Visual outcomes comparing emmetropia vs mini-monovision after bilateral implantation of a nondiffractive extended vision intraocular lens: randomized trial.

PURPOSE: To compare visual outcomes and patient satisfaction after bilateral implantation of a nondiffractive extended vision intraocular lens (IOL) when targeting emmetropia vs mini-monovision. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective, randomized controlled trial. METHODS: Patients undergoing bilateral cataract surgery with an extended vision IOL (Vivity) randomized to group I-IOL implantation with emmetropic target in both eyes or group II-IOL implantation with mini-monovision of -0.5 diopters (D) were included in this study. Outcome measures evaluated 6 months postoperatively were unaided and corrected near visual acuity (UNVA, CNVA) at 40 cm and unaided and corrected distance (UDVA, CDVA) and intermediate (UIVA, CIVA) visual acuity at 66 cm. Mesopic contrast sensitivity, binocular defocus curve, Patient-Reported Spectacle Independence Questionnaire, and satisfaction on the McAlinden questionnaire were also assessed. RESULTS: 70 patients enrolled in this study. 34 and 33 patients in groups I and II, respectively, completed follow-up. Binocular UNVA was significantly better in group II (0.26 ± 0.05 vs 0.22 ± 0.08 logMAR, P = .03). Reading add required in group II was significantly lower. UIVA (0.09 ± 0.06 vs 0.07 ± 0.08 logMAR, P = .15) and UDVA (0.02 ± 0.04 vs 0.02 ± 0.05 logMAR, P = .78) were not significantly different between groups. Mesopic contrast sensitivity was not significantly different between the groups. Binocular defocus curve showed significantly better mean visual acuities between -2.0 D and -3.0 D in group II. Patients in both groups had high levels of spectacle independence, with no patient reporting dysphotopsia. CONCLUSIONS: Binocular UNVA was significantly better, with comparable UDVA and mesopic contrast sensitivity when targeting mini-monovision with the nondiffractive extended vision IOL as compared with targeting binocular emmetropia.

Initial Pro Re Nata Brolucizumab for Exudative AMD: The PROBE Study.

The present study aimed to determine the efficacy and safety of pro re nata (PRN) intravitreal brolucizumab therapy for neovascular age-related macular degeneration (AMD) without a loading dose in the real-world setting. The PROBE study (Pro Re Nata Brolucizumab for Exudative AMD) is a retrospective, observational, multicentric study that included 27 treatment-naïve patients (27 eyes) with neovascular AMD who received PRN brolucizumab therapy with the treatment interval being at least 8 weeks, should the need for a second consecutive injection arise. The primary outcome measure was changed to best-corrected visual acuity (BCVA) over time. Secondary outcome measures included the determination of change in central subfield thickness (CST) and complications. The mean follow-up was 11.2 ± 1.2 months. The mean baseline and final BCVA were 57.4 ± 4.5 letters and 65.3 ± 3.12 letters, respectively (p = 0.014). The mean gain in letters at the end of follow-up was 7.8 ± 3.5 letters. There was a significant decrease in CST at the end of the follow-up period (p = 0.013). Patients received a mean of 2.2 ± 0.9 injections (in addition to the first mandatory injection) during the follow-up period. There were no adverse events noted. In conclusion, initial PRN brolucizumab for exudative AMD without a loading dose demonstrated significant visual improvement and no adverse events.

Brolucizumab for Choroidal Neovascular Membrane with Pigment Epithelial Tear and Subretinal Fluid.

The aim of this study was to determine the utility of brolucizumab in the management of choroidal neovessels (CNV) with a retinal pigment epithelial (RPE) tear and subretinal fluid. We used a case series of patients with CNV who developed an RPE tear either spontaneously or following an intravitreal injection. All patients received intravitreal brolucizumab as primary or switch therapy. Appropriate data were collected. Follow-up was one year. The paired t-test was used to determine the significance of the results. The primary outcome measure was the change in best corrected visual acuity (BCVA). Secondary outcome measures were the change in subretinal fluid and complications, if any. A total of five patients were included in the analysis. The age range was 67-74 years and baseline BCVA was from 20/80 to 20/100. On average, all patients showed improvement in BCVA (p = 0.012) and also showed a significant anatomical improvement (p = 0.03). None of the patients had any complications, and all patients responded to additional anti-VEGF injections. In conclusion, all patients showed significant visual and anatomical improvement with brolucizumab; no complications were noted. All patients, including those who received switch, demonstrated a favorable anatomical and visual response to intravitreal brolucizumab without safety concerns.

