Short-term fluctuation of lens corneal distance and clinical correlation with phacodonesis.

BACKGROUND: To analyze the role of short-term lens-corneal distance (LCD) fluctuation in quantifying preoperative phacodonesis and predicting intraoperative zonular weakness. METHODS: Patients were divided into control (lens without clinical phacodonesis) and study (lens with suspicious and clinical phacodonesis) groups for evaluation. Slit-lamp examination followed by IOLMaster (Carl Zeiss) for LCD assessment was performed. Five readings were taken at five time points (0 s, 15 s, 30 s, 45 s & 60 s) continuously over a minute (short term) for the LCD fluctuation calculation. RESULTS: A total of 135 eyes (82 controls and 53 study) were assessed. Study group included 32 (60.3%) suspicious and 21 (39.6%) moderate to severe phacodonesis. There was difference between the control and study eyes (p = 0.000) in short-term LCD fluctuation. Twenty-one study eyes (39.6%) showed LCD difference > 1 mm, including 11 eyes (52.3%) with > 2 mm. There was a difference in LCD with respect to severity of phacodonesis (p = 0.000). In the study eyes, 13 eyes underwent glued IOL implantation (clinical phacodonesis - ten, suspicious phacodonesis - three), and two eyes (suspicious phacodonesis) had glued capsular hook. Thirteen eyes (clinical phacodonesis - ten, suspicious phacodonesis - three) required intraoperative vitrectomy due to vitreous ingress. Intraoperative zonular weakness in 62.5% of eyes with suspicious donesis and association (Chi-square = 0.000) of weakness with preoperative LCD fluctuation was noted. CONCLUSIONS: Short-term lens-corneal distance fluctuation can be used as a parameter for quantifying lens stability and as an aid in assessing the intraoperative risk.

Giant Ocular Surface Squamous Neoplasia Wrapping Whole Cornea.

We present a giant ocular surface squamous neoplasia (OSSN) measuring approximately 20×18 mm arising from the fornix and wrapping the entire 12 clock hours of the cornea. The surgical excision was performed with preservation of the corneal surface. A 3-mm clear margin was obtained all around the mass. The histopathology confirmed as moderately differentiated squamous cell carcinoma with clear margins. The postoperative period was uneventful, and a clear cornea without a residual scar with best corrected visual acuity of 20/20 was attained. A giant OSSN can demonstrate corneal invasion, making surgical excision both challenging and associated with complications such as subsequent scarring. Extended surgical intervention, chemotherapy, chemoreduction, and immunotherapy have been reported in giant OSSNs. However, we report a giant OSSN wrapping the entire 12 clock hours of the cornea that was managed with single surgery with complete corneal restoration.

Optic surface changes in Intraocular lens scaffold: An ex vivo study.

PURPOSE: We aimed to assess the micro injuries on the intraocular lens (IOL) optic in the IOL scaffold technique by ex vivo study. SETTING: This study was conducted at the Tahira Research Laboratory, Dr Agarwal's Eye Hospital and Eye Research Centre, Chennai. DESIGN: This was an experimental study. METHODS: IOL scaffold technique was simulated in 12 caprine eyes with moderate lens changes using 12 IOLs (six acrylic hydrophilic and six polymethyl methacrylate IOL) in experimental set up. IOLs (6 mm optic diameter) were explanted from the caprine eyes immediately after the surgery and examined under light microscopy and phase contrast microscopy for anterior and posterior optic changes, and again after 24 hours. Scanning electron microscopy (SEM) was performed in IOLs with abnormalities. Two IOLs placed in caprine eyes that did not undergo scaffold procedure acted as controls. A trocar anterior chamber maintainer was used in four eyes. RESULTS: Four out of 12 IOLs showed mark defects on the surface in mid periphery. Linear mark defects measured IOL 1 (190 µm), IOL 6 (18 µm), IOL 2 (2.33 µm, 2.3 µm, 14 µm, 14 µm) and IOL 5 (12 µm). The marks do not change after 24 hours. There were no mark defects (micro abrasions or scratches) seen on any of the IOL's in the central 4 mm of the optic anterior surface. The control IOLs showed no surface changes. The pre-experiment mark defects (n = 0) in study IOLs changed to post-experiment (n = 7), with no statistical significance obtained (p = 0.059). CONCLUSION: IOL scaffold technique can cause microscopic optic surface changes seen as linear marks defects in the mid periphery and intraoperative fluid maintenance can reduce its incidence.

