Refractive cataract surgery.

PURPOSE OF REVIEW: The aim of this study to provide an overview of recent publications and opinions in refractive cataract surgery. RECENT FINDINGS: With the advent of intraocular lenses (IOLs) on different platforms, the surgeon has a wide arena of types of IOL to choose, depending on the patient's visual requirement. Optimization of the tear film, integrating tomography and topography devices for appropriate keratometry values, biometry, use of advanced formulas for IOL power calculation and application of newer IOLs can help achieve target refraction in cases scheduled for cataract surgery. Intraoperative aberrometry can be a useful aid for cataract surgery in postrefractive cases and can help minimize residual postoperative astigmatism. SUMMARY: Evolvement and rapid advancement of technology allows to impart desired refractive outcomes in most of the cases postcataract surgery. Appropriate preoperative and intraoperative factors should be considered to achieve the desired postoperative outcome.

Current and effective advantages of femto phacoemulsification.

PURPOSE OF REVIEW: The purpose is to review the current and effective advantages of femtosecond laser-assisted cataract surgery (FLACS). RECENT FINDINGS: FLACS has advantages over manual phacoemulsification in its precision, and predictability and may be especially advantageous in difficult situations such as shallow anterior chamber, subluxated cataracts, white cataracts, and so on. However, the femtosecond capsulorhexis may not be as strong as a manual rhexis. Laser-induced miosis is also a potential disadvantage. SUMMARY: There may be increased surgeon confidence and patient satisfaction with FLACS and it may be friendlier to the internal structures of the eye. However, it is not superior to manual phacoemulsification in terms of primary outcomes such as visual and refractive outcomes or overall complications. Further refinements in technology may be needed to give it distinct advantages over manual phacoemulsification and to make it the norm in cataract surgery.

Contact lens-assisted collagen cross-linking (CACXL): A new technique for cross-linking thin corneas.

PURPOSE: To report a novel method of contact lens-assisted corneal cross-linking (CACXL) in eyes with thin corneas. METHODS: Patients diagnosed as having progressive keratectasia with a minimum corneal thickness less than 400 and greater than 350 µm after epithelial abrasion were included. After epithelial abrasion, the iso-osmolar riboflavin 0.1% in dextran was applied every 3 minutes for 30 minutes. An ultraviolet barrier-free soft contact lens (0.09-mm thickness, 14-mm diameter) soaked in iso-osmolar riboflavin 0.1% for 30 minutes was placed on the cornea. Once the minimum corneal thickness value was confirmed to be greater than 400 µm, the ultraviolet-A irradiance was started along with instillation of iso-osmolar riboflavin 0.1% in the pre-corneal and pre-contact lens region. Intraoperative minimum corneal thickness changes were recorded with ultrasound pachymetry and optical coherence tomography. Postoperative visual acuity, corneal topography (Orbscan; Bausch & Lomb, Rochester, NY), endothelial cell loss (EM-3000; Tomey, Nagoya, Japan), and stromal demarcation line (Visante; Carl Zeiss Meditec, Jena, Germany) were measured. RESULTS: Fourteen eyes underwent the procedure. Mean preoperative minimum corneal thickness after epithelial abrasion was 377.2 ± 14.5 µm (range: 350 to 398 µm). There was a significant difference in minimum functional corneal thickness (Friedman test, P = .000) intraoperatively, before epithelial abrasion, after epithelial abrasion, and with contact lens and riboflavin film. Mean minimum functional corneal thickness after the contact lens was 485.1 ± 15.8 µm (range: 458 to 511 µm). Mean absolute increase in the minimum corneal thickness along with the contact lens and pre-corneal riboflavin film was 107.9 ± 9.4 µm (range: 90 to 124 µm). Mean depth of stromal demarcation line was 252.9 ± 40.8 µm (range: 208 to 360 µm). There was no significant endothelial loss (P = .063) and the corneal topography was stable at the last follow-up (P = .505). CONCLUSIONS: CACXL technique was effective and safe in performing cross-linking in corneas less than 400 µm after epithelial abrasion and appeared effective based on stromal demarcation line depth.

Modified technique for combining DMEK with glued intrascleral haptic fixation of a posterior chamber IOL as a single-stage procedure.

