Nontraditional approaches to sedation for anterior segment surgery: a narrative review.

PURPOSE OF REVIEW: Surgical and anesthetic technological advancement have made both cataract and noncataract anterior segment surgery significantly less invasive and time-intensive, facilitating the transition of some of these procedures from the operating room under monitored anesthesia care (MAC) to the office-based setting without MAC. This transition has been aided by the popularization of nonintravenous approaches to achieving patient sedation for these procedures. In this review, we discuss the literature surrounding traditional and nontraditional methods of achieving patient sedation for anterior segment surgery. RECENT FINDINGS: Our survey of the literature suggests that nonintravenous (IV) approaches to sedation for these procedures may be just as safe, effective, and satisfactory to patients as traditional IV approaches. SUMMARY: As anterior segment surgery becomes less invasive and less time-intensive, providers considering transitioning their cataract and anterior segment surgery out of the operating room and into the office-based setting without MAC anesthesia should consider the non-IV sedation options outlined in this review to achieve adequate patient sedation and comfort.

Aphakia treatment with sutureless scleral fixation or retropupillary iris-claw intraocular lens implantation: visual acuity, anterior segment and keratometry outcomes.

PURPOSE: Evaluation of anterior segment parameters using the Scheimpflug corneal topography 1 year after surgery in patients who underwent sutureless scleral fixation intraocular lens (SFIOL) implantation using the modified Yamane technique and retropupillary iris-claw intraocular lens (RPIOL) implantation. METHODS: A total of 60 eyes from 57 patients who underwent sutureless SFIOL implantation and 57 eyes from 52 patients who underwent RPIOL implantation were included. Anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), anterior-posterior corneal astigmatism, and keratometric values were assessed using the Scheimpflug corneal topography (Pentacam HR, Germany). RESULTS: There was no statistically significant difference in postoperative UCVA and BCVA between the sutureless SFIOL and the RPIOL group (p = 0.236, p = 0.293, respectively). While there was no statistically significant difference in postoperative IOP between the two groups (p = 0.223), a statistically significant decrease in IOP was observed in both groups (p < 0.001). While there was no statistical difference between the sutureless SFIOL group and the RPIOL group in terms of spherical value (p = 0.441) and spherical equivalence (p = 0.237), there was a statistically significant difference in cylindrical value (p < 0.001). While there was a statistical difference in anterior astigmatism (p < 0.001), there was no statistical difference in posterior astigmatism (p = 0.405). There was no statistical difference in terms of ACV, ACD, and ACA between the sutureless SFIOL and the RPIOL group (p = 0.812, p = 0.770, p = 0.401, respectively). CONCLUSION: In this study, although there was a statistical difference in cylindrical value and anterior corneal astigmatism between the sutureless SFIOL and RPIOL groups, vision was not affected. According to this study, sutureless SFIOL and RPIOL are two successful methods in terms of visual acuity, anterior segment, and keratometry outcomes in aphakic patients after phacoemulsification.

[Current possibilities of laser surgery on anterior eye segment]. / Sovremennye vozmozhnosti lazernogo vozdeistviya na struktury perednego segmenta glaza.

The article summarizes the experience of recent years in the development and implementation of novel original laser technologies used in surgery of the anterior segment of the eye. The presented technology of laser activation of scleral hydropermeability (LASH) in glaucoma is based on the effect of enhanced transscleral filtration and has been shown as effective and safe, which was confirmed by the results of a comprehensive clinical and experimental study. Development of another technique was associated with the need to improve the safety of laser interventions in anterior capsule contraction syndrome in pseudophakia, and resulted in a proposition to change the configuration of the anterior lens capsule incision from the usual linear-radial to T-shaped laser anterior capsulorhexis. The proposed technology of laser photomydriasis based on near-infrared radiation of the diode laser (0.810 µm) has shown its effectiveness and gentle nature (absence of atrophy of the iris stroma and post-burn pigmentation) in ectopias and pupil deformity.

The Effect of Tube Location on Corneal Endothelial Cells in Patients with Ahmed Glaucoma Valve.