Long-term assessment of tilt of glued intraocular lenses: an optical coherence tomography analysis 5 years after surgery.

PURPOSE: Long-term assessment of the optic position of glued transscleral fixated intraocular lens (IOL) with optical coherence tomography (OCT). DESIGN: Prospective observational case series. PARTICIPANTS: Patients with a minimum 5 years' follow-up after glued IOL surgery were included. METHODS: Postoperatively, IOL position was examined by anterior segment OCT (Carl Zeiss Meditec) and the scans were analyzed in 2 axes (180°-0° and 270°-90°) using MatLab (Mathworks). Best-corrected visual acuity (BCVA; Snellen's charts), Orbscan, retinoscopy, refraction, and slit-lamp biomicroscopy were performed. MAIN OUTCOME MEASURES: The distance between the iris margin and the anterior IOL optic (D1, D2), slope of the line across the iris and IOL, the slope ratio between the IOL and iris, IOL tilt, and optic surface changes were determined and correlated with the astigmatism and vision. RESULTS: A total of 60 eyes (mean follow-up of 5.9±0.2 years; range, 5-6 years) were evaluated. There was a significant correlation (P = 0.000) between the slope of iris and the IOL in horizontal and vertical axes. The mean D1 and D2 were 0.94 ± 0.36 and 0.95 ± 0.36 mm, respectively. Nine of 60 eyes (15%) had pigment dispersed on the IOL surface. Twenty-one eyes (35%) had optic tilt detected on OCT and 65% of eyes had no optic tilt. The mean angle between the IOL and the iris was noted to be 3.2 ± 2.7° and 2.9 ± 2.6° in horizontal and vertical axes, respectively. The mean ocular residual astigmatism (ORA) was 0.53 ± 0.5 diopters. There was no difference in the ORA between the eyes with and without tilt (P = 0.762). There was no correlation (P = 0.348) between the ORA and BCVA. Position of the IOL was not dependent on the type of lens, age of the patient, or the preoperative surgical indication. CONCLUSIONS: Long-term analysis with OCT demonstrated good IOL positioning without any significant optic tilt in patients with glued IOL fixation.

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.

Pre-Descemet's endothelial keratoplasty with glued intraocular lens implantation with pinhole pupilloplasty in a case of ocular comorbidity in achromatopsia.

Ocular comorbidities can happen as congenital defective gene associations. We present a 37-year-old female patient who was mentally challenged and had coexisting achromatopsia gene abnormality on genetic analysis. She was operated in childhood for congenital cataract, and posterior chamber intraocular lens (IOL) was implanted at 10 years of age elsewhere. The patient presented 27 years later with luxated IOL with endothelial decompensation. There was a coexisting steep and thin cornea noted on corneal topography. She was managed with pre-Descemet's endothelial keratoplasty with transpositioning of posterior chamber IOL to glued IOL with single-pass four-throw pupilloplasty. Postoperatively, the cornea was clear with centered glued IOL. The lesser postanesthetic challenges and faster rehabilitation are obtained in combination procedures with reduced complications in such rare scenarios.

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.

Combined surgical management of capsular and iris deficiency with glued intraocular lens technique.

PURPOSE: To determine the outcome after glued aniridia intraocular lens (IOL) and glued IOL with iridoplasty in eyes with combined lens capsular and iris deficiency. METHODS: Twenty-seven eyes of 25 patients (6 had congenital aniridia with subluxated cataract and 19 had acquired lens/iris defects) were included. Glued IOL with aniridia IOL (Intra Ocular Care, Gujarat, India) was performed in eyes with total aniridia and iridoplasty with glued IOL with a three-piece foldable IOL (Sofport; Bausch & Lomb, Rochester, NY) was performed in eyes with partial aniridia. The postoperative outcomes were analyzed at follow-up examination (range: 6 to 48 months). RESULTS: Eleven eyes underwent glued aniridia IOL and 16 eyes underwent glued IOL with iridoplasty. There was significant improvement in (spectacle) corrected distance visual acuity (CDVA) (P = .002). Postoperatively, pigment dispersion on the IOL (n = 1) and raised intraocular pressure was seen in the glued aniridia IOL group and chronic uveitis (n = 1), cystoid macular edema (n = 1), and hyphema (n = 1) in the glued IOL with iridoplasty group. The CDVA remained unchanged in 14 eyes (51.8%) and improved in 13 eyes (48.1%). There was a difference in postoperative CDVA (P = .001) between eyes with glued aniridia IOL and glued IOL with iridoplasty. There was no IOL decentration, retinal detachment, corneal decompensation, or endophthalmitis. There was reduction in glare and photophobia. CONCLUSIONS: Both glued aniridia IOL and glued IOL/iridoplasty showed good functional and anatomical results with fewer complications in eyes with lens capsule and iris deficiency. However, long-term follow-up is required.[J Refract Surg. 2013;29(5):342-347.].