PURPOSE: To describe changes in the surgical technique required for combining Descemet membrane endothelial keratoplasty with glued intrascleral haptic fixation of a posterior chamber intraocular lens ([IOL] glued IOL) as a single-stage surgery in patients diagnosed as having aphakic or pseudophakic bullous keratopathy. METHODS: Six patients with corneal decompensation and inadequate capsular support requiring implantation/exchange of an IOL underwent a single staged glued IOL with Descemet membrane endothelial keratoplasty at a tertiary care center. Stability of the anterior chamber and structure of iris diaphragm-IOL complex were assessed intraoperatively by injecting air and, when required, iridoplasty was performed. Patients were observed postoperatively. RESULTS: One patient had partial graft detachment requiring re-bubbling and 1 patient had a small peripheral detachment with spontaneous resolution. The graft remained attached in all patients. An iridoplasty was required for 2 patients. Visual acuity improved in all patients. The mean preoperative and postoperative corrected distance visual acuity were 0.11 ± 0.07 and 0.7 ± 0.17, respectively. There was significant change in the corrected distance visual acuity after surgery (P = .028). The mean postoperative endothelial cell density at 6 months was 1,710.3 ± 205.8 cells/mm(2). CONCLUSIONS: Descemet membrane endothelial keratoplasty with glued IOL provides stable IOL with decreased pseudophacodonesis for better graft fixation. Iris diaphragm covering IOL optic all around is essential to restore bicamerality, allows sufficiently sized, non-migrating air bubbles, and decreases graft detachment and dislocation both intraoperatively and postoperatively. A need for iridoplasty must be confirmed intra-operatively.

Comparison of Elisar-Fast and Sita-Fast Strategy for Visual Field Assessment in Glaucoma.

PURPOSE: To compare two fast threshold strategies of visual field assessment: SITA-Fast (SF; Humphrey field analyser) and Elisar-Fast (EF; Advanced vision analyser) in patients with glaucoma. METHODS: In this cross-sectional observational study, of total 192 subjects, 138 subjects [150 eyes, 80 glaucoma subjects (91 eyes) and 58 healthy controls (59 eyes)] were analysed and included. Each subject underwent 24-2 EF and SF in randomized order with a minimum time interval of 1 hour between tests. MAIN OUTCOME MEASURES: Mean test-time, pointwise and sectoral sensitivity, significance of values of mean sensitivity (MS) and global indices [mean deviation (MD) & pattern standard deviation (PSD)] and their correlation. RESULTS: The mean test-time was 2.59±0.25 and 3.38±0.28 minutes (P = 0.001) with SF and EF respectively. Correlation coefficient for pointwise threshold values correlated strongly for both the devices (range from 0.70 to 0.92). The Intra class correlation (ICC) value of ≥ 0.8 was observed across all sectors indicating good reliability. Bland-Altman plot denoted 95% of data for MS values within limit of Agreement (LOA). The ICC values for overall MS, MD and PSD were 0.916, 0.913 and 0.872 respectively indicating good reliability. High degree of correlation was observed for MD (r = 0.912, P=0.00) and PSD values (r=0.732, P=0.00). Comparison of values indicated a difference of 1.09 dB for MD and 0.06 dB for PSD between both strategies. CONCLUSIONS: High degree of correlation existed between the global indices and pointwise threshold values. The study documents the ability of EF to successfully assess visual field in patients with glaucoma.

Optimum pinhole size determination in pinhole pupilloplasty for higher-order aberrations.

PURPOSE: To determine optimal pinhole size (OPS) and establish a relationship with visual acuity (VA) and RMS (root mean square) values in cases with higher-order aberrations (HOAs) undergoing pinhole pupilloplasty (PPP). SETTING: Private practice, India. DESIGN: Prospective, interventional study. METHODS: RMS value for 6-mm-diameter optical zone was determined by Scheimpflug imaging (Pentacam). Patients with RMS value >0.3 µm were included. Preoperatively, a hand-held pinhole gauge with varied apertures determined the OPS, and single-pass four-throw technique was used to perform pupilloplasty with Purkinje-1 reflex as a marker for centration. VA with OPS, correlation of RMS values with OPS and pupil size, and Strehl ratio were the main outcome measures. RESULTS: 29 eyes with HOAs were analyzed; all patients chose 1.0 or 1.5 mm as OPS. The mean preoperative and postoperative pupil size was 3.25 ± 0.81 mm and 1.8 ± 0.54 mm ( P = .000), respectively. Postoperative mean pupil size when compared with OPS denoted that 14 eyes had a difference of <0.1 mm, 8 eyes ranged from 0.2 to 0.45 mm, and 7 eyes had ≥0.6 mm (range from 0.6 to 1.8 mm) difference from OPS. Eyes with higher RMS values needed smaller pupil gauge to achieve better VA. Preoperatively, vision with OPS correlated well with preoperative 6-mm RMS HOAs ( r = 0.728; P = .00). Postoperative UDVA correlated well with VA measured with OPS ( r = 0.847; P = .00). The preoperative and postoperative mean Strehl ratio was 0.109 ± 0.07 and 0.195 ± 0.11 ( P = .001), respectively. CONCLUSIONS: Higher RMS values required a smaller pupil to achieve optimum VA. PPP can help achieve pinhole size in accordance with patient's optimum pinhole requirement.

