Stable Measurement-Induced Floquet Enriched Topological Order.

The Floquet code utilizes a periodic sequence of two-qubit measurements to realize the topological order. After each measurement round, the instantaneous stabilizer group can be mapped to a honeycomb toric code, explaining the topological feature. The code also possesses a time-crystal order-the e-m transmutation after every cycle, breaking the Floquet symmetry of the measurement schedule. This behavior is distinct from the stationary topological order realized in either random circuits or time-independent Hamiltonian. Therefore, the resultant phase belongs to the overlap between the classes of Floquet enriched topological orders and measurement-induced phases. In this Letter, we construct a continuous path interpolating between the Floquet and toric codes, focusing on the transition between the time-crystal and stationary topological phases. We show that this transition is characterized by a divergent length scale. We also add single-qubit perturbations to the model and obtain a richer two-dimensional parametric phase diagram of the Floquet code, showing the stability of the Floquet enriched topological order.

Unifying Emergent Hydrodynamics and Lindbladian Low-Energy Spectra across Symmetries, Constraints, and Long-Range Interactions.

We identify emergent hydrodynamics governing charge transport in Brownian random time evolution with various symmetries, constraints, and ranges of interactions. This is accomplished via a mapping between the averaged dynamics and the low-energy spectrum of a Lindblad operator, which acts as an effective Hamiltonian in a doubled Hilbert space. By explicitly constructing dispersive excited states of this effective Hamiltonian using a single-mode approximation, we provide a comprehensive understanding of diffusive, subdiffusive, and superdiffusive relaxation in many-body systems with conserved multipole moments and variable interaction ranges. Our approach further allows us to identify exotic Krylov-space-resolved diffusive relaxation despite the presence of dipole conservation, which we verify numerically. Therefore, we provide a general and versatile framework to qualitatively understand the dynamics of conserved operators under random unitary time evolution.

Landau-Forbidden Quantum Criticality in Rydberg Quantum Simulators.

The Landau-Ginzburg-Wilson theory of phase transitions precludes a continuous transition between two phases that spontaneously break distinct symmetries. However, quantum mechanical effects can intertwine the symmetries, giving rise to an exotic phenomenon called deconfined quantum criticality (DQC). In this Letter, we study the ground state phase diagram of a one-dimensional array of individually trapped neutral atoms interacting strongly via Rydberg states, and demonstrate through extensive numerical simulations that it hosts a variety of symmetry-breaking phases and their transitions including DQC. We show how an enlarged, emergent continuous symmetry arises at the DQCs, which can be experimentally observed in the joint distribution of two distinct order parameters, obtained within measurement snapshots in the standard computational basis. Our findings highlight quantum simulators of Rydberg atoms not only as promising platforms to experimentally realize such exotic phenomena, but also as unique ones allowing access to physical properties not obtainable in traditional experiments.

Subconjunctival Lymphatics Respond to VEGFC and Anti-Metabolites in Rabbit and Mouse Eyes.

Purpose: To characterize and pharmacologically influence subconjunctival lymphatics in rabbit and mouse eyes. Methods: Rabbits received subconjunctival injections of trypan blue or fixable fluorescent dextrans. Bleb-related outflow pathways were quantified. Immunofluorescence for vessel-specific markers (lymphatics [podoplanin and LYVE-1] and blood vessels [CD31]) were performed in native rabbit conjunctiva and after fixable fluorescent dextran injection. Vascular endothelial cell growth factor-C (VEGFC) was injected subconjunctivally in rabbits. mRNA and protein were assessed for the above markers using RT-PCR and Western blot. Alternatively, mouse studies used Prox1-tdTomato transgenic reporter mice. Subconjunctival injection conditions included: no injection, balanced salt solution (BSS), VEGFC, 5-fluorouracil (5FU) and two concentrations of mitomycin-C (MMC). Two mouse injection protocols (short and long) with different follow-up times and number of injections were performed. Mouse eyes were enucleated, flat mounts created, and subconjunctival branching and length assessed. Results: Rabbit eyes demonstrated clear bleb-related subconjunctival outflow pathways that were distinct from blood vessels and were without nasal/temporal predilection. Immunofluorescence against vessel-specific markers showed lymphatics and blood vessels in rabbit conjunctiva, and these lymphatics overlapped with bleb-related subconjunctival outflow pathways. Subconjunctival VEGFC increased lymphatic (P = 0.004-0.04) but not blood vessel (P = 0.77-0.84) mRNA or protein in rabbits. Prox1-tdTomato transgenic reporter mice demonstrated natively fluorescent lymphatics. Subconjunctival VEGFC increased murine lymphatic branching and length (P ≤ 0.001-0.004) while antimetabolites (P ≤ 0.001-0.043) did the opposite for the long protocol. Discussion: Subconjunctival lymphatics are pharmacologically responsive to both VEGFC and antimetabolites in two animal models studied using different methodologies. These results may be important for bleb-forming glaucoma surgeries or ocular drug delivery.

