refractive astigmatism (PRA) was analyzed as % of eyes with PRA ≤0.50D.

Results
Visual disturbances reported for the Vivity lens implanted cohort were 10% starbursts, 20% halos and 20% glare. The Symfony lens implanted cohort reported 36% starburst, 27% halos and 18% glare. Mean binocular LogMAR VAs for Vivity vs Symfony were: DCDVA -0.03 vs 0.01, DCIVA 0.04 vs 0.05 and DCNVA 0.23 vs 0.28. Contrast VAs (10%) for distance were 0.12 vs 0.20 and intermediate 0.28 vs 0.32. 95% of Vivity eyes and 95% of Symfony eyes had a MRSE ≤0.50D. 90% of Vivity eyes and 100% of Symfony eyes had PRA ≤0.50D.

Conclusion
Visual disturbances were lower in the Vivity compared to the Symfony group. Distance, intermediate, and near visual acuities, as well as 10% contrast sensitivities were similar. The sample size of the pilot study is however too small to draw any statistically significant conclusions.

Authors

Presenting Author
Kai Man Xu, BEng
Authors
Toby Chan, MD

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Paper Abstract

Purpose
Over time, subconjunctival fibrosis post tube shunt surgery may result in suboptimal filtration. The XEN gel stent is a promising intervention with minimal trauma. This study explores whether XEN implantation with the ab-interno approach could be a viable approach in patients with suboptimal intraocular pressure (IOP) after tube shunt surgery.

Methods
This is a retrospective, single-surgeon study conducted on patients who had XEN implanted post-tube shunt. Main outcome measures were IOP and number of glaucoma medications preoperatively, and at postoperative week (POW) 1, postoperative month (POM) 1, 3, 6, and 12. Adverse events and further interventions such as bleb needling were noted. Surgery outcomes were categorized as absolute success (IOP < 18mmHg or > 20% IOP reduction without glaucoma medications), qualified success (IOP < 18mmHg or > 20% IOP reduction with glaucoma medications), or failure (additional glaucoma surgery, or IOP > 18mmHg and < 20% IOP reduction with maximum tolerated glaucoma medications).

Results
The study population consisted of 7 eyes from 6 patients, with 1 eye having data only up until POM3. Preoperative IOP was 23.9 + 5.3mmHg (mean + standard deviation) with 4.3 + 1.3 glaucoma medications and by POM12, mean IOP was 14.0 + 5.8mmHg with 1.5 + 1.6 glaucoma medications. By POM12, bleb needling was performed on 3 eyes (50%) and complications also occurred in 3 eyes (50%). 2 eyes (33.3%) were considered as absolute successes, 3 eyes (50%) as qualified successes, and 1 eye (16.7%) as a failure.

Conclusion
There is a trend for ab interno XEN implants after failed tube shunt surgery to reduce mean IOP and mean number of glaucoma medications, though mild complications occurred in some eyes. Interventions after XEN implant such as bleb needling can help further optimize IOP control.

Authors

Presenting Author
David Teenan, FRCOphth, FRCSEd    Email the author
Authors
Mehul D Damani, FRCS, MS, DNB, Stephen J. Hannan, OD

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Paper Abstract

Purpose
To analyse the clinical safety and efficacy along with patient reported outcomes of iDesign 2.0 in LASIK correction of varying levels of Myopia.

Methods
Outcomes of 1000 patients with a preoperative myopia range of -0.25D to -11.00D, and up to -5.50D of astigmatism. Patients underwent laser vision correction procedures using iDesign 2.0 between May 2019 and April 2020. Monocular and binocular UCDVA scores, manifest refraction, and patient reported outcomes were recorded 1 day, 1 month and 3 months post operatively. Clinical assessments, including any complications, were recorded in the electronic medical record then extracted.

Results
The total number of patients included was 1000 (2000 eyes), with pre-op refractive range of -0.25D to -11.00D with up to -5.50D of astigmatism. One month postoperatively, 89.6% had MSE within 0.5D of emmetropia. Additionally, 93.7% of patients had monocular UCDVA of 6/6 or better and 99.7% had 6/12 or better; 98.7% patients had binocular UCDVA of 6/6 or better and 100% had 6/9 or better. 0.2% had a loss in BCDVA of > 2 lines. 95.3% of patients reported very satisfied or satisfied.