PURPOSE: To compare the effects of the Ahmed glaucoma valve (AGV; New World Medical, Rancho Cucamonga, CA) with sulcus versus anterior chamber (AC) tube placement on the corneal endothelial density and morphology over time. DESIGN: Nonrandomized, interventional study. PARTICIPANTS: This study included 106 eyes from 101 pseudophakic patients who had the AGV tube placed in the AC (acAGV) and 105 eyes from 94 pseudophakic patients who had the AGV tube placed in the ciliary sulcus (sAGV). METHODS: All patients underwent preoperative specular microscopy, which was repeated postoperatively in 2019. The patients' demographic information, glaucoma diagnoses, and basic ocular information were obtained on chart review. Anterior segment OCT was conducted for patients who underwent sAGV to evaluate the sulcus tube position. Gonioscopy was performed to document peripheral anterior synechiae (PAS). Linear mixed-effects models were used to compare the different ocular and endothelial measurements between the 2 groups and to identify risk factors for endothelial cell density (ECD) loss over time. MAIN OUTCOME MEASURES: Monthly change in corneal endothelial measurements, including ECD and coefficient of variation (CV), calculated as the difference between preoperative and postoperative measurements divided by the number of months from the time of surgery to postoperative specular microscopy. RESULTS: The acAGV and sAGV groups were comparable in all baseline characteristics except that the acAGV group had longer follow-up (37.6 vs. 20.1 months, respectively, P < 0.001). Mean monthly loss in central ECD was significantly more in the acAGV group (mean ± standard deviation: 29.3±29.7 cells/mm2) than in the sAGV group (15.3±20.7 cells/mm2, P < 0.0001). Mean monthly change in CV was similar between the 2 groups (P = 0.28). Multivariate analyses revealed that younger age and tube location in the AC were associated with faster central ECD loss (P = 0.02, P < 0.0001, respectively). For patients with sAGV, while PAS was associated with faster central ECD loss (P = 0.002), a more forward tube position tenting the iris was not (P > 0.05). CONCLUSIONS: Compared with anterior segment placement, ciliary sulcus tube implantation may be a preferred surgery approach to reduce endothelial cell loss in pseudophakic patients.

Increased rate of ptosis following glaucoma drainage device placement and other anterior segment surgery: a prospective analysis.

PURPOSE: To determine the degree and rate of ptosis in patients undergoing glaucoma and cataract surgery. METHODS: Patients undergoing cataract extraction (CE), trabeculectomy, or glaucoma drainage device (GDD) placement, or a combination, were consecutively enrolled by a sole surgeon. Eyelid measurements, including margin reflex distance 1 (MRD1) and levator function, were obtained preoperatively and at 1 and 3 months postoperatively. Primary outcome measures were the change in MRD1 pre- vs postoperatively; percentage of patients with ptosis (defined as MRD1 < 2 mm pre- vs postoperatively). Secondary measures were the absolute change in MRD1 between groups, decrease in MRD1 of ≥ 2 mm, and change in levator function. RESULTS: In total, 104 eyes of 73 patients underwent CE, trabeculectomy, or GDD placement and completed at least 1-month follow-up; 93 eyes of 65 patients completed 3-month follow-up. MRD1 decreased significantly in trabeculectomy and GDD groups at 1 and 3 months postoperatively, while it did not change in the CE group. The GDD group had a significant increase in percentage of patients with ptosis at 3 months postoperatively. CONCLUSION: Patients who underwent glaucoma surgery, especially those who underwent GDD placement, were more likely to have postoperative ptosis than patients undergoing CE alone. High ptosis rates in patients undergoing glaucoma surgery may warrant preoperative counseling and post-operative referral to oculoplastic surgeons.

Peters anomaly: A 5-year experience.

