Endothelial Cell Loss, Cumulative Dissipated Energy, and Surgically Induced Astigmatism in Sutureless Scleral Tunnel Phaco-Assisted Cataract Extraction in Advanced Cataracts.

Purpose: To evaluate sutureless scleral tunnel phaco-assisted cataract extraction in regards to the cumulative dissipated energy (CDE) used, the resulting endothelial cell loss (ECL), and the surgically induced astigmatism (SIA) in advanced cataracts. Methods: A prospective interventional uncontrolled case series was performed. Patients with advanced cataracts according to the Lens Opacities Classification System III (LOCS III) had sutureless scleral tunnel phaco-assisted cataract extraction. They were followed up one week, one month, and 3 months postoperatively for SIA and ECL. The used CDE was recorded. Results: The study included 198 eyes: 36 eyes (18.2%) with LOCS III grade nuclear opalescence (NO4) cataracts, 102 eyes (51.5%) with LOCS III grade NO5, and 60 eyes (30.3%) with LOCS III grade NO6. Three months postoperatively, the mean SIA was 0.94 ± 0.71D. The endothelial cell density (ECD) was reduced significantly to 2341.31 ± 471 cells/mm2 (p=0.0001) with a mean ECL of 5.39%. The mean CDE and ECL% were 0.174 ± 0.46 U/S (2.07%), 0.859 ± 0.42 U/S (5.01%), and 2.306 ± 0.89 U/S (8.01%) in LOCS III grade NO4, NO5, and NO6, respectively. The overall mean CDE was 1.17 ± 0.99 U/S, which was significantly correlated with the ECL (p=0.0001). Conclusion: Sutureless scleral tunnel phaco-assisted cataract extraction in advanced cataracts enabled reduction in CDE with good preservation of the ECD and acceptable SIA.

Trocar-assisted flanged transconjunctival intrascleral sutureless intraocular lens fixation.

PURPOSE: To study the safety and efficacy of 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation in patients with insufficient posterior capsular support. METHODS: Five aphakic eyes with capsular insufficiency were included in this prospective interventional case series study, at Dar El Oyoun Hospital, Cairo, Egypt. Twenty five-gauge trocar-assisted flanged intrascleral sutureless technique was used for IOL fixation, in which retinal microforceps were used to capture and externalize both haptics through a scleral tunnel. CDVA, IOP measurements and IOL centralization were reported pre- and one day, one & 3 months postoperatively. Any intra- or postoperative complications were recorded. RESULTS: The mean LogMAR CDVA had significantly improved one day, 1 & 3 months postoperatively (0.74 ± 0.1, 0.42 ± 0.07 and 0.26 ± 0.08 respectively, p < 0.001) compared to the preoperative value (1.7 ± 0.17). The mean IOP showed no significant changes along the follow-up period (16.9 ± 0.1; 16.2 ± 1.1; 16.3 ± 0.9 mmHg, p = 0.68, 0.58, 0.89) respectively at 1st day, 1 & 3 months postoperatively) compared to the preoperative measurement (16.4 ± 1.8 mmHg). The IOL was found to be centralized in all cases. No intra- or postoperative complications were encountered. CONCLUSION: 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation is found to be a reliable and effective technique that overcomes Yamane technique's challenges for IOL fixation in cases with posterior capsular insufficiency.

Short-term effect of weight loss after bariatric surgery on IOP, RNFL thickness, and the optic nerve head blood flow measured by OCTA.

PURPOSE: To study the influence of weight reduction after bariatric surgery on the intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness, and blood flow of optic nerve head by optical coherence tomography angiography (OCTA). METHODS: This prospective observational cohort study included 60 obese patients. Body mass index (BMI), IOP, RNFL, and ganglion cell complex (GCC) thickness, rim area, and radial peripapillary capillary (RPC) vessel density were assessed before and 3 months after bariatric surgery. RESULTS: The BMI and the IOP showed significant postoperative reduction to 40.45 ± 4.3 kg/m2 and 14.83 ± 2.5 mmHg while the preoperative results were 51.13 ± 4.83 kg/m2 and 16.95 ± 4.2 mm (p < 0.0001), respectively. No statistically significant change was detected in the RNFL, GCC thickness, rim area, or the RPC vessel density (p > 0.05). No statistically significant correlation was detected between the BMI changes and changes in the IOP, RNFL thickness, rim area, GCC thickness, or RPC vessel density. CONCLUSION: No significant effect of bariatric surgery on the RNFL thickness and the optic nerve head blood flow measured by OCTA despite a significant IOP reduction 3 months post-surgical. OCTA can be a useful tool to assess the short-term influence of significant weight reduction on the retinal microcirculation. SUMMARY: Despite a significant BMI and IOP reduction following bariatric surgery in obese patients, the vascular flow of the ONH, measured by OCTA, and the RNFL thickness were not significantly affected. The former might be attributed to the complex autoregulatory mechanisms related to the ONH and its microcirculation.

