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Andrea Lucisano, , Marco Balestrieri, ,
Journal of Cataract and Refractive Surgery, Volume 43, pp 1007-1009;

We describe the use of a simple tool to evaluate the postoperative alignment of toric intraocular lenses (IOLs). The entire anterior segment is scanned using anterior segment optical coherence tomography and analyzed with an internal dedicated tool. A topographic map is displayed along with an anterior segment image, including a linear axis marker centered on the corneal apex. The marker can be rotated until it is aligned with the line connecting the IOL marking dots, precisely reproducing the IOL astigmatic axis, which is measured in angle degrees. The value of the IOL astigmatic axis is compared with the value of the astigmatic axis shown in real time on the same screen in the topographic map. Evaluating the alignment of a toric IOL axis simultaneously with the topographic astigmatic axis eliminates the potential errors that result from head tilting and strictly correlates with the astigmatic correction achieved.
, , Deniz Özarslan Özcan, Özge Begüm Seferoğlu
Journal of Cataract and Refractive Surgery, Volume 43, pp 1089-1099;

Purpose To evaluate the efficacy of different accelerated corneal crosslinking (CXL) treatment protocols in patients with progressive keratoconus. Setting Marmara University School of Medicine, Istanbul, Turkey. Design Retrospective case series. Methods Patients with progressive keratoconus had 9 mW accelerated CXL (10 minutes; 9 mW/cm2), 30 mW continuous-light accelerated CXL (4 minutes; 30 mW/cm2), or 30 mW pulsed-light accelerated CXL (8 minutes [1 second on/1 second off]; 30 mW/cm2). Results Of 134 eyes, 34 eyes had conventional CXL, 45 had 9 mW accelerated CXL, 28 had 30 mW continuous-light accelerated CXL (4 minutes, 30 mW/cm2), and 27 eyes had 30 mW pulsed-light accelerated CXL. The uncorrected (UDVA) (P< .001 both) and corrected (CDVA) distance visual acuities increased in with conventional CXL and 9 mW accelerated CXL (P = .001 and P = .002, respectively). With 30 mW continuous accelerated CXL, only CDVA improved (P = .019). With 30 mW pulsed accelerated CXL, UDVA and CDVA did not change significantly (P > .05). With conventional CXL and 9 mW accelerated CXL, all keratometric (K) readings (K1, K2, mean K, maximum K) improved significantly (conventional CXL: P = .014, P = .002, P = .008, and P< .001, respectively; 9 mW accelerated CXL: all P< .001). With 30 mW, no K values changed significantly compared with baseline (all groups P > .05). Conclusion Although 30 mW accelerated CXL treatment modalities appeared to be effective in stabilizing keratoconus progression, they seemed less effective in achieving topographic improvement.
Journal of Cataract and Refractive Surgery, Volume 43, pp 1107-1114;

Purpose To evaluate the surface chemical composition and roughness of different phaco tips before and after their use during cataract surgery. Setting Eye Clinic, University of Trieste, Trieste, Italy. Design Experimental study. Methods Of the 66 tips studied, 33 (15 new, 15 after single use, and 3 after multiple uses) were studied with X-ray photoemission spectroscopy and 33 (15 new, 15 after single use, and 3 after multiple uses) were examined using scanning electron microscopy with energy dispersive X-ray spectroscopy analysis and contact profilometry. All analyses were performed on the far end of the tip. Results Used phaco tips showed signs of wear at the end of the tip, with the deposition of debris. The cutting edge appeared to be rounded and irregular. After surgery, an increase in the surface roughness was detected. The chemical analyses showed modification of the superficial alloy composition and the biological origin of some debris deposited after surgery. The deterioration and wear observed were more remarkable after multiple surgical procedures. Conclusions Used phaco tips showed relevant signs of deterioration and deposition of biological material, mostly involving the cutting edge. Reusable tips might release remnants of previous procedures. The adoption of single-use disposable phaco tips seems to be highly advisable.
Mahmoud O. Jaroudi, Carole G. Cherfan,
Journal of Cataract and Refractive Surgery, Volume 43, pp 1115-1116;

