PURPOSE: To assess the impact of the use of artificial tears during the preoperative work-up performed before age-related cataract surgery, when a toric intraocular lens (IOL) was indicated. METHODS: This was a monocentric prospective study assessing 73 eyes of 51 patients, included consecutively after a preoperative work-up performed without artificial tears (no artificial tears group), when a toric IOL was indicated. Each included patient underwent a second series of examinations: biometry using the IOLMaster 700 (Carl Zeiss Meditec AG) and topography using the OPD-Scan II (Nidek), 1 minute after artificial tears instillation (artificial tears group; hyaluronate de sodium 0.15%, threalose 3% [Théalose; Théa]). Changes in anterior corneal astigmatism and subsequent changes in toric IOL calculation were analyzed. The error in predicted residual astigmatism was calculated. RESULTS: Anterior corneal astigmatism and total corneal astigmatism measured with the IOLMaster 700 were significantly modified when artificial tears were instilled before the examinations (1.51 ± 0.57 diopters [D], range: 0.75 to −3.55 vs 1.42 ± 0.63 D, range: 0.42 to 3.35 D; P = .043 and 1.59 ± 0.54 D, range: 0.87 to 3.48 vs 1.51 ± 0.59 D, range: 0.56 to 3.27 D, P = .038, respectively). This modification led to a change in IOL cylinder calculation in 43.8% of cases and to a change in implantation axis greater than 10° in 17.7% of cases. These changes were significantly greater in patients with a breakup time (BUT) less than 5 seconds (57.5% and 27.8%, with P = .009 and .029, respectively). In the subgroup of patients with a BUT of less than 5 seconds, the mean absolute error in predicted astigmatism was significantly lower after artificial tears instillation (0.48 ± 0.50 D, range: 0.00 to 2.79 vs 0.37 ± 0.25 D, range: 0.00 to 1.10 D, P = .048). CONCLUSIONS: Dry eye significantly impacted toric IOL calculations and should be taken into account during the preoperative assessments. Using artificial tears reduced the number of refractive errors. [ J Refract Surg . 2021;37(11):759–766.]

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Aim To assess the diagnostic value of brain magnetic resonance imaging (bMRI) for the etiological diagnosis of uveitis and to establish predictive factors associated with its advantageous use. Methods Retrospective study on all patients with de novo uveitis who were referred to our tertiary hospital and who underwent a bMRI between 2003 and 2018. The bMRI was considered useful if it served to confirm a diagnosis or correct a misdiagnosis. We also collected characteristics of uveitis and associated ophthalmological and neurological clinical signs. Results Brain MRI was contributive in 19 out of 402 cases (5%): 10 multiple sclerosis, 5 radiologically isolated syndromes, and 4 oculocerebral lymphomas. A total of 34 (8%) patients had neurological signs and 13 (38%) of those patients had a contributive bMRI. Meanwhile, in the absence of neurological signs, 1% of bMRIs were contributive, none of them resulted in specific treatment. Among patients with a contributive bMRI, 68% had neurological signs. Univariate analysis established that neurological signs (p<0.001), granulomatous uveitis (p=0.003), retinal vasculitis (p=0.002), and intermediate uveitis (p<0.001) were significantly associated with a contributive bMRI. Multivariate analysis confirms the significant association of neurological signs (p<0.001) and intermediate uveitis (p=0.01). Patients with oculocerebral lymphoma were significantly older (p<0.001) and all were above 40 years of age. Conclusion Brain MRI appears to be a relevant and contributive exam, but it should be performed in cases of intermediate/posterior uveitis or panuveitis accompanied by neurological signs, retinal vasculitis, or in patients older than 40, to rule out an oculocerebral lymphoma.

OBJECTIVE: To evaluate the effect of initial treatment regimen individualization, (Pro Re nata (PRN) or Treat-and-Extend (TAE)), according to macular neovascularization (MNV) subtype, on the functional and anatomical response in neovascular age-related macular degeneration (nAMD). The secondary objective is to compare the treatment burden between each MNV subtypes. METHODS: Consecutive treatment-naïve nAMD patients were retrospectively included. MNV subtype was graded by 2 independent blinded investigators on multimodal imaging. Functional and anatomical outcomes were analysed according to treatment regimen and MNV subtypes. RESULTS: A total of 281 eyes from 243 patients were included in the study. According to the treatment regimen, there was no significant difference in best-corrected visual acuity gain within the 2 first year of treatment for type 1 (p=0.106) and type 3 MNV (p=0.704). Conversely, there was a significant difference in favour of TAE regimen for type 2 (p=0.017) and type 4 MNV (p=0.047). Type 1 MNV had a higher proportion of visits with subretinal fluid (p=0.0007), but not with intraretinal fluid (p=0.22). The mean interval between the last 2 injections was significantly shorter for type 1 MNV (p=0.0045). CONCLUSION: The individualization of the initial treatment protocol according to MNV subtype can improve the functional outcome and may decrease the treatment burden.