Assessing accommodative presbyopic biometric changes of the entire anterior segment using single swept-source OCT image acquisitions.

BACKGROUND/OBJECTIVES: To evaluate biometric changes throughout the anterior chamber during accommodation and presbyopia using single image acquisition swept-source anterior-segment optical coherence tomography (AS-OCT). SUBJECT/METHODS: Anterior-segment images were obtained using a new swept-source AS-OCT device (ANTERION, Heidelberg Engineering) from healthy volunteers (n = 71) across two centers in this prospective observational case series. In one image acquisition, cornea through posterior lens, including the ciliary muscle on both sides of the right eye, was imaged. Subjects undertook no accommodative effort and -1, -3, and -5 D of target vergence. Two-way repeated measures ANOVA modeling was performed for ciliary muscle measurements, lens parameters, aqueous depth (AD), and pupil diameter (PD). The first ANOVA factor was accommodative stimuli, and the second factor included age and refractive status. RESULTS: Maximum ciliary muscle thickness increased with accommodative stimuli (p < 0.001), while the distance from the scleral spur to the maximal point on the ciliary muscle and posterior ciliary muscle thickness (CMT2) decreased (p < 0.001-0.002). Older individuals showed no accommodative changes for ciliary muscle parameters, lens thickness, lens vault, PD, and AD (p = 0.07-0.32). Younger- and middle-aged eyes showed statistically significant accommodative structural alterations for these endpoints (p < 0.001-0.002), but with different patterns, including early loss of CMT2 contraction in middle-aged eyes. Within the middle-aged group, myopic eyes maintained better capacity for accommodative structural change. CONCLUSIONS: Swept-source AS-OCT demonstrated multiple simultaneous anterior-segment biometric alterations in single acquisition images, including early loss of posterior ciliary muscle function and better maintained capacity for anterior-segment structural change in myopia.

Bleb-related Porcine Lymphatic Outflow is Greater from Subconjunctival compared to Subtenon Blebs.

Aim: Understanding the mechanism of fluid outflow by comparing the subconjunctival and subtenon spaces can lead to improved ocular therapeutics. The purpose of the current study is to evaluate subconjunctival vs subtenon lymphatic outflow by creating tracer-filled blebs in each location. Methods: Porcine (n = 20) eyes received subconjunctival or subtenon injection(s) of fixable and fluorescent dextrans. Blebs were angiographically imaged using a Heidelberg Spectralis ([Heidelberg Retina Angiograph] HRA + OCT; Heidelberg Engineering) and bleb-related lymphatic outflow pathways were counted. Optical coherence tomography (OCT) imaging of these pathways was used to assess structural lumens and the presence of valve-like structures. Furthermore, a comparison between tracer injection locations (superior/inferior/temporal/nasal) was made. Histologic analyses for subconjunctival and subtenon outflow pathways were performed, to confirm tracer co-localization with molecular lymphatic markers. Results: Subconjunctival blebs demonstrated a greater number of lymphatic outflow pathways compared to subtenon blebs in every quadrant [superior: 6.10 ± 1.18 (subconjunctival) vs 0.50 ± 0.27 (subtenon); temporal: 2.30 ± 0.40 vs 0.10 ± 0.10; nasal: 5.30 ± 0.60 vs 0.30 ± 0.21; inferior: 6.00 ±1.29 vs 0.1 ± 0.1; all comparisons p < 0.001]. For subconjunctival blebs, the temporal quadrant showed fewer lymphatic outflow pathways compared to the nasal side (p = 0.005). Discussion: Subconjunctival blebs accessed greater lymphatic outflow compared to subtenon blebs. Furthermore, regional differences existed, with fewer lymphatic vessels temporal than at the other locations. Clinical significance: Aqueous humor drainage after glaucoma surgery is incompletely understood. The present manuscript adds to our understanding of how lymphatics might influence filtration bleb function. How to cite this article: Lee JY, Strohmaier CA, Akiyama G, et al. Bleb-related Porcine Lymphatic Outflow Is Greater from Subconjunctival compared to Subtenon Blebs. J Curr Glaucoma Pract 2022;16(3):144-151.