Conclusion
iDesign 2.0 provides a highly safe and effective treatment option for visual correction of myopia. Postoperative visual gains in UCDVA were significant with 98.7% reaching 20/20 or better by month 1. Patient reported satisfaction was also high at 95.3%. Complication rates were low and only 0.2% of patients recorded a loss of >2 lines BCDVA.

Authors

Presenting Author
Sunil Shah, FRCOphth, FRCS, MBBS    Email the author

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Paper Abstract

Purpose
To determine the effect of a fractional skin rejuvenation system (Tixel) on alleviating dry eye signs and symptoms.

Methods
A prospective, cross-sectional, multicentre, controlled study was conducted at three research sites. A total of three Tixel treatments were delivered at 2-weeks intervals (40 peri-orbital non-ablative microthermal delivery of heat for 8 milliseconds and 400-micrometer protrusion (0.18 millijoules/point). Participants were followed up at the baseline, 2-weeks after 1st (visit 2), 2nd (visit 3) and 3rd treatment (visit 4), and 6 weeks after 3rd treatment (visit 5; 3 months from the 1st treatment). Comprehensive ocular surface assessments including OSDI questionnaires, non-invasive break-up time (NIBUT) and tear osmolarity were investigated.

Results
A total of 89 participants were recruited, average age was 52±15 years, among them 28 were males. By the time of reporting 80 participants completed visit 4 and 42 participants completed visit 5. Ocular dryness by OSDI score after visit 2, 3, 4, and 5 improved by 13.2±5.3, 17.1±7.7, 22.8±8.9, 28.8± 9.7 (P<0.001) respectively, which are higher than the minimal clinically important difference (MCID). NIBUT for right and left eyes were 7.9±3.3 and 7.9±3.4 sec which improved to 10.3±2.9 and 10.6±3.0 (P<0.001) sec respectively by visit 5. Tear osmolarity for right and left eye reduced from 297.7±14.8 and 298.9±14.4 to 295.8±8.7 (P=109) and 295.7±8.6 (P=0.034) mOsm/L respectively.

Conclusion
Tixel treatment significantly improves clinical signs and symptoms of dry eye and it is a proven technology for dry eye treatment. Patients impression of Tixel was higher than testing revealed and quite impressive compared to IPL treatments.

Authors

Presenting Author
Karsten Klabe, MD    Email the author

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Paper Abstract

Purpose
A large number of minimally invasive micro-bypass systems have come onto the market in recent years. Given encouraging initial results, the question of a long-term sustainable effects on the intraocular pressure reduction remains. In this context, we report on our 5-year results with the iStent inject from our practice.

Methods
The iStent injection was used in on combination surgery with phacoemulsification for phakic patients. Another time we report on the stand-alone procedure for pseudophakic patients. We monitored the development of visual acuity, intraocular pressure and medication consumption in our patients. In addition, the complication rate and necessary further other glaucoma surgery were analyzed.

Results
In the context of combined surgery, the intraocular pressure dropped significantly. A significant reduction in medication requirements was also achieved. After 5 years, we can have an average IOP drop of 21% and average drug use 0.19 instead of 1.47 preoperatively. As Complication we have 11 eyes with hyphema, 7 eyes with iStent occlusion and 2 eyes with hypotension and incarceration of the iris. With 5 eyes within 5 years, a new glaucoma operation was necessary.

Conclusion
The iStent injection shows a good pressure-reducing effect in our patient population,which remains stable over a period of more than 5 years.This reduction in intraocular pressure is accompanied by a significant and sustained reduction in medication. With appropriate patient selection, the number of necessary second interventions is also very small

Authors

Presenting Author
Abhipsa Sharma, MD    Email the author
Authors
Murugesan Vanathi, MD, Radhika Tandon, MD, DNB, FRCOphth, FRCSEd, Sudharshan Khokhar, MD, Noopur Gupta, MS, DNB, PhD

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Paper Abstract

Purpose
To study the changes in posterior corneal astigmatism in myopic femto-flap LASIK & SMILE over 3 months postoperative period.

