0000000000064612
AUTHOR
José L. Menezo
Ultraviolet radiation at Mediterranean latitudes and protection efficacy of intraocular lenses.
Summary Purpose After determining the mean intensity of ultraviolet radiation to which the human eye is exposed at Mediterranean latitudes, this data is used to evaluate the efficacy of the ultraviolet filters incorporated into various intraocular lenses. Methods Ultraviolet radiation measured at Mediterranean latitudes was used as a reference for the theoretical calculation of the amount of radiation to which the human eye is exposed. The spectral transmission curve from 290 to 380 nm was measured for 10 IOLs using a UV/VIS Perkins-Elmer Lambda 800 spectrometer. Results At Mediterranean latitudes, at sea level, with a mean annual solar irradiation of 50 j/cm 2 , the human eye receives a qu…
Modulation transfer function: Rigid versus foldable phakic intraocular lenses
Purpose To study in a standard eye model the changes in modulation transfer function (MTF) of a monofocal intraocular lens (IOL) when a phakic IOL (pIOL) is placed in the anterior chamber, compare the MTFs of the rigid Artisan pIOL and foldable Artiflex pIOL, and evaluate the temporal evolution of the MTF of the foldable pIOL after the mechanical stress the pIOL undergoes when injected. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods The MTF values of the IOLs were calculated from the cross-line spread function recorded with the Opal Vector System. The measurements were taken using an eye model following the British and EN-ISO standards with 2.0 mm, 3.0 mm, 4.0 mm…
Direct Objective Quantification of Corneal Haze after Excimer Laser Photorefractive Keratectomy for High Myopia
Purpose: The purpose of the study is to measure regional distribution differences in corneal haze after excimer laser photorefractive keratectomy for high myopia. Methods: The authors developed computerized gradient edge detectors with which were analyzed digitized anterior slit-lamp photographs of 40 eyes, an average of 21.0 plus or minus 14.5 weeks after photorefractive keratectomy for high myopia (−6 to −22 diopters). A treated area and an adjacent untreated area on the anterior corneal surface, each containing six regions, were quantified, and the difference was correlated with various parameters. Results: Mean differences between scarred and clear areas for haze grade 0.5, 1.0, 2.0, 3.…
Endothelial study of iris-claw phakic lens: four year follow-up.
Abstract Purpose: To study quantitative and morphometric endothelial changes in phakic eyes implanted with the Worst iris-claw lens to correct high myopia. Setting: Department of Ophthalmology, University Hospital “La Fe”, Valencia, Spain. Material and Methods: This retrospective study involved 111 phakic eyes (73 patients) implanted with the Worst iris-claw lens. Noncontact specular microscopy and computer-assisted analysis was performed preoperatively and 6 months and 1, 2, 3, and 4 years postoperatively. Results: The mean cell loss was 3.85% at 6 months, 6.59% at 1 year, 9.22% at 2 years, 11.68% at 3 years, and 13.42% at 4 years. At 2 years, the hexagonality and coefficient variation in …
Goldmann Applanation Tonometry Using Sterile Disposable Silicone Tonometer Shields
Abstract Purpose: Placement of a sterile single-use cover over the tonometer tip may be a convenient and safe alternative method to repeated chemical disinfection. This study was undertaken to evaluate the accuracy and performance of Goldmann applanation tonometry using a sterile disposable silicone tonometer shield over the biprism tip. Methods: The same investigator measured intraocular pressure in 120 eyes with and without the shield. The eyes were tested randomly first with either the uncovered or the covered tonometer to control for the possible effects of repeated tonometry influencing measurement differences. Readings were recorded independently in a masked fashion. Results: The intr…
Long-term results of surgical treatment of high myopia with Worst-Fechner intraocular lenses
Abstract This retrospective study evaluated the results in 90 eyes that had a minus-power anterior chamber intraocular lens implanted to correct high myopia. Preoperative myopia ranged from −7.00 to −24.00 D. Postoperative spherical equivalent was −0.50 D; 80.5% of eyes were within 1.00 D of emmetropia. Two years postoperatively, no cataract formation, retinal detachment, glaucoma, or significant endothelial damage had occurred. We conclude that minus-power lenses can rapidly, safely, and predictably correct high myopia in phakic patients.