Glued intraocular lens: a major review on surgical technique and results.

PURPOSE OF REVIEW: To review the changes and results of glued intraocular lens (IOL) procedure in eyes with inadequate capsule. RECENT FINDINGS: The recent review of 735 eyes with glued IOL showed 486 rigid glued IOL, 191 foldable IOL, 10 glued iris prosthesis, 16 eyes with glued IOL with pupilloplasty and 32 eyes with glued IOL with penetrating keratoplasty. The postoperative best corrected visual acuity (BCVA) in eyes with the rigid glued IOL was 0.38 ±â€Š0.27. There was a significant improvement in BCVA (P = 0.000). The mean postoperative BCVA in foldable glued IOL was 0.39 ±â€Š0.29. IOL optic-related complications included optic capture and decentration. Haptic-related complications seen are haptic extrusion, haptic dislodgement, broken haptic and subconjunctival haptic. Most of the haptic-related problems are due to improper scleral tucking. The second surgeries in rigid glued IOL included IOL repositioning (2.2%), haptic repositioning (1%), conjunctival peritomy closure (0.8%), posterior segment surgery (1.2%) and IOL explantation (0.4%). The surgical modifications included glued IOL scaffold and vertical glued IOL. Glued IOL, which was combined with corneal procedures such as penetrating keratoplasty, Descemet stripping automated endothelial keratoplasty and Descemet's membrane endothelial keratoplasty, showed good visual and anatomical outcome. SUMMARY: Glued IOL and its surgical modifications showed good visual outcome with minimal complications in the recent review of its results and complications profile. However, long-term functional and anatomical outcome has to be observed in future.

Anterior segment optical coherence tomography for imaging the sub-Tenon space.

In this study, we report the ability of anterior segment optical coherence tomography (AS OCT) in imaging the sub-Tenon space and its clinical application. High-speed AS OCT (Carl Zeiss Meditec, Dublin, Calif., USA) was used to visualize the sub-Tenon space during sub-Tenon injection. The sub-Tenon spaces, Tenon thickness, conjunctiva-Tenon thickness, injecting cannula position in relation to the sub-Tenon space and drug localization/distribution in the sub-Tenon space were analyzed. The sub-Tenon spaces of 12 of 11 patients were visualized with OCT during sub-Tenon injection up to 10-13 mm from the limbus. The mean conjunctiva-Tenon and Tenon thickness were 0.38 ± 0.08 and 0.21 ± 0.07 mm, respectively. The drug was tracked as bright white fluid. There was no conjunctival chemosis, subconjunctival drug or scleral perforation. Anterior segment OCT can be used for imaging the sub-Tenon space, especially during depot injections for confirmation of drug localization.

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.

Phacoemulsification, pinhole pupilloplasty, and pre-Descemet's endothelial keratoplasty for keratoconus with Fuchs' endothelial dystrophy.

The comorbidity of keratoconus with Fuchs' endothelial dystrophy with cataract is a rare clinical combination. We present an amalgamation of surgical techniques to manage the above clinical conditions and its complications in single setting. The modified triple procedure, namely, the phacoemulsification, pinhole pupilloplasty, and pre-Descemet's endothelial keratoplasty (PDEK) in the order of description is followed in single sitting. Lens removal by phacoemulsification, correction of irregular astigmatism by pinhole pupilloplasty (pinhole optics), and exchanging the endothelial layer for PDEK forms the main segments of the triple procedure. This combination of techniques may decrease the risk of multiple surgeries and its related complications. Moreover, it will allow the patient for faster visual rehabilitation by improving the uncorrected visual acuity and visual quality.