BACKGROUND: Peters anomaly is a rare, congenital eye malformation characterized by an opaque cornea and blurred vision. Central corneal opacification can lead to delayed progression of visual development caused by defects in Descemet membrane and the posterior stroma. These children require several anesthetics for multiple eye examinations under anesthesia and corneal transplantation. AIMS: We sought to review the anesthetic management of patients with Peters anomaly for ophthalmologic procedures at Westchester Medical Center, a major referral center for Peters anomaly. METHODS: A retrospective chart review was completed which included pediatric patients who underwent ophthalmologic procedures related to Peters anomaly from 2013-2018. RESULTS: The charts of 35 patients with Peters anomaly were reviewed: 14 patients with Peters anomaly Type I, 10 patients with Peters anomaly Type II, and 11 patients with Peters plus syndrome. Thirty patients required three procedures on average, two examinations under anesthesia pre- and post-transplant, and anesthesia for the corneal transplant itself. The youngest patient encountered for examination under anesthesia was 39-week postconceptual age. Anesthetic time for examination under anesthesia averaged 31 minutes using a laryngeal mask airway while corneal transplant averaged 104 minutes utilizing endotracheal intubation. Postanesthesia care unit stay averaged 51 minutes following examination under anesthesia and 65 minutes after corneal transplant. All examinations under anesthesia were successfully completed without adverse events with the use of a laryngeal mask airway. This case series includes two patients with Goldenhar syndrome and Al-Gazali syndrome accompanying Peters anomaly. CONCLUSION: Although limited by its retrospective nature, this case series describes the cardiac and systemic implications of patients undergoing anesthesia with Peters anomaly. Our experience indicates that general anesthesia and airway manipulation are tolerated with minor postoperative concerns in these infants. Pediatric patients with Peters anomaly require multiple anesthetics for repeated ophthalmologic interventions. The laryngeal mask airway can be routinely utilized in infants less than 3 months of age for an eye examination under anesthesia with no airway complications noted. Perioperative providers should be aware of the multisystemic implications in patients with Peters plus syndrome.

Demonstration of Optical Coherence Tomography Guided Big Bubble Technique for Deep Anterior Lamellar Keratoplasty (DALK).

Deep anterior lamellar keratoplasty (DALK) is a highly challenging procedure for cornea transplant that involves removing the corneal layers above Descemet's membrane (DM). This is achieved by a "big bubble" technique where a needle is inserted into the stroma of the cornea down to DM and the injection of either air or liquid. DALK has important advantages over penetrating keratoplasty (PK) including lower rejection rate, less endothelial cell loss, and increased graft survival. In this paper, we successfully designed and evaluated the optical coherence tomography (OCT) distal sensor integrated needle for a precise big bubble technique. We successfully used this sensor for micro-control of a robotic DALK device termed AUTO-DALK for autonomous big bubble needle insertion. The OCT distal sensor was integrated inside a 25-gauge needle, which was used for pneumo-dissection. The AUTO-DALK device is built on a manual trephine platform which includes a vacuum ring to fix the device on the eye and add a needle driver at an angle of 60 degrees from vertical. During the test on five porcine eyes with a target depth of 90%, the measured insertion depth as a percentage of cornea thickness for the AUTO-DALK device was 90 . 05 % ± 2 . 33 % without any perforation compared to 79 . 16 % ± 5 . 68 % for unassisted free-hand insertion and 86 . 20 % ± 5 . 31 % for assisted free-hand insertion. The result showed a higher precision and consistency of the needle placement with AUTO-DALK, which could lead to better visual outcomes and fewer complications.

Clinicopathologic Features and Treatment Characteristics of Congenital Corneal Opacity Infants and Children Aged 3 Years or Less: A Retrospective Single Institution Analysis.

OBJECTIVE: In this retrospective single institution study, we investigated the clinicopathologic features and treatment characteristics of 90 patients with congenital corneal opacities (CCO) (117 eyes) who were 3 years and younger and treated at our hospital. SUBJECT AND METHODS: We reviewed the clinical data of patients with CCO who presented for the first time for treatment at our hospital between January 1, 2017, and December 31, 2017. CCO were classified using the "STUMPED" (Sclerocornea, Tears in Descement's membrane, Metabolic, Peters, Endothelial dystrophy and Dermoid) method and confirmed by pathological examination. -Results: Seventy percent of the patients had unilateral CCO. Iridocorneal adhesions (61 eyes, 52.1%) and cataracts (22 eyes, 18.8%) were the 2 most common ocular abnormalities. Systemic abnormalities were present in 5 patients (5.6%), including growth retardation (4 patients) and congenital brain defects (1 patient). Eighty-five eyes (72.6%) underwent penetrating keratoplasty (PK), and lamellar keratoplasty (LK) was performed in 30 (25.6%) eyes. Forty-seven (95.9%) eyes with Peters anomaly and all 16 eyes with sclerocornea received PK, and all 24 eyes with dermoids were treated with LK. CONCLUSION: Our study demonstrates that CCO has varied manifestations in infants and young children in China. A thorough medical history, careful clinical examination, and the use of accessory examinations such as ultrasound biomicroscopy are critical for the accurate diagnosis and classification of CCO and to provide guidance on therapeutic choices.