Methods
Prospective longitudinal study of posterior corneal imaging [average keratometry (avKM) & posterior corneal astigmatism (PCA)] with Cassini Raytracing & Pentacam Scheimpflug imaging in 38 LASIK eyes & 36 SMILE eyes at preoperative, postoperative month (M) 1 & 3. Details on uncorrected & best corrected visual acuity (UCVA, BCVA), mean refractive spherical equivalent (MRSE), ablation depth (AD), flap thickness (FT), percentage tissue altered (PTA), was noted. Vector analysis of posterior corneal astigmatism was done.

Results
Mean avKM changed from -6.53D to -6.28D & -6.46D in LASIK; from -6.42D to -6.39D & -6.42D in SMILE at M1&3 respectively in Raytracing imaging. In Scheimpflug imaging avKM changed from -6.23D to -6.26D & -6.21D in LASIK; from -6.29D to - 6.26D & -6.26D in SMILE at M1 & 3 respectively. Vector analysis showed a change in J0 from -0.13 in LASIK to -0.03 and -0.13 at M 1(p=0.04) & M3(p=0.02) ; from -0.1 in SMILE to -0.1and -0.09 at M1(p=1) & M3(p=1). J45 showed a change from 0.01 in LASIK to 0.02 and 0.00 at M1(p=1) & M3(p=0.67); from 0.00 in SMILE to 0.02 and -0.01 at M1(p=1) & M3(p=1) by Ray tracing imaging. Vector analysis did not show significant changes in J0 and J45 by Scheimpflug imaging.

Conclusion
Raytracing imaging of posterior cornea over 3month postoperative period detected significant PCA changes in myopic femto-flap LASIK but not in SMILE. Scheimpflug’s imaging did not detect any statistically significant PCA changes in both LASIK and SMILE.

Authors

Presenting Author
Aadithreya Varman, MBBS    Email the author
Authors
Arulmozhi Varman, MD, Dinesh Balakumar, MS, DNB

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Paper Abstract

Purpose
This study is conducted to determine if selective laser trabeculoplasty is an appropriate first line treatment modality for patients with primary open angle glaucoma

Methods
Sample Size – 184 eyes 95 patients (89 both eyes+6 one eyes) 102 Virgin eyes, 82 previously medicated eyes. POAG, OHT, NTG, Pigmentary glaucoma, PXF Follow up period – 5 years Protocol:- Pilocarpine 2% Topical anaesthetic and a gonioscopic lens with coupling medium. The spot size (400 microns)fixed Laser duration 3 ns Treatment parameters – 120-130 shots applied over 360° with energy adjusted to 1.1-1.4 mJ End point - just visible tissue reaction or small microbubbles. ongoing study with nano SLT Sample size- 53 eyes Un treated OAG, OHT,NTG 2 weeks,1 month, 3 months,6 months follow up Average Pre SLT IOP-19 mm of Hg Sub group analysis of NTG patients was also done

Results
Of the 102 virgin eyes, 74 (72.54%) eyes required no further intervention. 19 (18.62%) eyes required a repeat procedure 9 (8.82%) eyes required a combination of repeat SLT and anti glaucoma medications. 82 eyes previously medicated eyes, 59 (71.95%) eyes required no further intervention. 12(14.63%) eyes required a repeat SLT procedure, 8 (9.75%) eyes required a combination of repeat SLT and anti glaucoma medications. 3 (3.65%)eyes required a filtering procedure for better control of IOP Results of ongoing study with nano SLT are to be added nano SLT protocol:Pulse duration – 1 ns Spot Size –400 Energy -0.2 to 2.0 mJ High pulse to pulse stability Results of NTG patients to be added

Conclusion
SLT is an effective, compliance-free, repeatable, cost-effective and safe therapeutic modality having only minor, transient, self-limiting side effects with no sequelae. SLT is an effective primary treatment in OAG and OHT.

Authors

Presenting Author
Dominique Geoffrion, PhD    Email the author
Authors
Mona Harissi-Dagher, MD, FRCSC

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Paper Abstract

Purpose
To determine the role and optimal timing of glaucoma surgery in relation to Boston keratoprosthesis type 1 (KPro) implantation.

