The purpose of the study was to compare the clinical outcomes of large 9.0-mm diameter and conventional 8.0-mm bigbubble deep anterior lamellar keratoplasty (DALK). Methods:In this comparative, retrospective interventional case series, medical records of 124 cases of large 9.0-mm diameter DALK from January 2017 to December 2019 and 133 conventional 8.0-mm DALK from January 2014 to December 2016 performed by a single surgeon for the indication of keratoconus were reviewed. Main outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), and postoperative complication rates.Results: Postoperative logarithm of the minimum angle of resolution BSCVA did not significantly differ between 9.0-mm and 8.0-mm DALK at any time points. Although the cumulative percentage of eyes achieving Snellen BSCVA of 20/40 or better was comparable between groups (9.0-mm DALK: 93%, 8.0-mm DALK: 90%, P = 0.571), the cumulative percentage of eyes achieving 20/20 or better (9.0-mm DALK: 44%, 8.0-mm DALK: 26%, P = 0.01) and 20/25 or better (9.0-mm DALK: 74%, 8.0-mm DALK: 59%, P = 0.03) was significantly higher in the 9.0-mm DALK group. RA was significantly lower in the 9.0-mm DALK group compared with the 8.0-mm DALK group during all time points (P , 0.001). The percentage of eyes with RA less than or equal to 4.0 D was significantly lower in the 9.0-mm DALK patients (90%) compared with in 8.0-mm DALK group (72%) (P = 0.002). Postoperative complication rates were similar between groups. Conclusions:Compared with conventional 8.0-mm DALK, large 9.0-mm DALK can provide superior visual outcomes at higher levels of Snellen BSCVA and significantly lower degrees of astigmatism without an increased risk of immune rejection and graft failure.
Background and aimsThe observation of optical microcirculation gives us an extraordinary way to directly assess in vivo the responses of human circulation to stress stimuli. We run a pilot study to analyze optical coherence tomography angiography (OCT-A) metrics at determined time-points during a hemodialysis (HD) session to understand how these metrics gradually change and to evaluate possible correlations with patients’ characteristics.MethodsAfter the eligibility screening, 15 patients (23 eyes) were included in the study. OCT-A parameters were collected at established time-points: Before treatment (t0), at first hour (t1), at second hour (t2), at third hour (t3), and finally at the end of HD treatment (t4). Patients were finally shared in hypotensive group if they occurred in a hypotensive episode during subsequent month methods or no hypotensive group. The instrument software automatically segmented OCT-A scans into four en-face slabs: The superficial capillary plexus (SCP), the deep capillary plexus (DCP), the outer retinal plexus and the choriocapillaris plexus. In this study we focus on SCP, DCP plexuses.ResultsOverall, the majority of ophthalmic parameters remained unaffected and comparable at dialysis end; a significant reduction being observed at the end vs. starting of HD only for deep capillary plexus (DCP: Whole, fovea, and parafovea) and for central choroid thickness (CCT) (p < 0.05). An overall trend during the session showed in general a decrease with a significance in particular for DCP (whole, fovea, and parafovea) and for CCT (P = 0.006). In the hypotension group, Superficial capillary plexus (SCP: Fovea and parafovea) significantly increased comparing post vs. pre-dialysis values while CCT significantly decreased. Analyzing the trend during treatment only CCT maintained a significant trend (p for trend = 0.002). In the no-hypotension group, neither pre- vs. post-analysis and trend analysis showed a statistical significance.ConclusionMain achievement of our study was to measure, for the first time in literature, single parameters at different time-points of a HD session. As a result of this process we did not notice a brusque decreasing or increasing of OCT-A metrics but we can characterize the different effect of HD on the two distinct areas distinguishing ocular vessels: Retinal and choroidal circulation. As interesting sub-analysis, Hypotensive group showed for CCT a decreasing trend with a difference statistically significant respect to the group with no-hypotension maintaining a constant trend. In our opinion, these results suggest the role of autonomic system on vessel control in patients affected by uremia.
Purpose: To evaluate the rate of dry eye via noninvasive ocular surface screening in patients scheduled for senile cataract surgery. Methods: Non‐invasive objective evaluation of ocular surface was performed in the eye undergoing cataract surgery by means of Keratograph 5 M (Oculus, Wetzlar, Germany) for the evaluation of: (i) tear menis‐cus height (TMH); (ii) non‐invasive break‐up time (NIBUT‐first). Subjective evaluation of ocular dis‐comfort symptoms was carried out by Ocular Surface Disease Index (OSDI) questionnaire. Results: Thirty‐seven eyes of 37 patients (22 males and 15 females; mean age 73.68 ± 7.35 years) were ana‐lyzed. Of these, 28 eyes (75.67% of total) had altered values of NIBUT‐first and OSDI questionnaire (respectively 4.35 ± 2.74 s and 25.82 ± 17.29) but normal TMH values (0.40 ± 0.21); 4 eyes (10.81%) showed pathological values of OSDI score (35.75 ± 11.32) but normal values of TMH and NIBUT (respectively 0.46 ± 0.16 mm and 16.27 ± 5.33 s); 5 eyes (13.51%) had normal values of TMH, NIBUT and OSDI (respectively 0.48 ± 0.14, 11.28 ± 2.98, and 10.6 ± 3.13). Conclusions: A fast and noninvasive screening of dry eye in patients undergoing cataract surgery showed that about three‐fourth of these patients had altered tear film stability and ocular discomfort symptoms. A prompt and customized treatment is needed in these patients preoperatively in order to optimize the surgical outcomes.
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