Biometric Indicators for Maximizing Intermediate Vision with a Monofocal IOL.

Purpose: To determine refractive or biometric variables that might be predictive of increased intermediate vision in patients receiving an Eyhance monofocal intraocular lens (IOL). Methods: This prospective, single-center, bilateral, non-randomized, open-label, observational study included a total of 110 subjects (220 eyes). Subjects had been previously bilaterally implanted with an Eyhance monofocal IOL (Johnson & Johnson Vision Care, Inc.) and were later divided into 2 groups based on their postoperative visual acuity. Subjects that had binocular distance corrected intermediate visual acuity (DCIVA) of 0.2 logMAR or better were classified into the Enhanced Group, and the remaining subjects were classified into the Non-Enhanced Group. Refractive outcomes and biometric measurements were compared between groups. Results: The number of subjects in each group was 61 for the Enhanced Group, and 49 for the Non-Enhanced Group. There were significant differences in pupil size between groups, with pupil sizes in the Enhanced Group significantly smaller than in the Non-Enhanced Group (p < 0.01). Subjects also reported significantly more dysphotopsias in the Non-Enhanced Group compared to the Enhanced Group (p = 0.03). Multiple regression analysis identified pupil size and axial length as significant predictors of increased monocular intermediate vision. Conclusion: The results of this study suggest that pupil size could be a predictor of increased intermediate vision in a patient receiving an Eyhance monofocal IOL.

Punch and rescue technique for scleral fixation of dislocated single-piece intraocular lenses.

In-the-bag intraocular lens (IOL) dislocation is a well-known complication after cataract surgery. As the number of cataract surgeries performed annually continues to increase, so will the incidence of IOL dislocations requiring surgical correction. Described is a new technique for rescue and refixation of a single-piece acrylic IOL. In this method, a new instrument called the IOL punch is used to create a hole at the optic-haptic junction or along the border of the optic, which acts as an anchor point for centration and subsequent scleral fixation of a dislocated IOL. The IOL punch allows for precise intraocular manipulation of the IOL and is less invasive compared with popular scleral fixation methods. This innovative technique may decrease the risk for postoperative complications and allows patients to maintain or recover previous uncorrected visual acuity by circumventing the need for IOL explantation or exchange.

Prospective study of visual outcomes and endothelial survival with Descemet membrane automated endothelial keratoplasty.

PURPOSE: To evaluate vision and endothelial cell survival in an initial Descemet membrane automated endothelial keratoplasty (DMAEK) series. METHODS: This was a prospective nonrandomized study of an initial consecutive series of 40 DMAEK cases, performed with or without concomitant phacoemulsification and intraocular lens implantation. The graft was dissected with a microkeratome. A central 6- to 7-mm big bubble was created to separate endothelium from stroma, and the overlying stroma was excised. The graft was cut to 8.5- to 9.5-mm diameter and inserted with a pull through technique. Eyes were treated for Fuchs endothelial dystrophy, secondary corneal decompensation, or previous failed endothelial transplant. Best spectacle-corrected visual acuity, manifest refraction, pachymetry, and endothelial cell density were assessed. RESULTS: Median best spectacle-corrected visual acuity was 20/30 at 1 month (range: 20/15-20/50), improved from 20/40 (range: 20/25-20/400) preoperatively, excluding 7 eyes (18%) with significant retinal pathology. Rates of 20/20, 20/25, 20/30, and 20/40 vision were 25%, 71%, 89%, and 100%, respectively, at 3 months and 48%, 74%, 93%, and 100%, respectively, at 6 months. Median endothelial cell loss relative to baseline donor cell density was 31% at 6 months. Air was reinjected in 10 eyes (25%) to promote graft attachment, and 2 grafts (5%) failed to clear. CONCLUSIONS: DMAEK provided significant improvement in visual acuity and marked reduction in central corneal thickness. DMAEK had a higher rate of postoperative air reinjection than Descemet stripping endothelial keratoplasty and comparable 6-month endothelial cell loss.

Descemet membrane automated endothelial keratoplasty: hybrid technique combining DSAEK stability with DMEK visual results.

We describe an endothelial keratoplasty technique in which Descemet membrane is transplanted with a peripheral ring of corneal stroma. As in Descemet stripping automated endothelial keratoplasty (DSAEK), a microkeratome resects an anterior corneal cap. A big-bubble technique is then used to detach the central 6.0 to 7.0 mm of Descemet membrane. The scleral rim is again mounted on an artificial anterior chamber. The stroma overlying the big bubble is excised and the tissue punched with an 8.5 to 9.0 mm trephine. This leaves a bare central Descemet membrane with an attached peripheral rim of stroma. The graft is inserted using methods previously described for DSAEK. The graft's stromal rim allows it to spontaneously unfold once inside the eye. The Descemet membrane automated endothelial keratoplasty transplantation technique combines the superior vision potential of Descemet membrane endothelial keratoplasty with the easier insertion and manipulation of DSAEK.

Corneal toxicity of intraocular hyaluronidase.

The purpose of this study was to examine the corneal toxicity of different preparations of intraocular hyaluronidase. SDS-PAGE analysis of bovine testicular hyaluronidase (Wydase) and chromatographically purified hyaluronidase (Sigma) was performed. These two preparations were injected into the anterior chamber of rabbits in amounts ranging from 1.5-150 IU (Wydase) and 1.5-300 IU (Sigma). A third set of rabbit eyes received Wydase vehicle alone or in combination with Sigma hyaluronidase. Treated control eyes were injected with saline. Slit lamp examination and indirect ophthalmoscopy were performed preoperatively and on postoperative days 1 and 7. Light microscopy of the corneas was performed. SDS-PAGE of Wydase revealed numerous protein impurities, while Sigma demonstrated one protein band consistent with mammalian hyaluronidase. Persistent corneal edema, severe anterior chamber fibrin, and endothelial necrosis, were seen in the majority of eyes injected with Wydase in amounts of 50 IU and greater (n = 11). Thirty percent (30%) of the eyes injected with the Sigma preparation (n = 11) had localized corneal opacity similar to 50% of eyes injected with saline (n = 2). Of the rabbit eyes injected with the Wydase vehicle (n = 19), 68% had toxic changes. Intracameral injection of Wydase is toxic to the rabbit cornea in amounts of 50 IU and greater. A chromatographically purified preparation showed only transient local toxicity. Toxicity of Wydase may be due to protein impurities and the thimerosal-containing vehicle.

Spontaneous reopening of a spontaneously closed macular hole.

PURPOSE: To report a case of spontaneous reopening after spontaneous closure of a full-thickness macular hole. METHODS: Observational case report. Retrospective clinical practice case review. RESULTS: A 57-year-old man with a full-thickness macular hole in his left eye developed spontaneous closure for 1.5 years with improved vision, followed by spontaneous reopening of the hole with loss of vision. Surgical repair resulted in repeat closure and recovery of 20/20 visual acuity. CONCLUSION: Spontaneous reopening, which occasionally occurs after surgical closure of macular holes, can also occur after spontaneous closure of a macular hole.