Iris defect management in the context of presbyopia-correcting intraocular lenses.

A 65-year-old man had uneventful cataract surgery in the right eye with a toric diffractive intraocular lens (IOL) placed fully within the capsule bag. On postoperative day 1 and week 1, the IOL was well positioned and his eye was healing normally. The plan was to proceed with cataract surgery in the left eye in the near future. One month postoperatively, he presented with blurred vision, glare, and halos and was noted to have iris prolapse out of the temporal clear corneal main incision. Of interest, the patient reported some itching and eye rubbing in the early postoperative period. He was taken back to surgery by the referring doctor, and despite 2 heroic attempts to reposit and save the iris tissue, there was significant iris loss causing transillumination defects and debilitating glare and halos. Ocular examination revealed an uncorrected distance visual acuity (UDVA) of 20/40 - 2 J3 and binocular corrected distance visual acuity (CDVA) 20/30 J1 in the right eye and UDVA of 20/60 J3 and binocular CDVA of 20/25 J1 in the left eye. Manifest refraction was -0.25 -1.25 × 155 in the right eye and plano -2.25 × 090 in the left eye. Fortunately, there was no relative afferent pupillary defect, and intraocular pressures were normal off all drops. On slitlamp examination of the right eye, pertinent findings revealed a protective ptosis, trace conjunctival injection with 1 large subconjunctival polypropylene flange at 8:30 o'clock 1.5 mm from the limbus and 1 exposed irregular polypropylene flange eroded through the conjunctiva at 10 o'clock 0.5 mm from the limbus (Figures 1 and 2JOURNAL/jcrs/04.03/02158034-202408000-00019/figure1/v/2024-07-30T221851Z/r/image-tiffJOURNAL/jcrs/04.03/02158034-202408000-00019/figure2/v/2024-07-30T221851Z/r/image-tiff). There was a localized area of erythema and scleral thinning surrounding the exposed flange. The cornea was edematous over the main incision. The iris was disinserted with atrophic changes and a residual iridodialysis extending from 8:30 to 10 o'clock. The trifocal IOL was fully in the capsule bag with trace fibrosis of the capsule and rotated approximately 7 degrees off the capsulotomy tab, designating the intended axis of 1 degree. The anterior chamber was deep and quiet, and the posterior segment was unremarkable with a 0.45 cup-to-disc ratio. Pertinent examination findings in the left eye included a 2 + NS cataract and a 0.45 cup-to-disc ratio. The remainder of the examination was otherwise unremarkable. What testing and surgical plan would you offer this patient? How would you counsel regarding postoperative expectations?

Clinical outcomes of intraocular lens scaffold surgery: a one-year study.

PURPOSE: To evaluate the safety and 1-year outcome of the intraocular lens (IOL) scaffold technique in eyes with soft to moderate nuclear remnants after intraoperative posterior capsule rupture (PCR). DESIGN: Single-center, retrospective, interventional, noncomparative, consecutive case series. PARTICIPANTS: A total of 20 eyes of 20 patients who had intraoperative PCR underwent IOL scaffold surgery in a tertiary clinic. METHODS: A retrospective analysis of medical records of a consecutive series of patients who underwent IOL scaffold surgery from August 2011 to February 2013 was reviewed. All surgeries were performed by a single surgeon, and a 3-piece, 6.0-mm optic, acrylic, foldable IOL with a modified C-loop haptic configuration was implanted in all eyes. MAIN OUTCOME MEASURES: The preoperative and postoperative parameters evaluated were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), specular microscopy, gonioscopy, ultrasound biomicroscopy, central macular thickness, intraocular pressure (IOP), and anterior and posterior segment inflammation. The final visual outcome at 1 year was evaluated. RESULTS: At 1-year follow-up, the mean postoperative UDVA and CDVA in Snellen's decimal equivalent was 0.58 ± 0.15 and 0.90 ± 0.17, respectively. The IOL was placed in the sulcus for 14 eyes and in the capsular bag for 3 eyes, and glued intrascleral fixation of IOL was performed in 3 eyes. The mean postoperative refractive error at the final examination was -0.4 ± 0.05 diopter (standard error of mean). Postoperative CDVA of 20/20 and 20/30 was achieved in 75% (15 eyes) and 25% (5 eyes), respectively. There was no correlation between preoperative specular count and percentage loss of cells (P = 0.602; r(2)=0.015). The mean central macular thickness at 1 year was 182.5 ± 11.79 µm. Clinical macular edema was observed in 1 of 20 eyes (5%). CONCLUSIONS: The IOL scaffold provided an effective, relatively noninvasive means of emulsifying moderate to soft nuclear remnants in eyes with intraoperative PCR, with a good visual outcome and a favorable complication rate.