A 27-year-old woman had microkeratome-assisted laser in situ keratomileusis (LASIK) for moderate bilateral hyperopia. The preoperative ophthalmologic examination was unremarkable except for minimal lissamine green staining bilaterally on the nasal conjunctiva. On the first postoperative day, the uncorrected distance visual acuity (UDVA) was 20/20 bilaterally and the corneas were clear. Four days later, the patient presented with mild blur in both eyes. Examination showed diffuse bilateral epithelial cysts encompassing the central 6.0 to 7.0 mm of the flaps with overlying diffuse lissamine green staining. The UDVA was 20/30 bilaterally. Aggressive lubrication was administered. The epithelial cysts coalesced into larger ones over subsequent visits and began regressing over several months, along with improvement in vision. At 6 months, the cysts had completely resolved, the corneas were clear, and the UDVA was 20/20.
Amelia Lim Lay Suan, , Tan Soo Ken, Vanessa Naseem Mansurali
Journal of Cataract and Refractive Surgery, Volume 43, pp 1031-1035;

Purpose To evaluate the efficacy and safety of intracameral mydriatics (lidocaine 1.0% and phenylephrine 1.5%) versus topical mydriatics (phenylephrine 2.5% and tropicamide 1.0%) in pupil dilation for phacoemulsification surgery in Malaysians. Setting Department of Ophthalmology, Penang General Hospital, Georgetown Penang, Malaysia. Design Prospective comparative case series. Method Patients with immature cataract were randomized to the topical mydriatic group (topical group) or intracameral mydriatic group (intracameral group). Patients with small pupils and complicated cataracts were excluded. Pupil diameter changes were measured throughout the surgery. Additional pupil dilation maneuvers and complications were recorded. Results The study comprised 112 patients. There was no difference in mean pupil dilation between the intracameral group (4.86 mm ± 0.74 [SD]) and the topical group (4.88 ± 0.91 mm) (P = .86). However, the mean pupil size before capsulorhexis in the topical group (7.23 ± 1.08 mm) was significantly larger than in the intracameral group (6.40 ± 0.80 mm) (P = .01). The pupils in the intracameral group continued to dilate during surgery (0.44 ± 0.62 mm), while those in the topical group constricted (−0.41 ± 1.04 mm) (P< .001). Three patients in the intracameral group and 6 in the topical group required additional maneuvers for pupil dilation (P = .49). Each group had 1 complication (P = 1.00). Conclusions Intracameral mydriatic agents dilated heavily pigmented pupils for phacoemulsification cataract surgery. However, in the early stages of surgery, pupil dilation was slower than with topical agents.
, Stefano Baiocchi, Simone Alex Bagaglia, Mario Fruschelli, Alessandro Meduri, Miguel Rechichi
Journal of Cataract and Refractive Surgery, Volume 43, pp 1081-1088;

Purpose To assess the clinical and microstructural results of accelerated 15 mW pulsed-light corneal crosslinking (CXL) to treat progressive keratoconus. Setting Siena Crosslinking Center, Siena, Italy. Design Prospective case series. Methods After epithelium removal (with Epi-Clear) and 10 minutes stromal soaking with riboflavin 0.1% hydroxypropyl methylcellulose solution, all eyes had 15 mW/cm2 pulsed-light epithelium-off accelerated CXL for 6 minutes of ultraviolet-A (UVA) irradiation (1 second on/1 second off), maintaining a total UVA exposure of 12 minutes at a fluence of 5.4 J/cm2. The 2-year follow-up examination included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, Scheimpflug tomography, in vivo confocal microscopy (IVCM), and spectral-domain optical coherence tomography (SD-OCT). Results The study comprised 132 eyes of 96 patients (mean age 23.7 years ± 4.3 [SD]) with stage II keratoconus. The change in UDVA and CDVA was statistically significant, from 0.51 ± 0.106 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.309 ± 0.074 logMAR (P = .0001) and 0.271 ± 0.144 logMAR at baseline to 0.135 ± 0.100 logMAR (P = .0023), respectively. Coma values measured by Scheimpflug analysis showed a statistically significant improvement beginning with the first postoperative month (P = .0004). The IVCM scans documented basal epithelial healing occurring 72 hours after treatment associated with the presence of subepithelial nerves. The SD-OCT scans performed in the central 6.0 mm of corneal diameter documented a demarcation line at a mean depth of 280 ± 32 μm. Conclusion The 15 mW/cm2 pulsed-light epithelium-off accelerated CXL was effective and safe, stabilizing keratoconus progression through 2 years of follow-up.
Tanner J. Ferguson
Journal of Cataract and Refractive Surgery, Volume 43, pp 1125-1126;

