PurposeTo evaluate refractive outcomes and associated factors in patients undergoing combined filtering glaucoma surgery (trabeculectomy or non-penetrating deep sclerectomy (NPDS)) and cataract extraction with toric intraocular lens implantation.DesignProspective consecutive case series.MethodsThis prospective case series included 43 eyes of 32 patients with preoperative corneal astigmatism ≥ 0.75 diopters (D) and moderate-to-severe open-angle glaucoma. Patients underwent trabeculectomy or NPDS and cataract surgery with toric intraocular lens (IOL) implantation. Main outcomes included refractive astigmatism (vector and refractive analysis), spherical equivalent (SE), mean absolute error (MAE), prediction error, intraocular pressure (IOP), and the influence of surgical technique and IOL characteristics.ResultsMean refractive astigmatism decreased from 2.29 ± 1.02 D to 0.57 ± 0.44 D at 6 months (p < 0.001). Mean SE improved from -1.38 ± 3.52 D to 0.06 ± 0.45 D. The MAE was 0.59 ± 0.40 D. No significant correlation was found between refractive results and surgical technique or IOL type. Complete IOP control without medication was achieved in 88.3% of eyes. Visual acuity improved in 97.6% of patientsConclusionsCombined glaucoma filtering surgery with toric IOL implantation yields effective astigmatism correction and favorable refractive outcomes without compromising IOP control. This approach is a valuable option for patients with moderate-to-severe glaucoma and preexisting corneal astigmatism.
Presentamos el caso de una mujer de 20 años, que se sometió a una técnica quirúrgica novedosa para el tratamiento de afaquia, aniridia y astigmatismo postraumáticos. Antes de la cirugía, el iris artificial (IA) (Customflex® Artificial Iris, HumanOptics) se suturó a una lente intraocular (LIO) tórica (Carlevale™, Soleko), se plegó, y posteriormente se implantó en el surco por una pequeña incisión corneal. El procedimiento transcurrió sin complicaciones, y logró resultados funcionales y estéticos favorables. La LIO Carlevale™ proporciona un soporte estable para el IA, permitiendo un tratamiento eficaz de la afaquia, la aniridia y el astigmatismo postraumáticos. Esta técnica asegura un centrado óptimo, fijación en 6 puntos en el surco y mejores resultados visuales y estéticos.
Purpose:To assess the predictability of intraocular lens (IOL) power calculation formulas for sutureless scleral fixation (SSF) of the Carlevale IOL. Methods:A prospective, single-center, interventional case series was conducted to compare predicted refractive outcomes using the SRK/T, Barrett II, Hoffer Q, and Holladay 1 formulas in patients undergoing SSF of the Carlevale IOL. The main outcomes included mean prediction error (PE), median absolute error (MedAE), mean absolute error (MAE), and the percentage of eyes with a PE within ±0.50 and ±1.0 diopters (D). Results:Sixty-nine eyes of 69 patients were included. Only the Barrett II formula resulted in a systematic myopic error (p=0.014). The PE of SRKT, HofferQ, and Holladay 1 was closer to 0, indicating that the post-operative refractive outcome was nearer to the predicted value than that of Barrett II (p=0.002, p<0.001, p=0.003, respectively). MedAE and MAE ranged from 0.41 to 0.53 D and 0.6 to 0.67 D, respectively, without significant differences between the formulas. The percentages of eyes with PE within ±0.50 and ±1.00 D varied from 47.8 to 56.5% and 79.7 to 87%, respectively, showing no significant differences across the assessed formulas. Conclusion:The SRK/T, Hoffer Q, and Holladay 1 formulas provide favorable refractive outcomes for the SSF of Carlevale IOL. The Barrett II formula is less accurate and is not recommended due to its systematic myopic refractive error.
To present a case of a 20-year-old female who underwent a novel surgical technique for post-traumatic aphakia, aniridia, and astigmatism. Prior to surgery, the artificial iris (AI) (Customflex Artificial Iris, HumanOptics) was sutured to a toric intraocular lens (IOL) (Carlevale, Soleko), folded, and then implanted in the sulcus through a small corneal incision. The procedure was complication-free and resulted in favorable functional and cosmetic outcomes. The Carlevale IOL provides stable support for the AI, effectively addressing post-traumatic aphakia, aniridia, and astigmatism. This technique ensures excellent centration, six-point fixation in the sulcus, and improved visual and aesthetic results.
To investigate the correlation between contrast sensitivity changes and post-surgical improvement in visual function perception and health-related quality of life among patients with blepharoptosis. This prospective cohort studied 55 patients with blepharoptosis surgical indication, one eye per patient was considered for analysis. Refraction, visual acuity (VA), eyelash ptosis and contrast sensitivity (CS) test were evaluated. The National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ25), concerning vision-related activities and symptoms, was used to assess the patient´s quality of life pre and postoperatively. Patients were analyzed globally and divided according to the severity of ptosis, lens opacity and the co-existence of glaucoma. 55 eyes underwent ptosis surgery. VA significantly improved without notable refractive changes (p = 0.0044). CS demonstrated significant enhancement in all patients and groups. The NEI-VFQ 25 overall score significantly improved from baseline to 3 months postoperatively (p < 0.001). General vision (p = 0.0319), near and peripheral vision (p < 0.001 and p = 0.0188, respectively), color vision (0.0177), ocular pain (p < 0.001), dependence (p = 0.0093) and mental health (p = 0.0341) exhibited significant improvement. All groups experienced a significant increase in the overall score postoperatively. They all concurred on the improvement of the subscale near vision, except for the glaucoma group, which showed no improvement in either of the subscales. Ptosis surgery significantly improves contrast sensitivity, visual function, and quality of life in patients, including those with ocular comorbidities such as lens opacity and glaucoma. NEI-VFQ 25 assessment revealed an important enhancement in near and peripheral vision, ocular pain, and dependence; which highlight the broad benefits of the surgery, increasing autonomy in daily activities.