Spectroscopy of a tunable moiré system with a correlated and topological flat band.

Moiré superlattices created by the twisted stacking of two-dimensional crystals can host electronic bands with flat energy dispersion in which enhanced interactions promote correlated electron states. The twisted double bilayer graphene (TDBG), where two Bernal bilayer graphene are stacked with a twist angle, is such a moiré system with tunable flat bands. Here, we use gate-tuned scanning tunneling spectroscopy to directly demonstrate the tunability of the band structure of TDBG with an electric field and to show spectroscopic signatures of electronic correlations and topology for its flat band. Our spectroscopic experiments are in agreement with a continuum model of TDBG band structure and reveal signatures of a correlated insulator gap at partial filling of its isolated flat band. The topological properties of this flat band are probed with the application of a magnetic field, which leads to valley polarization and the splitting of Chern bands with a large effective g-factor.

Structural Confirmation of Lymphatic Outflow from Subconjunctival Blebs of Live Human Subjects.

PURPOSE: To uncover the mechanism of subconjunctival outflow in human patients. DESIGN: Cross-sectional study. SUBJECTS/PARTICIPANTS AND/OR CONTROLS: Fifteen subjects receiving subconjunctival anesthesia prior to intravitreal injection for routine clinical care. METHODS: Anterior segment OCT (AS-OCT) was performed in patients with various instances of conjunctival edema or subconjunctival fluid. Other subjects received a subconjunctival mixture of 0.005% indocyanine green and 2% lidocaine. After subconjunctival injection of the tracer/anesthetic mixture, blebs and associated outflow pathways were angiographically imaged and the time for appearance recorded. The pattern and structure of outflow pathways were studied using AS-OCT. Angiographic and AS-OCT results were compared to trabecular/conventional outflow imaging which demonstrates veins. MAIN OUTCOME MEASURES: Ocular surface lymphangiography and AS-OCT images. RESULTS: AS-OCT of the conjunctiva in a normal eye demonstrated thin non-edematous conjunctiva with absent intraconjunctival lumens or subconjunctival fluid. Subjects with a history of trabeculectomy, subconjunctival drug injection, or chemosis demonstrated thickened conjunctiva and intraconjunctival luminal pathways that contained valve-like structures. Tracer-based studies in patients demonstrated blebs with irregular subconjunctival bleb-related outflow patterns that arose in a time-dependent fashion. These angiographic pathways were luminal on OCT, sausage-shaped, and contained intraluminal valve-like structures. This was in contrast to trabecular/conventional outflow imaging where pathways were classically Y-shaped, of even-caliber, and lacked valve-like structures. DISCUSSION: Outflow pathways were seen in cases of conjunctival edema and after subconjunctival tracer injection. These pathways were lymphatic based upon pattern and structural study. Better understanding of bleb-related lymphatic outflow may lead to improved bleb-requiring glaucoma surgeries and subconjunctival drug delivery.

Aqueous humour outflow imaging: seeing is believing.

