Repositioned versus exchanged flanged intraocular lens fixation for intraocular lens dislocation.

This study aimed to compare the outcomes of flanged intraocular lens (IOL) fixation with new IOL exchange after dislocated IOL removal and repositioned dislocated IOL in patients with IOL dislocation. Eighty-nine eyes that underwent flanged IOL fixation were retrospectively included, with 51 eyes in the exchanged IOL group and 38 eyes in the repositioned IOL group. In both groups, best-corrected visual acuity (BCVA) improved at 1, 3, 6, and 12 months postoperatively and did not differ between the two groups at any of these time points. However, at 1 week postoperatively, BCVA in the repositioned IOL group improved compared with baseline, whereas that in the exchanged IOL group did not. Moreover, there were lesser changes in the corneal endothelial cell density (ECD) and corneal astigmatism in the repositioned IOL group than in the exchanged IOL group. The IOL positions, including IOL tilt and IOL decentration, were not different between the groups. Flanged IOL fixation with new IOL exchange and with repositioned dislocated IOL for patients with IOL dislocation had similar visual outcomes and IOL position. However, the latter had a smaller corneal ECD decrease and astigmatic change. This technique was effective in treating IOL dislocation while minimizing corneal injury.

Case report: Management of recurrent pupillary optic capture with sutureless surgical technique using 7-0 polypropylene flange.

Background: To report a novel surgical technique for recurrent pupillary optic capture after flanged intraocular lens (IOL) fixation. Methods: In this retrospective case series, we detail our use of two parallel 7-0 polypropylene sutures passed between the iris plane and the optic of scleral-fixated IOL to address pupillary optic capture. Flanges were created using ophthalmic cautery to secure it to the sclera without suture. Results: Two eyes with pupillary optic capture underwent a sutureless surgical technique using 7-0 polypropylene flanges. No recurrences of pupillary optic capture were observed during the 1-year follow-up. Conclusion: Our sutureless surgical technique using a 7-0 polypropylene flange was an effective, efficient, and less invasive approach for treating recurrent pupillary optic capture.

RISK FACTORS FOR PUPILLARY OPTIC CAPTURE FOLLOWING SUTURELESS FLANGED INTRAOCULAR LENS FIXATION FOR INTRAOCULAR LENS DISLOCATION.

PURPOSE: To identify risk factors for pupillary optic capture after sutureless flanged intraocular lens (IOL) fixation for IOL dislocation. METHODS: This retrospective comparative study enrolled consecutive patients who underwent flanged IOL fixation using 25-gauge pars plana vitrectomy. One hundred twenty-six eyes (126 patients) were divided into two groups according to the presence or absence of pupillary optic capture. A swept-source anterior segment optical coherence tomography and a rotating Scheimpflug camera were used to analyze and compare surgical parameters, including axial length, anterior chamber depth, differences in scleral tunnel angle and length, and IOL tilt and decentration, between the two groups. RESULTS: Compared with the nonpupillary optic capture group (106 eyes, 84.1%), the pupillary optic capture group (20 eyes, 15.9%) had larger differences in the nasal and temporal scleral tunnel angles and larger horizontal tilt (P < 0.05). Multivariate regression analysis demonstrated that these factors correlated with the occurrence of pupillary optic capture (P < 0.05). CONCLUSION: To prevent pupillary optic capture after flanged IOL fixation, surgeons should avoid asymmetry in the angles of the nasal and temporal scleral tunnels, which causes horizontal IOL tilt and subsequent pupillary capture.

Corrigendum: Customized Color Settings of Digitally Assisted Vitreoretinal Surgery to Enable Use of Lower Dye Concentrations During Macular Surgery.

[This corrects the article DOI: 10.3389/fmed.2021.810070.].

Customized Color Settings of Digitally Assisted Vitreoretinal Surgery to Enable Use of Lower Dye Concentrations During Macular Surgery.

