Purpose: To compare the choroidal thickness (CT) of diabetic eyes (different stages of disease) with controls, using swept-source optical coherence tomography. Methods: A multicenter, prospective, cross-sectional study of diabetic and nondiabetic subjects using swept-source optical coherence tomography imaging. Choroidal thickness maps, according to the nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields, were obtained using automated software. Mean CT was calculated as the mean value within the ETDRS grid, and central CT as the mean in the central 1 mm. Diabetic eyes were divided into four groups: no diabetic retinopathy (No DR), nonproliferative DR (NPDR), NPDR with diabetic macular edema (NPDR + DME), and proliferative DR (PDR). Multilevel mixed linear models were performed for analyses. Results: The authors included 50 control and 160 diabetic eyes (n = 27 No DR, n = 51 NPDR, n = 61 NPDR + DME, and n = 21 PDR). Mean CT (ß = −42.9, P = 0.022) and central CT (ß = −50.2, P = 0.013) were statistically significantly thinner in PDR eyes compared with controls, even after adjusting for confounding factors. Controlling for age, DR eyes presented a significantly decreased central CT than diabetic eyes without retinopathy (β = −36.2, P = 0.009). Conclusion: Swept-source optical coherence tomography demonstrates a significant reduction of CT in PDR compared with controls. In the foveal region, the choroid appears to be thinner in DR eyes than in diabetic eyes without retinopathy.

Purpose: To analyse the clinical outcome in patients with meibomian gland dysfunction (MGD) who underwent intense pulsed light (IPL) plus low-level light therapy (LLL). Materials and Methods: The prospective non-comparative study included identified by MGD patients with altered interferometry and lower loss area of the meibomian glands (LAMG), who underwent IPL plus LLL, between July 2020 and August 2020. A multimodal assessment was performed before, 2– 3 weeks, and 6 months after treatment. The main outcome was lipid layer thickness (LLT) and the secondary outcomes were the ocular surface disease index (OSDI) score, presence of corneal fluorescein staining (CFS), blink rate (BR), Schirmer test (ST), tear meniscus height (TMH), tear osmolarity (OSM), non-invasive break-up time (NIBUT) and LAMG. Results: This study included 62 eyes of 31 patients, 61.3% female, with a mean age of 66.94± 9.08 years at the time of IPL plus LLL treatment. LLT (< 0.001) grades improved 6 months after treatment. The mean OSDI score improved (p< 0.001) from 45.02± 21.17 (severe symptoms) to 22.35± 17.68 (moderate symptoms) at 2– 3 weeks and 8.24± 17.9.91 (normal) at 6 months after treatment. CFS was identified in 51.6% (32/62) before and in 45.2% (28/62) 6 months (p=0.293) after treatment. ST (p=0.014) grades improved; OSM grades mild worsened (p< 0.001); TMH, NIBUT and LAMG grades did not modify 6 months after treatment. No patient suffered any adverse effects. Conclusion: IPL combined with LLL was effective and safe, improving the lipid layer thickness in MGD and decreasing the level of symptoms.

Purpose: To review the indications and efficacy of Intense Pulsed Light (IPL) application in the treatment of Meibomian Gland Dysfunction (MGD). Its main purpose is to describe its physiology, efficacy, indications, and adverse effects. Patients and Methods: A two database (PubMed, EMBASE) search was performed from July 2017 to July 2022 using the MeSH terms (“Intense Pulsed Light” AND (“Meibomian Gland Dysfunction” OR “Dry Eye”). We included randomized studies and systematic reviews with meta-analysis. Exclusion criteria were non-randomized trials, studies enrolling non-MGD dry eye disease, and other works older than 5 years. Results: Current literature shows that IPL is an effective and safe treatment modality for severe dry eye. Available evidence shows improvement of symptoms and objective indicators, such as noninvasive breakup time, thickness of lipid layer, and Schirmer test. However, our review concluded that the beneficial effects of IPL may lose some efficacy at 6-months after the initial session, and subsequent sessions may be required. Thus, IPL treatment should not be considered as first-line therapy for MGD but instead as an adjuvant option to the standard of care. The optimal treatment modality remains unknown and should be tailored according to each patient’s phenotype, clinician’s experience, and available technology. There is evidence that IPL treatment may down-regulate pro-inflammatory markers (such as interleukin (IL) 6, IL17a, IL-1) and Prostaglandin E2 (PGE2). Conclusion: MGD is a multifactorial disease and IPL treatment seems a promising treatment modality. Despite this, more evidence is needed to study its benefits – since this is an emerging technology, it is expected an increase in comparative studies in the following years, with longer follow-up periods, which may enable more precise conclusions about this treatment modality.