Elevated intraocular pressure (IOP) is the primary risk factor for blindness in glaucoma. IOP is determined by many factors including aqueous humour production and aqueous humour outflow (AHO), where AHO disturbance represents the primary cause of increased IOP. With the recent development of new IOP lowering drugs and Minimally Invasive Glaucoma Surgeries (MIGS), renewed interest has arisen in shedding light on not only how but where AHO is occurring for the trabecular/conventional, uveoscleral/unconventional, and subconjunctival outflow pathways. Historical studies critical to understanding outflow anatomy will be presented, leading to the development of modern imaging methods. New biological behaviours uncovered by modern imaging methods will be discussed with relevance to glaucoma therapies emphasized.

Age- and refraction-related changes in anterior segment anatomical structures measured by swept-source anterior segment OCT.

PURPOSE: To assess the effects of age and refractive status on anterior segment anatomical structures, including the ciliary body, using a new swept-source anterior segment optical coherence tomography (AS-OCT) device. METHODS: This prospective observational study included 63 healthy volunteers (mean age: 44.2 years). Images of the anterior segment were obtained using a new swept-source AS-OCT (ANTERION, Heidelberg Engineering GmbH, Heidelberg, Germany) with tracking and image averaging from the right eye of all participants. Repeatability as well as inter- and intra-observer reliability of biometric measurements were evaluated. The impact of image tracking and averaging on ciliary muscle measurements was tested. Univariate and multivariable statistical models were developed to evaluate the relationship of age and refractive status on anterior segment biometric measurements. RESULTS: For all test-retest repeatability and inter- and intra-observer reproducibility of swept-source AS-OCT measurements, high intraclass correlation (ICC) was noted (0.88-1.00). The nasal maximum ciliary muscle thickness (CMTMAX) and distance between scleral spur to the thickest point of the ciliary muscle (SSMAX) were larger than those on the temporal side (p<0.001 and p = 0.006, respectively). Nasal and temporal CMTMAX (p = 0.004 and p<0.001, respectively) and lens thickness (p<0.01) increased with age. Nasal and temporal SSMAX decreased with older age and increasing hyperopia (p = 0.01 and p<0.001, respectively). Image averaging resulted in improved ciliary muscle measurements (p = 0.008 to 0.02). Lens vault increased with older age and increased hyperopia (p<0.01). OCT measurements of the angle decreased with older age and increased hyperopia (p<0.001 to 0.03). Aqueous depth decreased with older age and increased hyperopia (p<0.01). Pupil diameter decreased with older age (p<0.01). CONCLUSIONS: Repeatability and reproducibility of biometric measurements using the ANTERION AS-OCT were excellent. Image averaging improved the accuracy of ciliary muscle measurements. The device produced measurements of biometric parameters that described superficial and deep structures including the ciliary body and full lens thickness from a single image.

Potential Therapeutic Usage of Nanomedicine for Glaucoma Treatment.

Glaucoma is a group of diseases characterized by progressive degeneration of retinal ganglion cells, leading to irreversible blindness. Currently, intraocular pressure reduction is the only established treatment available for glaucoma. With this treatment, the progression of the disease can only be delayed and there is no recovery. In addition, the commercially available eye drops have the disadvantage of low compliance and short therapeutic time, while glaucoma surgery always has the risk of failure due to wound fibrosis. Nanotechnology can overcome the limitations of the current treatment through the encapsulation and conjugation of drugs used for lowering intraocular pressure and antifibrotic agents using biodegradable or biocompatible nanoparticles for the sustained release of the drugs to protect the damaged ocular cells. Furthermore, using nanotechnology, treatment can be administered in various forms, including eye drops, contact lens, and ocular inserts, according to the convenience of the patients. Despite the promising results of delaying the progression of glaucoma, the regeneration of damaged ocular cells, including trabecular meshwork and retinal ganglion cells, is another critical hurdle to overcome. Bone marrow-derived mesenchymal stem cells and Müller glia cells can secrete neurogenic factors that trigger the regeneration of associated cells, including trabecular meshwork and retinal ganglion cells. In conclusion, this review highlights the potential therapeutic applications of nanotechnology- and stem cell-based methods that can be employed for the protection and regeneration of ocular cells.