Current intravitreal therapy and ocular hypertension: A review.

To determine the effect of commonly used intravitreal agents on immediate and long-term IOP elevations and their association, if any, with glaucoma. Literature searches in PubMed and the Cochrane databased in January 2020 yielded 407 individual articles. Of these, 87 were selected for review based on our inclusion criteria. Based on the evidence provided, 20 were assigned level I, 27 level II, and 22 level III. Eight articles were rejected because of poor quality, insufficient clarity, or irrelevance based on standardized protocols set out by the American Academy of Ophthalmology. The studies that reported on short-term IOP elevation (i.e., between 0 and 60 min) showed that an immediate increase in IOP is seen in all patients who receive anti-VEGF agents or triamcinolone acetonide when measured between 0 and 30 min of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection of anti-VEGF agents, while the position of the implant vis-à-vis, the anterior chamber was important for steroid therapy. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment. However, some studies demonstrated RNFL thinning in patients receiving chronic anti-VEGF therapy. Most, if not all, intravitreal agents cause ocular hypertension, both in the short term and long term. The functional consequences of these observations are not very clear.

Real-time imaging of airflow patterns and impact of infection control measures in ophthalmic practice: a pandemic perspective.

PURPOSE: To analyze exhaled airflow patterns in a clinical scenario and the impact of infection control practices and room air circulation in context of the COVID-19 pandemic. SETTING: Raghudeep Eye Hospital, India. DESIGN: Experimental study. METHODS: Ten patients attending ophthalmic outpatient clinic (OPD) and operating room (OR) were included. Using Schlieren imaging, exhaled airflow patterns were documented with/without an N95 mask or face shield during respiratory activities. Recordings were performed with and without room air conditioning turned on. Exhaled airflow patterns in OPD and OR when using vs not using these infection control measures and the impact of room air circulation on these were compared. RESULTS: Five patients each in OPD and OR were included. There was a forward stream of exhaled air from the patient's mouth/nose during all respiratory activities. An N95 mask dampened its intensity and forward transmission. Taping the mask around the nasal bridge further reduced airflow leakage. A mechanical barrier in front of the patient's face blocked forward propagation of the exhaled airflow. Turning on a forceful and direct draft of air over the surgeon's working area dampened and diverted the exhaled airflow away from the surgeons' breathing area. This effect was particularly pronounced in the OR, with the overhead laminar airflow. CONCLUSIONS: Using high force airflow with the draft facing downward can dampen and divert the exhaled airflow away from healthcare providers. Using masks/mechanical barriers and taping the mask reduces potential dissemination of aerosols and, thereby, human and surface contamination.

Cortical aspiration - The "POPS" technique.

In the present study, we describe a step-by-step technique for cortex aspiration during cataract surgery- POPS (positioning, occlusion, posterior displacement, and swiping). Firstly, the aspiration probe is positioned under the bulk of cortical fibers beyond the capsulorhexis margin. Subsequently, the aspiration port is occluded with minimal vacuum, and the occluded port is displaced posteriorly to detach the cortical fibers off the anterior capsule. Now, tangential, arc-like swiping movements are performed while gradually increasing vacuum at the same time. The fibers are brought to the center and finally aspirated. This allows complete removal of the equatorial fibers and lens epithelial cells (LEC) with the least stress to the capsulozonular complex. Unlike the conventional technique, which involves the radial pull of cortical fibers, in this technique, there is swiping and posterior displacement of the cortical fibers before pulling towards the center and aspirating. We believe this technique will ensure safer, more effective cortical and LEC removal, reducing zonular stress.