PURPOSE: This study evaluated the color contrast ratio (CCR) of the internal limiting membrane (ILM) using different color settings of digitally assisted vitreoretinal surgery (DAVS) with different indocyanine green (ICG) concentrations.s. METHODS: This is a prospective comparative observational study. Consecutive patients that underwent 25G vitrectomy and ILM peeling using a standard operating microscope (SOM) (25 eyes), DAVS Ver. 1.1 (12 eyes), or DAVS Ver. 1.3 (13 eyes) were enrolled. The SOM and DAVS Ver. 1.1 groups used 0.075% ICG, and the DAVS Ver. 1.3 group used 0.025% ICG. In DAVS Ver. 1.1, macular CCR was compared between four different presets in the red, green, and blue channels: Default (Red (R) 100%, Green (G) 100%, and Blue (B) 100%); Preset 1 (R 20%, G 100%, B 100%); Preset 2 (R 80%, G 80%, B 100%), and Preset 3 (R 85%, G 100%, B 90%). In DAVS Ver. 1.3, macular CCR was evaluated using two different customized settings that modified the hue and saturation: Customized Setting 1 (R 86, G 100, B 100%, Hue +2°, Saturation 90%, Gamma 1.2) and Customized Setting 2 (R 90, G 100, B 100%, Hue +20°, Saturation 100%, Gamma 0.9). All patients underwent ophthalmologic examinations including BCVA at baseline and at 12 months. RESULTS: In DAVS Ver. 1.1, macular CCR was highest in Preset 3 (P < 0.01). The CCR of Customized Setting 2 of DAVS Ver. 1.3 using 0.025% ICG did not differ from that of Preset 3 in DAVS Ver. 1.1 using 0.075% ICG. Furthermore, there was no significant difference in BCVA between the Customized Setting 2 of DAVS Ver. 1.3 with 0.025% ICG and the Preset 3 of DAVS Ver. 1.1 with 0.075% ICG groups at baseline and at 12 months (P > 0.05, respectively). CONCLUSION: Customized DAVS settings enabled surgeons to use a 3-fold lower ICG concentration in ILM peeling.

ASSESSMENT OF HYPERREFLECTIVE FOCI AFTER BEVACIZUMAB OR DEXAMETHASONE TREATMENT ACCORDING TO DURATION OF MACULAR EDEMA IN PATIENTS WITH BRANCH RETINAL VEIN OCCLUSION.

PURPOSE: To evaluate the association between hyperreflective foci (HRF) on spectral domain optical coherence tomography and therapeutic effect of intravitreal bevacizumab (IVB) or intravitreal dexamethasone implants (IVD) according to macular edema (ME) duration in branch retinal vein occlusion. METHODS: Consecutive treatment-naive patients received IVB or IVD for at least 6 months. Each group was subdivided according to ME duration (<3 months vs. ≥3 months). Hyperreflective foci and best-corrected visual acuity were compared. RESULTS: Of 139 eyes (139 patients), 69 received IVB and 70 received IVD. At baseline, eyes with ME ≥ 3 months had more outer and total retinal HRF than eyes with ME < 3 months (P < 0.001 and P = 0.001). At 6 months, the IVD group exhibited a greater reduction in outer retinal HRF than the IVB group in both ME duration subgroups (P = 0.015 and P < 0.001). In the ME ≥ 3 months group, IVD resulted in greater best-corrected visual acuity improvement than IVB (P = 0.017). CONCLUSION: Increased outer retinal HRF at baseline in eyes with ME ≥ 3 months together with a greater reduction in HRF at 6 months and better visual outcomes after IVD suggests that the inflammatory aspect of disease should be considered in the treatment of ME. Thus, IVD injection could be more appropriate for patients with a longer ME duration after branch retinal vein occlusion.

A 1-Year Prospective Comparative Study of Sutureless Flanged Intraocular Lens Fixation and Conventional Sutured Scleral Fixation in Intraocular Lens Dislocation.

PURPOSE: To compare surgical outcomes of sutureless flanged intraocular lens (IOL) fixation and conventional sutured scleral fixation (SF) for secondary IOL implantation in patients with IOL dislocation. METHODS: This is a prospective, comparative cohort study on 103 consecutive patients (103 eyes) with IOL dislocation who underwent vitrectomy with IOL removal and sutured SF (53 eyes) or flanged IOL fixation (50 eyes). Operating time, best-corrected visual acuity (BCVA), refractive difference, IOL tilt and decentration using swept-source anterior segment OCT, and postoperative complications were measured for 12 months. RESULTS: Operating time was significantly shorter for the flanged IOL fixation than for sutured SF (19.4 ± 4.6 vs. 48.9 ± 5.2 min, p < 0.001). BCVA in both groups improved at 1, 3, 6, and 12 months postoperatively (p < 0.05). BCVA in the 2 groups was similar during the 12 months of observation. The refractive difference, IOL tilt, IOL decentration, and incidence of postoperative complications were also not different in the 2 groups. CONCLUSION: Sutured SF and flanged IOL fixation had similar visual outcomes and IOL stability in patients with IOL dislocation. However, the operating time for flanged IOL fixation was less than half that of the sutured SF. This technique is an efficient alternative for treating IOL dislocation.