Methods
Retrospective study of a total of 100 eyes (100 patients) implanted with a KPro between 2008-2017 and diagnosed with glaucoma. Patients were separated into 2 groups: those with preexisting glaucoma and those who developed glaucoma de novo after KPro. Groups were then divided based on whether patients were medically or surgically managed. Glaucoma surgery included glaucoma drainage device (GDD) implantation, trabeculectomy, and cyclophotocoagulation (CPC). Outcomes included best-corrected visual acuity (BCVA), glaucoma progression, and complications. Differences in outcomes were compared using parametric and non-parametric tests, as well as log-rank test to compare time-to-outcome events.

Results
Among 72 eyes with preexisting glaucoma, 27 (38%) had glaucoma surgery before KPro (18 GDD), while 45 (62%) were medically managed only. Among the latter, 19 (42%) needed glaucoma surgery post-KPro (16 GDD). Among 28 eyes with de novo glaucoma, 12 (43%) had glaucoma surgery post-KPro (9 GDD). For eyes with preexisting glaucoma, glaucoma progression was greater with glaucoma surgery performed post-KPro (100%) compared to pre-KPro (74%, P=0.016) and to medical management (54%, P=0.002). Fewer eyes maintained BCVA of 20/200 or better over time with medical management (P=0.013). Eyes with de novo glaucoma had similar progression, BCVA and complications between medical and surgical care (P>0.05).
Conclusion
Glaucoma surgery should be performed prior or concurrently to KPro in eyes with preexisting glaucoma. Complication rates are not increased when glaucoma surgery is performed in KPro eyes with de novo glaucoma. To ensure optimal IOP control, glaucoma surgery should be performed early in those eyes.

Authors

Presenting Author
Tanya Trinh, FRANZCO, MBBS    Email the author
Authors
Benjamin Solomon, Michael Mimouni, MD, Eyal Cohen, MD, Larissa Gouvea, MD, Gisella Santaella, MD, Nir Sorkin, MD, Sara M. AlShaker, MD, Nizar Din, FRCOphth, David S. Rootman, MD, FRCS

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Paper Abstract

Purpose
To investigate outcomes of femtosecond laser (FL) assisted cataract (FLACS) and refractive lens surgery (RLE) on patients with prior radial keratotomy (RK).

Methods
Retrospective observational case series of all 1,057 FLACS or FL assisted RLE surgeries performed (2015 to 2020). Sixteen eyes of nine patients were included. Data included demographics, visual acuity, laser settings, intraoperative and postoperative complications. Main outcome measures were completeness of capsulotomy and lens fragmentation. Secondary outcomes were final best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA) and complications.

Results
There were 64.7% males and 52.9% right eyes. Average age and follow up time was 59.9 ± 9.9 years (44-75 years) and 3.3 ± 2.5 months respectively. Average number of RK cuts was 11.8 ± 5.3 (range 8-20). Mean preoperative UCVA and BCVA was 0.9 ± 0.4 logMAR (Snellen 20/160) and 0.2 ± 0.3 logMAR (20/30), respectively. Only monofocal IOLs were used. Two intraoperative anterior capsule tears were identified. One postoperative IOL dislocation occurred. Postoperatively, mean UCVA and BCVA was 0.2 ± 0.2 logMAR (20/30) and 0.1 ± 0.1 logMAR (20/25) respectively. BCVA & UCVA improvements were statistically significant (p = 0.01 and p < 0.001 respectively). Safety index was 1.6 & Efficacy index was 1.2.

Conclusion
This is the largest study to date demonstrating safe and effective use of FLACS or FL assisted RLE surgery in radial keratotomy patients. Caution is recommended with thickened incisional scars as potential sources of incomplete laser penetrance. Capsulotomy formation should be observed closely with trypan blue staining to reduce complications.

Authors

Presenting Author
Rudy M. Nuijts, MD, PhD    Email the author
Authors
Caridad Perez-Vives, PhD, BScOptom

Paper Abstract

Purpose
This is a sub-analysis of an International, ambispective registry study conducted in Europe, the UK and Australia to report the Real World clinical visual outcomes of with a non-diffractive design, AcrySof® IQ Vivity™ Toric Extended Vision IOL (models DFT315, DFT415, and DFT515) in a real world setting through routine clinical practice.