Tunable spin-polarized correlated states in twisted double bilayer graphene.

Reducing the energy bandwidth of electrons in a lattice below the long-range Coulomb interaction energy promotes correlation effects. Moiré superlattices-which are created by stacking van der Waals heterostructures with a controlled twist angle1-3-enable the engineering of electron band structure. Exotic quantum phases can emerge in an engineered moiré flat band. The recent discovery of correlated insulator states, superconductivity and the quantum anomalous Hall effect in the flat band of magic-angle twisted bilayer graphene4-8 has sparked the exploration of correlated electron states in other moiré systems9-11. The electronic properties of van der Waals moiré superlattices can further be tuned by adjusting the interlayer coupling6 or the band structure of constituent layers9. Here, using van der Waals heterostructures of twisted double bilayer graphene (TDBG), we demonstrate a flat electron band that is tunable by perpendicular electric fields in a range of twist angles. Similarly to magic-angle twisted bilayer graphene, TDBG shows energy gaps at the half- and quarter-filled flat bands, indicating the emergence of correlated insulator states. We find that the gaps of these insulator states increase with in-plane magnetic field, suggesting a ferromagnetic order. On doping the half-filled insulator, a sudden drop in resistivity is observed with decreasing temperature. This critical behaviour is confined to a small area in the density-electric-field plane, and is attributed to a phase transition from a normal metal to a spin-polarized correlated state. The discovery of spin-polarized correlated states in electric-field-tunable TDBG provides a new route to engineering interaction-driven quantum phases.

Topological Correspondence between Hermitian and Non-Hermitian Systems: Anomalous Dynamics.

The hallmark of symmetry-protected topological phases is the existence of anomalous boundary states, which can only be realized with the corresponding bulk system. In this work, we show that for every Hermitian anomalous boundary mode of the ten Altland-Zirnbauer classes, a non-Hermitian counterpart can be constructed, whose long-time dynamics provides a realization of the anomalous boundary state. We prove that the non-Hermitian counterpart is characterized by a point-gap topological invariant, and furthermore, that the invariant exactly matches that of the corresponding Hermitian anomalous boundary mode. We thus establish a correspondence between the topological classifications of (d+1)-dimensional gapped Hermitian systems and d-dimensional point-gapped non-Hermitian systems. We illustrate this general result with a number of examples in different dimensions. This work provides a new perspective on point-gap topological invariants in non-Hermitian systems.

Theory of correlated insulating behaviour and spin-triplet superconductivity in twisted double bilayer graphene.

Two graphene monolayers twisted by a small magic angle exhibit nearly flat bands, leading to correlated electronic states. Here we study a related but different system with reduced symmetry - twisted double bilayer graphene (TDBG), consisting of two Bernal stacked bilayer graphenes, twisted with respect to one another. Unlike the monolayer case, we show that isolated flat bands only appear on application of a vertical displacement field. We construct a phase diagram as a function of twist angle and displacement field, incorporating interactions via a Hartree-Fock approximation. At half-filling, ferromagnetic insulators are stabilized with valley Chern number [Formula: see text]. Upon doping, ferromagnetic fluctuations are argued to lead to spin-triplet superconductivity from pairing between opposite valleys. We highlight a novel orbital effect arising from in-plane fields plays an important role in interpreting experiments. Combined with recent experimental findings, our results establish TDBG as a tunable platform to realize rare phases in conventional solids.

Intraoperative Complications of Cataract Surgery Using Intracameral Illumination in the Elderly over 75 Years.