Decoding fluid droplet generation during phacoemulsification and pars plana procedures in the COVID-19 era-An experimental study.

PURPOSE: The purpose of this study is to evaluate fluid droplet spray generation during phacoemulsification (PE), pars plana vitrectomy (PPV), and fragmatome lensectomy (FL) and assess factors affecting these. METHODS: This is an experimental study. PE through 2.2 and 2.8 mm incisions was performed in six goat eyes and four simulator eyes using both continuous and interrupted ultrasound (U/S). PPV and FL were performed in three goat eyes. Generation of visible fluid droplet spray was analyzed from video recordings through the microscope camera and an external digital camera. Hydroxypropylmethylcellulose (HPMC) was applied over the incision site during PE and FL. RESULTS: When PE was performed through both incision sizes, there was no visible fluid droplet spray if the phaco tip was centered in the incision, without sleeve compression. When there was phaco tip movement with the phaco sleeve sandwiched between the tip and the incision wall, there was visible fluid droplet spray generation. It was more difficult to induce fluid droplet spray with 2.8 mm incision, and spray was lesser with interrupted U/S. During PPV, there was no droplet spray. During FL, fluid droplet spray was only seen when U/S was delivered with the fragmatome tip close to the sclerotomy. HPMC impeded droplet spray. CONCLUSION: Fluid droplet generation during PE can be minimized to a large extent by keeping the phaco tip centered within the incision, avoiding sleeve compression. Smaller incision and continuous U/S were more prone to droplet generation. FL should be performed away from sclerotomy. HPMC over incision is recommended.

Comparison of Optical Low-Coherence Reflectometry and Swept-Source OCT-Based Biometry Devices in Dense Cataracts.

PURPOSE: To investigate agreement between biometric measurements obtained from the Lenstar LS 900 (Haag-Streit AG) based on optical low-coherence reflectometry (OLCR) and the Tomey OA-2000 (Tomey Corporation) based on swept-source optical coherence tomography (SS-OCT) in dense cataracts. METHODS: In this prospective observational study, axial length, keratometry, anterior chamber depth (ACD), lens thickness, and central corneal thickness (CCT) were measured in 124 eyes of 76 patients. Intraocular lens prediction errors and absolute prediction errors were assessed based on postoperative manifest refraction. Analyses used were paired t test, Pearson correlation coefficient (r), and Bland-Altman plots. RESULTS: Failure in axial length measurements was noted in 28 eyes (22.58%) with OCLR compared to 2 eyes (1.6%) with SS-OCT. Although not statistically significant, axial length measurements were clinically higher with SS-OCT (23.78 ± 1.76 mm) compared to OCLR (23.72 ± 1.58 mm) (P = .81) (r = 0.23; P = .01). There was a significant trend toward myopic intraocular lens prediction with SS-OCT (-0.09 ± 0.48) compared to OLCR (0.09 ± 0.41, P < .01) (r = 0.25, P = .01). There was good agreement for keratometric and ACD values between the two devices. SS-OCT gave significantly higher values of lens thickness compared to OCLR (4.44 ± 0.44 vs 4.18 ± 0.48 mm, P < .01) (r = 0.39, P < .01). CCT measured with OCLR was significantly higher than SS-OCT (525.64 ± 27.0 vs 513.21 ± 29.24 µm; P < .01) (r = 0.98, P < .01). CONCLUSIONS: One-fifth of the patients with dense cataracts failed axial length measurement on OCLR. SS-OCT gives clinically higher axial length measurements leading to more myopic intraocular lens prediction errors postoperatively. OCLR provides higher pachymetry and lower lens thickness values compared to the SS-OCT device. [J Refract Surg. 2020;36(8):557-564.].

Intraoperative performance and long-term postoperative outcomes after scleral fixation of IOLs with polytetrafluoroethylene suture.

