1,720,990 research outputs found
Pediatric Ocular Health and Obstructive Sleep Apnea Syndrome: A Review
Full text linkObstructive sleep apnea (OSA) affects neurobehavioral, cognitive, and cardiovascular aspects, particularly in children, by obstructing the upper airways during sleep. While its impact in adult ocular health is recognized, there is ongoing debate about OSA's relevance in pediatrics. This review explores the relationship between OSA and ocular health in children, focusing on the effects and potential improvements through treatment. A systematic search found 287 articles through PubMeD/MEDLINE, Scopus, Web of Science, and ScienceDirect; 94.4% were excluded. After careful selection, six English articles were included, addressing the effects of OSA on children's eyes. Three studies examined choroidal alterations, three explored retinal and optic nerve changes, and two analyzed ocular changes following otorhinolaryngological intervention. The immediate correlation in children is inconclusive, but age may be a contributing factor. Pediatric OSA patients exhibit corneal anomalies and increased optic nerve thickness, possibly due to intermittent hypoxia. OSA influences retinal vascular density in children, with increased density after treatment and reduced choroidal thickness in cases of adenotonsillar hypertrophy. This review emphasized OSA's significant impact on children's ocular health, revealing alterations in the optic nerve, choroid, retina, and cornea. While the direct correlation with the optic nerve is not always evident, OSA raises intraocular pressure and induces structural changes. Treatment holds promise, highlighting the need for regular monitoring to promptly address childhood OSA
Long-term Results of Corneal Cross-linking for Recurrence of Keratoconus After Keratoplasty
No full textPurpose: To evaluate the long-term efficacy of accelerated corneal cross-linking (A-CXL) in halting the progression of recurrence of keratoconus in the graft. Methods: This was a retrospective chart review of patients who underwent A-CXL for recurrence of keratoconus between January 2017 and December 2018. Results of eye evaluations performed up to 4 years after A-CXL included slit-lamp examination, corneal tomography and biomechanics, binocular corrected distance visual acuity (CDVA), and the manifest refraction equivalent sphere. The efficacy of A-CXL was assessed with reference to thinnest corneal thickness (TCT), mean anterior axial radius curvature in corneal periphery (ARC), and posterior axial radius curvature (PRC) tomography data indicating the stability of the ectasia. Results: Data from 25 eyes were collected. Significant worsening in TCT, ARC, PCR, maximum keratometry, posterior eccentricity, and CDVA (P = .01) were found before A-CXL. At 4 years of follow-up, no changes in all tomographic parameters and significant improvement in CDVA (P = .02) and in corneal biomechanics (stiffness parameter A1, deformation amplitude ratio highest, inverse concave radius, and appla-nation 2 velocity; P = .01) were found. None of the included eyes developed postoperative complications or required re-grafting or refractive procedures. Conclusions: A-CXL is a safe procedure that could play a role in preventing graft ectatic changes in patients with recurrence of keratoconus after keratoplasty, strengthening the graft and halting the natural progression of the ectasia, with positive effects in improving CDVA
Sequential Customized Phototherapeutic Keratectomy After Meniscus-shaped Stromal Lenticule Addition Keratoplasty in Kerotoconic Eyes
No full textPURPOSE: To assess the safety and effectiveness of sequential customized transepithelial phototherapeutic keratectomy (SCTK) performed after meniscus-shaped stromal lenticule addition keratoplasty (MS-SLAK) in patients with advanced keratoconus, with a focus on higher order aberrations (HOAs), corrected distance visual acuity (CDVA), and corneal biomechanics. METHODS: This prospective interventional study included patients previously treated with MS-SLAK for advanced keratoconus, showing corneal HOAs 3 pm or greater at a 4-mm pupil diameter and at least 200 pm of stromal thickness anterior to the implanted lenticule. All patients underwent SCTK using excimer laser ablation based on the corneal aberrometer, treating HOAs. Two sequential customized SCTK ablations were performed with intraoperative topographic reassessment. Patients were evaluated at baseline and at 3, 6, and 12 months postoperatively. Parameters included CDVA, manifest refraction spherical equivalent, corneal and ocular wavefront, tomographic data, and dynamic corneal response measurements. RESULTS: Six eyes from six patients were analyzed. The procedure