Bilateral implantation of a supplementary intraocular pinhole.

PURPOSE: To evaluate the safety and efficacy of bilateral implantation of a supplementary small-aperture device to treat irregular corneal astigmatism. SETTING: Private practice. DESIGN: Retrospective consecutive case series. METHODS: Patients with bilateral irregular corneal astigmatism secondary to multiple causes and consented for implantation of the XtraFocus intraocular pinhole (IOPH) were enrolled. The mean follow-up was 27 months (range 5 to 66 months). Patients were assessed in their scheduled follow-up visits and monocular and binocular uncorrected and corrected distance and near visual acuities were recorded. Assessment of darkening vision complaints was also performed after implantation in the first eye and repeated after second-eye surgery. RESULTS: Thirty-two eyes of 16 patients were analyzed. The mean monocular and binocular uncorrected distance visual acuities improved from logMAR 1.091 ± 0.208 and 1.078 ± 0.259 preoperatively to 0.342 ± 0.091 (P < .001) and 0.342 ± 0.147 (P = .001) 1 year postoperatively. Three patients were excluded because of darkening vision complaints after surgery in the first eye. No major complications were noted after implantation of the IOPH. CONCLUSIONS: Bilateral implantation of the XtraFocus IOPH is a safe technique in a selected group of patients. There was improvement in visual acuity sustained over the analyzed period. Postoperative darkening vision complaints vary between individuals and can limit the application of this approach in certain patients.

Long-term safety of in-the-bag implantation of a supplementary intraocular pinhole.

PURPOSE: To evaluate the long-term effectiveness and safety of the XtraFocus intraocular pinhole (IOPH) when it is implanted inside the capsular bag. SETTING: Private practice. DESIGN: Retrospective consecutive case series. METHODS: Patients who had an IOPH implanted in the capsular bag together with the primary intraocular lens (IOL) to treat irregular corneal astigmatism secondary to multiple causes were enrolled. The mean follow-up was 16 months (range 7 to 48 months). Patients were assessed in their scheduled follow-up visits. The uncorrected and corrected distance visual acuities were recorded at each visit. An infrared slitlamp photograph was captured and analyzed to verify the presence of interlenticular membrane formation. RESULTS: Sixty eyes of 58 patients were analyzed. The mean uncorrected and corrected distance visual acuities improved from logarithm of the minimum angle of resolution 1.34 ± 0.338 and 0.57 ± 0.145 preoperatively to 0.14 ± 0.012 (P < .001) and 0.12 ± 0.008 (P = .001) at 1 year postoperatively, respectively. A mild pinhole decentration was noted in 5 eyes (8.3%). Interlenticular opacification (ILO) was not noted in any patient. CONCLUSIONS: Implantation of the XtraFocus IOPH inside the capsular bag was a safe technique. Improvement observed in both uncorrected and corrected distance visual acuities was significant and sustained over time. ILO did not occur when this implant was positioned in the capsular bag together with a primary IOL.

Phacoemulsification with intraocular pinhole implantation associated with Descemet membrane endothelial keratoplasty to treat failed full-thickness graft with dense cataract.

We present a case in which a different approach was used to treat an eye with dense cataract associated with an irregular failed full-thickness corneal graft. After cataract surgery, a foldable intraocular pinhole was implanted in the capsular bag to treat the irregular corneal astigmatism. Next, a Descemet membrane endothelial keratoplasty graft was used to improve transparency in the failed penetrating keratoplasty. This approach addressed the cataract, irregular cornea, and failed graft through a standard 2.2 mm clear corneal phacoemulsification incision, thus avoiding open-sky surgical time and expediting visual rehabilitation.