In office management of optic capture of scleral fixated posterior chamber intraocular lenses.

INTRODUCTION: Optic capture of sutured scleral fixated posterior chamber intraocular lenses (PC IOLs) is an occasional complication resulting in blurred vision and discomfort. METHODS: A retrospective study of the management of 18 eyes (3.6%) with optic capture out of 495 eyes with scleral fixated IOLs during the study period. 54 procedures were performed in the management of optic capture of sutured scleral fixated PC IOLs. An in-office technique was utilized to relieve the optic capture by repositioning the optic posterior to the iris. This technique was performed after topical anesthesia and topical 5% betadine with the patient stably positioned at the slit lamp. Using a 30-gauge needle, sometimes after a 15-degree paracentesis blade, the needle was advanced in a parallel plane above the iris until the tip reached the edge of the captured optic. The optic is engaged in the inferior periphery away from the central visual axis, and pushed gently posteriorly just enough to reposition the optic posterior to the iris. In some cases, pilocarpine 2% drops were utilized after the procedure to decrease the risk of recapture of the optic. RESULTS: All 54 procedures were successfully performed in the office without significant pain or discomfort. Vision before optic capture, during optic capture, and at the first office visit after optic capture were comparable. There were not any cases of endophthalmitis, hyphema, iris trauma, iris prolapse or keratitis. While eight patients only had one episode of optic capture, 10 patients had multiple episodes of optic capture, all managed with this in office procedure. Recurrent optic capture occurred more frequently in eyes with fixation at less than 2 mm from the limbus than eyes with scleral fixation at 2 mm from the limbus. CONCLUSION: Reposition of the optic after pupillary capture of a scleral fixated PC IOL can be successfully performed in the office without discomfort or significant complications and is an alternative management option to a return to the operating room. This procedure may be especially important when there is poor access to the operating room or restricted access to the operating room as during the COVID19 pandemic.

Retinal Vascular Caliber Association with Nonperfusion and Diabetic Retinopathy Severity Depends on Vascular Caliber Measurement Location.

PURPOSE: To evaluate the association of retinal nonperfusion and diabetic retinopathy (DR) severity with location of vascular caliber measurement using ultrawide field (UWF) imaging. DESIGN: Retrospective image review. PARTICIPANTS: Adults with diabetes mellitus. METHODS: All images from subjects with same-day UWF fluorescein angiography (FA) and color imaging were evaluated. Predominantly peripheral lesions (PPL) and DR severity were graded from UWF color images. Nonperfusion was quantified using UWF-FA in defined retinal regions [posterior pole (PP), mid-periphery (MP), far-periphery (FP)]. Retinal vessel calibers were measured at an optic disc centered inner and outer zone. MAIN OUTCOME MEASURES: Nonperfusion index (NPI) in the PP, MP and FP. Mean arteriole and venule diameter in the inner and outer zones. RESULTS: Two hundred eighty-five eyes of 193 patients (24.9% mild nonproliferative DR [NPDR], 22.8% moderate NPDR, 37.5% severe NPDR and 14.7% proliferative DR [PDR]) were reviewed. No significant associations between inner zone arteriolar diameter and retinal NPI overall or in any retinal region. In the outer zone, eyes with thinnest arteriolar calibers (quartile 1) were associated with a 1.7- to 2.4-fold nonperfusion increase across all retinal regions compared to the remaining eyes (P = 0.002 [PP] to 0.048 [FP]). In the outer zone, the percentage of eyes in the thinnest quartile of retinal arteriolar diameter increased with worsening DR severity (mild NPDR: 10% vs PDR: 31%, P = 0.007). This association was not observed when measured within the inner zone (P = 0.129). All venular caliber associations were not statistically significant when corrected for potentially confounding factors. Thinner outer zone retinal arteriolar caliber (quartile 1) was more common in eyes with PPL compared to eyes without PPL (34.1% vs 20.8%, P = 0.017) as were thicker outer venular calibers (quartile 4) (33% vs 21.3%, P = 0.036). Presence of PPL was associated with thinner outer zone arteriolar caliber (109.7 ± 26.5µm vs 123.0 ± 29.5µm, P = 0.001). CONCLUSIONS: The association of vascular caliber with nonperfusion and DR severity differs based upon the retinal location at which vascular caliber is measured. Peripheral arterial narrowing is associated with increasing nonperfusion, worsening DR severity and presence of PPL. In contrast, inner zone retinal arteriolar caliber is not associated with these findings.

Safety and effectiveness of the SUPRACOR presbyopic LASIK algorithm on hyperopic patients.

BACKGROUND: To evaluate the safety and effectiveness of the Supracor excimer laser algorithm to treat hyperopic presbyopic patients using laser in-situ keratomileusis (LASIK). METHODS: This is a retrospective case review of patients diagnosed with hyperopia (Sphere ≥ +0.0 D and presbyopia reading add ≥ 1.0 D) who underwent Supracor excimer laser treatment on at least one eye for presbyopia correction from year May 2011 to May 2013. Binocular vision was further analyzed after patients were subdivided into three groups: Group A (n = 22 eyes, 11 patients) had Supracor on both eyes; Group B (n = 18 eyes, 18 patients) had Supracor in one eye and hyperopic LASIK on fellow eye; and Group C (n = 29 eyes, 29 patients) had Supracor in one eye and no treatment on the fellow eye. RESULTS: This study evaluated 58 patients wherein 69 eyes underwent Supracor presbyopic LASIK. Preoperatively, mean manifest refraction spherical equivalent (MRSE) of all eyes that underwent Supracor was +1.37 ± 0.72 D with mean uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA) of 20/50 (0.35 logMAR), 20/50 (0.35 logMAR), and J9 (0.61 logMAR), respectively. At 6 months postoperatively, mean MRSE was -0.43 ± 0.59 D with mean UDVA, UIVA and UNVA of 20/25 (0.13 logMAR), 20/20 (0.01 logMAR), and J1 (0.05 logMAR), respectively. Loss of two lines of best-corrected distance visual acuity (BCDVA) was seen in 6% of eyes. Mean corneal steepening of 1.0 D at the 3 mm zone and 0.7 D in the 5 mm zone was observed. Mean vertical coma increased from -0.02 to +0.10 while mean 4th order spherical aberration became more negative from 0.20 to -0.14. Mean binocular UDVA, UIVA, and UNVA are 20/20, 20/20 and J1, respectively, in all treatment groups at the 6 month postoperative follow-up. No significant differences in binocular UDVA (p ≥ 0.36), UIVA (p ≥ 0.19) and UNVA (p ≥ 0.56) among groups were seen. CONCLUSIONS: Supracor excimer laser algorithm is safe and effective for the treatment of presbyopia in hyperopes. Monolateral and bilateral Supracor treatments yielded similarly good binocular vision outcomes.