Anne van Os, Mark J.C. Stassen, ,
Journal of Cataract and Refractive Surgery, Volume 43, pp 1077-1080;

The use of yellow filters increased retinal straylight by a small but significant amount compared with the use of unfiltered light. This suggests that the visual comfort often experienced while wearing these filters is not associated with reduced straylight.
Journal of Cataract and Refractive Surgery, Volume 43, pp 1003-1006;

We describe a surgical technique for secondary stabilization of a bag-in-the-lens intraocular lens (BIL IOL) using 2 modified bean-shaped ring segments in cases of zonular dehiscence associated with pseudophakodonesis. The first modified bean segment is anchored in the sulcus with a suture to the sclera in the area of maximum zonular dehiscence, and the second segment is implanted in the opposite sulcus area. Both segments are placed in the BIL IOL interhaptic groove. The segments stabilize and center the BIL IOL by creating an artificial zonule that provides the necessary extra support for the IOL.
, Sibel Oto, , Dilek Dursun Altinors, , Sirel Gur Gungor
Journal of Cataract and Refractive Surgery, Volume 43, pp 1054-1061;

Capsule thickness was positively correlated with increasing age in all groups. The anterior lens capsules of patients with PXF had more elasticity and less stiffness than the other groups. Intracameral trypan blue application had no effect on capsule elasticity and stiffness.
Mitchell P. Weikert
Journal of Cataract and Refractive Surgery, Volume 43, pp 1119-1120;

Richard N. McNeely, , Andrew Spence, Olivier Richoz, , ,
Journal of Cataract and Refractive Surgery, Volume 43, pp 1020-1026;

Both refractive rotationally asymmetric multifocal IOLs provided an excellent level of quality of vision 12 months postoperatively. Both IOL models restored distance, intermediate, and near visual function; however the IOLs in Group B provided better near visual performance.
, , Jiten Morarji, Simon P. Kelly, Evangelos Sioras
Journal of Cataract and Refractive Surgery, Volume 43, pp 1027-1030;

The incidence of subclinical CME detectable on SD-OCT after routine phacoemulsification in patients using PGA eyedrops throughout the perioperative period was 3.3%. There were no cases of clinical CME. These findings might guide clinicians in their decision to use PGAs perioperatively.
, Yoshinori Takayanagi
Journal of Cataract and Refractive Surgery, Volume 43, pp 1050-1053;

Refractive astigmatism and keratometric astigmatism after MICS were strongly correlated.
Dhivya Ashok Kumar, Harspreet Kaur, , Sajitha Selvaraj, Sathish Kumar Pandian, Vamsi Chintalpati
Journal of Cataract and Refractive Surgery, Volume 43, pp 1062-1067;

