Cataract surgery using two 3D visualization systems: Complication rates, surgical duration & comparison with traditional microscopes.

PURPOSE: To compare the complication rates and surgical duration of cataract surgery using two 3D visualization systems and a traditional binocular microscope among experienced and inexperienced surgeons. METHODS: This retrospective case series included 571 eyes that received cataract surgery using either heads up cataract surgery, via a 3D head mounted system (N = 148-Group 1) or a 3D display screen (N = 338 eyes-Group 2), or traditional binocular microscope (N = 85 eyes-Group 3). The surgical records of consecutive patients who underwent cataract surgery by two groups of surgeons (experienced and inexperienced) were reviewed. Patients in all groups received either femtosecond laser assisted cataract surgery (FLACS) or traditional phacoemulsification. Complication rate, as well as duration of cataract surgery were evaluated between all three visualization approaches, between experienced and inexperienced surgeons. RESULTS: There was no statistically significant difference in duration of surgery between all 3 visualization approaches for both experienced and inexperienced surgeons (p < 0.05). Furthermore, the type of surgical technique (manual or FLACS) did not affect the surgical duration for both experienced and inexperienced surgeons (p < 0.05). No intraoperative complications were demonstrated in the current cohort. CONCLUSIONS: The implementation of heads up-3D visualization either through a screen or a head mounted platform for cataract surgery seems to offer similar safety and efficiency as the traditional binocular microscope, and both experienced and inexperienced surgeons demonstrate the same outcomes in terms of safety and efficiency.

ZEPTO-assisted pseudophakic capsulotomy: Precision pulse technology for management of capsular contraction syndrome.

We describe a novel technique that uses precision pulse capsulotomy (PPC) to perform a secondary capsulotomy for the management of anterior capsule contraction syndrome (ACCS), a condition that comprises a late complication after cataract surgery and intraocular lens (IOL) implantation. Micropulse secondary capsulotomy offers a controlled and safe approach for patients with severe anterior capsule contraction syndrome and may be considered as an alternative surgical technique.

Current Developments in the Management of Amblyopia with the Use of Perceptual Learning Techniques.

Background and Objectives: Amblyopia is a neurodevelopmental disorder caused by interocular suppression of visual input, affecting visual acuity, stereopsis, contrast sensitivity, and other visual functions. Conventional treatment comprises occlusion of the sound eye. In recent years, novel therapies that deploy perceptual learning (PL) principles have been introduced. The purpose of this study is to assess the latest scientific data on this topic. Materials and Methods: For this purpose, we conducted a literature search for relevant studies published during the previous 4 years (2020-2023). Results: A plethora of visual perceptual learning protocols have been recently developed. Dichoptic video games, contrast rebalanced movies, and online perceptual training platforms are the main formats. Perceptual learning activates neuroplasticity, overcomes interocular suppression, and improves the visual impairments induced by amblyopia. Conclusions: This novel treatment is effective in both children and adults, as well as in patients non-responding to patching.

Short-Term Refractive Outcomes of Pseudomyopia Induced by Ocular Blunt Trauma.

A teenage female patient visited the ophthalmology emergency department reporting blunt ocular trauma from a stretched elastic band, accompanied by blurred vision. At presentation, uncorrected visual acuity (VA) was 6/60 in the affected eye, improving to 6/7.5 with pinhole. A slit lamp examination showed a mild anterior chamber reaction and iridoplegia with pupil shape irregularity. Gonioscopy revealed partial cyclodialysis with angle recession. Fundoscopy revealed focal commotio retinae with blot hemorrhages. B-scan ultrasonography yielded no pathology. Follow-up examination, the day after the injury, included detailed refraction, which showed a myopic shift in the affected eye. Uncorrected VA improved to 6/15 and the patient achieved 6/7.5 with correction. Clinical findings indicated myopia, which resolved within one week from the incident, and refractive error rapidly decreased to prior emmetropic values.

Descemet's Stripping Automated Endothelial Keratoplasty Using Donor Tissue from an 83-Day-Old Infant.