A modified intrascleral intraocular lens fixation technique with fewer anterior segment manipulations: 27-gauge needle-guided procedure with built-in 8-0 absorbable sutures.

BACKGROUND: To report a modified surgical technique for intrascleral intraocular lens (IOL) fixation with fewer anterior segment manipulations in eyes lacking sufficient capsular support. METHODS: Eyes from 14 patients who underwent 27-gauge needle-guided intrascleral IOL fixation with built-in 8-0 absorbable sutures were studied. The 8-0 absorbable sutures were inserted into 27-gauge round needles and used to create sclerotomies at the 4 o'clock and 10 o'clock positions under the scleral flap. The sutures were used to tie knots at the end of each haptic and guide haptic externalization through the sclerotomy. After externalization, a sufficient flange was created at the end of each haptic and fixed under the scleral flaps. The best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), IOL tilt and decentration, previous surgery history, and complications were determined. RESULTS: Fourteen cases were analyzed. The majority of eyes exhibited an improvement in the BCVA after surgery. When comparing the last follow-up to preoperative visual acuity, the mean change in BCVA was + 26.32 letters (p = 0.011). Postoperative complications included postoperative hypotony in 3 eyes, ocular hypertension in 2 eyes. No cases of postoperative cystoid macular edema (CME), vitreous hemorrhage (VH), IOL dislocation, or endophthalmitis were observed. CONCLUSIONS: The 27-gauge needle-guided intrascleral IOL fixation technique with built-in 8-0 absorbable sutures is easy to perform with fewer anterior chamber manipulations and achieves both anatomical and optical stability.

XEN® stent complications: a case series.

BACKGROUND: XEN® gel stent (Allergan, Dublin/Republic of Ireland) is a relatively new microinvasive glaucoma device providing an ab-interno approach to the subconjunctival space for aqueous drainage and reduction of intraocular pressure. It is thought to be less invasive, reduce surgical time and post-operative infection rates compared with traditional glaucoma procedures. Little information however, has been published regarding complications and subsequent management. CASE PRESENTATION: The authors highlight five complicated cases of XEN® stent insertion, how they were managed and key learning points. Cases include: entire stent found at the bottom of the anterior chamber several months after uncomplicated insertion, stent broke into multiple pieces during manipulation within subconjunctiva, XEN45 stent migrated into the anterior chamber 7 months post-operatively and a case of limbal-based conjunctival dissection during open revision which lead to additional scarring around the stent and subsequent raised intraocular pressure. CONCLUSIONS: We present some new and interesting complications of XEN implant as well as potential management options. This can assist clinical decision-making and enable better pre-operative discussions with patients regarding risks of surgery.

[Glaucoma Surgery in Anterior Segment Dysgeneses]. / Glaukomchirurgie bei Vorderabschnittsdysgenesien.

Anterior segment dysgeneses are rare conditions, and mostly occur sporadically. The severity of dysgenesis and the number of structures affected are highly variable. Glaucoma occurs in approximately 50% of all patients, either as part of primary chamber angle dysgenesis or secondary to surgery, mostly for removal of congenital cataracts. This review provides a brief overview of the embryological background and the spectrum of phenotypes, such as primary congenital glaucoma, Axenfeld Rieger and Peters Anomaly. Current surgical approaches to lower intraocular pressure are discussed. Special attention is paid to the increasingly used microcatheter-assisted 360° trabeculotomy and glaucoma drainage devices in paediatric glaucoma surgery.

