Eleonora Micheletti

Purpose: To investigate the intraocular pressure (IOP) changes after cataract extraction (CE) with an acrylic hydrophobic EyeCee One versus a hydrophilic Akreos MI60 intraocular lens (IOL) implant. Methods: All patients who underwent CE with acrylic EyeCee One IOL implant and Akreos MI60 IOL implants were included. Parameters such as age, sex, history of glaucoma or ocular hypertension (OHT), IOP, axial length (AXL), anterior chamber depth (ACD) and type of IOL implant were measured. Results: A total of 193 eyes of 193 patients were included. Of them, 115 eyes underwent CE with EyeCee One IOL, while 78 eyes underwent CE with Akreos MI60 IOL. Mean age (± SD) was 76.1 (± 9.4). A preoperative diagnosis of open-angle glaucoma (OAG) and ocular hypertension (OHT) was found in 10.9% and 3.6%, respectively. Mean pre-operative IOP was 16.8 ± 4.1. Mean IOP reduction at 2 months follow-up after CE was 2.8 ± 3.7 mmHg in the Akreos group and 0.3 (± 4.3) in the Eye Cee One group (<0.001). Five patients who underwent EyeCee One IOL implant had IOP rise ≥ 10 mmHg at 2 months follow-up, whereas none of the patients in the Akreos MI60 group had IOP spikes. Age and type of IOL implant were associated with greater IOP reduction in both univariable and multivariable analyses. Conclusion: CE with acrylic hydrophobic EyeCee One IOL implant was associated with more IOP spikes compared to the acrylic hydrophilic Akreos MI60 IOL implant. Further studies are warranted to clarify the association between IOP and IOL implants.

A 27-year-old White man presented with a recent onset of malaise, chills, night sweats, sore throat with difficulty swallowing, and a skin rash affecting his trunk, limbs, and genitalia. His right eye was red with watery discharge and there was a dome-shaped nodule on his lower eyelid. What would you do next?

Assessment of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination. It is intrinsically related to the diagnosis and treatment of glaucoma and has a role in its prevention. Although slit-lamp gonioscopy is considered the gold-standard technique for ACA evaluation, its poor reproducibility and the long learning curve are well-known shortcomings. Several new imaging techniques for angle evaluation have been developed in the recent years. However, whether these instruments may replace or not gonioscopy in everyday clinical practice remains unclear. This review summarizes the last findings in ACA evaluation, focusing on new instruments and their application to the clinical practice. Special attention will be given to the comparison between these new techniques and traditional slit-lamp gonioscopy. Whereas ultrasound biomicroscopy and anterior segment optical coherence tomography provide quantitative measurements of the anterior segment’s structures, new gonio-photographic systems allow for a qualitative assessment of angle findings, similarly to gonioscopy. Recently developed deep learning algorithms provide an automated classification of angle images, aiding physicians in taking faster and more efficient decisions. Despite new imaging techniques made analysis of the ACA more objective and practical, the ideal method for ACA evaluation has still to be determined.