Hypersonic vitrectomy in intraoperative posterior capsular rupture with retained nuclear fragments.

In our report, we present the hypersonic vitrectomy (Vitesse, Bausch and Lomb) being employed for anterior vitreous liquefaction and removal in posterior capsular rupture. The capsular tear with nucleus drop during conventional phacoemulsification was managed by vitrectomy using the hypersonic vitrector after posterior-assisted levitation followed by intraocular lens (IOL) implantation. The minimal cortical and epinuclear lens particles in the anterior chamber and vitreous were also liquefied with a stoke length of 30 to 40 µm and aspirated via the Vitesse vitrectomy system. The same probe performs the vitrectomy and the nucleus removal. The postoperative period was uneventful with clear cornea, normal fundus, and 20/20 best-corrected visual acuity (BCVA). The hypersonic vitrectomy utilizes the ultrasound power of 29.5 kHz and a stoke length of 0 to 60 µm for liquefaction of the vitreous. It can be a safe alternative for vitrectomy and lens removal in a single setting.

Comparative Analysis of 10-2 Test on Advanced Vision Analyzer and Humphrey Perimeter in Glaucoma.

Purpose: To evaluate diagnostic precision and prove equivalence of 2 devices, Advanced vision analyzer (AVA, Elisar Vision Technology) and Humphrey field analyzer (HFA, Zeiss) for the detection of glaucoma on 10-2 program. Design: Prospective, cross-sectional, observational study. Participants: Threshold estimates of 1 eye each of 66 patients with glaucoma, 36 control participants, and 10 glaucoma suspects were analyzed on 10-2 test with AVA and HFA. Methods: Mean sensitivity (MS) values of 68 points and central 16 test points were calculated and compared. Intraclass correlation (ICC), Bland-Altman (BA) plots, linear regression of MS, mean deviation (MD), and pattern standard deviation (PSD) were computed to assess the 10-2 threshold estimate of the devices. Receiver operating characteristic curves were generated for MS and MD values, and the area under the curve (AUC) was compared with assessing diagnostic precision. Main Outcome Measures: Mean sensitivity values of 68 points and central 16 points, AUC for MS and MD values, ICC values, BA plots, and linear-regression analysis. Results: Bland-Altman plot showed significant correlation for MS, MD, and PSD values for both devices. For MS, the overall ICC value was 0.96 (P < 0.001) with a mean bias of 0.0 dB and limits of agreement range of 7.59. The difference in MS values between both devices was -0.4760 ± 1.95 (P > 0.05). The AUC for MS values for AVA was 0.89 and for HFA was 0.92 (P = 0.188); whereas it was similar at 0.88 for MD values (P = 0.799). Advanced vision analyzer and HFA identically discriminated between healthy and patients with glaucoma (P < 0.001), although HFA denoted marginally greater ability (P > 0.05). Conclusions: Statistical results denote adequate equivalence between AVA and HFA because threshold estimates of AVA strongly correlate with HFA for 10-2 program. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.

Advanced Vision Analyzer-Virtual Reality Perimeter: Device Validation, Functional Correlation and Comparison with Humphrey Field Analyzer.