Epithelial map-guided anterior stromal micropuncture for the treatment of recurrent corneal erosion syndrome.

PURPOSE: To introduce the use of corneal epithelial mapping by anterior segment optical coherence tomography (AS-OCT) as an ancillary testing for the identification of areas of loose epithelial adherence in recurrent corneal erosion syndrome (RCES), and the subsequent treatment of the latter with anterior stromal puncture (ASP). METHODS: Five patients were presented with RCES following traumatic corneal abrasions. Following resolution of acute episodes, AS-OCT epithelial mapping was performed revealing in all patients an area of increased epithelial thickness (hot spot) corresponding to the site of loose attachment of the epithelium to the epithelial basement membrane. ASP to the area of epithelial thickening, as delineated by the epithelial map, was performed. RESULTS: To date, none of the patients has shown any signs of disease recurrence over a period ranging from 6 to 20 months following the application of epithelial map-guided ASP. CONCLUSIONS: AS-OCT epithelial mapping can reveal the exact area of loose epithelial adherence in RCES. Hence, epithelial mapping can delineate the target area for treatment with ASP and may decrease the high failure rates of ASP.

Outcome of optical iridectomy in Peters anomaly.

PURPOSE: Optical iridectomy creates a defect in the iris to allow an alternative clear visual axis in cases of central corneal opacities occluding the pupillary axis. The purpose of this study is to evaluate the outcomes of optical sector iridectomy in children with Peters anomaly. METHODS: Retrospective case series. The medical records of all patients diagnosed with Peters anomaly who underwent optical iridectomy during the years 2002-2014 were reviewed. Data collection included surgical and visual acuity outcomes. RESULTS: Twenty-nine eyes (22 patients) were included in the study. Mean age at the time of surgery was 15.6 ± 26.3 months. Eighteen (81.8%) patients had bilateral disease. No intraoperative complications occurred. A red reflex was obtained in 28 (96.6%) eyes after surgery. Mean visual acuity improved from 2.5 ± 0.3 to 1.8 ± 0.6 in logMAR (p < 0.001). Vision improved in 21 (72.4%) eyes, remained stable in 5 (17.2%) eyes, and deteriorated in 3 (10.3%) eyes. Postoperatively visual acuity improved significantly in the patients with the bilateral disease (p < 0.05), but not in the unilateral group (p = 0.056). Mean follow-up time was 41.6 ± 43.8 months. During the follow-up period, five (17.2%) eyes were diagnosed with glaucoma, two (6.9%) eyes underwent PK, one (3.4%) eye underwent an additional sector iridectomy, and one (3.4%) eye underwent keratoprosthesis. CONCLUSIONS: In this largest series published of optical iridectomy for Peters anomaly, it was found to be a safe procedure. Improvement in visual acuity is expected, particularly in bilateral cases. The utility of optical iridectomy in unilateral cases necessitates further studies.

Comparison of bleb morphology between trabeculectomy and deep sclerectomy using a clinical grading scale and anterior segment optical coherence tomography.

IMPORTANCE: The role of the filtration bleb for IOP management following trabeculectomy (TRAB) and deep sclerectomy (DS) in glaucoma is highlighted in this study. BACKGROUND: This study serves to analyse the bleb morphology and IOP using the Indiana Bleb Appearance Grading Scale (IBAGS) and the anterior-segment optical coherence tomography (AS-OCT) postoperatively and at 3 months. DESIGN: The retrospective study was performed by a single surgeon. PARTICIPANTS: Twenty-eight patients with open-angle glaucoma were recruited into the study, 14 in each of the TRAB (fornix) and DS groups. METHODS: The surgical intervention was dependent on the irido-corneal angle configuration on gonioscopy. MAIN OUTCOME MEASURES: Pre-operatively, we collected visual acuity, medications and IOP. Three months postoperatively, we used the IBAGS to assess bleb morphology, including bleb height, extent, vascularity and leak. AS-OCT was also used to assess bleb height, thickness, cyst presence and posterior and intrascleral fluid. RESULTS: Central corneal thickness and mean IOP at 3 months postoperatively were significantly lower in the TRAB group (7.75 vs. 12.27 mmHg; P = 0.005). Blebs that were significantly higher, broader and less vascular compared with DS were displayed by TRAB eyes. The AS-OCT measurements confirmed TRAB eyes had significantly higher blebs and increased intrascleral fluid compared with DS eyes. CONCLUSIONS AND RELEVANCE: Significant differences in bleb morphology, correlating with improved IOP outcomes in TRAB eyes compared with DS eyes in patients with open-angle glaucoma, were showed by both the IBAGS and AS-OCT. Despite the limitations of each classification system, a higher bleb with an increased aqueous reservoir is associated with optimal IOP results.

[Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation]. / Sistema zritel'noi reabilitatsii patsientov s obshirnymi defektami struktur perednego otrezka glaznogo iabloka na osnove implantatsii iridokhrustalikovoi diafragmy.

The diversity of methodological approaches and lack of pathogenetically reasonable tactics for patients with combined ocular injuries became the basis for the development and systematization of surgical rehabilitation stages of patients, in whom post-traumatic cataract is combined with post-traumatic aniridia and corneal scarring. AIM: to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). MATERIAL AND METHODS: We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). RESULTS: Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. CONCLUSION: The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.

Correction of Moderate to High Myopia with a Foldable, Angle-Supported Phakic Intraocular Lens: Results from a 5-Year Open-Label Trial.

PURPOSE: To evaluate the 5-year efficacy of a foldable, hydrophobic, angle-supported phakic intraocular lens (pIOL) when used to correct moderate to high myopia. DESIGN: Prospective, nonrandomized, multicenter, open-label cohort study conducted in the United States, the European Union, and Canada (3 separate protocols). PARTICIPANTS: This was a pooled analysis of 515 eyes from 360 patients 18 to 49 years of age with moderate to high myopia (preoperative corrected distance visual acuity [CDVA] ≤0.34 logarithm of the minimum angle of resolution [logMAR]) and with variance in the manifest refraction spherical equivalent within ±0.5 diopter (D) for a minimum of 12 months. INTERVENTION: Implantation of the AcrySof Cachet angle-supported anterior chamber pIOL (Alcon Laboratories, Inc., Fort Worth, TX). MAIN OUTCOME MEASURES: Uncorrected distance visual acuity (UDVA), CDVA, predictability and stability of manifest refraction spherical equivalent (MRSE), serious adverse events, endothelial cell density, and patient satisfaction. RESULTS: Of 360 patients who received implantation in at least 1 eye (515 eyes), 326 (90.6%) completed the study (5-year best-corrected visual acuity data available for 415 eyes). At 5 years, a decrease in CDVA of 2 lines or more was observed in 0.5% of eyes (n = 2/415) compared with preoperative baseline. At 5 years, all 415 eyes achieved a CDVA of 0.34 logMAR or less; 91.3% (n = 379/415) had a CDVA of 0.04 logMAR or less. Mean UDVA ± standard deviation (SD) was 0.01±0.18 logMAR; 94.7% (n = 393/415) and 66.3% (n = 275/415) of eyes had a UDVA of 0.34 logMAR or less or 0.04 logMAR or less, respectively, at 5 years. Mean MRSE ± SD was -0.34±0.57 D (range,-2.50 to 1.63 D). Most eyes (89.8%; n = 371/413) had an MRSE within ±1.00 D of their target refractive error at 5 years and 67.3% (n = 278/413) were within ±0.50 D. Mean annualized central endothelial cell loss was 1.46% (90% confidence interval [CI], -1.6% to -1.3%) from 6 months to 5 years. The most common pIOL-related serious adverse event was adhesion between the cornea and the iris (synechia; n = 24). Most patients (98.1%) indicated that they would have the same pIOL implanted again. CONCLUSIONS: In patients with moderate to high myopia, the AcrySof Cachet angle-supported pIOL provided excellent refractive correction for up to 5 years after implantation, with a low rate of mean central endothelial cell loss. Careful patient selection is necessary to achieve optimal postsurgical outcomes.

Recurrent late-onset fibrotic capsular block syndrome after neodymium-yttrium-aluminum-garnet laser anterior capsulotomy: a case report.

