Safety of office-based lens surgery: U.S. multicenter study.

PURPOSE: To evaluate the rate of adverse events after office-based lens surgery performed across multiple private practices in the United States. SETTING: 36 private practices across the U.S. DESIGN: Retrospective multicenter study. METHODS: This analysis included case records of all consecutive patients who underwent office-based lens surgery for visually significant cataract, refractive lens exchange, or phakic intraocular lens implantation between August 2020 and May 2022 at 36 participating sites across the U.S. The study outcome measures included the assessment of intraoperative and postoperative complications such as the incidence of unplanned vitrectomy, iritis, corneal edema, and endophthalmitis after lens surgery. The frequency of patients requiring a return to the operating room (OR) or referral to a retina surgeon and the frequency of patients requiring hospitalization or calling emergency services (911) for any reason were also evaluated. RESULTS: The study reviewed 18 005 cases of office-based cataract or refractive lens surgery performed at 36 clinical sites. The rates of postoperative endophthalmitis, toxic anterior segment syndrome, and corneal edema were 0.028%, 0.022%, and 0.027%, respectively. Unplanned anterior vitrectomy was performed in 0.177% of patients. Although 0.067% of patients needed to return to the OR, 0.011% of patients were referred to the hospital. CONCLUSIONS: The rate of adverse events for office-based cataract or refractive lens surgery is similar to or less than the reported adverse event rate for modern cataract surgery in the ambulatory surgery center setting.

Corneal melt of incisions overlying corneal ring segments: case series and literature review.

PURPOSE: : To describe 4 cases of corneal melt encountered after insertion of intrastromal corneal ring segments (ICRS) for ectasia, propose a theory as to the etiology of the melt, and review relevant literature. METHODS: : Retrospective observational case series. Eyes with corneal melt after ICRS implantation were identified and the charts were reviewed. Relevant literature was reviewed to establish the overall incidence of corneal melt after ICRS and potential contributing factors. RESULTS: : Each of our 4 cases of corneal melt occurred in an eye with a corneal incision overlying the ICRS. Case 1 occurred in an eye with pellucid marginal degeneration in which the ICRS incision overlaid the segment. Case 2 occurred in an eye after radial keratotomy that underwent ICRS to address refractive instability. Corneal melt developed around a gaping radial keratotomy (RK) incision. Case 3 occurred in an eye after radial keratotomy and subsequent hyperopic laser in situ keratomileusis that developed ectasia for which an ICRS was inserted. Corneal melt developed in association with an RK incision overlying the ICRS in the area of a peripheral corneal ulcer. Case 4 occurred in an eye after radial keratotomy with an unstable cornea that underwent ICRS implantation for improved stability. The ring segment extruded through an overlying RK incision and corneal melt developed. The literature on ICRS implantation for keratoconus and ectasia was reviewed. Of 1835 eyes after ICRS implantation for keratoconus or ectasia, there were 12 reported cases of corneal melt (0.7%), a majority (7% or 58%) were associated with overlying incision. CONCLUSIONS: : Corneal melt is a rare complication of ICRS. We conclude that wound gape over ICRS contributes to the development of melt. Strategies can be employed to reduce the incidence of this rare but important complications of ICRS.

Lasers in refractive surgery: history, present, and future.

The history of laser refractive surgery is reviewed, followed by an overview of the current state of the field as well as a look at promising future developments.

Efficacy of laser in situ keratomileusis in correcting anterior and non-anterior corneal astigmatism: comparative study.