Purpose: To evaluate the Advanced Vision Analyzer (AVA; Elisar Vision Technology) and to compare pointwise threshold sensitivity and functional correlation of Elisar Standard Algorithm (ESA) with the Swedish Interactive Threshold Algorithm (SITA) of the Humphrey Field Analyzer (HFA; Carl Zeiss Meditec, Inc). Design: Prospective, cross-sectional, observational case series. Participants: One hundred sixty eyes (85 control participants, 75 glaucoma patients) for functional assessment, 15 eyes for test-retest variability (TRV), 107 eyes for blind spot trial (45 normal eyes, 62 glaucoma eyes) were recruited consecutively. A separate group of participants was chosen for each assessment. Methods: All participants underwent ESA and SITA Standard 24-2 testing, and 1 eye of each participant was selected randomly. Intraclass correlation coefficient (ICC), Bland-Altman, linear regression, mean bias (MB), and proportional bias analyses were quantified and assessed. Threshold measurements, TRV, and blind spot location accuracy were compared with those of the HFA. Main Outcome Measures: Pointwise threshold sensitivity, sectoral mean sensitivity (MS), mean deviation (MD), pattern standard deviation (PSD), TRV, blind spot location, average test time were computed, and data were correlated. Results: The mean time required to perform a field test with the AVA was 7.08 ± 1.55 minutes and with HFA was 6.26 ± 0.54 minutes (P = 0.228). The MS difference between AVA and HFA was -2.2 ± 2.3 dB in healthy participants (P < 0.001) and -2.6 ± 3.5 dB in participants with glaucoma (P < 0.001). The correlation coefficients for pointwise threshold values were moderately to strongly correlated for both the devices (r = 0.68-0.89). For MS, the overall ICC value was 0.893 (P < 0.001) with MB of 2.48 dB and a limits of agreement (LOA) of 10.90 (range, 7.93 to -2.97). For TRV, response variability decreased with an increase in sensitivity and increased with eccentricity. Blind spot location was accurate, and global indices of testing methods correlated well. Conclusions: The AVA effectively captures threshold values for each point in the visual field. Adequate functional correlation suggests substantial equivalence between the AVA (ESA) and HFA (SITA Standard), implying that AVA may allow accurate assessment of visual field.

Pinhole pupilloplasty after previous radial keratotomy.

The multiple radial stromal deep corneal incisions placed in radial keratotomy (RK) lead to higher-order aberrations and pose a surgical challenge to performing any further corrective procedure on the cornea because of fear of inducing an incisional dehiscence. A method to perform pinhole pupilloplasty (PPP) in the setting of previous RK is presented. Application of pinhole optics by performing PPP leads to significant improvement in image quality and helps to optimize visual potential in post-RK cases.

All India Ophthalmological Society - Indian Journal of Ophthalmology consensus statement on preferred practices during the COVID-19 pandemic.

The COVID-19 pandemic has taken tragic proportions and has disrupted lives globally. In the wake of governmental lockdowns, ophthalmologists need practical and actionable guidelines based on advisories from national health departments on how to conduct their duties during nationwide lockdowns and after these are lifted. In this paper, we present a preferred practice pattern (PPP) based on consensus discussions between leading ophthalmologists and health care professionals in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. In this document, the expert panel clearly defines the range of activities for Indian ophthalmologists during the ongoing lockdown phase and precautions to be taken once the lockdown is lifted. Guidelines for triage, governmental guidelines for use of personal protective equipment from ophthalmologists' point of view, precautions to be taken in the OPD and operating room as well as care of various ophthalmic equipment have been described in detail. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics and should help Indian ophthalmologists in performing their professional responsibilities without being foci of disease transmission.

Pinhole pupilloplasty: Small-aperture optics for higher-order corneal aberrations.

This technique of performing pinhole pupilloplasty helps filter the straylight from the periphery of the cornea in cases with higher-order corneal aberrations. The pinhole effect blocks distorted and unfocused light rays and isolates more focused central and paracentral rays through the central aperture, thereby reducing aberrations of the optical system as a whole and enhancing visual acuity and its image quality.

Native means of graft stabilization: Host descemetic scaffolding and wound scaffolding to decrease the risk for graft detachment in DMEK and PDEK.

The main postoperative complication of Descemet membrane endothelial keratoplasty and pre-Descemet endothelial keratoplasty (PDEK) is graft detachment. We report a technique in which the host Descemet membrane or the incision is used for graft scaffolding. The descemetorhexis is created 0.5 mm smaller than the graft from between 1 quadrant to 360 degrees, preferably in two opposite quadrants. Using the Jacob technique of pressurized air infusion (air pump-assisted PDEK), the host Descemet membrane is gently teased from under the graft with a reverse Sinskey hook and allowed to overlap the graft from the posterior aspect in a scaffolding manner. Wound scaffolding within the incision is attained by pulling any overlapping part of the graft into the inner part of the corneal incision instead of allowing it to lie posterior to the inferior lip. Both these scaffolding maneuvers give an extra degree of scaffolding or support that provides graft stability and thereby decreases the risk for graft detachment.