resulted in significant visual improvement, with median spectacle CDVA improving from 20/125 to 20/32 at 12 months (P = .0001), and median contact lens CDVA reaching 20/25. HOAs significantly decreased, particularly root mean square (RMS) coma (from 3.3 (1.6) to 1.0 (0.5) pm, P = .02) and ocular RMS HOA (from 4.1 (1.8) to 1.8 (0.4) pm, P = .03). Corneal biomechanics remained stable throughout follow-up, with no signs of ectasia. CONCLUSIONS: SCTK following MS-SLAK seems an effective sequential treatment strategy in advanced keratoconus. Combining biomechanical reinforcement with optical surface regularization enhances visual function and reduces HOAs, and could offer a viable alternative to corneal transplantation in selected cases
Small-incision lenticule addition in ex vivo model of ectatic human corneas
No full textPURPOSE: To investigate the feasibility of intrastromal lenticule insertion to restore corneal shape in a model of ectatic human cornea. METHODS: For this experimental ex vivo study on 34 human corneas unsuitable for transplantation, 17 corneas were thinned by decentralized posterior excimer laser ablation to 200 μm thickness and 6.5 mm diameter and then inflated up to 100 mm Hg to expose the ectasias (recipient corneas). Pachimetry and topography were obtained. Stromal lenticules of the same diameter and thickness as the ectasias were shaped with a femtosecond laser from the remaining 17 donor corneas. An intrastromal pocket was created with femtosecond laser within the ectatic recipient corneas and the donor lenticule was inserted inside it. Changes in corneal architecture and profile were evaluated by means of corneal topography and anterior segment optical coherence tomography. RESULTS: All stromal lenticules were successfully implanted. Tomography confirmed regularity of the lenticule profile within the stromal pocket. Corneal thickness was significantly increased after the procedure (P < 0.0001). Maximal posterior elevation from the best-fitted toric ellipsoid was significantly reduced (P < 0.0001). Significant flattening of posterior K1 and K2 was also obtained (P = 0.041 and P = 0.004, respectively). Anterior and posterior astigmatism, anterior and posterior asphericity, and spherical aberration did not differ significantly after the procedure. CONCLUSIONS: Femtosecond laser-assisted stromal lenticule addition is feasible for restoring corneal thickness to an ectatic area and for regularizing posterior corneal elevation. The technique opens new perspectives for the treatment of corneal ectasias
Toric Aberrometric Extended Depth of Focus Intraocular Lens: Visual Outcomes, Rotational Stability, Patients' Satisfaction, and Spectacle Independence
Full text link: Objective: To evaluate visual outcomes, rotational stability, patients' satisfaction, and spectacle independence after bilateral Toric extended depth of focus intraocular lens (EDOF IOL) implantation. Methods: Prospective observational study including cataract patients with bilateral corneal astigmatism between 0.75 and 3.00 D implanted with Toric EDOF IOLs. After three months distance corrected and uncorrected visual acuity at 4 m (DCVA and UDVA), 80 cm (DCI80VA and UI80VA), 67 cm (DCI67VA and UI67VA), and 40 cm (DCNVA and UNVA), IOL stability by Toric IOL Assistant tool (Osiris T, CSO, Florence, Italy), binocular defocus curves, contrast sensitivity (CS), halometry, reading performance, and subjective and objective (Root mean square-RMS, modulation transfer function-MTF, cut-off and point-spread-function-PSF-Strehl ratio) visual quality were evaluated. Results: Forty eyes from 20 astigmatic patients were enrolled. Mean refractive spherical equivalent and residual cylinder were -0.21 ± 0.74 D and 0.29 ± 0.31 D, respectively. No patients needed additional surgery due to IOL rotation. Binocular UDVA, UI80VA, UI67VA, and UNVA ≤ 0.2 logMAR was found in 90%, 95%, 85%, and 80%. Distance-corrected visual outcomes have overall shown higher performances. All visual acuities at defocus curves were ≤0.125 logMAR between +0.50 D and -2.00 D. PSF-Strehl ratio, MTF cut-off, RMS were 0.26 ± 0.28, 19.82 ± 12.35, 0.31 ± 0.17. Reading analysis reached 125.42 ± 27.21 words/minute, 92.56 ± 7.82, 0.17 ± 0.15 logMAR and 0.50 ± 0.11 logRAD for mean reading speed, visual acuity score, reading acuity, and critical print size, respectively. CS was higher in photopic conditions. Subjective spectacle independence was achieved in 80% of patients. Conclusions: Toric EDOF IOL showed rotational stability and reliable astigmatic correction. It provided spectacle independence and good performance from distance to near distance, reaching high patient satisfaction without undermining binocular quality of vision