Endodiathermal Tautening of Floppy or Irregular Iris in Endothelial Keratoplasty (Iridodiathermy).

ABSTRACT: Floppy or irregular irides may be seen during endothelial keratoplasty in complex cases or in eyes with damaged irides and may cause uneven air fill, retro-pupillary air escape, anterior bowing of iris, forward movement of lens-iris diaphragm, shallowing of anterior chamber (AC), bellowing and floppiness of iris, uneven AC depth, difficulty in inserting and opening graft, iris trauma, intraoperative bleeding, and iridodialysis. We present a technique of iridodiathermy for tautening and flattening such irides. With continuous irrigation using AC maintainer, the bipolar endodiathermy probe tip is applied in localized spots to midperipheral iris in the affected area with power and duration adjusted to induce mild localized shrinkage and tightening of iris stroma. Such iris tautening decreases its floppiness and prevents anterior bowing, excessive mobility, irido-corneal touch, and peripheral anterior synechiae formation. It provides a stable AC with regular depth and improved, uniform, and nonmigratory air fill, thus decreasing intraoperative challenges.

Endothelial cell loss associated with diffuse lamellar keratitis because of laser-assisted in situ keratomileusis.

PURPOSE: To report a case of severe interface inflammation, flap edema, and endothelial cell loss after laser-assisted in situ keratomileusis (LASIK). METHODS: A 22-year-old woman with no previous ocular abnormality underwent LASIK for myopia. The surgery was uneventful. Her preoperative endothelial count was 3,066 and 2,898 cells per square millimeter OD and OS, respectively. RESULTS: On the first postoperative day, the right eye had interface infiltrates, flap edema, and radiating Descemet's folds and the left eye had flap edema with interface infiltrates. Bilateral flap relifts and thorough irrigation were performed on the second day, followed by amputation of the nonviable flap in the right eye on the third day. On medical management, the corneal edema resolved for more than 1 month. At 6 months, the best-corrected vision was 20/32 OD and 20/25 OS, with endothelial cell count of 1,763 and 2,055 cells per square millimeter OD and OS, respectively. CONCLUSIONS: Endothelial status should be monitored in patients with a severe interface reaction or severe diffuse lamellar keratitis after LASIK.

Intraocular lens power calculation changes before and after isotonic collagen cross-linking in keratoconus patients.

PURPOSE: To find the intraocular lens (IOL) power calculation changes before and after isotonic collagen cross-linking (CXL) in keratoconus patients. METHODS: : Thirty-five eyes of 25 patients who underwent isotonic CXL were included. The cases included conventional CXL (n = 16), accelerated CXL (n = 7), contact lens-assisted CXL (CACXL) (n = 9), accelerated CACXL (n = 3). All underwent ocular biometry (IOL master), corneal topography (Orbscan II), and simulated keratometry (Orbscan II) preoperatively and 1-year post CXL. Change in best-corrected visual acuity (BCVA), axial length (AL), simulated keratometry (Sim K), anterior chamber depth (ACD), and IOL power were analyzed in the overall data and then grouped based on flattening (Group A) and no flattening (Group B) of Sim K value post CXL procedure. RESULTS: For the overall data, there was no significant change in IOL power (P = 0.05) at the end of 1 year, BCVA showed a significant increase (P < 0.01), and Sim K reading showed a statistically significant flattening (P = 0.001); ACD and AL showed insignificant change. In intergroup comparison, there was no statistically significant change in IOL power. However, in Group A, a significant change in BCVA and Sim K values was observed. In both groups (Group A and Group B), IOL power was found to be negatively correlated with AL and Sim K values. CONCLUSION: Isotonic CXL did not affect IOL power calculation at the end of 1 year. However, significant change in BCVA and sim K reading was noted.

Semilunar sign of cornea: A multimodal analysis of the posterior corneal opacity in non-infectious anterior scleritis.