PURPOSE: To report intraoperative performance and long-term postoperative outcomes after scleral fixation of intraocular lenses (IOLs) with polytetrafluoroethylene suture (PTFE). SETTING: Raghudeep Eye Hospital, Ahmedabad, India. DESIGN: Prospective, interventional case series. METHODS: One hundred eyes undergoing scleral fixation of IOLs using PTFE suture (Gore-Tex) with 12 months or more postoperative follow-up were included. The primary outcome measures were occurrence of intraoperative and postoperative complications such as glaucoma, suture-related complications, and inflammation within the follow-up period. The secondary outcome measure was improvement in visual acuity (VA). RESULTS: Of the 100 eyes, posteriorly dislocated IOLs (53 eyes) followed by dropped nuclei (33 eyes) were the most common surgical indications. Mean follow-up was 23 months (range 12 months to 5 years). Seventy-one patients (77.17%) had 18 months or more follow-up; 21 eyes had a rise in intraocular pressure in the early postoperative period; 12 of them required glaucoma surgery. Early complications were vitreous hemorrhage in 13 eyes, retinal detachment in 6 eyes, and transient hyphema in 1 eye. Late postoperative complications were cystoid macular edema (9 eyes), epiretinal membrane (3 eyes), and bullous keratopathy (3 eyes). Mean VA improved from 0.92 ± 0.16 (SD) logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.41 ± 0.27 logMAR. LogMAR at final follow-up was 0.41 ± 0.28 (P < .01). There were no cases of suture-related complications (erosion/breakage/granuloma) or IOL decentration throughout the follow-up period. CONCLUSIONS: Scleral fixation of IOLs with PTFE suture was found to be safe and well tolerated. All eyes had well-centered IOLs, with no suture-related complications during long-term follow-up. VA improved significantly with acceptable postoperative complications.

Visual outcomes after toric intraocular lens implantation in pediatric eyes undergoing cataract surgery.

PURPOSE: To evaluate long-term visual outcomes and complications after toric intraocular lens (IOL) implantation in children with preexisting corneal astigmatism undergoing cataract surgery. SETTING: Iladevi Cataract & IOL Research Center, Ahmedabad, India. DESIGN: Prospective, interventional case series. METHODS: Children with regular corneal astigmatism of at least 1.5 diopters (D) were included. A standardized surgical technique with in-the-bag implantation of a toric IOL was performed. All children were followed up on postoperative day 1 and periodically thereafter, until 36 months postoperatively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and residual refractive astigmatism were documented 36 months postoperatively. Rotational stability of toric IOL was also evaluated through the follow-up duration. Complications, particularly visual axis obscuration (VAO) and glaucoma, were documented. RESULTS: In total, 76 eyes (51 children) were included in the study. Mean age at surgery was 7.41 ± 2.82 years (SD) and mean preoperative keratometric astigmatism was 1.56 ± 2.13 D. The CDVA (logarithm of the minimum angle of resolution [logMAR]) improved significantly from 0.59 ± 0.43 preoperatively to 0.23 ± 0.27 36 months postoperatively (P = .03). Mean postoperative UDVA was 0.32 ± 0.26 logMAR. Mean refractive astigmatism at final follow-up was -0.55 ± 0.40 D, with 74% patients having a UDVA of at least 20/40; 5% of eyes needed VAO treatment and none developed glaucoma. No eye required repositioning of toric IOL until final follow-up. CONCLUSIONS: Toric IOL implantation reduced postoperative refractive astigmatism and gave excellent UDVA at 36 months follow-up in pediatric eyes undergoing nontraumatic cataract surgery.

Sustained Intraocular Pressure Rise after the Treat and Extend Regimen at 3 Years: Aflibercept versus Ranibizumab.

