Delayed Perforation of an Intrastromal Corneal Ring Segment into the Anterior Chamber: A Case Report and Review of the Literature

Intrastromal corneal ring segments (ICRSs) are an effective treatment for stabilizing and normalizing corneal shape in patients with keratoconus and other corneal ectasias. Intraoperative segment perforation through the corneal endothelium into the anterior chamber (AC) is an uncommon but known complication. However, perforation into the AC postoperatively is an exceedingly rare complication with only 3 reported cases in the literature. One case was due to Descemet membrane detachment and another due to ocular trauma. In the third case, the mechanism for perforation was unclear. We present the fourth case of delayed ICRS perforation due to silent migration through the endothelium into the AC. We also present all reported cases in the literature of intraoperative and postoperative perforation into the AC.

Association between visual field damage and corneal structural parameters

The main goal of this study is to identify the association between corneal shape, elevation, and thickness parameters and visual field damage using machine learning. A total of 676 eyes from 568 patients from the Jichi Medical University in Japan were included in this study. Corneal topography, pachymetry, and elevation images were obtained using anterior segment optical coherence tomography (OCT) and visual field tests were collected using standard automated perimetry with 24-2 Swedish Interactive Threshold Algorithm. The association between corneal structural parameters and visual field damage was investigated using machine learning and evaluated through tenfold cross-validation of the area under the receiver operating characteristic curves (AUC). The average mean deviation was − 8.0 dB and the average central corneal thickness (CCT) was 513.1 µm. Using ensemble machine learning bagged trees classifiers, we detected visual field abnormality from corneal parameters with an AUC of 0.83. Using a tree-based machine learning classifier, we detected four visual field severity levels from corneal parameters with an AUC of 0.74. Although CCT and corneal hysteresis have long been accepted as predictors of glaucoma development and future visual field loss, corneal shape and elevation parameters may also predict glaucoma-induced visual functional loss.

Ethnic Differences of Corneal Parameters: A Cross-Sectional Study

Purpose: To investigate the ethnic differences of corneal parameters in Arabs and other ethnicities. Methods: This study recruited 250 Saudi Arabian participants, 18–45 years of age. The McMonnies questionnaire was used to exclude participants with dry eye. The KR8800 auto refractometer (Topcon, Japan) was used to measure the refractive error. Oculus Keratograph 4 topography was used to assess 16 corneal parameters, including the k-readings, horizontal visible iris diameter, mean eccentricity index, asphericity, corneal shape factor, corneal flattening factor, sagittal height, sagittal curvature, and vertical palpebral aperture. Results: A statistically significant difference was found between male and female participants. Corneal parameters were compared to other ethnicities, including Caucasians and Asians, and those of Mongoloid origin. The horizontal visible iris diameter was wider in Saudi Arabians than in Asians but similar to Caucasians. The sagittal height was deeper and the corneal shape factor was higher than in the other ethnicities, and the eccentricity index was lower than that in Caucasians and Asians of Mongoloid origin. Conclusion: Our data provided normative corneal parameters of Saudi Arabians that may be useful for ophthalmic clinicians and designers of contact lenses. Furthermore, the parameters suggest that the corneal characteristics of Arabians are distinct from those of major ethnicities.

Analysis of Corneal Distortion after Myopic PRK

The purpose of the study is to evaluate the corneal biomechanical properties (CBP) and their behaviors after myopic refractive surgery both with Ocular Response Analyzer (ORA) and Corvis ST (CST). This retrospective study included 145 eyes of 145 patients with a mean age of 33.13 ± 9.24 years, who underwent myopic photorefractive keratectomy (PRK) for a refractive defect, measured as spherical equivalent, of mean −4.69 ± 2.04 D and have been evaluated before surgery and at 1, 3 and 6 months follow-up. Corneal hysteresis (CH) and corneal resistance factor (CRF) values significantly decreased after 1 month and remained statistically stable during further follow-ups. CST parameters had a different evolution: only second applanation time (AT2) differences showed a significant variation after 1 month that did not statistically change over time. Highest concavity deformation amplitude (HCDA), highest concavity peak distance (HCPD), first applanation time (AT1) and velocity (AV1) showed continuous significant differences both after 3 and after 6 months. This study suggests that after central surface ablation surgery, such as myopic PRK, corneal shape is remodeling, and its deformation parameters are going to change even at 6 months follow-up. This indicates that it should be important to evaluate refractive surgery patients during a longer follow-up because this could allow earlier diagnosis and better management of late-onset complications.