Purpose: To report a case of Descemet stripping automated endothelial keratoplasty (DSAEK) combined with phacoemulsification in an adult recipient using endothelial graft from an 83-day-old infant donor. Methods: A corneoscleral button was obtained from an infant donor and a DSAEK graft was prepared using a microkeratome. In comparison to the standard technique of DSAEK graft preparation some modifications were made in order to avoid inadvertent perforation, as the donor cornea had a very spherical shape, probably due to the very young age of the donor. The DSAEK graft was transplanted to the left eye of a 68-year-old woman suffering from Fuchs' endothelial dystrophy. Her preoperative best-corrected visual acuity (BCVA) in that eye was 20/100 and central corneal thickness 831 µm. Results: An uneventful DSAEK combined with phacoemulsification was performed. The main complication noted was detachment of the peripheral part and contraction of the corneal graft, observed two months after the procedure. The implanted tissue remained centrally attached with a BCVA of 20/40, 3 years postoperatively. Conclusion: This case report highlights the difficulties emerging from preparation and implantation using an endothelial graft tissue from the youngest ever reported donor.

Potential Ophthalmological Side Effects Induced by Anti-Neoplastic Regimens for the Treatment of Genitourinary Cancers: A Review.

The outcomes of patients with genitourinary (GU) cancers have been steadily improving in recent years. Novel therapies have entered our armamentarium, while several other regimens are currently being studied in clinical trials. This recent explosion of new agents has improved patient survival and the quality of life for patients, but has also significantly increased the frequency of several side effects. The current review will focus on the potential ocular adverse reactions of GU neoplastic treatments. The broad spectrum of manifestations of ocular toxicity underscores the uniqueness and complexity of the anatomic, physiologic, and metabolic features of the human eye. Most side effects are mild in severity and transient, but some can be severe, disabling, and irreversible. Clinicians should be aware of complications that might be vision threatening and impact the patient's quality of life. In this review, we focused on the ocular toxicity of the antineoplastic regimens that are currently used for the treatment of GU, including prostate cancer, bladder cancer, renal cell carcinoma, testicular cancer, pheochromocytoma, adrenocortical carcinoma, and penile cancer.

Incidence and Risk Factors of Bilateral Herpetic Keratitis: 2022 Update.

Simultaneously occurring bilateral herpetic keratitis is a rare clinical manifestation of ocular herpes. Immunocompromised patients are more susceptible to develop bilateral disease. The purpose of this study is to review recent literature on the topic and to highlight latest updates, regarding risk factors and possible correlations to the disease, as well as new therapeutic options.

Clinical variations and therapeutic challenges in the management of symptomatic retinal artery macroaneurysm: a tertiary center experience.

PURPOSE: To find out clinical characteristics, therapeutic options, and visual outcome in symptomatic retinal artery macroaneurysm (RAMA) patients. METHOD: Newly diagnosed cases of symptomatic RAMA from January 2015 to December 2019 were included. Fifteen eyes of 15 patients with mean age 62.46 years ± 14.89 (SD) fulfilled the inclusion criteria. RESULT: Hypertension was present in 66.6% of the patients, and the commonest site was superotemporal (12 eyes, 80%). The most commonly employed treatment was Nd: Yag laser hyaloidotomy in 4 eyes (26.6%). Other treatments were intravitreal bevacizumab in 3 eyes (20%), focal laser with intravitreal bevacizumab in 3 eyes (20%), PPV with focal laser (13.3%) in 2, focal laser only in one (6.6%), PPV with focal and intravitreal bevacizumab in one (6.6%). The mean best-corrected visual acuity (BCVA) at baseline was 1.35 ± 0.84 LogMAR, which improved to 0.39 ± 0.53 LogMAR at the last follow-up. Presenting VA 0.77 (±0.40) improved to 0.20 (±0.17) p value (0.180) in intravitreal bevacizumab only group, 1.29 (±0.35) to 0.75 (±0.15) p value 0.66 in Nd: Yag laser group, 2.67 (±0.58) to 0.46 (±0.28) p value 0.019 in PPV group and did not improve in combined anti-VEGF and focal laser group due to dense hard exudates at the fovea in one and persistent cystoid macular edema in another case. CONCLUSION: With regard to its presentation, which can vary tremendously, there are no approved guidelines for its treatment. The present study reinforces the need for a treatment guideline development. Customization of treatment should be considered depending on the clinical presentation of each case.