PURPOSE: To determine the risk factors associated with sustained intraocular pressure (IOP) rise in patients enrolled in the treat and extend (T&E) protocol receiving aflibercept/ranibizumab therapy for 3 years. DESIGN: Retrospective, observational chart review. Setting. Multicentric. Patients. 789 patients (1021 eyes; 602 males) enrolled in T&E using aflibercept/ranibizumab for diabetic macular edema (DME), wet age-related macular degeneration (AMD), or macular edema in retinal vein occlusion (RVO). Intervention. The history, examination (clinical and special investigations), and treatment records were thoroughly scrutinized. Sustained IOP rise was defined as a rise in IOP above baseline by ≥6 mmHg and/or >24 mmHg on 2 or more consecutive visits. The Wilk-Shapiro test was used for confirming normality of data. The Mantel-Haenszel test and generalized estimating equations were used to analyse multicentric data as well as to analyse data from both eyes of the same patients in the event that both eyes were under therapy. The relative risk, chi-square test (with and without Yates' correction), and univariate and multivariate analysis were used wherever appropriate. Statistical significance was set at P < 0.05. The primary outcome measure was the determination of risk factors for sustained IOP rise with ranibizumab/aflibercept therapy. Secondary outcome measures included determining the incidence of IOP rise (short term and sustained), visual field, and retinal nerve fibre layer (RNFL) changes. RESULTS: The mean follow-up was 42.4 months. Male gender, South Asian ethnicity, older age, presence of AMD and vein occlusion, use of ranibizumab, higher number of injections, narrow angles, switch to bevacizumab/ranibizumab, and preexisting glaucoma were associated with sustained IOP rise. No significant visual field and RNFL changes were seen. The overall incidence was 8.91%. No patient required filtering surgery. No patient with IOP rise returned to baseline. CONCLUSION: IOP rise is an important consideration as the chronicity of the condition can eventually lead to glaucomatous changes in eyes with already compromised vision. Follow-ups and use of appropriate therapy can be determined correspondingly.

Bevacizumab as an Adjunct to Trabeculectomy in Primary Open-Angle Glaucoma: A Randomized Trial.

PURPOSE: To compare the outcomes of trabeculectomy using two different routes of bevacizumab administration as an adjunct in patients with primary open angle glaucoma. METHODS: Prospective, randomized, masked trial that included 180 eyes of 180 patients of documented primary open angle glaucoma were eligible for surgery. Patients were randomized to receive either a single intraoperative dose of subconjunctival bevacizumab (1.25 mg, Group I) or topical bevacizumab (5 mg/ml) for 30 days (Group II). One eye was randomly selected, if both were eligible for surgery. All patients underwent a complete ocular and systemic examination. Bleb morphology was examined and scored as per Moorfields system (MBGS) at 1, 3, 6, 12, 18, and 24 months postoperatively. Visual field, fundus photography, and disc analysis were performed. Outcome measures (at one year) included (1) comparison of bleb morphology in both groups, (2) proportion of patients achieving surgical success, and (3) side effects of treatment. RESULTS: The groups did not differ with respect to age, sex, and crystalline lens status. Group II patients had significantly lower vascularity scores for central (P=0.042) and peripheral bleb areas (P=0.042) and peripheral bleb areas (P=0.042) and peripheral bleb areas (n = 88) patients achieved average vascular scores of less than 2.5 (P=0.042) and peripheral bleb areas (n = 88) patients achieved average vascular scores of less than 2.5 (vs. 94%; P=0.042) and peripheral bleb areas (. CONCLUSION: Topical bevacizumab gives a better vascularity profile at one year, but the studied routes appear equally safe and do not seem to affect the outcome in any other way.

Intravitreal dexamethasone implant as an alternative to systemic steroids as prophylaxis for uveitic cataract surgery: a randomized trial.

PURPOSE: To determine the utility of the dexamethasone implant (IVD) as an alternative to systemic steroids as prophylaxis against cystoid macular edema (CMO) in patients with chronic, recurrent CMO associated intermediate or posterior uveitis (IU/PU), and cataract undergoing cataract surgery. METHODS: This was a randomized, parallel design, and clinical trial. Patients with IU/PU and cataract scheduled for cataract surgery were randomly assigned to receive the IVD concurrently with cataract surgery (Group 1: 20 patients) or systemic steroids (Group 2: 23 patients) tapered over 4-6 weeks along with uneventful cataract surgery and routine postoperative care. Patients with glaucoma/contraindications to steroids were excluded. All patients were followed up for 6 months. OUTCOME MEASURE: Primary-incidence of postoperative CMO. Secondary-the change in BCVA (corrected distance visual acuity) and Central Subfield thickness (CST) and complications. Appropriate statistical analysis was done. RESULTS: The median age was 47.3 ± 4.23 years (group 1) and 49.12 ± 5.32 years (Group 2). One patient (Group 1) and two (Group 2) developed CMO. The BCVA improved significantly in both groups (p = 0.013). The CST change was insignificant. Four patients (Group 1) required intraocular pressure (IOP) lowering medications. Three patients (Group 2) required early steroid taper. CONCLUSIONS: IVD is a good alternative as prophylaxis in IU/PU and cataract in preventing postoperative CMO.