Rate of Cataract Formation in 343 Highly Myopic Eyes After Implantation of Three Types of Phakic Intraocular Lenses
ABSTRACT PURPOSE: To assess the feasibility of using phakic intraocular lenses (PIOL) to treat high myopia, and evaluate the incidence of cataract, comparing three different lens types. METHODS: From 1989 to 2002, we implanted three different phakic intraocular lenses (PIOL) in 343 eyes of 232 patients; 231 eyes recieved an Ophtec (Worst-Fechner model, iris-claw), 89 an Adatomed (silicone posterior chamber), and 23 a Staar (posterior chamber, models V2, V3, V4). Average follow-up was 96.2 months for the Ophtec group, 31.5 months for the Adatomed group, and 19.3 months for Staar group. Eyes that subsequently developed cataract were studied for clinical evolution and had PIOL explantation and…
Long-term Results of Combined Cataract, IOL and Glaucoma Surgery
OBJECTIVE: To determine the long-term intraocular pressure (IOP) control in patients that had undergone combined extracapsular cataract extraction (ECCE), lens implant and glaucoma surgery and compare the results obtained by the longer and shorter follow-up groups. STUDY DESIGN: Retrospective study of postoperative results with a minimum follow-up of one year, maximum of 10 years and a mean of 33.1 months. SETTING: Department of Opthalmology, ‘La Fe’ University Hospital. Department of Surgery of Valencia School of Medicine, Valencia, Spain. PATIENTS: Ninety-five eyes examined of 72 patients presenting coexisting cataract and glaucoma who underwent combined surgery in the last 11 years. MAIN…
Lens Opacities in Valencia, Spain
Purpose. To evaluate the most common lens opacities in Valencia (Spain), analyzed by gender, grade, and type of cataracts. The results are compared with other studies performed at other geographical latitudes and on different races. Methods. A total of 1951 eyes of patients diagnosed with cataracts, aged between 30 and 96 years, were evaluated in accordance with age, gender, type and degree of the cataract, bilaterality and symmetry of this disease. Lens Opacities Classification System III was used to classify the cataract and the degree was graded as mild or moderate to advanced. Results. The most common type of cataract is corticonuclear in the elderly and subcapsular in younger subjects.…
Combined procedure for glaucoma and cataract: A retrospective study
Abstract To ascertain the long-term effects of a triple procedure in the case of coexisting cataract and glaucoma, we did a retrospective study of 93 eyes that had cataract extraction, IOL implantation, and trabeculectomy within a ten-year period. Mean follow-up was 32.4 ± 21.9 months. Mean postoperative intraocular pressure (IOP) was significantly lower than preoperatively, even though fewer medications were being used. One year after surgery, 60% of eyes had a best corrected visual acuity of 20/40 or better with an average improvement of 3.8 Snellen lines. Patients who had had surgery four or more years before the study had the highest percentage of eyes with an IOP exceeding 22 mm Hg. Th…
Congenital hypertrophy of the retinal pigment epithelium and familial polyposis of the colon.