Purpose: To analyze the morphological outcomes of the posterior corneal opacity or "semilunar sign" in noninfectious anterior scleritis using multimodal imaging. Methods: This was a prospective observational case series. Patients with anterior scleritis from January 2018 to January 2019 were included. Clinical and demographic data were collected. Posterior cornea was visualized using the digital slit lamp photography (Elite, mega digital vision), spectral domain optical coherence tomography (MS39), and specular count analyzer (EM-3000). "Semilunar sign" was defined by the (1) presence of posterior corneal opacity, (2) concave semilunar pattern, (3) absence of blood vessels, and (4) normal anterior cornea. Incidence, clinical characteristics and significance, correlation with Mantoux sensitivity, and role of multimodal valuation were assessed. Results: Overall 76 eyes of 72 patients were recruited with anterior scleritis. Fifteen eyes of 11 patients (15.3%) presented with semilunar sign. The scleritis was both nonnecrotizing (n = 8) and necrotizing (n = 7). The semilunar configuration appeared as isolated (n = 9) and continuous lesion (n = 6). The extent was directly related to the scleral disease extent (P = 0.002). The mean thickness measured 212.5 ± 129.3 µm. The mean central endothelial cell density (ECD) was 2540.8 ± 351.7 cells/mm2, which was significantly higher than the involved peripheral cornea (P = 0.05). The mean surface area of the semilunar sign was 7.7 ± 5.2 mm2. There was no significant correlation between the opacity thickness and the best-corrected visual acuity (P = 0.895, r = -0.39), ECD (P = 0.52, r = -0.188), and Mantoux (P = 0.696, r =- 0.142). Conclusion: Corneal semilunar sign of scleritis affected the peripheral cornea and caused no functional abnormality in early presentation. Multimodal analysis can aid in clinical assessment and severity.

Surface ablation with iris recognition and dynamic rotational eye tracking-based tissue saving treatment with the Technolas 217z excimer laser.

PURPOSE: To evaluate the visual and refractive outcomes and expected benefits of Tissue Saving Treatment algorithm-guided surface ablation with iris recognition and dynamic rotational eye tracking. METHODS: This prospective, interventional case series comprised 122 eyes (70 patients). Pre- and postoperative assessment included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, and higher order aberrations. All patients underwent Tissue Saving Treatment algorithm-guided surface ablation with iris recognition and dynamic rotational eye tracking using the Technolas 217z 100-Hz excimer platform (Technolas Perfect Vision GmbH). Follow-up was performed up to 6 months postoperatively. Theoretical benefit analysis was performed to evaluate the algorithm's outcomes compared to others. RESULTS: Preoperative spherocylindrical power was sphere -3.62 ± 1.60 diopters (D) (range: 0 to -6.75 D), cylinder -1.15 ± 1.00 D (range: 0 to -3.50 D), and spherical equivalent -4.19 ± 1.60 D (range: -7.75 to -2.00 D). At 6 months, 91% (111/122) of eyes were within ± 0.50 D of attempted correction. Postoperative UDVA was comparable to preoperative CDVA at 1 month (P=.47) and progressively improved at 6 months (P=.004). Two eyes lost one line of CDVA at 6 months. Theoretical benefit analysis revealed that of 101 eyes with astigmatism, 29 would have had cyclotorsion-induced astigmatism of ≥ 10% if iris recognition and dynamic rotational eye tracking were not used. Furthermore, the mean percentage decrease in maximum depth of ablation by using the Tissue Saving Treatment was 11.8 ± 2.9% over Aspheric, 17.8 ± 6.2% over Personalized, and 18.2 ± 2.8% over Planoscan algorithms. CONCLUSIONS: Tissue saving surface ablation with iris recognition and dynamic rotational eye tracking was safe and effective in this series of eyes.

Cost-effectiveness of cataract surgery.

PURPOSE OF REVIEW: To review the changes in the cost-effectiveness of cataract surgery in the last few decades. RECENT FINDINGS: Cataract surgery is the commonly performed procedure and it has evolved through various techniques, namely extracapsular cataract extraction, phacoemulsification and small or microincision cataract surgery. In this article we have reviewed the healthcare variant analysis, mainly the cost-effectiveness and cost utility over the past few years. SUMMARY: Cost-effectiveness implies the economic analysis of relative costs and practical outcomes after cataract surgery. Cost utility is typically in terms of cost per quality-adjusted life-year gained. Cost-utility values for cataract surgery for first eye varied from US$245 to US$22000/QALY in Western countries and from US$9 to US$1600 in developing countries. There are two methods that have been used to calculate the cost utility namely the costs that are discounted at 3% for 12 years and discounted at 3% for 5 years.

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.