Impact of fluidic parameters during phacoemulsification on the anterior vitreous face behavior: Experimental study.

Purpose: To evaluate the eff ect of different aspiration flow rates (AFR) and bottle heights (BH) on vitreous face (AVF) during phacoemulsifi cation. Methods: Experimental study in 20 porcine eyes. Transzonular viscodissection was performed between the posterior capsule(PC) and AVF to dissect out the Berger's space. Triamcinolone acetonide was injected into this space to aid visualization with ultrasound B-Scan(USG). Realtime USG was performed during phacoemulsifi cation. Eyes were divided randomly into-Group I: Low parameters(AFR = 20 cc/min, BH = 90 cm, vacuum = 400 mmHg),and Group II: High parameters (AFR = 40 cc/min, BH = 110 cm, vacuum=650 mm Hg). Results: 15 eyes were analysed (8 in Group I; 7 in Group II). In all eyes, forward and backward movement of the PC was seen when going from foot position 0 to 1, or on occlusion break. Amplitude of these movements was much greater in Group II compared to Group I. There was no PC rupture in either group. In 2 of the 7 eyes in Group II, USG showed a sudden, spontaneous dispersion appearance of sono-opaque echoes in the vitreous cavity alongwith disappearance of the well-defi ned, crescentic stained space despite an intact PC. This suggests rupture of the AVF, leading to dispersion of the triamcinolone into the entire vitreous cavity. No AVF rupture was seen in Group I. Conclusion: We report a rarely described entity of AVF rupture with intact PC. The use of high AFR and BH may have clinically invisible detrimental consequences to the anterior vitreous face.

Pro Re Nata Dexamethasone Implant for Treatment-Naive Phakic Eyes with Diabetic Macular Edema: A Prospective Study.

PURPOSE: To determine the utility and safety of the intravitreal dexamethasone implant as primary therapy (pro re nata [PRN]) in phakic eyes with early treatment-naive diabetic macular edema (DME). DESIGN: Prospective, case series. PARTICIPANTS: Patients with diabetes mellitus whose eyes were phakic and had early treatment-naive clinically significant macular edema. METHODS: Patients whose eyes were phakic with DME (<3 months) were included if the central subfield thickness (CST) was >300 µm and corrected distance visual acuity (CDVA) between 0.3 and 1.0 logarithm of minimum angle of resolution. A comprehensive ocular and systemic examination was performed and the implant injected PRN using a standardized technique. Patients had follow-up at least monthly for 2 years. Descriptive statistics were used to analyze categorical variables in terms of size and proportions. The repeated-measures analysis of variance test was used to determine the change in CDVA, CST, intraocular pressure, and hard exudate area over time. MAIN OUTCOME MEASURES: The primary outcome measure was the determination of the change in CDVA at month 24 from baseline. Secondary outcome measures included determining the change in CST, median number of injections, proportion gaining 15 letters, and complications, if any. RESULTS: A total of 153 patients (85 males) were included. At 2 years, mean CDVA improved from 0.62 to 0.4 logarithm of minimum angle of resolution, and median CST improved from 397 to 236 µm. The median number of injections was 1.6. Cataract developed in 3 patients with a clear lens, and 31 patients required topical antiglaucoma therapy. Proliferative disease developed in 4 patients, which was managed with panretinal photocoagulation. None of the study patients required rescue therapy. CONCLUSIONS: In patients with treatment-naive phakic eyes who had DME, primary therapy with the intravitreal dexamethasone implant PRN (for 2 years) resulted in significantly improved mean CDVA. A fifth of the patients required control of intraocular pressure, and new-onset cataract developed in 3 of 153 patients.