Glaucoma surgery during the first year of the COVID-19 pandemic
Full text linkPurpose: To summarize the actions taken to give continuity to the surgical treatment of glaucoma patients and to present the volume and characteristics of glaucoma surgery in the first year of pandemic at the Tertiary Glaucoma Center of the University Hospital of Verona (Veneto, Italy). Methods: Demographical and surgical features of patients who underwent glaucoma surgery from March 9th, 2020 to March 8th, 2021 have been collected and compared to the same date range of the previous year. The analyzed data included age, gender, region of origin, glaucoma staging, type of anesthesia and surgical procedure. Results: The surgical volume of glaucoma has dropped by 30.1%. In comparison with the previous year, we found a significant variation in the overall distribution of the performed surgical procedures (p < 0.001). There was a decline in Baerveldt tube implants (- 4.9%), and an increase of non-penetrating surgery (+ 2.6%), cyclo-photo ablative procedures (+ 4.2%) and MIGS (+ 5.7%). Only 24.3% of the procedures were performed under general anesthesia compared to 41.5% in the pre-pandemic period (p < 0.001). The number of procedures performed on eyes affected by advanced or end-stage glaucoma is doubled (p < 0.001). Conclusions: To give continuity to glaucoma surgery, we prioritized interventions on patients with poorer visual fields, rapidly progressing visual field deficit and elevated IOP uncontrolled by maximal medical therapy. Secondly, we have rescheduled the other interventions following the same priority criteria. Finally, we managed some lower priority cases with MIGS, minimizing the need for close post-intervention follow-up. Considering the negative consequences that a delay in the management of glaucoma can have in terms of visual loss, the closure of the operating rooms in the first quarter of the pandemic was detrimental. It appears that glaucoma surgery deserves urgencies that cannot be overshadowed and the greatest effort must be to give continuity to this type of eye surgery
Femtosecond laser-assisted implantation of corneal stroma lenticule for keratoconus
Full text linkPURPOSE: To review recent progress, challenges, and future perspectives of stromal keratophakia for the treatment of advanced keratoconus. METHODS: We systematically reviewed the literature in the PubMed database, last update June 30, 2020. No language restriction was applied. The authors checked the reference lists of the retrieved articles to identify any additional study of interest.RESULTS: Several techniques have been proposed for the treatment of keratoconus in order to avoid or delay keratoplasty. This was primarily due to the lack of accessibility to donor corneas in many countries. The ease and predictability of the more advanced femtosecond lasers used to correct ametropias by stromal lenticule extraction lead to hypothesize that generated refractive lenticules could be implanted into corneal stromal layers to restore volume and alter the refractive properties of the cornea in patients with corneal ectasias. At the same time, new techniques for preservation, customization, and cellular therapy of the corneal stromal have been developed, directing to the valorization of otherwise discarded byproducts such as donor corneas unsuitable for either lamellar of penetrating keratoplasty.CONCLUSIONS: Femtosecond laser-assisted stromal keratophakia could be a suitable therapeutic option for the treatment of corneal ectasias, especially in patients with advanced keratoconus, providing biomechanical support recovering the pachimetry to nearly normal value at the same time. The accuracy and predictability of the refractive outcome are yet a critical issue and the patient eligible for the procedure still has to be characterized
Simple Epithelial Transplantation for Ocular Surface Reconstruction After Severe Ocular Burn Injury
No full textPurpose: To manage ocular surface complications and recover conjunctival and corneal epithelia after unilateral severe chemical burn. Methods: We performed simple conjunctival epithelial transplantation (SCET) to obtain renewal of fornix and bulbar-tarsal conjunctiva epithelium, followed by simple limbal epithelial transplantation (SLET) to recover limbal function and epithelial corneal surface. Slit-lamp examination, fluorescein staining, in vivo confocal microscopy, Kheirkhah grading system for symblepharon severity, Wong-Baker FACES Pain Rating Scale, and best-corrected visual acuity were assessed before surgery, at 1 to 3 months after SCET and SLET, and thereafter at 6 to 12 to 36 months. Results: Two patients with unilateral burn injuries underwent surgery. Eye mobility and fornix