Efficacy of postoperative mitomycin-C eye drops on the clinical outcome in endoscopic dacryocystorhinostomy.

PURPOSE: To evaluate the effect of postoperative topical mitomycin-C (MMC) eye drops in endoscopic (dacryocystorhinostomy) DCR and compare them with intraoperative MMC soaking. DESIGN: Retrospective, nonrandomized, interventional case series. METHODS: One hundred and sixty cases of endoscopic DCR with a single surgeon for primary nasolacrimal duct obstruction (NLDO) were included. Cases were divided into three groups. Group 1 was treated with intraoperative application of 0.02 % MMC for 5 min. Group 2 was treated with 0.02 % MMC eye drops for 5 days after surgery, without intraoperative application of MMC. Group 3 was the control group of cases without the use of MMC. Each group was evaluated for surgical success, presence of complications including granuloma, synechiae, and tube-induced inflammation, and the adverse effect of the MMC at least 6 months after the surgery. RESULTS: The success rate showed no significant difference among the three groups (P = .122, chi-square analysis). In the analysis between the two groups, although the success rate of Group 2 appeared not to be statistically different compared with that of Group 1 (P = .419, chi-square analysis), Group 2 had a statistically higher success rate for surgery than Group 3 (P = .041, chi-square analysis). The presence of granuloma was significantly lower in Group 1 than in the other two groups (P = .022, chi-square analysis). Synechiae and silicone tube-induced inflammation were not significantly different (P = .308, P = .881, chi-square analysis). There were no adverse effects associated with intraoperative or postoperative MMC application. CONCLUSION: Use of postoperative topical 0.02 % MMC is a safe and effective adjunctive modality to increase the success rate of endoscopic DCR.

Transient corneal edema is a predictive factor for pseudophakic cystoid macular edema after uncomplicated cataract surgery.

PURPOSE: To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME). METHODS: A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery. RESULTS: Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery. CONCLUSIONS: Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.

Retinal nerve fiber layer configuration in eyes with epiretinal membrane.

PURPOSE: To characterize configurations of the optic nerve head (ONH) and peripapillary retinal nerve fiber layer (RNFL) eyes with epiretinal membrane (ERM). METHODS: We reviewed medical records of consecutive patients with ERM who were examined between September 2012 and August 2013. Patients were categorized based on the severity of ERM on fundus imaging; patients with ERM but without retinal distortion were in group 1, and patients with ERM and retinal distortion were in group 2. Optic nerve head and RNFL parameters measured by spectral domain optical coherence tomography were assessed and compared between eyes with ERM and normal fellow eyes. RESULTS: There were no significant differences in ONH and RNFL parameters between ERM eyes and normal fellow eyes in group 1 (n = 12). In group 2 (n = 33), cup volume was smaller (p = 0.020), temporal quadrant RNFL thickness was greater by 18.8 ± 16.6 µm (p < 0.001), and RNFL peak angle was smaller by 18.7 ± 25.3 degrees in ERM eyes compared with fellow eyes (p = 0.001). In the 15 patients in group 2 who underwent ERM removal, temporal quadrant RNFL thickness decreased and the RNFL peak angle increased after the surgery (p = 0.008 and p = 0.001, respectively). CONCLUSIONS: The configurations of the ONH and peripapillary RNFL in eyes with ERM were different from those in fellow eyes. The characteristic configurations of RNFL such as small peak angle and temporal quadrant thickening may be considered when evaluating parameters as measured by spectral domain optical coherence tomography.

Vitreous hyper-reflective dots in optical coherence tomography and cystoid macular edema after uneventful phacoemulsification surgery.