Inquiries to Manuel Diaz Llopis, M.D., Cl Cirilo Amoros No. 1 PTA 2, Valencia 46004, Spain. Familial polyposis of the colon is a dominant autosomal disorder that is characterized by hundreds and sometimes thousands of adenomatous polyps throughout the entire colon, which begin in adolescence. Virtually all pa tients with familial polyposis develop carcino ma of the colon by age 50 years. A total colectomy should be carried out early in adult life in affected persons. Because of the autosomal dominant inheritance pattern, an intensive sur vey of family members must be conducted. There is no phenotype biochemical abnormality or serologic marker that indicates whether a familial member will…
Correlation between optics quality of multifocal intraocular lenses and visual acuity
Purpose To study the relationship between the optics quality of multifocal intraocular lenses (IOLs) and distance-corrected near, intermediate, and distance visual acuity to determine the degree to which optics quality must change to produce a significant difference in visual acuity. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods Monocular distance-corrected visual acuity (decimal and logMAR) was measured at 4 m, 70 cm, and 30 cm under photopic and mesopic conditions in eyes with 1 of 3 multifocal IOL models. Visual acuity versus the “average modulation” of the IOL was assessed. Results The pupil diameter and patient age were similar between the 3 IOL groups (20 …
Excimer laser photorefractive keratectomy for high myopia
Abstract One hundred and thirty-three eyes of 103 patients had photorefractive keratectomy with a slit scan mode excimer laser for myopia ranging from −6.00 to −22.00 diopters (D). The epithelium was removed with 20% ethanol, and the ablation was done with a tapered profile surrounding the optical zone. Patients were divided into two groups based on preoperative myopia: Group A, −6.00 D to −12.00 D (88 eyes); Group B, −12.50 D to −22.00 D (45 eyes). In Group A, mean preoperative refraction was −9.59 ± 1.79 D. Mean postoperative refraction was −0.29 ± 1.47 D at one month, −0.85 ± 1.68 D at three months, −1.17 ± 2.04 D at six months, and −0.56 ± 0.74 D at one year. Anterior stromal haze was g…
Influence of optic quality on contrast sensitivity and visual acuity in eyes with a rigid or flexible phakic intraocular lens
Purpose To determine whether the difference in optic quality between 2 types of phakic intraocular lenses (pIOLs) affects visual quality. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods Before implantation of a pIOL for myopia, all eyes had an examination including corrected (CDVA) and uncorrected (UDVA) distance visual acuity testing, corneal endothelial cell count (ECC), and intraocular pressure (IOP) measurement. The postoperative outcomes, determined at least 1 year after surgery, were CDVA; UDVA; contrast sensitivity function under photopic, mesopic, and mesopic with glare conditions; ECC; IOP; keratometry (Scheimpflug photography); and total ocular aberratio…
Image quality with multifocal intraocular lenses and the effect of pupil size
Purpose To analyze the image quality with a refractive and 2 hybrid refractive–diffractive multifocal intraocular lenses (IOLs) in vitro to determine the IOL modulation transfer function (MTF) following the EN-ISO international standard for distance and near vision and to study the IOLs' behavior with different pupil sizes. Setting Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods This study evaluated 4 IOLs: the hybrid refractive–diffractive AcrySof ReSTOR SN60D3 (Alcon) and Tecnis ZM900 (AMO), the refractive ReZoom NXG (AMO), and the monofocal AcrySof SN60WF (Alcon). The MTF was calculated from the cross-line spread function recorded with the OPAL Vector System (Image Sci…
Reproducibility of digital image analysis for measuring corneal haze after myopic photorefractive keratectomy.
Purpose To evaluate the usefulness of digital image analysis for quantifying corneal haze by determining the reproducibility of its measurements at the corneal plane. Methods In a prospective study, 20 randomly selected eyes that had undergone myopic photorefractive keratectomy were photographed focusing the slit beam on their anterior corneal surface. Each photograph was examined using computer image analysis techniques that detect the edge of the reticular pattern of the image. Quantification of the difference between two areas, treated and adjacent untreated cornea, each containing 3,750 pixels with a resolution of 256 gray levels, was performed. Intra-analyzer variation was determined b…
Iris Claw Phakic Lens—Intermediate and Long-term Corneal Endothelial Changes