Seven-day storage of pneumatically dissected Descemet's endothelial grafts with and without Dua's layer.

PURPOSE: To evaluate the efficacy of big-bubble (BB) technique in separating Dua's layer together with the Descemet's membrane endothelial (DE) graft and the effect of 7-day storage of the prepared tissues on the endothelial cells. METHOD: This is an experimental study in which 21 human corneo-scleral tissues unsuitable for transplantation were used. Grafts were mounted on artificial chamber; epithelial side-up with BB technique was used to detach the DE graft. The resultant tissues were stored in tissue culture medium for 7 days. Dua's layer presence, endothelial cell density (ECD), endothelial cell loss and viability were assessed after the dissection and at 7 days after storage. RESULTS: Complete detachment of DE grafts was achieved in 20 cases (95.24%). Histological analysis revealed Dua's layer presence in 14 cases (70%). The mean ECD for the corneas before dissection was 2375 ± 338 cells/mm(2) with significant reduction to 2200 ± 319 cells/mm(2) (p < 0.00001) with endothelial cell loss of 7.3 ± 3.5% and non-viable cells of 6.5 ± 2.5% at the end of the 7-day storage. On comparing the dissected DE grafts with Dua's layer versus those without at 1 day after dissection and at 7 days after storage, we found no statistically significant changes in endothelial cell loss (p = 0.387; p = 0.836 respectively) and non-viable cells percentage (p = 0.180; p = 0.260, respectively). CONCLUSION: Big-bubble technique is reproducible in dissecting DE grafts with minimal damage to the endothelial cells. The percentage of endothelial cell loss and non-viable cells is similar in the DE grafts with/without Dua's layer after 7-day storage.

Combined intrastromal astigmatic keratotomy and laser in situ keratomileusis flap followed by photoablation to correct post-penetrating keratoplasty ametropia and high astigmatism: One-year follow-up.

PURPOSE: To evaluate a new technique combining intrastromal astigmatic keratotomy (AK) with a laser in situ keratomileusis (LASIK) flap followed by excimer laser photoablation to correct post-penetrating keratoplasty (PKP) high astigmatism and ametropia. SETTING: Kasr El Aini Hospital, Cairo University, Cairo, Egypt. DESIGN: Prospective interventional uncontrolled case series. METHODS: Patients with post-PKP high astigmatism and ametropia had paired intrastromal AK with LASIK flap using the M2 microkeratome followed 2 to 3 months later by excimer laser photoablation. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), mean refractive spherical equivalent (SE), and mean cylinder after each step and at the 1-year follow-up. RESULTS: The study comprised 20 eyes (20 patients). All parameters were significantly improved in all patients by the last follow-up visit. The mean UDVA improved from 1.07 logMAR ± 0.2 (SD) preoperatively to 0.23 ± 0.18 logMAR (P < .001), the mean CDVA improved from 0.79 ± 0.18 logMAR to 0.12 ± 0.12 logMAR (P < .001), the mean refractive SE improved from -5.04 ± 2.62 diopters (D) to -1.47 ± 1.32 D (P = .001), and the mean cylinder reduced from -5.39 ± 0.98 D to -1.05 ± 0.71 D (P < .001). The mean correction index was 0.84 ± 0.10, and the mean flattening index was 0.83 ± 0.10. Thirty-five percent of cases developed microperforations, and 15% developed epithelial ingrowth. CONCLUSION: This combined approach allowed for the correction of high astigmatism and ametropia following PKP; however, epithelial ingrowth requiring intervention is a complication to be considered. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of Artisan aphakic intraocular lens in cases of pediatric aphakia with insufficient capsular support.

PURPOSE: To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support. METHODS: In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients >2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth <3 mm, central endothelial cell density (CECD) <2500 cells/mm(²), uncontrolled glaucoma, or uveitis were excluded. Best-corrected visual acuity, intraocular pressure (IOP), and CECD were measured at 1, 6, and 12 months postoperatively. RESULTS: A total of 25 aphakic eyes of 18 patients (mean age, 7.86 ± 3.08 years) with insufficient capsular support for a standard posterior chamber IOL were included, 18 eyes with subluxated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95 ± 0.36; for patients with subluxation, 0.7 ± 0.26. Values improved at 1 year to 0.38 ± 0.15 (P < 0.002) and 0.3 ± 0.2 (P < 0.0001), respectively. One year after surgery the CECD (2892.64 ± 441.79 cells/mm(²)) was significantly reduced from the preoperative and 1 month postoperative values (3573.36 ± 468.9 cells/mm(2), 3081 ± 495 cells/mm(²); P < 0.0001, P < 0.02 resp.). Two cases (8%) developed traumatic dislocation. Pupillary block occurred in 1 case (4%). CONCLUSIONS: Artisan IOL implantation for pediatric aphakia achieved a good visual outcome.