Twofold technique of nonappositional repair with single-pass four-throw pupilloplasty for iridodialysis.

The twofold technique of nonappositional closure of iris defect combined with single-pass four-throw (SFT) pupilloplasty allows adequate closure of defects in varied degrees of iridodialysis, thereby preventing iatrogenically induced problems of glare, photophobia, and eccentric pupil.

Twenty-five-gauge trocar anterior chamber maintainer: New device for infusion.

The technique, feasibility, and results of a new 25-gauge trocar-anterior chamber maintainer (ACM) designed for maintaining intraoperative fluid infusion is described in this prospective interventional analysis. The 25-gauge trocar-ACM with an overall length of the trocar blade of 6.0 mm, cannula length of 4.0 mm, and the cannula tip beveled at 45 degrees to the base was designed and used in all the cases. The dimensions of the sclerotomy wound that comprised of the internal ostium, external ostium, wound length, and the time interval for wound apposition in the postoperative period was analyzed by spectral-domain anterior segment optical coherence tomography.

Vitrectomy-assisted phacoemulsification for lenticular coloboma.

We describe a technique to prevent continuous vitreous hydration during phacoemulsification in eyes with lenticular coloboma. The hydration results from communication between the anterior and posterior chambers from the edges of the colobomatous defect. To avoid this, a valved trocar is placed at the pars plana site around the area of the lenticular defect, which allows a limited dry vitrectomy during phacoemulsification. Intermittent vitrectomy with a moderate cutting rate and low vacuum parameters accompanied by temporary halting of the phacoemulsification procedure prevents vitreous herniation into the anterior chamber and limits the extension of zonular compromise, facilitating safe phacoemulsification with appropriate capsule expansion and fixation devices and implantation of an intraocular lens.

Young donor-graft assisted endothelial keratoplasty (PDEK/DMEK) with epithelial debridement for chronic pseudophakic bullous keratopathy.

OBJECTIVE: The aim of this study was to describe the applicability and report visual outcomes for the treatment of subepithelial fibrosis and anterior stromal scarring in cases of chronic pseudophakic bullous keratopathy (PBK) with epithelial debridement and endothelial keratoplasty (EK) (pre-Descemet endothelial keratoplasty [PDEK]; Descemet membrane endothelial keratoplasty [(DMEK]) using young donor tissue. DESIGN: Prospective, single-centre, interventional study. PARTICIPANTS: 6 cases with chronic PBK (> 1 year duration). METHODS: Case 1 underwent PDEK with glued intraocular lens (IOL) as a single-stage procedure, whereas cases 2 and 3 underwent glued IOL followed by DMEK and PDEK, respectively, as a second-stage procedure. Cases 4 and 6 underwent PDEK, whereas case 5 underwent DMEK. Epithelial debridement was performed in all cases at the time of EK, and young donor grafts were used. The main outcome measures were best spectacle-corrected visual acuity, clearance of corneal scar and haze, central corneal thickness (CCT), specular microscopy, and endothelial cell count (ECC). RESULTS: Postoperatively, all cases demonstrated significant improvement in visual acuity. The mean value of depth of subepithelial haze was 121±71.7 µm and 25.3 ± 19.8 µm in the preoperative and postoperative periods, respectively (p = 0.028). At the 1-month follow-up, the mean preoperative CCT of 676 ± 92.7 µm was reduced to 534.6 ± 21.1µm. At the 6-month follow-up, the mean ECC loss resulting from the procedure was 36.5 ± 10.4%. CONCLUSIONS: EK with epithelial debridement performed for the treatment of chronic PBK resulted in significantly improved visual acuity to a functional level, with the clearance of subepithelial fibrosis and anterior stromal scar, in most patients.

Trocar anterior chamber maintainer: Improvised infusion technique.

UNLABELLED: We present an improvised technique of infusion that uses a trocar cannula as an anterior chamber maintainer (ACM). Although routinely used in posterior segment surgery, the trocar cannula has been infrequently used in complex anterior segment procedures. The trocar ACM creates a transconjunctival biplanar wound of appropriate size that is self-sealing and overcomes the shortcomings of an ACM, such as spontaneous extrusion and forced introduction into the eye from variability in the size of the corneal paracentesis incision. Constant infusion inflow through the trocar ACM is used to maintain positive intraocular pressure through a self-sealing sclerotomy incision at the limbus. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.