OBJECTIVE: To study the alterations in the corneal endothelial layer two years after the implantation of iris claw phakic lenses. STUDY DESIGN: Prospective study of postoperative results with a minimum follow-up of 6 months, maximum of two years and a mean of 14 months. SETTING: Department of Ophthalmology, ‘La Fe’ University Hospital, Department of Surgery of Valencia School of Medicine, Valencia, Spain. PATIENTS: Ninety eyes of 70 patients presenting high myopia who underwent anterior chamber phakic lens implantation with iris fixation IOLs in the last two years. MAIN OUTCOME MEASURES: Non-contact specular microscopy with video image system was used to perform examination of the corneal e…
Mesopic Contrast Sensitivity Function After Laser in situ Keratomileusis
ABSTRACT PURPOSE: To evaluate contrast sensitivity under mesopic conditions in patients who have undergone uncomplicated bilateral laser in situ keratomileusis (LASIK) for myopia. METHODS: Best-corrected monocular contrast sensitivity was measured with the Stereo Optical F.A.C.T. chart at 1.5, 3, 6, 12, and 18 c/deg in 20 patients (20 left eyes) before and after bilateral LASIK (with the Nidek EC-5000 excimer laser and the Automated Corneal Shaper). Mean preoperative refractive error was -6.40 ± 1.28 D (range -4.00 to -8.00 D) and postoperative mean refractive error was -0.41 ± 0.45 D (range -0.75 to +0.50 D). Contrast sensitivity function was measured before and 6 months after surgery usin…
Bacterial Contamination of Anterior Chamber Fluid Following Non-complicated Cataract Surgery
Objective: To study the anterior chamber contamination during non-complicated cataract surgery and its relationship with normal conjuctival organisms. Setting: Ophthalmology Department, La Fe Hospital, University of Valencia. Patients: Forty patients who had undergone cataract extraction using either ECCE, phacoemulsification or nucleus fracture methods. Results: Positive cultures of aqueous humour were obtained in 32.5% of cases. The most commonly isolated organism was Staphylococcus coagulase-negative. Only in 7.7% of cases was the microorganism found in the conjunctiva the same as that found in the anterior chamber. The inoculum size ranged between 20 and 160 colonies/ml. One of the case…
Intravitreal foscarnet for cytomegalovirus retinitis in a patient with acquired immunodeficiency syndrome.
We treated a patient who had acquired immunodeficiency syndrome and cytomegalovirus retinitis of the left eye. After anesthetic had been topically administered, the patient received intravitreal injections of 1,200 micrograms of foscarnet. Plasma and vitreous foscarnet levels were measured by high-performance liquid chromatography. Systemic absorption of the drug was not evident. Elimination half-life from the vitreous after one injection was 54.0 hours. Vitreous levels remained above the mean 50% inhibition value for cytomegalovirus for approximately 56 hours and above the mean inhibition value for human immunodeficiency virus for approximately 241 hours. The patient's visual acuity improv…
Diclofenac sodium and cyclosporin A inhibit human lens epithelial cell proliferation in culture.
• Purpose: To investigate the effect of diclofenac sodium salt and cyclosporin A (CsA) on human lens epithelial cell (HLEC) growth in culture. • Methods: Cultures of HLEC were obtained from anterior capsules from extracapsular cataract surgery. Third-passage cells were seeded in 96-well plates in 0.1 ml culture medium. Cytotoxicity was estimated by the tetrazolium test in confluent monolayers after 24 h exposure to a wide range of concentrations of diclofenac and CsA. The effect of subcytotoxic concentrations of diclofenac and CsA on HLEC proliferation in subconfluent cultures was evaluated after 24 and 72 h of exposure. To investigate the relationship between PGEZ synthesis and the inhibit…
Iris Claw Phakic Intraocular Lens for High Myopia
ABSTRACT BACKGROUND: The implantation of a WorstFechner iris claw intraocular lens (IOL) is one of the surgical procedures used for the correction of high myopia. This technique reduces myopia with stähle refractive results; however, its potential long-term risks have not been evaluated. We report results in 94 eyes with a minimum follow -up of 3 years. METHODS: We studied 94 eyes of 62 patients with myopia 5= -7.00 diopters (D) who underwent Worst-Fechner IOL implantation. Lens decentration, permeability of the blood-aqueous barrier by iris angiography, and changes in corneal endothelial density were analyzed. RESULTS: Mean follow-up time was 48.9 months (range 36 to 72 mo). Three years af…