Purpose To analyze the alterations in corneal topography and keratometry (K) after glued transscleral-fixated intraocular lens (IOL) implantation. Setting Dr. Agarwal’s Eye Hospital, Chennai, India. Design Prospective case series. Methods Eyes having glued IOL implantation for aphakia or subluxated lens (>180 degrees) were included. Preoperative autorefractometer and corneal topography was performed. Intraoperative parameters, namely the type, position, and incision size, flap position, and number of sutures were noted. The mean corneal curvature in a steep meridian (maximum K), flat meridian (minimum K), simulated K, pachymetry, and surgically induced astigmatism (SIA) were analyzed. Results This study evaluated 16 eyes with aphakia and 15 eyes with a subluxated over a mean follow-up of 12 months ± 6 (SD). There was a significant reduction in mean simulated K (P = .014) after surgery. The maximum K decreased significantly (P = .002), from 44.85 ± 2.83 diopters (D) preoperatively to 44.47 ± 2.75 D at 6 months. The mean SIA was 1.0 ± 0.7 D (range 0.16 to 3.6 D) and the postoperative astigmatism analysis by the Alpins method was negative (−1.8), showing relative flattening after surgery. Multiple regression analysis found no association between postoperative vision and preoperative maximum K, postoperative simulated K, incision size, and number of sutures. There was no correlation between the postoperative simulated K and incision position (P = .674), sutures (P = .881), and scleral flap position (P = .401). Conclusion Glued transscleral fixation resulted in a reduction in mean corneal curvature in the steep meridian and there was significant change in corneal astigmatism.
Journal of Cataract and Refractive Surgery, Volume 43, pp 1044-1049;

Purpose To report outcomes of cataract surgery in patients with Mooren ulcer. Setting L.V. Prasad Eye Institute, Hyderabad, India. Design Retrospective case series. Methods The medical records of patients with Mooren ulcer who had cataract surgery between 2000 and 2015 were assessed. The main outcome measures were the role of preoperative immunosuppression and disease inactivity, cataract surgery safety, visual outcomes, and postoperative ulcer recurrence. Results Of 22 patients (26 eyes), the mean corneal ulceration was 6.8 clock hours ± 2.9 (SD). Corticosteroids were the most commonly used (84.6% of the 26 eyes) preoperative immunosuppression agents and 38.5% of the 26 eyes were under maintenance immunosuppression. The median disease inactivity before surgery was 7 months. Cataract surgery was extracapsular in 10 patients, small incision in 3 patients, and phacoemulsification in 13 patients. Twenty-two eyes had scleral incisions. The median follow-up was 6 months (interquartile range, 10 months). The median corrected distance visual acuity (CDVA) improved from 1.48 logarithm of minimum angle of resolution (logMAR) before surgery to 0.30 and 0.35 logMAR at 1 month and at the last follow-up after surgery, respectively (P ≤ .0001). Mooren ulcer recurred in 5 eyes between 3 months and 7 years after surgery. No disease activity was seen in the immediate postoperative period. No significant risk factors for disease recurrence were noted. Conclusions With adequate immunosuppression, cataract surgery in eyes with Mooren ulcer was safe and CDVA improved significantly with no disease reactivation immediately after surgery. No proven role of maintenance immunosuppression was observed. The type of cataract surgery had no influence on ulcer reactivation. Patients with a disease-free interval of 6 months or more before surgery and those who had scleral incisions had favorable outcomes.
, Imren Akkoyun, Eylem Yaman Pınarcı, Gürsel Yılmaz, Hülya Topçu
Journal of Cataract and Refractive Surgery, Volume 43, pp 1068-1071;

Purpose To compare the refractive accuracy of intraocular lens (IOL) power calculations between patients with vitreomacular interface disorders who had phacovitrectomy for vitreomacular traction (VMT), epiretinal membranes (ERM), and macular holes. Setting Baskent University Department of Ophthalmology, Ankara, Turkey. Design Retrospective case series. Methods Refraction results 8 weeks postoperatively were compared between phacovitrectomy (3 study groups comprising eyes with VMT with intrafoveal pseudocysts, ERM, or medium-to-large macular holes) and phacoemulsification (control group comprising eyes having phacoemulsification only). The IOLMaster 700 partial coherence interferometry (PCI) device and Haigis formula were used for all calculations. Results This study included 100 eyes (100 patients), 25 in each of the 4 groups. There was no statistically significant difference in axial length (AL) between the groups (P = .305). Differences in the preoperative macular thickness were statistically significant between all groups except between the macular hole and VMT groups. Most eyes (92%) in the VMT and macular hole groups and all eyes in the VMT and phacoemulsification groups achieved a final refraction within ±1.00 diopter of the refractive aim. The mean prediction error and the mean absolute error did not differ significantly between the groups. In all groups, there was no significant correlation between prediction error and age, AL, preoperative refractive error, or preoperative or postoperative macular thickness (P > .05). Conclusions The IOL power calculation with PCI yielded no difference in postoperative refraction errors between the vitreomacular interface disorders. There was no correlation with preoperative refraction, age, or preoperative or postoperative macular thickness.
Vasileios T. Papastavrou, , Jill M. O’Brien, Neeta Ray-Chaudhuri, Baljean Dhillon, ,
Journal of Cataract and Refractive Surgery, Volume 43, pp 1036-1043;