Emerging Treatment Modalities for Neovascular Age-Related Macular Degeneration: A Systematic Overview.

INTRODUCTION: Neovascular age-related macular degeneration (nAMD) represents a leading cause of irreversible visual loss affecting the quality of life of millions of elderly patients worldwide. Although the introduction of intravitreal injections with anti-vascular endothelial growth factors (anti-VEGF) agents has revolutionized the management of nAMD, their effectiveness and ultimate success are limited by several therapeutic challenges. Consequently, real-world efficacy appears significantly inferior to that reported by randomized controlled trials. Therefore, further innovative, long-term treatment options are essential to improve the prognosis and outcome of nAMD therapy. METHODS: Emerging pharmacological therapies for nAMD and those currently in clinical trials are reviewed and their mechanism of action, safety, and efficacy are discussed. The evidence presented herein has been collected from online databases PubMed, Cochrane library, and the ClinicalTrials.gov site. RESULTS: A number of promising technologies and novel anti-VEGF therapies are currently being tested and some have already reached phase III trials. Anti-VEGF agents with enhanced durability and possibly efficacy, gene therapy, angiogenic targets, alternative drug delivery routes such as sustained delivery implants, drug carriers, and encapsulated cell technology are currently being explored. We briefly discuss the potential value of these options. CONCLUSION: Several options may optimize future nAMD management. On the basis of current, albeit limited evidence, the most promising technology to reach clinical practice soon appears to be the sustained drug delivery options, which may improve visual outcome and reduce the socioeconomic burden of nAMD.

Cataract Services in Greek Public Hospitals through and after the Austerity Period.

The recent financial crisis caused several problems in the health systems of affected countries like Greece. The present short report highlights several issues regarding the operation of cataract services in Greek public hospitals while certain acts are proposed to cope with recently appeared tight spots. The final aim is to promote relevant discussion in Greece and countries in the region that similar conditions may apply. The cataract service is one of the busiest parts of modern ophthalmology clinics and since they are considered high cost procedures, are affected by limited monetary funding. Institution of a national cataract institute could improve the quality of provided services: To reduce waiting period for a cataract operation, secure safety of procedures and maintain an adequate level of cataract surgeons training.

Teleophthalmology and Artificial Intelligence As Game Changers in Ophthalmic Care After the COVID-19 Pandemic.

The current COVID-19 pandemic has boosted a sudden demand for telemedicine due to quarantine and travel restrictions. The exponential increase in the use of telemedicine is expected to affect ophthalmology drastically. The aim of this review is to discuss the utility, effectiveness and challenges of teleophthalmological new tools for eyecare delivery as well as its implementation and possible facilitation with artificial intelligence. We used the terms: "teleophthalmology," "telemedicine and COVID-19," "retinal diseases and telemedicine," "virtual ophthalmology," "cost effectiveness of teleophthalmology," "pediatric teleophthalmology," "Artificial intelligence and ophthalmology," "Glaucoma and teleophthalmology" and "teleophthalmology limitations" in the database of PubMed and selected the articles being published in the course of 2015-2020. After the initial search, 321 articles returned as relevant. A meticulous screening followed and eventually 103 published manuscripts were included and used as our references. Emerging in the market, teleophthalmology is showing great potential for the future of ophthalmological care, benefiting both patients and ophthalmologists in times of pandemics. The spectrum of eye diseases that could benefit from teleophthalmology is wide, including mostly retinal diseases such as diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration but also glaucoma and anterior segment conditions. Simultaneously, artificial intelligence provides ways of implementing teleophthalmology easier and with better outcomes, contributing as significant changing factors for ophthalmology practice after the COVID-19 pandemic.

Outcomes of toric IOL implantation guided by iris-registered femtosecond laser capsulotomy markings.