PURPOSE: To evaluate intraoperative complications and utilization of adjunctive devices between microscope and intracameral illuminations during cataract surgery in the elderly over 75 years. DESIGN: A retrospective, consecutive, interventional case series Participants. Two hundred eighty-six eyes of 184 patients older than 75 years who underwent cataract surgery using microscope and intracameral illuminations. METHODS: A chart review was performed on an advanced cataract surgery group of 141 consecutive cases in which the intracameral illumination was used and on a standard cataract surgery group of 145 consecutive cases in which the intracameral illumination was not used. MAIN OUTCOME MEASURES: Intraoperative complications (posterior capsule rupture, radial tear of the anterior capsule, dropped nucleus, or sulcus-implanted/sclera-fixated IOL) and utilization of adjunctive devices (pupil expansion device or anterior capsule staining). RESULTS: The frequency of use of the pupil expansion device was lower in the advanced cataract surgery group than that in the standard cataract surgery group (0.7% vs 6.9%; p=0.007). Furthermore, the rates of a posterior capsule rupture and at least one intraoperative complication were lower in the advanced cataract surgery group than those in the standard cataract surgery group (0.7% vs 4.8%; p=0.067) (0.7% vs 7.6%; p=0.004). CONCLUSIONS: In the current cohort of patients over 75 years, the rate of intraoperative complications was lower when using the intracameral illumination than that when using the conventional method. Cataract surgery using intracameral illumination would be good option for elderly people.

Macular photostress and visual experience between microscope and intracameral illumination during cataract surgery.

PURPOSE: To evaluate macular photostress and visual experience between coaxial microscope illumination versus oblique intracameral illumination during cataract surgery. SETTING: Gachon University Gil Hospital, Incheon, South Korea. DESIGN: Prospective case series. METHODS: Consecutive patients who had cataract surgery using microscope illumination and intracameral illumination were included. The patients were asked to complete a questionnaire (seeing strong lights, feeling photophobia, feeling startled (fright) when seeing lights, seeing any colors, seeing any instruments or surgical procedures, and estimating intraoperative visual function) designed to describe their cataract surgery experience. The images projected on the retina of the model eye (rear view) with artificial opaque fragments in the anterior chamber during simulating cataract surgery were compared between the 2 illumination types. RESULTS: Sixty patients completed the questionnaire. Scores for strong lights, photophobia, fright, and color perception were significantly higher with microscope illumination than with intracameral illumination (all P < .001). More patients preferred the intracameral illumination (45 [75.0%]) to the microscope illumination (13 [21.7%]). In the rear-view images created in a model eye, only the bright microscope light in the center was seen without any lens image in the microscope illumination. However, in the intracameral illumination, the less bright light from the light pipe in the periphery and the lens fragments were seen more clearly. CONCLUSIONS: In a view of the patients' visual experience, oblique intracameral illumination caused less subjective photostress and was preferred over coaxial microscope illumination. Objective findings from the model-eye experiment correlated to the result of visual experience.

Signal Alteration in the Optic Nerve Head on 3D T2-weighted MRI: a Potential Neuroimaging Sign of Glaucomatous Optic Neuropathy.

PURPOSE: To investigate whether a signal alteration (SA) in the optic nerve head (ONH) on 3D T2-weighted magnetic resonance imaging (MRI) is associated with glaucomatous optic neuropathy Materials and Methods: A total of 35 patients with bilateral open-angle glaucoma and 31 age-matched controls underwent 3D high-resolution (0.98 × 0.98 × 1 mm3) T2-weighted MRI and detailed ophthalmologic examinations including spectral-domain optical coherence tomography (OCT). Two independent reviewers blinded to subject data determined mild or prominent SA on 3D T2-weighted MRI for the incomplete or complete loss of ocular hypointense continuity in the ONH, respectively. The prevalence of SAs was compared between the two groups with the chi-square test. The OCT measurements were compared among the eyes with a mild or prominent SA and those without an SA using the Kruskal-Wallis test. RESULTS: Of the 35 eyes with glaucoma, 26 eyes (74.3%) exhibited an SA in the ONH, whereas it was observed in 5 (16.1%) of the 31 controls (P < 0.001). The eyes with a prominent SA had a significantly different average retinal nerve fiber layer thickness (P = 0.002) and the ONH parameters except for the disk area (all P < 0.001) than those without an SA. The eyes with a mild SA had a significantly narrower neural rim area, larger cup volume, and larger average and vertical cup-to-disk ratios compared with those without an SA (P = 0.011, 0.003, 0.004, and 0.004, respectively) Conclusions: The SA in the ONH on 3D T2-weighted MRI was significantly more frequent in eyes with open-angle glaucoma than in the controls.

