Deviation from the planned axis of three toric intraocular lenses.

In this study, we retrospectively evaluated the deviation from the planned axis of 3 Toric intraocular lenses (TIOL). Included in the study 190 eyes, operated by two surgeons using two different manual marking techniques. The patients were implanted with either AcrySof IQ Toric SN6AT (Alcon) (n = 90), POD FT (PhysIOL) (n = 50), or TECNIS Symfony Toric (J&J) (n = 50). At least 1 month postoperatively, the IOL was photographed, and the axis was measured using a designed software. The difference between the planned and actual axis was defined as axis deviation. The effect of IOL type, astigmatism direction, and marking techniques on the average degree and direction of the IOL deviation were evaluated and compared. There was no significant difference in the average deviation between the IOLs (TECNIS Symfony: 4.03° ± 4.34, POD FT: 3.52° ± 3.38, and SN6AT: 4.24° ± 4.10), and its direction (55.8%, 39.0%, and 56.6% clockwise (CW) deviation, respectively). With the rule, astigmatism had significantly more CW deviation compared with against the rule and oblique astigmatism (64.3%, 43.8%, and 41.7%, respectively, P = 0.027), but the average deviation was similar. The marking techniques did not influence the degree or direction of the deviation.

Outcomes of first 50 cases using a new pupil expander.

PURPOSE: To describe the initial experience with the Assia Pupil Expander 200 (APX-200, APX Ophthalmology) in eyes that underwent phacoemulsification or intraocular lens repositioning surgery that required mechanical pupil expansion. SETTING: Department of Ophthalmology, Meir Medical Center, Kfar-Saba, and Ein-Tal Eye Center, Tel Aviv, Israel. DESIGN: Retrospective case series. METHODS: The APX-200 is a single-use device, intended for mechanical expansion of the pupil during intraocular surgery. Two devices are inserted through 2 opposite 19-gauge incisions using designated forceps. The surgical course and early postoperative follow-up was recorded in 50 eyes. RESULTS: The study included 50 consecutive eyes, with mean preoperative pupil diameter was 3.7 mm. The APX effectively dilated the pupils in all cases. No complication related to the use of the APX such as hyphema, iridodialysis, or Descemet membrane detachment were noted in this series. A central and round pupil was restored in all eyes at 1-month postoperatively, with 14 eyes (28%) having mild sphincter tears. Pupilloplasty was not required in any of the cases. CONCLUSIONS: The APX-200 was an effective and safe device for pupil expansion during intraocular surgery.

Pars plana vitrectomy for posteriorly dislocated intraocular lenses: risk factors and surgical approach.

PURPOSE: To present updated risk factors, anatomical and visual outcomes and a surgical approach to posteriorly dislocated intraocular lenses (IOL). METHODS: A retrospective case series review of patients presenting with posteriorly dislocated IOL to the vitreous was performed. All cases were managed surgically with pars plana vitrectomy (PPV) followed by IOL repositioning and refixation or IOL exchange. Clinical characteristics, risk factors for IOL dislocation, visual outcomes and intraoperative and postoperative complications were investigated. RESULTS: Forty patients with posteriorly dislocated IOL underwent 3-port PPV and lens retrieval at an average of 6.5 years after cataract surgery. The main causes of IOL dislocation were previous PPV, myopia, pseudoexfoliation syndrome, ocular trauma and recurrent intravitreal injections. The existing IOL was repositioned and secured in 90% of the cases. Visual acuity improved in 34 patients, maintained in 5 and deteriorated in 1. All IOLs were central and stable at final follow-up. CONCLUSION: Posterior intraocular lens dislocation is becoming more prevalent. The main underlying causes found in this series were previous vitrectomy, myopia and recurrent intra-vitreal substance injections. Visual acuity improved in most cases after lens repositioning; however visual outcome is often limited due to associated ocular co-morbidities despite adequate lens position. Despite complete lack of zonular support, a posteriorly dislocated IOL can often be preserved by repositioning and fixation of the lens in the posterior chamber. Pathologies primarily associated with this type of lens malposition include history of vitrectomy, high myopia and multiple intravitreal substance injections.

Refractive outcome of toric intraocular lens calculation in cases of oblique anterior corneal astigmatism.