Methods
After a minimum of 3 months follow-up per local clinical practice standards, subjects undergone visual performance assessments of visual acuity at distance, intermediate (66 cm) and near (40 cm) distances. Refractive residual error, subject satisfaction, and spectacle independence recorded via validated questionnaires will be recorded. This paper reports the first interim analysis of subjects implanted with the Vivity Toric IOL.

Results
To-date, 129 subjects have been enrolled, of which 21 subjects were implanted with Vivity Toric IOL. Binocular mean (SD) (logMAR) UDVA was 0.02 (0.08) ; UIVA 0.08 (0.11) and UNVA 0.24 (0.15) . All eyes had ≤ 0.50 D of manifest refractive cylinder after surgery. 95.3% of subjects reported rarely or never wearing glasses at arm’s length and 93.2% are satisfied with their sight. No halos, glare and starbursts were reported by 76.2%, 76.2% and 95.2%, respectively. There are no unanticipated AEs to date.

Conclusion
This initial Real-World assessment of patients implanted with the toric version of the Vivity IOL suggests very good visual and refractive outcomes, high levels of patient satisfaction and a low need to wearing spectacles for distance and intermediate activities.

Authors

Presenting Author
Matteo Piovella, MD    Email the author
Authors
Barbara Kusa, MD

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Paper Abstract

Purpose
Purpose: To evaluate two systems Blephex (Scope Ophthalmics – Franklin – TN) and LipiView and LipiFlow (J&J /TearScience, Morrisville,NC) for the thermal pulsation treatment of Meibomian Gland Dysfunction(MGD) to improve quality of the tear film

Methods
Methods: Since 2014, 378 patients (mean age 66.58 ±11.55 years) were diagnosed with partial or total Meibomian glands occlusion by the LipiView lids transillumination. Patients received a LipiFlow treatment to remove obstructions and restore meibomian gland function. 123 of these patients received Blephex treatment immediately before since September 2019

Results
We provide drops therapy for 2 months post treatment. Patients reported no discomfort or pain during or after treatment. Postop quality of vision improved due a better corneal tears film and provide more regular cornea to get more precise and comparable biometry results.

Conclusion
This system provides with the transilluminator option an effective way to detect MG occlusion in MGD. It should be considered in order to optimize the tear film and visual outcomes. This treatment helps to adopt presbyopic implants up to 100% of cataract patients

Authors

Presenting Author
Anubhav Garg    Email the author
Authors
Bryan M. Wong, Tanya Trinh, FRANZCO, MBBS, Michael Mimouni, MD, Stephanie Ramdass, OD, Jennifer Liao, OD, Manokaraananthan Chandrakumar, MSc, Clara C. Chan, MD, FRCS, Allan R. Slomovic, MD, FRCS, MSc, ABO

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Purpose
To perform an economic appraisal of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) lens in patients with distorted corneal surface or ocular surface disease in Canada.

Methods
Retrospective non-randomized unmasked observational cohort study. Visual acuity outcomes of 76 patients who received a PROSE device from the only PROSE clinic in Canada from 2018 to 2020 were assessed. Cost, cost utility, and benefit-cost analyses were performed to assess the value provided by PROSE. Benefits were defined as improvements in visual acuity which were converted into utilities then quality-adjusted life years (QALYs). Economic values were derived via government statements, the clinic’s financial statements, and published literature.

Results
Average BCVA improvement was -0.42±0.41 logMAR (p=2.68*10-13) or Snellen 20/53 for the overall cohort, -0.51±0.48 (p=5.42*10-8) or Snellen 20/65 for distorted corneal surface patients, and -0.31±0.30 (p=1.30*10-7) or Snellen 20/41 for ocular surface disease patients. Average fitting cost was $5,469.85, of which $4,971.38 was clinic cost and $498.47 was patient cost. Cost utility was favourable, at $10,256.47 for the overall cohort, $8,439.79 for distorted corneal surface patients, and $13,069.90 for ocular surface disease patients. Benefit-cost ratio was also favourable, at 34.4 for all patients, 43.8 for distorted corneal surface patients, and 28.3 for ocular surface disease patients.

