The Asia-Pacific Journal of Ophthalmology

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Articles appearing in this section have been peer-reviewed and accepted for publication and posted online before formal publication. Articles appearing here may contain statements, opinions, and information that have errors in facts, figures, or interpretation. Accordingly, the editors and authors and their respective employees are not responsible or liable for the use of any such inaccurate or misleading data, opinion or information contained the articles in this section.

Original Study - Clinical

Personality and Total Health Through Life Project Eye Substudy: Methodology and Baseline Retinal Features Wijngaarden, Peter van; Keel, Stuart; Hodgson, Lauren A.B.; Kumar, Dinesh K.; Aliahmad, Behzad; Paim, Cristiane C.; Kiely, Kim M.; Cherbuin, Nicolas, Anstey, Kaarin J.; Dirani, Mohamed
Purpose: To describe the methodology and present the retinal grading findings of an older sample of Australians with well-defined indices of neurocognitive function in the Personality and Total Health (PATH) Through Life project.

Design: A cross-sectional study.

Methods: Three hundred twenty-six individuals from the PATH Through Life project were invited to participate. Participants completed a general questionnaire and 2-field, 45-degree nonmydriatic color digital retinal photography. Photographs were graded for retinal pathology according to established protocols.

Results: Two hundred fifty-four (77.9%) subjects, aged 72 to 78 years, agreed to participate in the eye substudy. Gradable images of at least 1 eye were acquired in 211 of 254 subjects (83.1%). Retinal photographic screening identified 1 or more signs of pathology in 130 of the 174 subjects (74.7%) with gradable images of both eyes. A total of 45 participants (17.7%) had self-reported diabetes and diabetic retinopathy was observed in 22 (48.9%) of these participants.

Conclusions: This well-defined sample of older Australians provides a unique opportunity to interrogate associations between retinal findings, including retinal vascular geometric parameters, and indices of neurocognitive function.
Long-Term Stability of Minimally Invasive Radial Keratotomy for Mild to Moderate Keratoconus Fujimoto, Kahoko; Osawa Hideya; Moriyama, Takashi; Miyamoto, Takako; Irie, Tomomi; Nishimura, Tetsuya; Inoue, Tomoyuki
Purpose: this study aimed to evaluate the long-term stability of mini-mally invasive radial keratotomy (mini-rK) for eyes with mild to moder-ate keratoconus.

Design: retrospective observational case series.

Methods: Eleven eyes from 6 patients with hard contact lens (Hcl)-intolerant keratoconus underwent mini-rK and were followed up for more than 5 years. the mini-rK consisted of 8 radial incisions with depths of 90% of the thinnest corneal thickness, based on the lindstrom nomogram. Best-corrected visual acuity (BcVa), keratometry, and cor-neal endothelial cell density (Ecd) were examined preoperatively and for 5 to 10 years postoperatively. Changes in keratometric astigmatism were evaluated using power vector analysis. Severities of keratoconus preoperatively and 1 year postoperatively were graded using the amsler-Krumeich classification. Results: the postoperative observation periods were from 6 to 10 years (mean, 7.9 years). there were no changes in the BcVa, Ecd, and kera-tometric astigmatism. the mean keratometric refraction significantly de-creased from 47.5 diopters (d) preoperatively to 44.0 d at 1 month after mini-rK (P = 0.037) and was stable over 5 years, whereas keratometric astigmatism did not change from the preoperative through the postop-erative period (P > 0.59). Keratoconus of grade 2 or higher improved to lower grades.

Conclusions: the mini-rK treatment was safe and effective for Hcl-intolerant eyes with mild to moderate keratoconus.
The Effect of Eye Patching on Clear Corneal Incision Architecture in Phacoemulsification: A Randomized Controlled Trial Ho, Fui Li; Salowi, Mohamad Aziz; Bastion, Mae-Lynn Catherine
Purpose: To investigate the effects of postoperative eye patching on clear corneal incision architecture in phacoemulsification.

Design: A single-center, randomized controlled trial.

Methods: A total of 132 patients with uncomplicated phacoemulsification were randomly allocated to the intervention or control group. The intervention group received postoperative eye patching for approximately 18 hours, whereas the control group received eye shield. The clear corneal incision architecture was examined postoperatively at 2 hours, 1 day, and 7 days after surgery using optical coherence tomography.

Results: Epithelial gaping was significantly reduced on postoperative day 1 in the intervention group (52.4%) compared with control (74.2%) (P = 0.01). No differences were found for other architectural defects. Descemet membrane detachment was associated with lower intraocular pressure on postoperative day 7 (P = 0.02). Presence of underlying diabetes mellitus did not seem to influence architectural defects.

Conclusions: Postoperative eye patching facilitated epithelial healing and reduced the occurrence of epithelial gaping on postoperative day 1. It may play a role in protecting and improving corneal wounds during the critical immediate postoperative period.

Review Article

Femtosecond Lasers and Corneal Surgical Procedures Marino, Gustavo K.; Santhiago, Marcony R.; Wilson, Steven E.
Our purpose is to present a broad review about the principles, early history, evolution, applications, and complications of femtosecond lasers used in refractive and nonrefractive corneal surgical procedures. Femtosecond laser technology added not only safety, precision, and reproducibility to established corneal surgical procedures such as laser in situ keratomileusis (LASIK) and astigmatic keratotomy, but it also introduced new promising concepts such as the intrastromal lenticule procedures with refractive lenticule extraction (ReLEx). Over time, the refinements in laser optics and the overall design of femtosecond laser platforms led to it becoming an essential tool for corneal surgeons. In conclusion, femtosecond laser is a heavily utilized tool in refractive and nonrefractive corneal surgical procedures, and further technological advances are likely to expand its applications.
Visual Quality After Femtosecond Laser Small Incision Lenticule Extraction Miao, Huamao; Han, Tian; Tian, Mi; Wang, Xiaoying; Zhou, Xingtao
Femtosecond laser small incision lenticule extraction (SMILE) is a newly developed form of “flapless” corneal refractive surgery with all-in-one technology. Femtosecond laser SMILE is increasingly attractive for both doctors and patients because it is minimally invasive and does not require a flap to be lifted during surgery. It exhibits many advantages in terms of morphology, biomechanical effects, corneal wound healing, and nerve rehabilitation. However, visual quality assessment after refractive surgeries is just as important as these advantages and correlates with patient satisfaction. Evaluation indexes for visual quality include visual acuity, contrast sensitivity, aberration, intraocular scattering, and so on. This paper reviewed visual quality and patient satisfaction after SMILE for myopia correction.
Grafts in Glaucoma Surgery: A Review of the Literature Thakur, Sahil; Ichhpujani, Parul; Kumar, Suresh
Patients with bleb leakage, dehiscence, or infection after trabeculectomy need urgent bleb salvaging to prevent vision loss. Patients who have undergone a glaucoma drainage device surgery may have tube erosion, which is yet another devastating and outcome-compromising complication. The bleb or the tube in such cases needs to be patched by a biologic tissue, which is roofed by the conjunctiva and acts as a barrier against external infections. Sclera, pericardium, cornea, and dura mater are the commonly used patch graft materials. This review reports the outcomes of several new and old graft materials used to repair the post trabeculectomy compromised bleb and tube exposure in glaucoma drainage device surgeries.
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