PURPOSE: To assess the accuracy and stability of iris-registered femtosecond laser-assisted anterior capsule axis markings (compensating cyclotorsion) along with refractive and visual outcomes after toric IOL implantation. METHODS: This prospective case series included eyes with visually significant cataracts and regular corneal astigmatism ranging from 1.25D to 4.0D, which received FLACS and toric IOL implantation, at The Eye Institute of West Florida, Largo, Florida, USA. Preoperative iris registration was used in conjunction with a femtosecond laser platform to create cyclotorsion corrected axis marks at the capsulotomy edge to facilitate toric IOL axial alignment. Patients were examined one, seven and thirty days after surgery to assess capsulotomy marks axis, toric IOL axis along with visual and refractive outcomes. RESULTS: Eighteen eyes of 13 patients aged 74.35 ± 8.65 years were included. Mean pre-op CDVA was 0.24 ± 0.16 LogMAR, while mean post-op UDVA was 0.09 ± 0.09 LogMAR. Mean pre-op corneal astigmatism was 1.85 ± 0.41 D, decreasing to 0.24 ± 0.41 D of refractive astigmatism postoperatively (p < 0.001). The capsular toric axis markings were visible in 100% of eyes throughout the follow-up; the mean difference between intended capsulotomy mark axis and measured capsulotomy mark axis was 1.6°, 1.7° and 1.3 o at the 1, 7 and 30 day intervals (p > 0.05), respectively. No capsule-related or any other type of complications was noted. CONCLUSIONS: Iris-registered femtosecond laser-assisted anterior capsule axis markings are safe and may be considered as an alternative option to the known axis marking techniques for toric IOL axial alignment at the time of cataract surgery.

Branch Retinal Vein Occlusion as a Rare Presentation of Antisynthetase Syndrome.

A 52-year-old woman developed branch retinal vein occlusion (BRVO) in her right eye, resulting in blurred vision with visual acuities of 6/9 and 6/6-2 in the affected and unaffected eye respectively (Snellen). The patient was successfully treated with a course of eight intravitreal aflibercept injections, improving binocular visual acuity to 6/6. During the course of her ocular management, she was admitted for acute dyspnoea secondary to interstitial lung disease (ILD). The patient was diagnosed with the antisynthetase syndrome (ASS), testing positive for PL-7 auto-antibodies. ASS may have a systemic association with BRVO; although ASS is a rare condition, it should be suspected and investigated in patients with risk factors, particularly if they present with symptoms of ILD. Early ocular intervention is associated with excellent visual outcomes, and prompt diagnosis and treatment of ASS may potentially reduce risks of further retinal vaso-occlusive episodes.

Cystoid Macular Edema Associated With Venous Stasis in a Patient With Previously Undiagnosed Hyperhomocysteinemia.

A 74-year-old female patient visited our department reporting unilateral painless vision reduction in her left eye noticed a few months ago. Clinical examination revealed decreased visual acuity in the left eye. Fundoscopy showed bilateral retinal venous stasis with cystoid macular edema in the affected eye, also confirmed by optical coherence tomography (OCT) imaging. OCT angiography showed no evidence of ischemia. Bilateral findings raised suspicion for a systemic underlying cause. Laboratory tests showed elevated homocysteine plasma levels. Brain MRI showed ischemic encephalopathy. Hyperhomocysteinemia creates a hypercoagulable state and therefore it is a risk factor for vascular thrombosis and retinal vein occlusion. Our patient was considered to suffer from an impending retinal vein occlusion due to venous stasis, causing a persistent macular edema, and, therefore, was treated with anti-vascular endothelial growth factor (VEGF) injections. She was also prescribed oral folic acid for life. Her visual acuity showed improvement and remained stable for a long period of time. When macular edema reoccurred she was treated with another intravitreal injection.

Outcomes of toric intraocular lens implantation after femtosecond laser and traditional cataract surgery.

