Purpose: To describe the visual and topographical changes after accelerated corneal collagen cross-linking (ACXL) in keratoconus-affected eyes. Methods: Clinical records of patients with keratoconus-affected eyes that underwent ACXL treatment and had 24 months of follow-up were reviewed. Data regarding demographics, visual acuity (VA), refraction and Sheimpflug values before and post ACXL were analyzed. We included patients with keratoconus older than 12 years old, with corneal thickness greater than 400 microns and steepest keratometry <60 diopters by Sheimpflug (Pentacam), with reported uncorrected distant visual acuity (UDVA), manifest refraction and best-corrected visual acuity (BCVA) evaluation pre ACXL and 24 months after surgery. The exclusion criteria were: history of ocular trauma, anterior segment surgery, retinal detachment or any type of maculopathy. Results: 21 eyes were included. Mean age was 27 years. Mean uncorrected distant VA (UDVA) before the procedure was 1.01 logMAR (20/200 Snellen) and after 24 months improved significantly to 0.62 logMAR (20/83 Snellen) with a p value of 0.005. No statistical significant difference was found between preoperative and postoperative refractive, keratometric and pachymetric data. Induced astigmatism value was -1.11 D (range 0.13 D – 2.28 D). Conclusions: ACXL is a technique to prevent the progression of keratoconus, however refractive and VA changes could be expected after procedure. The observed changes must be considered when performing the procedure together with refractive surgery.

Purpose: To evaluate visual and refractive outcomes after intracorneal circular ring implantation with femtosecond laser for keratoconus treatment. Design: Prospective, cohort Methods: Were included 22 eyes of 16 adults patients with central keratoconus who had been implanted with continuous intracorneal circular ring (ICCR) MyoRing (Dioptex GmbH, Linz, Austria) in a pocket created by femtosecond laser (Ziemer Z6 LDV, Port, Switzerland). Visual and refractive outcomes, keratometry, pachymetry and asphericity were evaluated at one, three, six month and one year postoperative. Results: Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) improved from 1,33 (Standard deviation [SD]: 0,37) to 0,38 logMAR (SD 0,16) (p<.001) and from 0,25 (SD: 0,15) to 0,21 logMAR (SD: 0,23) (p=0,43) respectively at one year postoperative. Central keratometry, sphere, cylinder and corneal asphericity presented reduction of 8,13 Diopters (D) (p<.001), 5,42D (p<.001), 2,03D (p=0.01), 1,46 e2 (p=0,00) respectively. Visual, refractive and keratometric results did not reveal significant changes after the third month of follow up. Conclusion: Intracorneal circular ring implantation using femtosecond laser is an effective and safe procedure for central keratoconus treatment. Keratometric and refractive values can be effectively improved and good visual outcomes achieved. RESUMEN Objetivo: Evaluar los resultados visuales y refractivos tras el implante de anillo intracorneal circular continuo, usando láser de femtosegundo en el tratamiento de pacientes adultos con queratocono. Diseño: Prospectivo de cohorte. Materiales y Métodos: Se incluyeron 22 ojos de 16 pacientes, con diagnóstico de queratocono tipo central a los cuales se les implanto un anillo intracorneal circular continuo (ICCR), MyoRing (Dioptex GmbH, Linz, Austria) en un bolsillo creado con láser de femtosegundo (Ziemer Z6 LDV, Port, Switzerland). Se evaluó resultado visual, refractivo, queratometrías, paquimetría y asfericidad corneal al mes , tres meses, seis meses y a un año posoperatorio. Resultados: La agudeza visual sin corrección (AVSC) y la agudeza visual con corrección (AVCC) mejoraron de 1,33 (Desviación estándar [DE]: 0,37) a 0,38 logMAR ([DE]:0,16, p=0.001) y de 0,25 ([DE]:0,15) a 0,21 logMAR ([DE]:0,23, p= 0,43) respectivamente al año postoperatorio. La queratometría central, la esfera, el cilindro y la asfericidad corneal presentaron disminución de 8,13 Dioptrías (D) (p <.001), 5,42 D (p<.001), 2,03D (p=0.01) y 1,46 e2 (p<0,000) respectivamente. Los resultados visuales, refractivos y queratométricos no presentaron cambios significativos a partir del tercer mes posoperatorio. Conclusiones: El implante del anillo intracorneal circular continuo con láser femtosegundo, demostró ser un procedimiento eficiente y seguro para el tratamiento de queratocono tipo central, mejorando significativamente los valores queratométricos y refractivos, logrando buenos resultados visuales.