PURPOSE: To report the observation of hyper-reflective dots in the vitreous cavity using spectral domain optical coherence tomography (SD-OCT) after uneventful phacoemulsification cataract surgery and to investigate their association with cystoid macular edema (CME). MATERIALS AND METHODS: Medical records of consecutive Asian patients who had no preoperative retinopathy and underwent uneventful phacoemulsification cataract surgery from March 2012 through February 2013 were reviewed. SD-OCTs were performed before, 1 week, and 1 month after surgery. The number of vitreous hyper-reflective dots (VHDs) was counted in 5 OCT images of high-definition 5-line raster scans. The development of CME was assessed using postoperative 1-month OCT. RESULTS: In 74 eyes of 74 patients, all of three SD-OCTs with a signal to noise ratio of 0.6 or more were available and were analyzed in this study. In preoperative OCT, the VHD was observed in 2 (2.7%) of 74 eyes; one eye had 1 VHD and the other eye had 2 VHDs. In 72 eyes with no preoperative VHD, VHDs were observed in 40 (55.6%) eyes at 1 week after the surgery. In the multivariate analysis, the number of VHDs measured at 1 week after the surgery was significantly associated with CME development at 1 month after the surgery (odds ratio = 1.93, 95% confidence interval = 1.15 to 3.24, P = 0.012). CONCLUSIONS: VHDs were frequently observed in OCT after uneventful phacoemulsification cataract surgery. VHDs observed at 1 week after the surgery may be a risk factor for the development of pseudophakic CME. Further studies are needed to identify the source of the VHDs.

A comparison of anchored conjunctival rotation flap and conjunctival autograft techniques in pterygium surgery.

PURPOSE: To compare conjunctival autograft and anchored conjunctival rotation flap techniques, in terms of recurrence and complication rates, after performing a primary pterygium surgery. METHODS: Sixty patients who underwent pterygium surgery, which was performed on 1 eye (M:F = 25:35), either using conjunctival autograft (25 eyes) or anchored conjunctival rotation flap (35 eyes) techniques, were followed up postoperatively for a minimum period of 18 months. The anchored conjunctival rotation flap surgery was conducted by designing a conjunctival flap with a similar shape as that of the autograft, but with the preservation of the inferior limbal anchoring point (1 mm) by the incomplete cutting of the limbal area. After rotation of the flap around the anchoring point, the flap was tightened with sutures to cover the bare scleral area. Early postoperative complications, such as flap or graft edema and granuloma formation, were assessed. The recurrence rate of pterygium was evaluated, and a comparison was made between the 2 surgical techniques. RESULTS: The recurrence rate was 8.0% in the conjunctival autograft group and 8.6% in the anchored conjunctival rotational flap group (P = 0.659). However, the occurrence of flap or graft edema was lower for anchored conjunctival rotational flap surgery (14.3% vs. 72.0%, P < 0.001). No granuloma formation was observed in either group. CONCLUSIONS: The anchored conjunctival rotational flap surgery showed similar pterygium recurrence rates and a lower incidence of flap edema, while enabling simple recognition of flap orientation, compared with the conjunctival autograft technique.

Predicting postoperative astigmatism using Scheimpflug keratometry (Pentacam) and automated keratometry (IOLMaster).

PURPOSE: To compare keratometry measurements obtained using an automated keratometer (AK, IOLMaster) and a Scheimpflug keratometer (Pentacam) in predicting residual astigmatism after cataract surgery. METHODS: Preoperative corneal astigmatism was calculated using preoperative refraction, an AK and a Scheimpflug keratometer (anterior corneal power [ACP] and true net power [TNP]) in 155 eyes of 107 Asian subjects. Phacoemulsification cataract removal and nontoric intraocular lens insertion (Akreos(®)MI-60™, Bausch & Lomb, Rochester, NY, USA) were performed through a 2.8 mm temporal clear corneal incision. Six months later, postoperative astigmatism (postA) was calculated using manifest refraction. Error angle (EA) and error magnitude (EM) of above keratometries (AK, ACP, and TNP) in prediction of postA was calculated. The correlation between preoperative astigmatism and postA was analyzed using power vectors (J(0) and J(45)). RESULTS: AK resulted in the lowest EM and ACP resulted in the lowest EA. Preoperative astigmatism (preA) measured using AK, ACP, and TNP showed significant correlation with postA in both J(0) and J(45) components. (AK: rJ(0) = 0.554, rJ(45) = 0.559, ACP: rJ(0) = 0.346, rJ(45) = 0.281, TNP: rJ(0) = 0.409, rJ(45) = 0.231). Preoperative refractive astigmatism showed no significant correlation in any components. CONCLUSIONS: PreA determined using AK showed superior performance in prediction of postA than ACP and TNP.