Visual performance with multifocal intraocular lenses
Abstract Objective To evaluate distance and near visual performance under bright (photopic) and dim (mesopic) conditions in patients who had undergone uncomplicated cataract extraction with multifocal or monofocal intraocular lens (IOL) implantation. Design Prospective, nonrandomized, masked, comparative, observational case series. Participants Thirty-two eyes of 32 patients after zonal-progressive multifocal IOL implantation (Allergan Medical Optics Array SA-40N) and 32 eyes of 32 age-matched patients after monofocal IOL implantation (Allergan Medical Optics SI-40NB). Intervention All eyes underwent phacoemulsification and IOL implantation. Main outcome measures At 18 months after surgery,…
Multilayer amniotic membrane transplantation in severe ocular graft versus host disease
To clarify the usefulness of multilayer amniotic membrane transplantation in an unusual case of calcareous corneal degeneration in a patient with graft-versus-host disease.A 20-year-old Caucasian woman had bilateral calcareous corneal degeneration of one year of evolution, secondary to graft-versus-host disease. Treatment for both eyes with topical steroids and antibiotic ointment was not successful. Right eye had a spontaneous corneal perforation, and a three-layer circle amniotic membrane graft was applied to the whole cornea.During a follow-up period of 20 months we observed stability of the corneal epithelium and stroma. The amniotic membrane-covered area showed rapid epithelization, re…
Posterior chamber phakic intraocular lenses to correct high myopia: A comparative study between Staar and Adatomed models
ABSTRACT PURPOSE: To determine the feasibility of using posterior chamber phakic intraocular lenses (PIOLs) to treat high myopia, comparing two different models, Staar and Adatomed. METHODS: Twenty-four eyes from 12 patients were studied prospectively. A phakic Staar IOL was implanted in one eye of each patient, and the other eye received a phakic Adatomed IOL. Patients with uveitis or ocular trauma prior to ocular surgery, diabetic retinopathy, or capsular pseudoexfoliation were excluded. The mean preoperative spherical equivalent refraction was -16.00 ± 5.05 D for the Staar group and -15.39 ± 2.83 D for the Adatomed group. Average follow-up was 32.4 months (range, 19 to 46 mo) for the Ada…
Endophthalmitis following penetrating eye injuries
Postinjury endophthalmitis is the eye infection with the worst prognosis. A retrospective 9-year study was made of penetrating eye injuries, with an analysis of the incidence of infection and its relation to the type of wound and the presence of intraocular foreign bodies. There were 403 cases of penetrating eye injury; of these, 233 affected the cornea and 170 involved the posterior pole. Intraocular foreign bodies were present in 40 cases. Endophthalmitis developed in 4.2% of cases (17/403), and was more common in patients with posterior pole involvement (7%) than in purely corneal trauma (2.1%) (p = 0.03, Chi-square). Infection was in turn more frequent in the presence of intraocular for…
Phakic intraocular lenses to correct high myopia
Abstract Purpose: To evaluate the feasibility and safety of using phakic intraocular lenses (IOLs) to correct high myopia by comparing 3 IOL models: Adatomed, Staar, and Artisan. Setting: La Fe University Hospital, Department of Ophthalmology, and the Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Methods: In this prospective comparative study, a phakic IOL was implanted in 217 highly myopic eyes (118 patients). Fifty-nine eyes received an Adatomed IOL, 21 eyes a Staar IOL, and 137 eyes an Artisan IOL. The mean preoperative spherical equivalent was −15.39 diopters (D) ± 2.83 (SD), −16.00 ± 5.05 D, and −16.17 ± 2.75 D in the Adatomed, Staar, and Artisan groups, respectively. The …
Branch retinal vein occlusion associated with the 20210 G-to-A prothrombin variant.
Purpose To describe a case of branch retinal vein occlusion (BRVO) in a patient who tested positive for the 20210 A allele of the prothrombin (PT) gene. Methods A 48-year-old man had visual loss in the right eye secondary to BRVO confirmed by ophthalmoscopy and fluorescein angiography. His medical history was not remarkable for common risk factors for retinal occlusive diseases. Results Laboratory tests for hypercoagulability were positive for PT 20210 A variant. The patient's family tested negative for the PT variant. Conclusions Laboratory tests for coagulopathy, including the PT 20210 A variant, should be added to the examination of patients with central or BRVO, especially if most commo…