BACKGROUND: Capsular block syndrome is an uncommon complication that occurs after cataract surgery. It is characterized by capsular distension, anterior intraocular lens displacement, anterior chamber shallowing, and unexpected myopic shifts. We report a case of recurrent fibrotic capsular block syndrome with Elschnig's pearl-type posterior capsule opacification 10 months after neodymium-yttrium-aluminum-garnet (Nd:YAG) laser anterior capsulotomy. CASE PRESENTATION: A 72-year-old Asian man complained of decreased visual acuity 5 years after undergoing phacoemulsification with posterior chamber lens implantation. Under slit-lamp examination, late postoperative capsular block syndrome was diagnosed and Nd:YAG laser anterior capsulotomy was performed. Ten months after anterior capsulotomy, the patient returned with decreased visual acuity and was diagnosed with recurrent fibrotic capsular block syndrome. Nd:YAG laser posterior capsulotomy was performed. CONCLUSIONS: We found that fibrotic capsular block syndrome could recur with Elschnig's pearl-type posterior capsule opacification after Nd:YAG laser anterior capsulotomy for late postoperative capsular block syndrome without posterior capsule opacification.

ESPRESSO: A novel device for laser-assisted surgery of the anterior eye segment.

INTRODUCTION: Merging robotics with laser eye surgery could enhance precision, repeatability and automation. During some eye laser procedures the patient is awake, thus eye stabilization is desired to avoid movements that could affect the treatment. MATERIAL AND METHODS: The ESPRESSO platform has a two-stage actuation system to position a stabilization tool on the eye, a proximity sensing unit to monitor the stabilization tool position, and a sensing unit to monitor the pressure exerted on the eye. The platform is tested in-vitro and ex-vivo with clinicians. A maximum pressure to be exerted on the eye is defined with expert ophthalmic surgeons to be 22 mmHg: physiological intraocular pressure (IOP) range is 10-21 mmHg. This pressure corresponds to a force of 0.3 N. RESULTS: The necessary contact force to have eye fixation (according to the clinicians' feedback) is evaluated: maximum values resulted always below 0.3 N. A maximum IOP increase of 4.67 mmHg is observed, that is a slight variation with respect to the performance of other platforms (IOP elevations up to 328 mmHg). CONCLUSION: Design and initial assessment of the platform is presented. Eye stabilization is performed without exceeding the critical contact force value and causing large/sudden IOP increases.

[The application of anterior segment optical coherence tomography in residual strabismus surgery].

OBJECTIVE: To evaluate the application of anterior segment optical coherence tomography (ASOCT) in surgical design for residual horizontal strabismus patients. METHODS: This article was a retrospective case series analysis. Total 20 residual strabismus patients (13 with residual exotropia and 7 with residual esotropia) in Eye Hospital of Wenzhou Medical University from Jan 2009 to Jan 2011 were studied. Routine strabismus examinations were completed preoperatively. The distance between insertion of horizontal rectus muscles and corneal limbus were measured with ASOCT preoperatively and calipers intraoperatively. Reoperational amount and method for residual strabismus patients were designed according to the limbus-insertion distance. The paired t test was used to compare the agreement between two methods of measurement of limbus-insertion distance. The cure rates of reoperation were analyzed. RESULTS: No statistical significance was observed between the measurements with ASOCT (7.7±1.7) mm and calipers (7.8±1.1)mm (t=-1.37, P=0.19). According to ASOCT image, the second surgical method was re-recession muscle for 4 patients; re-recession of original performed muscle combined with antagonist muscle resection for 10 patients and antagonist muscle resection combined with horizontal rectus muscle recession in fellow eye for 6 patients. All the surgical processes went on successfully, no severe intraoperative and postopereative complications were noted. Sixteen cases were cured (80%) . CONCLUSIONS: Horizontal rectus muscle evaluation with ASOCT preoperatively may benefit the choice of performed muscle, calculation of surgical amount, reduction of unnecessary surgical procedure and optimization second surgical design for residual strabismus patients. (Chin J Ophthalmol, 2016, 52: 568-573).