Purpose: To determine the relation between manifest refractive error and cycloplegic refractive error in children and adolescents in Campinas - SP, Brazil, and to compare the results with previous published studies. Methods: Dynamic and static retinoscopy was performed in children and adolescents. To obtain cycloplegia, three drops of 1% cyclopentolate was instilled in each eye every 5 minutes. Maximum cycloplegic effect was achieved after 45 minutes. The working distance for retinoscopy was 67 cm. During retinoscopy, the room was dimly illuminated, and patients were instructed to look at a spot of light at a distance of 6 m. Retinoscopic findings were measured before and after cycloplegia. Results: Two hundred and twenty-two (222) eyes of one hundred and eleven (111) children and adolescents were included. The average age of the participants was 10 years (range 4 to 15 years); 57 (51%) were girls, and the other 54 (49%) were boys. The most common refractive error in younger children was hyperopia, whereas myopia was the most common error in older children. The value of the latent error (the difference between cycloplegic and non-cycloplegic error) increased with hyperopia, especially in younger patients. The value decreased gradually in patients with moderate hyperopia and myopia. Conclusion: The cycloplegic refraction is more sensitive than the subjective one to measure refractive error at all age groups especially in children and young adults. The cyclo-refraction technique is highly recommended to precisely measure the refractive error in momentous conditions such as refractive surgery, epidemiological research, and amblyopia.

Purpose: To determine the relationship between pseudostrabismus and predictors of increased frequency of this presentation in our environment: epicanthus and hypertelorism. Study design: Binary logistic regression to relate Pseudostrabismus and predictors, and odds ratio for risk assessment. Statistical analysis: Binary logistic regression to relate pseudostrabismus and predictors, and odds ratio for risk assessment. Results: The association of Pseudostrabismus with hypertelorism (62 children - 50%) and hypotelorism (20 children -16.1%) determined through the DI in our study population showed statistical significance (p <0.05). The multivariate analysis OR), who evaluated the risk of having the diagnosis of Pseudostrabismus in the presence of these predictors showed values of 3,276 for hypertelorism and 2,087 for hypotelorism. The results of the association of Pbismus with the epicanthus (50 children without-40.3% and 74 with -59.7%) did not show statistical significance (p> 0.05); however, multivariate analysis or logistic regression gave us a value of 1.949. Conclusions: In our study population, hypotelorism and hypertelorism are predictors of the diagnosis of Pseudostrabismus. The statistical analysis for this association is significant (p <0.5), and the risk (O.R) of having Pseudostrabismus in the presence of hypertelorism is three times more, and two times more in the presence of hypotelorism. The risk of having Pseudostrabismus per epicanthus is 2-fold (O.R.1.949), the statistical analysis for this association was not significant (p> 0.05). RESUMEN Objetivo: Determinar la relación entre pseudoestrabismo y los predictores de mayor frecuencia de presentación en nuestro medio: epicanto e hipertelorismo. Tipo de estudio: Observacional, con nivel relacional y transversal. Análisis estadístico: Regresión logística binaría para relacionar Pseudoestrabismo con predictores, y Odds Ratio (O.R) para la determinación del riesgo. Resultados: La asociación de pseudoestrabismo con hipertelorismo (62 niños, 50%) e hipotelorismo (20 niños, 16.1%) determinados a través de la DI en nuestra población de estudio, mostró significación estadística (p<0.05) e igualmente el análisis multivariado (O.R) que estudió el riesgo de tener el diagnóstico de Pseudoestrabismo en presencia de éstos predictores muestran valores de 3.276 para el hipertelorismo y de 2.087 para el hipotelorismo. Los resultados de la asociación de Pseudoestrabismo con el epicanto (50 niños sin 40.3% y 74 con 59.7%) no mostró significación estadística.(p>0.05), sin embargo el análisis multivariado o regresión logística nos dio un valor de 1.949. Conclusiones: Hipotelorismo e hipertelorismo, en nuestra población de estudio, son predictores para el diagnóstico de Pseudoestrabismo. El análisis estadístico para ésta asociación es significativo (p<0.5), y el riesgo (O.R) de tener Pseudoestrabismo en presencia de Hipertelorismo es tres veces más y dos veces más en presencia de Hipotelorismo. El riesgo de tener pseudoestrabismo por epicanto es de 2 veces más (O.R.1.949), el análisis estadístico para esta asociación no fue significativa (p>0.05).