Theoretical Effect of Coma and Spherical Aberrations Translation on Refractive Error and Higher Order Aberrations

(1) Background: The purpose of the study is to present a simple theoretical account of the effect of translation of coma and spherical aberrations (SA) on refractive error and higher order aberrations. (2) Methods: A computer software algorithm was implemented based on previously published methods. The effect of translation (0 to +1 mm) was analyzed for SA (0 to +2 µm) and coma (0 to +2 µm) for a circular pupil of 6 mm, without any rotation or scaling effect. The relationship amongst Zernike representations of various aberrations was analyzed under the influence of translation. (3) Results: The translation of +0.40 µm of SA (C[4,0]) by +0.25 mm with a pupil diameter of 6mm resulted in induction of tilt (C[1,1]), −0.03D defocus (C[2,0]), +0.03D astigmatism (C[2,2]) and +0.21 µm coma (C[3,1]). The translation of +0.4 µm of coma (C[3,1]) by +0.25 mm with a pupil diameter of 6 mm resulted in induction of tilt (C[1,1]), −0.13D defocus (C[2,0]) and +0.13D astigmatism (C[2,2]). A theoretical quantitative relationship between SA, coma, astigmatism and defocus is presented under the influence of translation. (4) Conclusion: The results can act as a guide for the clinician, in order to readily assess theoretical impact of wavefront map translation from pupil center to the visual axis. The resultant refractive coupling has to be taken into consideration especially when treating eyes with an abnormal corneal shape and/or large pupil center to corneal vertex chord.

The impact of irregular corneal shape parameters on visual acuity and contrast sensitivity

Background To understand which irregular corneal parameters determine the visual quality in keratoconus subjects. Methods The cross-sectional study examined the eyes of 44 subjects, graded from the first to third keratoconus stages by Amsler-Krumeich classification. We obtained measurements in two ways: (a) by projecting two perpendicular axes onto a cornea (first, through the central point of the cornea and keratoconus apex; second, as the perpendicular axis) to read the elevation values at points on these axes as parameters characterising the corneal surface; (b) by projecting circles with different diameters around the central part of the cornea (1, 2, and 3 mm) and reading elevation values at points equally displaced on these circles as parameters characterising an anterior surface slope. Irregular corneal shape parameters’ correlations with visual acuity and contrast sensitivity were determined in order to understand which corneal slope parameter has the strongest correlation with visual acuity and contrast sensitivity. Results Parameters characterising the corneal surface’s correlations with contrast sensitivity were from r = 0.25 (p = 0.03) at 3 cpd to r = 0.47 (p < 0.01) at 9 cpd for the highest elevation and from r = 0.33 (p = 0.09) at 5 cpd to r = 0.40 (p < 0.01) at 11 cpd for the lowest elevation in all subjects together, while for visual acuity the parameters were r = 0.30 (p < 0.01) for the highest elevation and r = 0.21 (p = 0.06) for the lowest elevation in all subjects together. The correlation between contrast sensitivity and the highest and lowest corneal point in all measured cornea was stronger for subjects with a peripheral corneal apex than for those with a central apex. In keratoconus subjects, contrast sensitivity displayed a strong correlation with slope in the central part of the cornea (with a radius of 1 mm) ranging from 0.48 (p < 0.01) at 3 cpd to 0.61 (p < 0.01) at 9 cpd. Conclusion Contrast sensitivity has a higher correlation with corneal shape parameters than with visual acuity. Subjects with a peripheral corneal apex had stronger correlations with visual acuity and contrast sensitivity than did subjects with a central apex. In keratoconus subjects, the strongest correlation was for contrast sensitivity and elevation (slope) in the region within a 1 mm radius of the corneal centre in the opposite direction of the keratoconus apex (direction (ax) CB).

Which feature influences on-eye power change of soft toric contact lenses: Design or corneal shape?