Intracameral air injection during Ahmed glaucoma valve implantation in neovascular glaucoma for the prevention of tube obstruction with blood clot: Case Report.

RATIONALE: Glaucoma drainage implant surgery is a treatment option for the management of neovascular glaucoma. However, tube obstruction by blood clot after Ahmed glaucoma valve (AGV) implantation is an unpredictable clinically challenging situation. PATIENT CONCERNS-DIAGNOSES-INTERVENTIONS: We report 4 cases using intracameral air injection for the prevention of the tube obstruction of AGV by blood clot. OUTCOMES: The first case was a 57-year-old female suffering from ocular pain because of a tube obstruction with blood clot after AGV implantation in neovascular glaucoma. Surgical blood clot removal was performed. However, intractable bleeding was noted during the removal of the blood clot, and so intracameral air injection was performed to prevent a recurrent tube obstruction. After the procedure, although blood clots formed around the tube, the tube opening where air could touch remained patent. In 3 cases of neovascular glaucoma with preoperative severe intraocular hemorrhages, intracameral air injection and AGV implantation were performed simultaneously. In all 3 cases, tube openings were patent. It appears that air impeded the blood clots formation in front of the tube opening. LESSONS: Intracameral air injection could be a feasible option to prevent tube obstruction of AGV implant with a blood clot in neovascular glaucoma with high risk of tube obstruction.

Phacoemulsification using a chisel-shaped illuminator: enhanced depth trench, one-shot crack, and phaco cut.

PURPOSE: To evaluate the efficacy and outcomes of intracameral illuminator-assisted nucleofractis technique in cataract surgery. METHODS: Since June 2012, this novel technique has been performed in all cataract cases by one surgeon (approximately 300 cases of various densities). Trenching continues until the posterior plate white reflex between an endonucleus and an epinucleus is identified (enhanced depth trench). After trenching, cracking is initiated with minimal separation force, and completion of cracking is confirmed by posterior capsule reflex (one-shot crack). With followability enhanced by an elliptical phaco mode, the divided nucleus is efficiently cut into small fragments by a chisel-shaped illuminator (phaco cut). RESULTS: We have not experienced any capsular bag or zonular complications, and the effective phacoemulsification time seemed to be shorter than that with the conventional technique. CONCLUSIONS: This technique simplifies the complete division of the nucleus, which is the most challenging step in safe and efficient phacoemulsification.

Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification for rhegmatogenous retinal detachment repair.

AIM: To assess the outcomes of combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for rhegmatogenous retinal detachment (RRD) repair. METHODS: This was a retrospective, consecutive, non-comparative, interventional case series of 30 eyes of 30 patients who underwent combined sutureless vitrectomy and clear corneal cataract surgery for the repair of RRD. The principal outcome measures were primary anatomical success rate, reasons for redetachment, final visual acuity, and surgical complications. RESULTS: Primary reattachment was achieved in 27 eyes (90.0%). The reasons for redetachment (3 eyes, 10%) were incomplete laser retinopexy, persistent chronic subretinal fluid, and proliferative vitreoretinopathy, respectively. The logarithm of the minimum angle of resolution visual acuity (mean±SD) improved from 0.76±0.74 preoperatively to 0.21±0.37 6 months' postoperatively (P<0.0001). Postoperative hypotony was not detected, but 1 eye (3.3%) had increased intraocular pressure (30mmHg) with spontaneous resolution. No endophthalmitis developed during follow-up. Macular pucker was detected in 3 eyes (10.0%). CONCLUSION: Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for RRD repair was proven safe and effective. It may provide not only the known advantages of conventional combined surgery, but also additional advantages such as less conjunctival fibrosis and the maintenance of stable intraocular pressure with low risks of postoperative hypotony and intraocular pressure elevation.