In this small series of patients with late-onset retinal degeneration, cataract surgery was successfully performed without long-term complications involving intraocular lens stability. The objective improvement in CDVA seemed to be limited to patients with good foveal photoreceptor architecture.
, Karen E. Grove, , Melissa B. Daluvoy,
Journal of Cataract and Refractive Surgery, Volume 43, pp 1010-1014;

Purpose To assess the relationship between use of a hydrogel ocular sealant (Resure) to secure clear corneal incisions (CCIs) in cataract surgery and surgeon efficiency, patient symptomatology, and postoperative results. Setting Duke University Eye Center, Durham, North Carolina, USA. Design Retrospective case series. Methods A 1:1 matched cohort of hydrogel sealant exposure–discordant eyes of cataract surgery patients was retrospectively generated. Consecutive patients who had bilateral cataract surgery during the study period and in whom the hydrogel sealant was used to secure the CCI in only 1 of the 2 eyes were included in the study. The relationship between use of the hydrogel sealant and surgical time, 1-day postoperative foreign-body sensation, clinically noted corneal edema, and intraocular pressure (IOP) was evaluated. Results Ninety eyes of 45 patients were included in the study. One day postoperatively, no wound leak was found in any eye; the sealant was noted to be out of place in 2 (4.4%) of 45 cases. No statistically significant difference was found between sealant and non-sealant eyes in total surgical time (P = .16) or in IOP (P = .55), corneal edema (P = 1.00), or foreign-body sensation (P = .38) 1 day postoperatively. Conclusion The hydrogel sealant was not observed to affect duration of surgery or 1-day postoperative IOP, corneal edema, or foreign-body sensation.
Alja Crnej, , Con Petsoglou,
Journal of Cataract and Refractive Surgery, Volume 43, pp 1072-1076;

Purpose To compare objective methods for assessing backward and forward light scatter and psychophysical tests in patients with cataracts. Setting Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Design Prospective case series. Methods This study included patients scheduled for cataract surgery. Lens opacities were grouped into predominantly nuclear sclerotic, cortical, posterior subcapsular, and mixed cataracts. Backward light scatter was assessed using a rotating Scheimpflug imaging technique (Pentacam HR), forward light scatter using a straylight meter (C-Quant), and straylight using the double-pass method (Optical Quality Analysis System, point-spread function [PSF] meter). The results were correlated with visual acuity under photopic conditions as well as photopic and mesopic contrast sensitivity. Results The study comprised 56 eyes of 56 patients. The mean age of the 23 men and 33 women was 71 years (range 48 to 84 years). Two patients were excluded. Of the remaining, 15 patients had predominantly nuclear sclerotic cataracts, 13 had cortical cataracts, 11 had posterior subcapsular cataracts, and 15 had mixed cataracts. Correlations between devices were low. The highest correlation was between PSF meter measurements and Scheimpflug measurements (r = 0.32). The best correlation between corrected distance visual acuity was with the PSF meter (r = 0.45). Conclusions Forward and backward light-scatter measurements cannot be used interchangeably. Scatter as an aspect of quality of vision was independent of acuity. Measuring forward light scatter with the straylight meter can be a useful additional tool in preoperative decision-making.
, Jason Ludlow, Jason Nguyen, Joah Aliancy, Larry Ha, Bryan Masino, Sean Enright, Ray K. Alley, ,
Journal of Cataract and Refractive Surgery, Volume 43, pp 1100-1106;