Conclusion
PROSE provided a significant, cost-effective benefit to patients with distorted corneal surfaces and ocular surface diseases. This benefit was more pronounced than in a previous economic appraisal due to increased FDA valuation of a life, reduced device costs, and lower clinical costs. PROSE clinics are an efficient health care funding investment.

Authors

Presenting Author
Matteo Piovella, MD    Email the author
Authors
Barbara Kusa, MD

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Purpose
Purpose: To evaluate visual performances of trifocal IOLs AT LISA tri 839 MP and AT LISA tri toric 939MP trifocal IOLs (Carl Zeiss Meditec AG - Jena - Germany) in patient that experienced previous laser vision correction

Methods
Methods:Only eyes with regular cornea were included in this study: 35 eyes of 20 patients mean age: 56.57 ± 8.76 years. Preop SE was -0.91 ± 3,31 BCDVA 20/21.40 ± 3,18. Postop were measured: distance (5m) near (40cm) and intermediate (80 cm) VA, corneal topography and aberrometry, contrast sensitivity and defocus curve and quality of vision.Follow-up examinations were performed at day 1 2 7 30 90 180 360 and yearly

Results
Results:At six months BCDVA was 20/20,65 ± 2,51. SE was -0,20 ± 0,45.Residual astigmatism was 0,02 ± 0,42.83% of eyes after trifocal IOLs implantation achieved postop refractive results within ± 0.75 diopters

Conclusion
Conclusion: Trifocal IOLs provided good visual performances also with patients that experienced laser vision correction decades ago. To be selected for surgery eyes biometry needed to be applied with no difficulties and hav to demonstrate no significant differences related the perfect IOLs power also after multiple attempts.

Authors

Presenting Author
Matteo Piovella, MD    Email the author
Authors
Barbara Kusa, MD

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Purpose
Purpose:Radial tears in the capsulorhexis increase the rate surgical complications.Zepto precision pulse capsulotomy (PPC) technology (Mynosys - Fremont, California) is compared with manual continuous curvilinear capsulorhexis (CCC) outcomes by the reproducibility, uniformity, circularity, diameter size and complications rate

Methods
Methods:A novel capsulotomy method and technology called PPC and trade named Zepto was adopted on 203 consecutive eyes with cataract

Results
Results: The ACD was 2.79 ± 0.43. ECC preop was 2270 ± 360 and 1 year postop 2214 ± 53 with a 2.46 % lost cells. We experienced 17 anterior radial tears during a difficult learning curve

Conclusion
The Zepto PPC technology creates a precise circular anterior capsulotomy. This technique allows cataract surgeons to reduce the rate of capsulorhexis and cataract surgery complications. Really helpfull for white mature cataract and small pupils

Authors

Presenting Author
Matteo Piovella, MD    Email the author
Authors
Barbara Kusa, MD

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Purpose
To demonstrate visual performance of the IC-8 small aperture IOL (AcuFocus, Irvine, CA) implanted in patients in whom a cataractous lens has been removed. Pinhole IOLs technology demonstrated to be the best available technology to be implanted in patients that have experienced previous RK or with irregular corneal astigmatism.

Methods
29 eyes with cataract, corneal astigmatism 1.50 ± 2.57, had IC-8 IOL implantation. 21 patients experienced IC-8 IOL in the non-dominant eye and a monofocal IOL in the dominant eye. 4 Patients had bilateral IC 8 IOL implantation. One pateint 20 years after RK.

Results
The IC8 musk decreases halos and glare in aberrate cornea At 4 years in the IC-8 eye, UDVA is 20/20,56 UIVA is 20/20 at 80cm and 67 cm and UNVA is 20/20.5.In the monofocal eye, UDVA is 20/18,UIVA is 20/23 at 80cm 20/25.7 at 67cm and UNVA is 20/50.Binocular UDVA is 20/18,UIVA is 20/18.3 (80 cm and 67cm)and UNVA is 20/20.5.

Conclusion
Pinhole effect normally corrects up to two diopters of corneal astigmatism and overcome toric IOL management within this range. IC 8 is the most effective solution to correct presbyopia and astigmatism in eyes with irregular cornea.