Comparative evaluation of femtosecond laser-assisted cataract surgery and conventional phacoemulsification in eyes with a shallow anterior chamber.

PURPOSE: To compare intraoperative performance and postoperative outcomes between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification in eyes with a shallow anterior chamber (AC). SETTING: Iladevi Cataract & IOL Research Centre, India. DESIGN: Prospective randomized masked clinical study. METHODS: Patients undergoing cataract surgery with a shallow AC (<2.5 mm) were randomized to have FLACS (Group 1, n = 91) or conventional phacoemulsification (Group 2, n = 91). Patients were followed up at 1 day, 1 week, and at 1, 3, and 6 months. The primary outcome measure was central corneal thickness (CCT). The secondary outcome measures were corneal clarity, AC cells and flare, endothelial cell density (ECD), coefficient of variance, hexagonality, and uncorrected distance visual acuity (UDVA) at 1 week. RESULTS: The study comprised 182 eyes (91 in each group) The cumulative dissipative energy was lower in the FLACS group (P < .05). The mean CCT was significantly lower with FLACS (540.40 µm + 49.40 [SD] vs 556 + 12.5 µm, P = .03) at 1 day and 1 week (535.5 + 44.3 µm vs 551 + 40.8 µm, P = .04), with fewer eyes having higher than grade 2 AC cells and flare with FLACS (85% vs 72%, P = .056) at 1 day and 1 week (15% vs 28%, P = .03). At 1 week, the UDVA was better with FLACS (0.089 ± 0.31 logarithm of the minimum angle of resolution [logMAR] vs 0.178 ± 0.65 logMAR, P = .042). At 6 months, the reduction in ECD was lower in the FLACS group; however, the difference was not statistically significant. CONCLUSION: In eyes with shallow ACs, compared with conventional phacoemulsification, FLACS maintained clearer corneas, showed less increase in CCT, lower AC inflammation, and better UDVA in the early postoperative period.

Safety and Efficacy of a New Phakic Posterior Chamber IOL for Correction of Myopia: 3 Years of Follow-up.

PURPOSE: To evaluate the outcomes of a new posterior chamber phakic intraocular lens (IPCL; Care Group, Baroda, India) to correct myopia. METHODS: This prospective, observational case series included 30 eyes undergoing implantation of the IPCL for high myopia (> -8.00 diopters [D]). Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, vault, endothelial cell loss, and adverse events were evaluated 3 years after implantation of the IPCL for high myopia. RESULTS: The mean spherical equivalent decreased from -16.50 ± 5.62 D preoperatively to -0.89 ± 1.27 D at 3 years. The mean UDVA and CDVA were 0.38 ± 0.21 and 0.24 ± 0.09 logMAR. No eye lost any lines and 49% of eyes gained one line or more of CDVA. One eye (3.3%) developed anterior subcapsular cataract, but did not require cataract surgery at 3 years of follow-up. Two eyes (6.6%) developed a mild transient increase in intraocular pressure, which required topical medication only for 3 months. The percentage of endothelial cell loss at 3 years was 9.73% ± 6.72%. The IPCL vault tended to reduce with time, from a mean of 626.66 ± 188.98 µm at 1 month to 540.22 ± 210.76 µm at 3 years. No vision-threatening complications occurred. CONCLUSIONS: Implantation of the new posterior chamber phakic IOL is an effective alternative to correct high myopia, showing good outcomes at 3 years. [J Refract Surg. 2018;34(12):817-823.].

Comparison of ocular wavefront aberrations in subluxated lenses before and after lens extraction with intraocular lens implantation.