Purpose: Determine the benefits and challenges of combined femtosecond laser assisted cataract surgery with the Catalys® system (Abbott, Abbott Park, IL) and vitrectomy. Design: Retrospective study Methods: We retrospectively reviewed eight consecutive cases of combined femtosecond laser assisted cataract surgery with the Catalys® system and vitrectomy by a single surgeon. The University of Minnesota Institutional Review Board provided Expedited Review Approval for this project. Results: The study population was 25% male with mean age of 69.1 years, mean pre-operative intraocular pressure of 14.9 mmHg, and mean best corrected visual acuity of 0.44. All patients completed both portions of the combined procedure. There were no complications from the femtosecond laser portion with the mean vacuum time 163s (range 125-320s). Post-operative findings included intraocular pressure rise (25%), and persistent macular edema (38%). The mean intraocular pressure at month one was 16 mmHg with an improvement in mean best corrected visual acuity to 0.27 (range 0-0.52, p<0.05). Intraocular lens was centered in all cases, and mean manifest refraction spherical equivalent was -0.77 (range -2.75-0), which was not statistically significantly different than the target spherical equivalent of -0.59 (p=0.24). Conclusions: Combined femtosecond laser assisted cataract surgery with the Catalys® system and vitrectomy was not associated with significant complications, with an overall improvement in visual acuity.

Purpose: To describe the characteristics of the OBL and its possible relationship with flap and laser parameters. Study Design: Observational, descriptive and transversal investigation. Method: The study was performed on 76 patients undergoing FemtoLASIK with refractive suite WaveLight FS 200 and EX500 Excimer Laser (Alcon) from September to December 2016. Analyzed flap and laser variables, through absolute and relative frequencies, and odds ratio to identify factors that could increase the likelihood of OBL. Results: OBL was present in 15.8% of the cases, with a predominance (83.3%) of late OBL. A greater probability of OBL was obtained in patients with flap diameter of 8.0 mm (OR = 8.4 p = 0.004), laser energies greater than 0.80 mJ (OR = 62 p <0.001), channel length of 0, 7 mm (OR = 5.7 p = 0.01), suction time greater than 50 s (OR = 8.3 p = 0.01). There is no greater probability of OBL for thinner flap thickness (OR = 0.2 p = 0.06) or higher temperature (OR = 2.0 p = 0.26) Conclusions: A low incidence of OBL was obtained. Late OBL was the most frequent. There is a greater probability of this complication in surgeries with ablation energies greater than 0.80 mJ, flap diameters of 8.0 mm, channel length of 0.7 mm and suction time greater than 50 seconds. Resumen Objetivo: Describir las características de la OBL y su posible relación con parámetros del flap y del láser. Diseño: Investigación observacional, descriptiva y transversal. Método: Se realizó un estudio en 76 pacientes intervenidos por FemtoLASIK con la suite refractiva WaveLight FS 200 y EX500 Excímer Láser (Alcon) de Septiembre a Diciembre del 2016. Se analizaron variables del flap y del láser, a través de frecuencias absolutas y relativas, y el odds radio para la identificación de factores que podrían aumentar la probabilidad de OBL. Resultados: Se obtuvo presencia de OBL en el 15,8 % de los casos, con predominio (83,3 %) de OBL tardía. Se obtuvo mayor probabilidad de OBL en pacientes con diámetro del flap de 8,0 mm (OR=8,4 p=0.004), energías del láser superiores a 0.80 mJ (OR=62 p<0,001), longitud del canal de 0,7 mm (OR=5,7 p=0,01), tiempo de succión superior a 50 s (OR=8,3 p=0,01). No existe mayor probabilidad de OBL por menor grosor del flap (OR=0,2 p=0,06) o mayor temperatura (OR=2,0 p=0,26). Conclusiones: Se obtuvo una baja incidencia de OBL. La OBL tardía fue la más frecuente. Existe mayor probabilidad de presencia de esta complicación en cirugías con energías de ablación superiores a 0,80 mJ; diámetros del flap de 8,0 mm; longitud del canal de 0,7 mm; tiempo de succión superior a 50 segundos.