Purpose To evaluate the biocompatibility (uveal and capsular) of intraocular lens (IOL) power adjustment by a femtosecond laser obtained through increased hydrophilicity of targeted areas within the optic, creating the ability to build a refractive-index shaping lens within an existing IOL. Setting John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Design Experimental study. Methods Six rabbits had phacoemulsification with bilateral implantation of a commercially available hydrophobic acrylic IOL. The postoperative power adjustment was performed 2 weeks after implantation in 1 eye of each rabbit. The animals were followed clinically for an additional 2 weeks and then killed humanely. Their globes were enucleated and bisected coronally just anterior to the equator for gross examination from the Miyake-Apple view to assess capsular bag opacification. After IOL explantation for power measurements, the globes were sectioned and processed for standard histopathology. Results Slitlamp examinations performed after the laser treatments showed the formation of small gas bubbles behind the lenses that disappeared within a few hours. No postoperative inflammation or toxicity was observed in the treated eyes, and postoperative outcomes and histopathological examination results were similar to those in untreated eyes. The power measurements showed that the change in power obtained was consistent and within ±0.1 diopter of the target. Conclusions Consistent and precise power changes can be induced in the optic of commercially available IOLs in vivo by using a femtosecond laser to create a refractive-index shaping lens. The laser treatment of the IOLs was biocompatible.
, Vinod Maseedupally, Preeji Mandathara, Varsha M. Rathi,
Journal of Cataract and Refractive Surgery, Volume 39, pp 56-65;

To determine and compare corneal elevation and thickness indices, thereby formulating a reliable index to distinguish eyes with pellucid marginal degeneration (PMD) from keratoconus eyes and normal (control) eyes. LV Prasad Eye Institute, Hyderabad, India. Initial model-building retrospective study. Anterior and posterior corneal elevations and thickness indices were obtained from the Orbscan IIz topographer. These values were analyzed and compared between PMD patients, keratoconus patients, and control subjects. Of the indices, the mean values of anterior elevation (AE), ratio of the AE to the anterior best-fit sphere, ratio of the average power values of nasal quadrant to the average power values of inferior quadrant, and difference between maximum keratometry (K) and minimum K were significantly different between the 3 groups (P<.05). The highest area under the receiver-operating-characteristic (AROC) curve in discriminating PMD from keratoconus was for asphericity (0.974; cutoff ≥-0.07; sensitivity 93.3%; specificity 90.6%) followed by the ratio of average power values of the nasal and temporal quadrants to the average power values of the inferior and superior quadrants (Avg NT((D))/IS((D))) (0.959; cutoff ≥1.005; sensitivity 96.7%; specificity 90.6%). The PMD index (AROC curve, 0.935), with a cutoff of 3.45 or higher had 90% sensitivity and 93.7% specificity to distinguish PMD from keratoconus and had 100% sensitivity and 100% specificity to distinguish PMD from control eyes, with a cutoff of 2.46 or higher (AROC curve, 1.000). The PMD index appeared to be highly sensitive and specific for diagnosing PMD. Asphericity and Avg NT((D))/IS((D)) were clinically relevant in discriminating PMD from other groups.
Uday K. Bhatt, , Sunil Shah, Harmindar Singh Dua, Toshifumi Mihashi, Tatsuo Yamaguchi,
Journal of Cataract and Refractive Surgery, Volume 39, pp 36-40;