reconstruction were promptly achieved, and conjunctival epithelium with goblet cells was observed on the bulbar and tarsal conjunctiva 3 months after SCET. After SLET, corneal epithelium and cornea-conjunctiva transition zone were observed at 3 and 6 months, respectively. From before surgery to 6 months after SLET, symblepharon improved from grade IVa2 and IIIb2 to Ic0 and Ib0, the Wong-Baker FACES Pain Rating Scale changed from grade 6 and 4 to 0, and best-corrected visual acuity upgraded from 1.40 and 1.10 logarithm of the minimum angle of resolution to 0.5 logarithm of the minimum angle of resolution, in patient 1 and 2, respectively. After 3 years, results remained stable. Conclusions: SCET effectively healed the bare conjunctival area relieving subjective symptoms and discomfort. Sequential SCET and SLET showed to be feasible in restoring a normal ocular surface with long-lasting results suggesting the aim in patients with severe ocular burn is not merely corneal epithelium renewal but also the regeneration of ocular surface homeostasis
Clinical performance of the pseudo-non diffracting beam Toric EDOF intraocular lens: visual function, rotational stability, and quality of life
No full textPurpose: To evaluate visual acuity, refractive outcomes, rotational stability, and patient-reported satisfaction 3 months after bilateral implantation of the Lucidis Toric extended-depth-of-focus (EDOF) intraocular lens in cataract patients with 1.00-3.00 D of regular corneal astigmatism. Methods: Prospective, single-arm study of 25 patients (50 eyes) undergoing phacoemulsification with bilateral Lucidis Toric IOL implantation. The primary endpoint was binocular uncorrected distance visual acuity (UDVA) at 3 months. Secondary endpoints included monocular/binocular UDVA, distance-corrected VA (DCVA) at 4 m; intermediate (80 cm, 66 cm) and near (40 cm) uncorrected and distance-corrected acuities; defocus curve; residual spherical equivalent (SE) and cylinder; IOL rotation; optical quality (MTF cutoff, Strehl ratio, HOA RMS); contrast sensitivity; halometry; and NEI-RQL-42. Paired t-tests or Mann-Whitney tests compared pre-/postoperative values. Results: At 3 months, the mean postoperative spherical equivalent was 0.17 ± 0.52 D (median 0.00 D; range -0.75 to +0.75 D) and the mean refractive cylinder was 0.04 ± 0.32 D (median 0.00 D; range -0.50 to +0.50 D). Median IOL rotation was 2.1 ± 2.3 degrees, with no eyes requiring repositioning. Mean binocular UDVA, UI80VA, UI66VA and UNVA were -0.01 ± 0.1, 0.08 ± 0.24, 0.04 ± 0.1, and 0.01 ± 0.14 logMAR, respectively. There were no statistically significant differences between uncorrected and distance-corrected visual acuities at any distance. The binocular defocus curve showed visual acuity better than 0.1 logMAR from +0.50 D to -3.00 D. NEI-RQL-42 scores indicated high patient satisfaction, particularly in clarity of vision, far, near vision, activity limitations, and glare domains. Conclusion: Bilateral Lucidis Toric EDOF IOL implantation delivers stable rotational performance, broad-range uncorrected vision, and high spectacle independence in astigmatic cataract patients. Future randomised, head-to-head trials with longer follow-up are warranted
Autologous simple conjunctival epithelial transplantation for primary pterygium
No full textPurpose: To evaluate the feasibility of a new method of conjunctival transplantation to achieve recovery of the normal conjunctival epithelium over the bare sclera after pterygium excision and prevent its recurrence. Methods: After excision of the primary pterygium, we performed simple conjunctival epithelial transplantation (SCET) in which we glued an amniotic membrane patch pre-loaded with tiny autologous conjunctival tissue fragments over the scleral defect. Slit-lamp evaluation was performed at 2 and 7-10 days, and then at 1, 3, 6, and 12 months after surgery, together with confocal microscopy at 3, 6, and 12 months. Results: Surgical excision and SCET for nasal primary pterygium were performed in 6 eyes (6 patients). No graft detachment occurred. An inflammatory granuloma was excised without sequelae in one patient 2 months after surgery. No signs of recurrence or sight-threatening complications were recorded at 12 months, and in vivo confocal microscopy showed progressive expansion of the conjunctival cell population and formation of a clear corneal-conjunctival transition. Conclusions: SCET takes advantage of the ability of the amniotic membrane and conjunctival cells to renew. Outcomes after SCET are comparable to conventional conjunctival flap surgery and can be achieved in less surgical time and with less donor tissue to be removed
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