PURPOSE: To compare the efficacy of conventional laser in situ keratomileusis (LASIK) in treating corneal astigmatism and in treating noncorneal ocular residual astigmatism. SETTING: Private practice, Nashville, Tennessee, USA. DESIGN: Retrospective case series. METHODS: The records of dominant eyes of consecutive patients who had LASIK were retrospectively analyzed to compare the efficacy of LASIK in eyes with predominantly anterior corneal astigmatism with the efficacy in eyes with predominantly ocular residual astigmatism (ORA). The ORA was determined by vector analysis using refractive cylinder and topographic astigmatism. Preoperatively, the ratio of ORA to preoperative refractive cylinder (R) was used to divide the patients into 2 groups; that is, eyes with predominantly anterior corneal astigmatism (ORA/R ratio <1.0) and eyes with predominantly ORA (ORA/R ratio ≥1.0). Efficacy was determined by examining the magnitude of the remaining uncorrected astigmatism and comparing the index of success (proportion of preoperative refractive astigmatism that remained uncorrected by LASIK) between the 2 groups. RESULTS: The study evaluated 61 eyes of 61 patients. Conventional LASIK was twice as efficacious in the low-ORA group as in the high-ORA group. The index of success was 0.24 and 0.50, respectively, and the difference between groups was statistically significant (P = .036). CONCLUSION: The efficacy of astigmatic correction by LASIK was significantly higher in eyes in which the preoperative refractive astigmatism was located mainly on the anterior corneal surface than in eyes in which it was mainly located posterior to the anterior corneal surface.

The safety of intraocular ketorolac in rabbits.

PURPOSE: To assess the safety of a possible substitute treatment for intraocular steroid injections, intraocular injections of ketorolac tromethamine, one of the nonsteroidal anti-inflammatory drugs, were performed in rabbits. METHODS: Either 0.5% or 0.25% preservative-free ketorolac tromethamine ophthalmic solution (0.1 mL) was injected into the vitreous of the right eye of 15 rabbits. Physiologic saline solution (BSS; Alcon, Ft. Worth, TX) was injected into the left eye of each rabbit as a control. A standard electroretinogram and intraocular pressure measurements were obtained before injection, and repeated 1 day and 1, 2, 3, and 4 weeks after injection. After 4 weeks, the rabbits were euthanatized and the retinas examined by light and electron microscopy. Differences in the electroretinograms, intraocular pressure, and histopathology between the two eyes were recorded. Further, the elimination half-life of the drug in the vitreous was assessed. RESULTS: There were no statistically significant differences in electroretinograms, or intraocular pressure measurements obtained between the ketorolac-injected eyes and the control eyes. The half life of the drug was measured to be 2.3 hours. No histopathologic changes were observed in study eyes compared with control eyes. CONCLUSIONS: Preservative-free ketorolac tromethamine is nontoxic to the retinas of rabbits when injected intravitreally and could be considered as an alternative to intraocular steroid injections.

Identification of visually significant operculum without macular hole by optical coherence tomography.

CASE REPORT: We report a case that illustrates the effectiveness of optical coherence tomography (OCT) in identifying visually significant vitreoretinal interface opacities in the absence of a macular hole. A patient presented with a scotoma in the right eye. Fundoscopic examination revealed a small lesion in close proximity to the foveal avascular zone. OCT of the right eye revealed a small operculum in the vitreous anterior to the fovea without evidence of a macular hole. COMMENTS: To our knowledge, ours is the first reported case of the use of OCT to identify the presence of a visually significant operculum without an associated macular hole.

Processed human pericardium barrier for gold weight implantation.

PURPOSE: To determine the safety and efficacy of processed human pericardium as a barrier material for gold weight implantation. METHODS: In this retrospective, noncomparative case series, all patients undergoing gold weight implantation with human pericardium barrier between November 2000 and May 2002 were studied. Charts were reviewed for surgical indications, gold weight size, follow-up interval, and complications. RESULTS: Twenty-three eyelids of 23 patients underwent gold weight implantation with processed human pericardium barrier material. There were 15 female and 8 male patients. Mean patient age was 53 years (range, 22 to 78 years). Indications for surgery included extruded implant (4 eyelids), thin tissues overlying existing implant (3 eyelids), thin anterior lamellar eyelid tissues (6 eyelids), radiotherapy (1 eyelid), and requirement for long-term gold weight therapy (9 eyelids). Mean follow-up was 11 months (range, 3 to 36 months). Acceptable tissue coverage was found in 23 of 23 eyelids. There were no complications of infection, extrusion, or thinning of overlying tissues. One patient had prolonged eyelid edema and erythema that resolved spontaneously 3 months after surgery. CONCLUSIONS: Human pericardium appears to be well tolerated on at least a short-term basis within the eyelid when used as a barrier material for gold weight implantation.