Purpose This study investigates how both the peripheral zone design and corneal shape affect the behaviour of soft contact lenses on-eye. Methods In this study, soft contact lenses of varying nominal cylindrical powers and peripheral zone designs—a single-prism gravity-based stabilised lens (G1P), two-prism blink-based stabilised lens (B2P) and four-prism blink-based stabilised lens (B4P)—were generated as finite element models. The on-eye simulation results were analysed to identify the impact of each peripheral zone design (Each with different volume ratios) on the effective power change (EPC) when worn by a subject. Topographies of three eyes of varying average simulated anterior corneal curvature (flat, average & steep) were used in this study. Results The volume of the lens’s peripheral zone as a ratio of the total lens volume (Vp) recorded very weak correlations with the effective power change (EPC) among the three investigated designs when they were fitted to the flat eye (R = -0.19, -0.15 & -0.22 respectively), moderate correlations with the average eye (R = 0.42, 0.43 & 0.43 respectively) and strong correlations with the steep eye (R = 0.91, 0.9 & 0.9 respectively). No significant differences were noticed among the three investigated designs and none of the cylindrical lenses designed with axis 90° recorded EPC values outside the acceptance criteria range (ACR) of ±0.25 D. No significant differences in EPC were recorded among the three designs G1P, B2P and B4P (p>0.6) when they were designed with three axes at 90°, 45° and 0°. Moving the toric lens axis away from 90° dragged the EPC to the negative side and most of the investigated lenses with axes at 45° and 0° recorded EPCs outside the ±0.25D range. Conclusions In all cases, the shape of the cornea had a more dominant effect on EPC when compared to the peripheral zone design. Corneal shape influences the soft toric contact lens’s on-eye power change more than the lens design.

The Impact of Irregular Corneal Shape Parameters on Visual Acuity and Contrast Sensitivity

Background: To understand which irregular corneal parameters determine the visual quality in keratoconus subjects.Methods: The cross-sectional study examined the eyes of 44 subjects, graded from the first to third keratoconus stages by Amsler-Krumeich classification. We obtained measurements in two ways: (a) by projecting two perpendicular axes onto a cornea (first, through the central point of the cornea and keratoconus apex; second, as the perpendicular axis) to read the elevation values at points on these axes as parameters characterising the corneal surface; (b) by projecting circles with different diameters around the central part of the cornea (1, 2, and 3 mm) and reading elevation values at points equally displaced on these circles as parameters characterising an anterior surface slope. Irregular corneal shape parameters’ correlations with visual acuity and contrast sensitivity were determined in order to understand which corneal slope parameter has the strongest correlation with visual acuity and contrast sensitivity.Results: Parameters characterising the corneal surface’s correlations with contrast sensitivity were from r=0.25 (p=0.03) at 3 cpd to r=0.47 (p<0.01) at 9 cpd for the highest elevation and from r=0.33 (p=0.09) at 5 cpd to r=0.40 (p<0.01) at 11 cpd for the lowest elevation in all subjects together, while for visual acuity the parameters were r=0.30 (p<0.01) for the highest elevation and r=0.21 (p=0.06) for the lowest elevation in all subjects together. The correlation between contrast sensitivity and the highest and lowest corneal point in all measured cornea was stronger for subjects with a peripheral corneal apex than for those with a central apex. In keratoconus subjects, contrast sensitivity displayed a strong correlation with slope in the central part of the cornea (with a radius of 1 mm) ranging from 0.48 (p<0.01) at 3 cpd to 0.61 (p<0.01) at 9 cpd.Conclusion: Contrast sensitivity has a higher correlation with corneal shape parameters than with visual acuity. Subjects with a peripheral corneal apex had stronger correlations with visual acuity and contrast sensitivity than did subjects with a central apex. In keratoconus subjects, the strongest correlation was for contrast sensitivity and elevation (slope) in the region within a 1 mm radius of the corneal centre in the opposite direction of the keratoconus apex (direction (ax) CB).

The Impact of Irregular Corneal Shape Parameters on Visual Acuity and Contrast Sensitivity

Background: The image optical quality is affected by changes in corneal shape of patients with keratoconus. The goal of this study was to explore which corneal parameters determine the visual quality in keratoconus subjects, which corneal slope parameter has the strongest correlation with visual quality and contrast sensitivity. Methods: The study covered eyes of 77 subjects, graded from the first to third keratoconus stages. To characterize the shape of cornea, we obtained measurements in two ways: (a) projected two perpendicular axes onto a cornea – the main axis passed through the central point of the cornea (visual axis projection) and keratoconus apex, while the second axis was perpendicular to the main axis – and read elevation values at points on theses axis; (b) projected circles with different diameters around the central part of the cornea (1, 2 and 3 mm) and read elevation values at points equally displaced on these circles. The measurements were used to calculate various elevation change (slope) parameters. Results: According to the acquired data, the visual acuity of a corrected eye does not have a strong correlation with the measured keratoconus apex slope. Contrast sensitivity displayed a strong correlation with keratoconus slope in the central part of the cornea (with a radius of 1 mm). Correlations in different spatial frequencies ranging from 0.47 to 0.6. Conclusion: Contrast sensitivity is more important parameter which describes the visual quality of keratoconus subjects than visual acuity. The most important region which determines the visual quality in keratoconus subjects is the region with a 1 mm radius of the corneal centre in the opposite direction of keratoconus apex.