Paresthesia and hypesthesia in the dorsum of the foot as the presenting complaints of a ganglion cyst of the foot.

Although ganglion cysts of the foot represent a substantial amount of lumps in this region, they rarely cause peripheral nerve symptoms. We describe the clinical case of a 43-year-old female with complaints in the previous three months of hypesthesia and paresthesia in the anterior portion of the medial half of the dorsum of her left foot that extended into the first interdigital cleft. She associated the start of her neurological symptoms to the appearance of a lump in the dorsum of the foot. A presumptive diagnosis of compression of the medial branch of the deep fibular nerve and of the medial dorsal cutaneous nerve in the dorsum of the foot by a ganglion cyst was made. Ultrasonography confirmed the cystic nature of the lesion and surgery allowed complete excision of a mass arising from the joint between the medial and intermediate cuneiform bones that was compressing the deep fibular nerve and the medial dorsal cutaneous nerve. Pathological examination confirmed that the lesion was a cystic ganglion. As far as the authors know, the simultaneous compression of the medial branch of the deep fibular nerve and of the medial dorsal cutaneous nerve in the dorsum of the foot by a ganglion cyst has not been described before.

Comparison of Surgically Induced Astigmatism and Morphologic Features Resulting From Femtosecond Laser and Manual Clear Corneal Incisions for Cataract Surgery.

PURPOSE: To compare the surgically induced astigmatism (SIA) vector, flattening effect, torque, and wound architecture following femtosecond laser and manual clear corneal incisions (CCIs). METHODS: In a double-armed, randomized, prospective case series, cataract surgery was performed for 600 eyes using femtosecond laser (300 eyes) or manual (300 eyes) 2.4-mm CCIs in temporal or superior oblique locations. SIA, flattening effect, torque, and the summated vector mean for SIA were calculated. Correlation with individual features was established and incision morphology was investigated by anterior segment optical coherence tomography at 3 months of follow-up. RESULTS: The SIA, flattening effect, and torque were lower in the femtosecond laser group for both incision locations, although the differences were not significant (all P > .05). The femtosecond laser group showed less dispersion of SIA magnitude and flattening effect. Temporal and superior oblique incisions resulted in flattening effect values of -0.11 and -0.21 diopters (D), respectively, in the femtosecond laser group and -0.13 and -0.34 D, respectively, in the manual group. Significant correlations with individual features were only found in the femtosecond laser group, with preoperative astigmatism being the only significant SIA predictor by multiple regression analysis (P = .003). Femtosecond laser CCIs showed less deviation from the intended length, wound enlargement, endothelial misalignment, and Descemet membrane detachments (all P < .037). CONCLUSIONS: Femtosecond laser CCIs were more reproducible. Although SIAs were smaller in femtosecond laser CCIs than in manual CCIs for both temporal and superior oblique incisions, the difference was not statistically significant. Association with individual features is highly variable. [J Refract Surg. 2018;34(5):322-329.].

Comparison of Methodologies Using Estimated or Measured Values of Total Corneal Astigmatism for Toric Intraocular Lens Power Calculation.

PURPOSE: To compare the prediction error in the calculation of toric intraocular lenses (IOLs) associated with methods that estimate the power of the posterior corneal surface (ie, Barrett toric calculator and Abulafia-Koch formula) with that of methods that consider real measures obtained using Scheimpflug imaging: a software that uses vectorial calculation (Panacea toric calculator: http://www.panaceaiolandtoriccalculator.com) and a ray tracing software (PhacoOptics, Aarhus Nord, Denmark). METHODS: In 107 eyes of 107 patients undergoing cataract surgery with toric IOL implantation (Acrysof IQ Toric; Alcon Laboratories, Inc., Fort Worth, TX), predicted residual astigmatism by each calculation method was compared with manifest refractive astigmatism. Prediction error in residual astigmatism was calculated using vector analysis. RESULTS: All calculation methods resulted in overcorrection of with-the-rule astigmatism and undercorrection of against-the-rule astigmatism. Both estimation methods resulted in lower mean and centroid astigmatic prediction errors, and a larger number of eyes within 0.50 diopters (D) of absolute prediction error than methods considering real measures (P < .001). Centroid prediction error (CPE) was 0.07 D at 172° for the Barrett toric calculator and 0.13 D at 174° for the Abulafia-Koch formula (combined with Holladay calculator). For methods using real posterior corneal surface measurements, CPE was 0.25 D at 173° for the Panacea calculator and 0.29 D at 171° for the ray tracing software. CONCLUSIONS: The Barrett toric calculator and Abulafia-Koch formula yielded the lowest astigmatic prediction errors. Directly evaluating total corneal power for toric IOL calculation was not superior to estimating it. [J Refract Surg. 2017;33(12):794-800.].

