"Stop & drop"- a modified "stop & chop" phacoemulsification technique for cataract surgery.

PURPOSE: To introduce a novel technique termed "stop and drop" for creating the first crack in the initial hemi-nucleus, eliminating the need to slip a chopper under the anterior capsular rim during horizontal chopping, hence lowering the risk of capsular or zonular damage. METHODS: Placing a blunt chopper tip on the upper surface of the hemisection proximal to the capsular edge and pressing it downward to initiate a crack in a pinching manoeuvre. Once a crack has formed, the chopper can slide to the side, widening the crack and assisting the phaco needle to pull out the first fragment. RESULTS: The technique was used in over 100 cases of cataracts successfully. No radial tear, posterior capsule rupture or zonulolysis occurred. CONCLUSIONS: "Stop and drop" is an effective and safe technique for performing phacoemulsification. It is not suitable for soft nuclei where the chopper will likely "cheese-wire" through the nuclear material.

Patients' Experience of Anxiety and Pain during Retrobulbar Injections prior to Vitrectomy.

PURPOSE: The purpose of this study was to evaluate the correlation between pain associated with retrobulbar block and anxiety levels before the injection. METHODS: This prospective observational, noninterventional study included consecutive patients who received a retrobulbar block by a single surgeon prior to undergoing 25G PPV at the Department of Ophthalmology, Rambam Health Care Campus, between April 2016 and August 2017. Patients plotted their anxiety levels (scale 0-10) using the visual analogue scale for anxiety (VASA), and immediately after receiving the injection, they plotted their experienced level of pain (scale 0-10) using the visual analogue scale for pain (VAS), with scores ≥7 defined as severe. RESULTS: Overall, 48 eyes of 48 patients aged 68.4 ± 10.3 years were included, of which 62.5% were of male gender. Severe anxiety and pain were experienced by 10.4% and 12.5%, respectively. There was a significant correlation between VASA and VAS scores (r = 0.43, p=0.002) with no other preprocedural parameters demonstrating a significant association with the VAS score. In multivariate analysis, the VASA score was the only factor that was significant (p=0.01), and a patient with a severe VASA score was 20 times more likely of experiencing severe pain (p=0.006). The ROC curve analysis revealed an area under the curve of 0.89 (p < 0.001), and a VASA score >4 demonstrated a sensitivity of 83.3% and a specificity of 73.8% in predicting severe pain. CONCLUSIONS: Approximately 10% of patients experience severe anxiety and pain during retrobulbar blocks. Considering the importance of compliance, reducing anxiety and premedication may be considered, particularly in high-risk patients (VASA score > 4).

Laser Pointer-Induced Maculopathy: More Than Meets the Eye.

PURPOSE: To describe the clinical findings in patients with laser-induced retinal injury. METHODS: Consecutive patients presenting to a tertiary center between January 2014 and December 2015 following inadvertent ocular exposure to a laser pointer were included. Evaluation included a full ophthalmic examination and spectral-domain optical coherence tomography (SD-OCT). RESULTS: Seven young patients (8 eyes) were identified. Their mean age was 18.7 years (median: 16 years; range: 12 to 36 years). In most cases, patients were exposed for several seconds to a 5-mW green laser. At presentation, all patients complained of a central/paracentral scotoma. Snellen best corrected visual acuity (BCVA) at presentation ranged from counting fingers to 6/6. In 5 eyes, a round, well-defined deep yellowish-orange discoloration at the level of the retinal pigment epithelium in the foveola, ranging from 150 to 350 µm in diameter, was noted on ophthalmoscopic examination. Additional findings were macular subhyaloid hemorrhage in 2 eyes and a full-thickness macular hole with cystoid macular edema in 1 eye. In all cases, baseline SD-OCT revealed disruption involving the photoreceptor inner segment/outer segment junction/ellipsoid zone band, and extended toward the inner aspect of the retinal pigment epithelium band, ranging from focal interruption to extensive full-thickness macular hole. All patients received oral corticosteroid treatment with prednisone (0.5 to 1 mg/kg). Follow-up ranged between 2 and 12 months. Over time, improvement in visual acuity to 6/8 and 6/6 was noted in all eyes but one, which remained poor at counting fingers from 2 meters. The visual improvement was associated with complete or near-complete restoration of the integrity of macular structure noted on SDOCT. CONCLUSIONS: Commercial handheld laser pointers may inflict notable macular injury and damage vision permanently. Although good visual recovery was often noted, access to commercially available laser devices is potentially hazardous, especially to minors, and public awareness should be raised. [J Pediatr Ophthalmol Strabismus. 2018;55(5):312-318.].