PURPOSE\ud \ud To design and validate a new miniaturized open-field wavefront device that can be attached to an ophthalmic surgical microscope or slitlamp.\ud \ud SETTING\ud \ud Solihull Hospital and Aston University, Birmingham, United Kingdom.\ud \ud DESIGN\ud \ud Comparative noninterventional study.\ud \ud METHODS\ud \ud The dynamic range of the Aston aberrometer was assessed using a calibrated model eye. The validity was compared with that of a conventional desk-mounted Hartmann-Shack aberrometer (Topcon KR1W) in dilated eyes. The instruments were used in random order, with measurements repeated 5 times to assess intrasession repeatability.\ud \ud RESULTS\ud \ud The open-field aberrometer had a large dynamic range of at least +21.0 diopters (D) to -25.0 D. It gave similar measurements to the conventional aberrometer for mean spherical equivalent (SE) (mean difference 0.02 D ± 0.49 [95% confidence interval]; correlation r = 0.995; P<.001), astigmatic components (J0: 0.02 ± 0.15 D; r = 0.977, P<.001; J45: 0.03 ± 0.28, r = 0.666, P<.001), and higher-order aberration (HOA) root mean square (RMS) (0.02 ± 0.20 D, r = 0.620, P<.001). Intraclass correlation coefficient assessments of intrasession repeatability were excellent (SE = 1.000, P<.001; J0 = 0.998, P<.001; J45 = 0.980, P<.01; HOA RMS = 0.961, P<.001).\ud \ud CONCLUSIONS\ud \ud The new aberrometer gave valid, repeatable measurements of refractive error and HOAs over a large range. It can measure continuously, thus providing direct feedback on the optical status of the visual system to surgeons during intraocular lens implantation and corneal surgery
, Janice Dias, Volkan Hürmeriç, Mohamed Abou Shousha, Chiyat Ben Yau, Vincent T. Moy, William W. Culbertson, Sonia H. Yoo
Journal of Cataract and Refractive Surgery, Volume 39, pp 110-117;

To quantify the cut quality of lamellar dissections made with the femtosecond laser using atomic force microscopy (AFM). Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA. Experimental study. Experiments were performed on 3 pairs of human cadaver eyes. The cornea was thinned to physiologic levels by placing the globe, cornea side down, in 25% dextran for 24 hours. The eyes were reinflated to normal pressures by injecting a balanced salt solution into the vitreous cavity. The eyes were placed in a holder, the epithelium was removed, and the eyes were cut with a Visumax femtosecond laser. The energy level was 180 nJ for the right eye and 340 nJ for the left eye of each pair. The cut depths were 200 μm, 300 μm, and 400 μm, with the cut depth maintained for both eyes of each pair. A 12.0 mm trephination was then performed. The anterior portion of the lamellar surface was placed in a balanced salt solution and imaged with AFM. As a control, the posterior surface was placed in 2% formalin and imaged with environmental scanning electron microscopy (SEM). Four quantitative parameters (root-mean-square deviation, average deviation, skewness, kurtosis) were calculated from the AFM images. From AFM, the 300 μm low-energy cuts were the smoothest. Similar results were seen qualitatively in the environmental SEM images. Atomic force microscopy provided quantitative information on the quality of lamellar dissections made using a femtosecond laser, which is useful in optimizing patient outcomes in refractive and lamellar keratoplasty surgeries.
, Edward E. Feinberg,
Journal of Cataract and Refractive Surgery, Volume 43, pp 985-987;

We report the case of a patient who developed the uveitis-glaucoma-hyphema (UGH) syndrome secondary to extensive fibrosis (Soemmerring ring) around the haptics of the single-piece intraocular lens (IOL) in the capsular bag. The development of significant capsule fibrosis caused the IOL to tilt out of the iris plane, leading to haptic-iris and haptic-ciliary body chafing. The mechanisms described should prompt clinicians to consider the UGH syndrome even in the setting of a single-piece IOL properly placed in the capsular bag. Anterior segment imaging with ultrasound biomicroscopy can be used to evaluate the position of the IOL haptics in suspected cases.
, , Petra Draschl, Jörg Wiesinger
Journal of Cataract and Refractive Surgery, Volume 43, pp 902-908;