PURPOSE: To compare the change in ocular higher-order wavefront aberrations (HOAs), visual acuity, and modulation transfer function (MTF) after lens extraction with intraocular lens (IOL) implantation in patients with subluxated lenses. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective case series. METHODS: Eyes with subluxated lenses having lens extraction with IOL implantation were included. Capsular bag fixation with in-the-bag IOL implantation or sutured or sutureless scleral fixation of the IOL was performed. Aberrometry was performed preoperatively and 6 months postoperatively. The following were compared: root-mean-square (RMS) value for total ocular HOAs, coma aberration, spherical aberration, MTF, and corrected distance visual acuity (CDVA). RESULTS: Of the 39 eyes with subluxated lenses, 26 eyes had Cionni ring fixation, 9 had sutured scleral fixation, and 4 had intrascleral fixation of the IOL. The mean preoperative and postoperative values, respectively, were as follows: RMS HOAs, 10.5 µm ± 9.5 (SD) and 4.73 ± 4.6 µm (P < .001); coma aberration, 2.46 ± 2.4 µm and 0.11 ± 0.1 µm (P = .03); and spherical aberration, 0.37 ± 0.9 µm and 0.02 ± 0.06 µm (P = .02). The MTF improved significantly in all eyes (mean 0.05 ± 0.02 preoperatively and 0.32 ± 0.16 postoperatively) (P = .005). The CDVA was statistically significant improved 6 months postoperatively. CONCLUSION: Lens extraction with IOL fixation in eyes with subluxated lenses significantly reduced ocular HOAs and improved the MTF.

Postoperative outcomes of intraocular lens implantation in the bag versus posterior optic capture in pediatric cataract surgery.

PURPOSE: To compare complications in children up to 4 years old having cataract surgery with intraocular lens (IOL) implantation using 2 techniques: in-the-bag IOL with anterior vitrectomy or optic capture of IOL with no anterior vitrectomy. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. DESIGN: Prospective randomized control clinical trial. METHODS: The study included children having cataract surgery with IOL implantation. Patients were randomized to Group 1 (in-the-bag 3-piece hydrophobic acrylic IOL [Acrysof MA60AC] with anterior vitrectomy) or Group 2 (optic capture of the same IOL without anterior vitrectomy). Intraoperative complications were documented. Postoperative visual axis obscuration (VAO), glaucoma, cell deposits on the IOL, and posterior synechiae were compared at 1, 3, 6, and 12 months. RESULTS: The study comprised 61 children (61 eyes). The mean ages were 14.8 months ±11.47 (SD) in Group 1 (n = 30) and 18.2 ± 11.47 months in Group 2 (n = 31). Overall, only 1 eye in Group 1 developed a VAO requiring membranectomy 4 months postoperatively, and 2 eyes in Group 1 developed glaucoma over 12 months (P = .49). Intraocular lens cell deposits and posterior synechiae were comparable between groups. The IOL could not be captured in 5 eyes (16.1%); no complications occurred in these eyes. CONCLUSIONS: Optic capture of 3-piece hydrophobic acrylic IOLs could be achieved in most eyes. The VAO, glaucoma, and inflammation were comparable 12 months postoperatively. Thus, optic capture of an IOL is an alternative surgical technique that can be used to avoid vitrectomy, even in children younger than 4 years.

Femtodelineation to enhance safety in posterior polar cataracts.

UNLABELLED: We describe the technique of femtodelineation for posterior polar cataracts. In this technique, the femtosecond laser is used with a cylindrical pattern of lens division to create multiple cylinders within the lens, which results in sharply demarcated layers. The number, size, and depth of the cylinders can be controlled by the surgeon using the live anterior segment optical coherence tomography view. The multiple layers act as mechanical cushions that protect each layer as it is removed. Because of its sharp demarcation, the last epinuclear layer can be easily stripped using a combination of the phaco probe and bimanual irrigation/aspiration. This approach eliminates the need for any type of hydro procedure in posterior polar cataracts. It reduces posterior capsule rupture rates and enhances safety in posterior polar cataract emulsification. FINANCIAL DISCLOSURE: Dr. A.R. Vasavada receives research support from Alcon Laboratories, Inc. No other author has a financial or proprietary interest in any material or method mentioned.