PURPOSE: To establish whether toric intraocular lens (IOL) calculation on the basis of anterior corneal measurements alone, in corneas with oblique anterior astigmatism, will result in a systematic overcorrection or undercorrection of postoperative refractive astigmatism, and to establish whether adjustment of oblique anterior corneal astigmatism to allow for the likely effect of posterior corneal astigmatism is needed in such eyes. SETTING: The Queen Elizabeth Hospital, Department of Ophthalmology, Adelaide, South Australia. DESIGN: Retrospective case series. METHODS: Data were collected from consecutive eyes with oblique anterior corneal astigmatism undergoing cataract surgery or refractive lens exchange. Toric IOL calculations were made using unadjusted anterior corneal astigmatism measurements and an astigmatically neutral technique. By comparison of targeted vs achieved astigmatic correction using vector analysis, the astigmatic power prediction error and angle of error were derived. RESULTS: In 50 eyes, the mean postoperatively measured refractive astigmatism was 0.42 diopters (D) (SD 0.33 D), the mean targeted refractive astigmatism was 0.15 (SD 0.18), and the vector-derived mean absolute prediction error was 0.23 D (SD 0.21). All 50 eyes (100%) fell at or within ±1.00 D of the target and 45 eyes (90%) at or within ±0.50 D. The geometric mean astigmatism correction index was 0.98, and the mean absolute angle of error was 8.63 degrees (SD 8.55). CONCLUSIONS: There is no systematic error attributable to posterior corneal astigmatism in toric IOL calculation and no need for adjustment of anteriorly measured corneal keratometric values for toric IOL calculation in eyes with oblique anterior corneal astigmatism. To do so may introduce an error in astigmatic outcome.

Feasibility of using experimental high viscosity silicone oils: a pilot study.

BACKGROUND: Polydimethyl silicones (silicone oils) are used in complex retinal surgeries, including difficult or recurrent retinal detachments, severe eye trauma, and other indications for long term tamponade. Two major problems with currently available silicone oils are emulsification and recurrent retinal detachment. The primary endpoint of this study was to evaluate the toxicity and safety of high viscosity silicone oils and second, the feasibility of using them with currently available vitrectomy systems. METHODS: In this experimental study, 8 eyes of 8 New Zealand White rabbits underwent vitrectomy. The vitreous cavities of 2 eyes were filled with medical grade 5500 cS silicone oil, 4 eyes with 12,500 cS oil, and 2 eyes with 30,000 cS oil for 3 months, after which the animals were sacrificed and the eyes sent for histopathological examination. The duration required to inject 5 cc each of 1300, 12,500 and 30,000 cS oils, using a commercially available system (Alcon VFC Pac) were also evaluated. RESULTS: Retinal histopathology was comparable in all eyes, with no excess toxic effect or damage seen in eyes with experimental oils. All oils were readily injectable with the VFC Pac system. CONCLUSIONS: High viscosity experimental silicone oils have similar chemical and physical properties to lower viscosity oils currently used. Therefore, toxicities are expected to be similar. In a small pilot sample of 8 rabbit eyes filled with silicone oil for 3 months, histopathology in eyes with 12,500, 30,000 cS or medical grade 5500 cS silicone oil were similar. Injecting these oils using available vitrectomy equipment is feasible. New, high viscosity silicone oils may offer several advantages over currently available oils for some patients.

[Diplopia following subcutaneous injections of botulinum toxin for cosmetic or medical use].

BotuLinum toxin A (Botox, Allegan) is a potent neurotoxin that blocks the release of acetylcholine at the neuromuscular junction of cholinergic nerves. Botulinum toxin was introduced to clinical medicine in 1980. Since then it has become a major therapeutic drug in many medical sub-specialties and its use for facial rejuvenation has become increasingly popular. Diplopia after botulinum toxin injection for facial rejuvenation is a rare and transient complication which is related to chemodenervation of adjacent muscle groups. We would like to report 3 cases of double vision related to extra-ocular muscle paresis after an injection of botulinum toxin for facial rejuvenation and blepharospasm. In all 3 cases recovery occurred, without any treatment, over 3 to 4 months (apparently from regeneration of inactivated proteins necessary for degranulation of acetylcholine vesicles). The clinicians engaged in botulinum toxin injections for facial rejuvenation or blepharospasm, should be aware of the possible complications, and inform the patients about the risk of developing double vision. The clinicians should take into account and ask about Botox when treating patients complaining of diplopia.