Purpose: To evaluate the indications for pIOL explantation, pIOL survival time, and visual outcomes and access endothelial cell loss (ECL) after explantation. Setting: Ophthalmology Department, Centro Hospitalar Universitário do Porto, Portugal. Design: Retrospective longitudinal study. Methods: A chart review was performed for all consecutive patients who underwent pIOL explantation from January 2010 to December 2019 in a single center. Results: This study included 175 eyes of 112 patients (77% women). The mean pIOL survival was 12.9 ± 4.8 (3.7 to 28.6) years, and the mean follow-up period after explantation was 4.1 ± 3.0 (0.3 to 9.9) years. The most frequent causes for explantation were cataract formation (44.0%, n = 77) and ECL (50.3%, n = 88). During the follow-up period after explantation, the mean ECL rate was 2.27 ± 9.32%/year in the cataract group and −2.14 ± 10.24%/year in the ECL group, reflecting a positive change in cell density in the latter. 8 eyes (4.6%) required a corneal transplant during the follow-up. The mean corrected distance visual acuity was 0.17 ± 0.24 logMAR at the last visit. Conclusions: This study demonstrated that pIOL explantation, after a mean survival time of 13 years, was a safe procedure. The main causes for explantation were cataract formation and ECL. Most patients showed a sustained improvement in visual acuity and endothelial cell density after pIOL explantation, and yet its timing should be ideal to avoid irreversible complications.

Purpose: To describe the anatomical and functional results of the implantation of asymmetric thickness intracorneal ring segments (AS-ICRS) in eyes with keratoconus and asymmetric/irregular astigmatism (type 2 – Duck – and type 3 – Snowman – phenotypes, Fernandez-Vega/Alfonso morphologic Keratoconus classification). Materials and Methods: Retrospective observational study including 19 consecutive patients (21 eyes) with keratoconus who underwent manual implantation of the Keraring^® Asymmetric ICRS (AS). Analysis included demographic and clinical data and Pentacam (Oculus^®) measurements: topographic astigmatism; topographic flat meridian (K1), steepest meridian (K2) and the maximum keratometric point (Kmax); total root mean square (RMS) and high order RMS (HOA) aberrations and comatic Zernike coefficients (Z3¹;Z3^{− 1}) at 0º and 90º meridians. Results: Overall mean age was 35.3± 11.7 years and median follow-up was 7.1 months (range 6– 12). At the end of follow-up, a significant improvement from baseline was achieved in both UDVA (0.24± 0.22; p=0.017) and CDVA (0.21± 0.17; p< 0.001). Regarding topographic measurements, the greatest decrease was observed in K2 (2.76± 1.9D; p< 0.001) and astigmatism (1.97± 1.5; p< 0.001). Aberrometry analysis showed a reduction of 1.27± 3.2μm in the total RMS (p=0.085), 0.24± 0.9μm in HOA (p=0.227) and 0.78± 0.5 (p< 0.001) in the 90º component of comatic aberration. The procedure effects in the CDVA, topographic and aberrometric parameters were higher in type 2 cones without statistical significance (p> 0.05 in all). Conclusion: Implantation of the Keraring^® Asymmetric ICRS in keratoconus with asymmetric/irregular astigmatism allowed an improvement of several clinical, topographic and aberrometric parameters, with clinical efficacy and safety, with a tendency to a greater effect in the type 2 cones.