Authors

Presenting Author
Matteo Piovella, MD    Email the author
Authors
Barbara Kusa, MD

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Purpose
To evaluate results in cataract eyes trifocal IOLs implantation to provide distance intermediate and near vision.Minimal postop refractive defects provide high quality of vision and patients satisfaction.New center organization and preop eyes evaluation are key points to spread the use of trifocal lenses to the majority of cataract patients

Methods
378 eyes with cataract were implanted with trifocal IOLs.184 eyes(48.7%)with ATLISA tri 839MP-Carl Zeiss Meditec AG Jena and 194 (51.3%) eyes were implanted with AT LISA tri 939MP - Carl Zeiss Meditec AG Jena. Bilateral implant 178 patient 74 Patients implanted with both TRIFOCAL IOLs(41.5%) 78 Patients implanted with both TORIC TRIFOCAL IOLs (43.8%) 26 Patients implanted with TRIFOCAL IOL in one eye and TORIC TRIFOCAL IOL in the other eye (14.7%) Mean Age 67.29 ±11.66 IOL calculations were performed adopting advanced biometry instruments and astigmatism axis alignment performed with digital system. Tears film quality and MGD was always detected Lipiflow and Blephex were applied routinely

Results
At 5 years monocular Trifocal IOLs results are UCDVA 20/22 ± 2.40 UCIVA 20/24 ± 3.13 UCNVA 20/27 ± 5.37 , monocular Toric Trifocal IOLs are UCDVA 20/20 ± 3.25 UCIVA 20/35 ± 4.75 UCNVA 20/29 ± 2.56 Binocular results (178 patients) are UCDVA was 20/20, intermediate 20/20 and near vision 20/24 96 % OF PATIENTS IN THE RIGHT RANGE (Almost One Eye in the Right Range Sphere Equivalent Within - ±0.50 Sph) Toric IOLs correction is mandatory when 0.75 D of corneal astigmatism is detected. It is necessary to determinate total corneal astigmatism to provide best refractive postoperative outcomes. We have adopted IOL Master 700 TK for the purpose to measure anterior and posterior corneal curvature

Conclusion
AT LISA tri toric 939MP and AT LISA tri 839 MP trifocal IOLs are the most efficient today development of multifocal IOLs family. Clinical outcomes indicate that this is an effective multifocal design to correct refractive defects and to defeat presbyopia after cataract surgery. Data show that it is possible to adopt them in the majority of patients

Authors

Presenting Author
Maria Tsessler, MD    Email the author
Authors
Shir Cohen, Li Wang, MD, PhD, Douglas D. Koch, MD, ABO, David Zadok, MD, Adi Abulafia, MD

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Purpose
To use a new method for analyzing the accuracy of different intraocular lens (IOL) power calculations formulas by 2 biometry devices.

Methods
A retrospective study. Patients having a routine cataract surgery, with a single IOL model (Tecnis ZCBOO, Johnson&Johnson) were included. The following formulas were evaluated with measurements taken by a SS-OCT biometer (IOLMaster 700, Zeiss) with either standard keratometry or total keratometry (TK) and by an OLCR biometer (Lenstar LS900, Haag-streit):Barrett Universal II (BUII), Emmetropia Verifying Optical 2.0 (EVO), Haigis, HILL-RBF 2.0, HILL-RBF 3.0, Hoffer Q, Holladay 1, Holladay 2, Kane, Olsen, and SRK/T. Statistical analysis was applied according to a heteroscedastic statistical method with a standard deviation (SD) of prediction error as the main parameter for formula performance.

Results
153 eyes of 153 patients were included in the study. The prediction accuracies were similar for the 2 biometry devices for all formulas. The lowest SD values were obtained with HILL-RBF 3.0 [0.266-0.285], BUII [0.282-0.303], EVO 2.0 [0.285-0.302], Kane [0.287-0.307], and the HILL-RBF 2.0 [0.290-0.308] formulas as compared to all other formulas, except for the Haigis and Olsen formulas (P < .05). The Hill-RBF 3 formula was more accurate as compared to the Hill-RBF 2 formula. Total keratometry measurements as measured by the SS-OCT biometer did not improve the prediction accuracy significantly.

Conclusion
HILL-RBF 3.0, BUII, EVO 2.0, Kane and the HILL-RBF 2.0 formulas had the best prediction performance using a heteroscedastic statistical method for analysis.