Comparison of astigmatic prediction errors associated with new calculation methods for toric intraocular lenses.

PURPOSE: To compare the prediction errors in residual astigmatism associated with new calculation methods for toric intraocular lenses (IOLs). SETTING: Hospital da Luz, Lisbon, Portugal. DESIGN: Retrospective case series. METHODS: In eyes having cataract surgery with toric IOL implantation (Acrysof IQ), the predicted residual astigmatism by each calculation method was compared with the manifest refractive astigmatism. The prediction error in residual astigmatism was calculated by vector analysis. RESULTS: The study evaluated 86 eyes (86 patients). All calculation methods resulted in overcorrection of with-the-rule astigmatism and undercorrection of against-the-rule astigmatism. For the original Alcon calculator, the centroid prediction error was 0.43 @ 170, which was reduced by the application of the Baylor nomogram (0.35 @ 169) or the Abulafia-Koch formula (0.34 @ 170). For the Holladay toric calculator, the centroid prediction error was 0.40 @ 168, which was reduced by the Baylor nomogram (0.35 @ 169), the Abulafia-Koch formula (0.25 @ 158), and the Goggin coefficient of adjustment (0.38 @ 170). The Barrett calculator and the newly introduced Alcon calculator yielded the lowest centroid prediction errors (0.17 @ 165 and 0.19 @ 164, respectively). The centroid prediction error of ray-tracing calculations (PhacoOptics) using real posterior corneal surface measurements was 0.32 @ 171. CONCLUSIONS: The Barrett toric calculator and the new Alcon calculator yielded the lowest astigmatic prediction errors. Of the nomogram methods, application of the Abulafia-Koch formula achieved the best results. The outcomes of toric IOL implantation might be improved by using 1 of these calculation methods.

Ocular biometric measurements in cataract surgery candidates in Portugal.

OBJECTIVE: Describe the ocular biometric parameters and their associations in a population of cataract surgery candidates. METHODS: A cross-sectional study of 13,012 eyes of 6,506 patients was performed. Biometric parameters of the eyes were measured by optical low-coherence reflectometry. The axial length (AL), mean keratometry (K) and astigmatism, anterior chamber depth (ACD) (epithelium to lens), lens thickness (LT), and Corneal Diameter (CD) were evaluated. RESULTS: The mean age was 69 ± 10 years (44-99 years). Mean AL, Km, and ACD were 23.87 ± 1.55 mm (19.8-31.92 mm), 43.91 ± 1.71 D (40.61-51.14 D), and 3.25 ± 0.44 mm (2.04-5.28 mm), respectively. The mean LT was 4.32 ± 0.49 mm (2.73-5.77 mm) and the mean CD was 12.02 ± 0.46 mm (10.50-14.15 mm). The mean corneal astigmatism was 1.08 ± 0.84 D (0.00-7.58 D) and 43.5% of eyes had astigmatism ≥ 1.00 D. Male patients had longer AL and ACDs (p < .001) and flatter corneas (p < .001). In regression models considering age, gender, Km, ACD, LT, and CD, a longer AL was associated with being male and having higher ACD, LT and CD. CONCLUSIONS: These data represent normative biometric values for the Portuguese population. The greatest predictor of ocular biometrics was gender. There was no significant correlation between age and AL, ACD, or Km. These results may be relevant in the evaluation of refractive error and in the calculation of intraocular lens power.