Bianca Nicolela Susanna

Purpose: To assess how OCT-derived epithelial thickness–difference metrics relate to corneal topographic inferior–superior (IS) asymmetry and to identify the most informative annular zones and axis-defined sector-pair metrics. Setting: University of São Paulo Design: Prospective, comparative observational study Methods: In this IRB-approved study of consecutive patients undergoing refractive surgery screening (regardless of ultimate eligibility), we analyzed 526 eyes. Axial IS values from Placido-based topography defined four strata (negative, 0.0–1.0, 1.0–1.4, and >1.4 D). Twelve epithelial thickness–difference metrics (including axis-defined sector-pair differences) were computed from 9-mm OCT maps across the 2–5 mm, 2–7 mm, and 2–9 mm annuli. Associations between continuous IS and each metric were tested using Pearson correlation and linear regression across the full spectrum and within analyses anchored at the clinically established IS = 1.4 D reference. Results: The central 2–5 mm annulus yielded the strongest associations with IS. Correlations were weak and slightly positive for IS ≤1.4 D but became stronger and consistently negative for IS >1.4 D, most prominently along the inferotemporal–superonasal (IT–SN) axis (r = −0.62; P < 0.0001). Mean epithelial differences were largely similar across strata up to 1.4 D, with clearer deviations in the >1.4 D stratum. Conclusions: Using manually derived, zone- and axis-specific OCT epithelial thickness–difference metrics, we found a nonlinear association with topographic IS, with the most informative signal in the central 2–5 mm annulus and along the IT–SN axis. Clinically, central, axis-defined epithelial asymmetry may serve as an adjunct interpretive marker in higher-IS (or borderline) eyes, whereas low-IS eyes show weak and variable epithelial–IS coupling—potentially explaining the limited performance of epithelial metrics in low-asymmetry settings.

Objective: To evaluate the effect of pterygium on different biometric intraocular lens calculation formulas. Methods: This is an interventionist, prospective, and non-randomized study. We included patients who underwent pterygium surgery and performed a biometric examination before and one month after surgery. We compared the mean variability between these measurements in each intraocular lens formula. We classified the patients according to the TAN staging system and evaluated the effect of pterygium magnitude on biometric variability. Results: We included 25 eyes [...] ABSTRACT Objective: To evaluate the effect of pterygium on different biometric intraocular lens calculation formulas. Methods: This is an interventionist, prospective, and non-randomized study. We included patients who underwent pterygium surgery and performed a biometric examination before and one month after surgery. We compared the mean variability between these measurements in each intraocular lens formula. We classified the patients according to the TAN staging system and evaluated the effect of pterygium magnitude on biometric variability. Results: We included 25 eyes

Purpose: To evaluate the reproducibility and intra-eye similarity of the intraocular pressure (IOP) peaks induced by the water drinking test (WDT) in treated glaucoma patients. Methods: This prospective cohort study evaluated 99 patients (198 eyes) who were treated for primary open-angle glaucoma. All patients underwent WDT in two consecutive visits with no change in their current therapy. The interval between the tests was 4 four to six months. The tests were administered at a similar time (4:00 PM ± 1 hour). The reproducibility of the time of the IOP peaks and the correlation between the peak time of both eyes during the two consecutive WDT sessions were assessed. Results: Of all IOP peaks, 59.6% and 71.7% occurred at the same time during the two WDT sessions in the right and left eyes, respectively. In the first and second WDT sessions, the agreements in IOP peak time between the right and left eyes were 60% and 63%, respectively. Conclusion: The IOP peak time between the two consecutive WDT sessions was moderately reproducible, and there was a moderate agreement in the peak time between the two eyes. In light of these findings, clinicians should avoid performing simplified versions of WDT to evaluate IOP peaks.

Purpose: To investigate the effectiveness and safety of customized femtosecond laser-assisted corneal allogenic intrastromal ring segments (CAIRS) implantation in keratoconus patients with a history of intrastromal corneal ring segment (ICRS) explantation. Setting: Sorocaba Eye Hospital (Hospital Oftalmológico de Sorocaba - HOS), Sorocaba, Brazil. Design: Prospective case series. Methods: We included eight keratoconus patients with stable disease and with history of ICRS explantation at least six months before the inclusion in the study. Patients were excluded if presenting any other ocular pathology. Customized CAIRS was produced and implanted using femtosecond laser LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland). Patients were followed-up for six months. Results: The mean reduction of the maximum, mean, and steep central keratometry was 3.03 ± 1.35 diopters (D) (p =0.01), 2.88 ± 2.51 D (p=0.02), and 2.41 ± 2.72 D (p=0.04), respectively. The mean spherical equivalent and refractive astigmatism reduced 6.28 ± 2.71 D (p =0.01), and 1.62 ± 2.83 D (p=0.16). All eyes, but one gained two or more lines of best spectacle corrected visual acuity (BSCVA). Additionally, five patients achieved a BSCVA of 20/40 or better. No intra or post-operative complications were observed. Conclusions: Customized femtosecond laser assisted CAIRS may be an effective and safe option for visual rehabilitation in keratoconus patients with previous ICRS explantation.

Purpose: To report a case of central retinal artery (CRA) occlusion secondary to prepapillary loop in a 13-year-old girl. Methods: A 13-year-old girl presented with a history of sudden visual loss in her left eye. Results: Fundus examination confirmed thrombosis in a prepapillary arterial loop causing CRA occlusion and extensive retinal ischemia. Macular region was watered by an anomalous macular branch, which explained her 20/20 vision central vision. Conclusion: Congenital prepapillary vascular loops are rare and usually asymptomatic. We report a case of central artery occlusion confirmed by multimodal imaging.