Purpose To evaluate the influence of a manual capsulorhexis size, shape, and position on postoperative axial position, tilt, and centration of intraocular lenses (IOLs). Setting Hanusch Hospital, Vienna, Austria. Design Prospective cases series. Methods Patients had cataract surgery and had follow-ups 1 hour and 3 months after surgery. Postoperatively, patients were divided into 3 groups according to the capsulorhexis shape and size as follows: control, symmetrical capsulorhexis between 4.5 mm and 5.5 mm; small group, capsulorhexis smaller than 4.5 mm; and eccentric, all other capsulorhexes. At both follow-ups, a retroillumination image, partial coherence interferometry measurements, and Purkinje meter measurements were performed. Results This study comprised 255 eyes. The mean postoperative absolute anterior chamber depth shift in the control, eccentric capsulorhexis, and small capsulorhexis groups was 0.31 mm ± 0.27 (SD), 0.36 ± 0.24 mm, and 0.26 ± 0.24 mm, respectively (P = .419). The mean tilt in the control, eccentric capsulorhexis, and small capsulorhexis groups was 4.08 ± 2.13 degrees, 3.66 ± 2.04 degrees, and 2.82 ± 1.67 degrees, respectively (P = .370), and the mean decentration was 0.38 ± 0.23 mm, 0.40 ± 0.21 mm, and 0.17 ± 0.08 mm, respectively (P = .027). Conclusions Capsulorhexis size and shape had little effect on the capsular bag performance of modern IOLs. Only eyes with a severely malformed capsulorhexis had a slightly decentered IOL.
, Perry S. Binder,
Journal of Cataract and Refractive Surgery, Volume 43, pp 946-951;

Purpose To assess the currently recommended percentage tissue altered (PTA) metric for its ability to screen for ectasia after laser in situ keratomileusis (LASIK). Setting Gavin Herbert Eye Institute, University of California, Irvine, California, USA, and Rothschild Foundation, Paris, France. Design Retrospective case series. Methods The study used a LASIK database created by 1 surgeon for LASIK cases with normal preoperative topography that had a minimum follow-up of 24 months with complete preoperative and intraoperative data to permit the calculation of PTA values to detect eyes at risk for developing ectasia. Results Of the eyes, 593 eyes had complete data and met the inclusion criteria. Based on measured flap thickness, 126 eyes (21%) had a PTA value of 40% or more (mean 44) and a percentage of that flap thickness accounted for the PTA (mean 66.7%; range 34% to 92%). The mean attempted laser ablation was 79.8 μm ± 29.2 (SD), and the mean residual bed thickness was 304.4 ± 29.2 μm (range 212 to 369 μm). No eye developed ectasia over a mean follow-up of 30 months. Conclusions The current PTA calculation when applied to a LASIK population with normal preoperative topography and flap thickness measured with ultrasound did not predict the risk for ectasia. Differences between study populations and assumptions might have accounted for the different outcomes obtained in the initially published PTA study.
Sabite E. Gökce, John H. Zeiter, , , Warren Hill,
Journal of Cataract and Refractive Surgery, Volume 43, pp 892-897;

Purpose To investigate the accuracy of 7 intraocular lens (IOL) calculation formulas in predicting refractive outcome in eyes with axial lengths (AL) equal to or less than 22.0 mm and to evaluate factors contributing to prediction errors. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, and private practice, Mesa, Arizona, USA. Design Retrospective case series. Methods Eighty-six eyes of 67 patients were included. Seven IOL calculation formulas were evaluated: Barrett Universal II, Haigis, Hill-RBF, Hoffer Q, Holladay 1, Holladay 2, and Olsen. The refractive prediction error was calculated as the difference between the postoperative refraction and the refraction predicted by each formula. The mean refractive prediction error and median absolute error were also calculated. Results The Hoffer Q and Holladay 2 formulas produced myopic refractive prediction errors of −0.22 diopter (D) and −0.23 D, respectively, and the Olsen formula produced a hyperopic refractive prediction error of +0.27 D (all P< .05). Without adjustment of the mean refractive prediction errors to zero, the only difference between formulas was that Hill-RBF had a statistically significantly smaller median absolute error than Hoffer Q (P< .05). With adjustment of the mean refractive prediction errors to zero, there were no statistically significant differences in the median absolute errors between the 7 formulas (P = .076). Conclusions The Hoffer Q and Holladay 2 formulas produced slightly myopic refractive prediction errors, and the Olsen formula produced hyperopic refractive prediction errors. When the mean numerical refractive prediction error was adjusted to zero, no statistically significant differences in the median absolute error were found between the 7 formulas.
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