CLINICAL RELEVANCE: Having an understanding of the refractive outcomes of different forms of cataract surgery will assist optometrists in explaining the implication of such procedures to patients being referred for such procedures. BACKGROUND: The purpose of this study was to compare the refractive outcomes after toric intraocular lens implantation between femtosecond laser-assisted cataract surgery and traditional phacoemulsification. METHODS: This retrospective non-randomised case series included 114 eyes of 92 consecutive patients (59 male and 55 female) aged 71.65 ± 10.46-years (range 57 to 92-years), who underwent either femtosecond laser-assisted cataract surgery (using two laser platforms) (group 1) or traditional phacoemulsification (group 2) between August 2013 and September 2015. Pre-operative keratometric values, the attempted refraction from the biometry platform and the toric intraocular lens web-based calculator, and the one month post-operative manifest refraction were assessed to evaluate the refractive outcomes of the two groups. RESULTS: Mean pre-operative topographic corneal astigmatism was -1.94 ± 0.73 D (range 0.91 to 4.61 D) and -1.98 ± 0.60 D (range 1.07 to 3.43 D) for groups 1 and 2, respectively (p > 0.05). Mean axial length was 24.22 ± 0.73-mm (range 21.78 to 29.30-mm) and 24.60 ± 1.09-mm (range 21.82 to 25.95-mm) for groups 1 and 2, respectively (p > 0.05). Multivariate vector analysis of the remaining refractive error between the two groups (desired refraction minus achieved refraction) revealed no statistically significant difference (p > 0.05). Analysis within each group demonstrated a higher accuracy of refractive outcomes for the femtosecond laser-assisted cataract surgery eyes (p < 0.05) when compared to the traditional phacoemulsification (p > 0.05). CONCLUSION: Femtosecond laser-assisted cataract surgery and traditional phacoemulsification demonstrate similar refractive outcomes after toric intraocular lens implantation, while femtosecond laser-assisted cataract surgery seems to provide a slightly higher accuracy.

The use of fibrin glue during aqueous shunt surgery.

PURPOSE: To examine the safety and economic effect of using fibrin glue to reduce suturing of a donor patch graft and in conjunctival closure during aqueous shunt implantation. STUDY DESIGN: Retrospective interventional case series of 150 patients from a single institution including historical controls from before the introduction of the change in technique. The surgery was performed by multiple glaucoma surgeons. RESULTS: One hundred and fifty eyes of 150 patients were identified. The mean age was 54.3 ± 21.1 years. Previous surgery included: cataract extraction (34.7%), trabeculectomy (36%) and retinal surgery (15.3%). All operations were carried out by either a consultant (57%) or fellow (43%). A Baerveldt Glaucoma Implant (Advanced Medical Optics, Santa Ana, California, USA) was used in 149 eyes. Conventional surgery (CS) was performed for 91 eyes and fibrin glue (FG) was used for 59 eyes. Compared with conventional surgery (CS) in which the donor patch graft and conjunctiva were sutured, use of fibrin glue (FG) reduced the overall mean operating time by 11.2 min ± 6.4 min (P = 0.031), though much less for consultants (8.5 min ± 6.2 min) (P = 0.16) than fellows (32.9 min ± 7.2 min) (P < 0.0001). There were four cases of conjunctival dehiscence-three in the FG group and one in the CS group (P = 0.30). Only one patient required re-suturing in the FG group. CONCLUSIONS: The use of fibrin glue is safe and effective during aqueous shunt implantation. We have shown that the mean operating time can be reduced significantly with the use of fibrin glue which has significant implications for resource utilisation.

Reoperations After Cataract Surgery: Is the Incidence Predictable Through a Risk Factor Stratification System?

Introduction The objective of the study was to quantify the number of procedures needed to achieve the best possible surgical outcome, depending on the number and type of risk factors identified. Methods Two independent observers reviewed the medical records of 1,502 patients who underwent phacoemulsification surgery, during a two-year period (January 1, 2014 to December 31, 2015). Preoperative risk factors were documented according to the stratification system used. Based on the total risk score, each case was allocated to one of four risk groups with 0, 1-2, 3-5, and >6 total risk factors, respectively. All qualitative and quantitative characteristics were gathered and included in a multivariate analysis. Results A total of 1,792 eyes were included. Αge over 88 years, low cooperation ability with the patient, and surgeries performed by residents tended to have more often complications, while white/intumescent cataract, iridodonesis/phacodonesis, α1 blockers intake, and male gender are risk factors positively associated with more than one surgery. Conclusions Risk factors tend to be prognostic for possible intraoperative complications. The number of procedures needed for the best possible surgical outcome seems to depend on these preoperative risk factors. A stratification method increases the level of awareness of the surgeon, and therefore may decrease the number of complications and even procedures while enhancing the "safe" practice and skills of residents.