Purpose: To describe the characteristics of myopic choroidal neovascular membranes of hispanic subjects treated with a loading dose of Ranibizumab (Lucentis®). Study design: Non-randomized prospective observational case study. Methods: Five eyes of 5 patients with naïve CNV secondary to pathological myopia were recruited for this study. Demographics, basal best-corrected visual acuity, grade of myopia, angiographic and tomographic features were obtained at baseline. A loading dose of three monthly Ranibizumab (Lucentis®) injections were given to the recruited subjects. After completion of the loading dose, a complete ophthalmological evaluation, angiography and spectral domain optical coherence tomography (SD-OCT) were obtained subsequently at six and twelve months of follow-up. Results: The mean age of patients was 45 years. The mean spherical equivalent refractive error was -13.85. At baseline, the mean number of letters was 61.4 and at follow-up to 12 months the mean number of letters was 73.2. The central foveal thickness and subfoveal choroidal thickness decreased in all cases. After loading dose there was no persistent nor recurrent leakage from treated CNV on fluorescein angiography. FAF evidenced an increase in the area of atrophy, with a special circle pattern around the CNV. Conclusions: This study showed a functional and morphologic improvement at 12 months in five Colombian subjects treated with a loading dose of 3 Ranibizumab monthly injections.

Purpose: To describe the results of selective laser trabeculoplasty for patients with open-angle glaucoma during a 2-year period. Study design: Descriptive, retrospective, and longitudinal study. Method: A descriptive, retrospective, and longitudinal study was conducted among 40 eyes of 20 patients who underwent selective laser trabeculoplasty from 2012 to 2015 and received topical antiglaucoma medication. The following variables were measured: uncorrected visual acuity, best-corrected visual acuity, and intraocular pressure before treatment and during monitoring controls after 1 day, 7 days, 1 month, 3 months, 6 months, 12 months, and 24 months. Results: No significant differences were identified between uncorrected visual acuity preoperatively and at 1 year (p=0.091) or between preoperative uncorrected visual acuity preoperatively and at 2 years (p=0.827). Best-corrected visual acuity preoperatively and at 1 year showed no statistical significance (p=0.125); however, best-corrected visual acuity preoperatively and at 2 years had statistical significance (p=0.007). Mean ± standard deviation of preoperative intraocular pressure at 2 years had decreased from 17.28±5.7 to 13.05±2.4 mm Hg (statistically significant; p=0.00) and the success rate was 75%. Although the mean ± standard deviation of preoperative for drug use at 2 years decreased from 1.90±1.1 to 1.65±1.3, no significant difference (p=0.058) was identified. No complications were identified. Conclusions: Selective laser trabeculoplasty is an effective and safe treatment that reduces intraocular pressure as well as the number of drugs required by patients with open-angle glaucoma.