Visual and refractive outcomes of new intraocular lens implantation after cataract surgery.

To report the visual and refractive outcomes of new aspheric hydrophobic acrylic monofocal intraocular lens (IOL). Retrospective case series. This study included eyes of patients who underwent routine cataract surgery for uncomplicated age-related cataract with implantation of a Aktis SP (NS-60YG; Nidek Co. Ltd., Japan) IOL and attended regular follow ups at 1 week, 1 month, 3 months, and 12 months. At each post-operative visit, ophthalmological evaluation included measurement Uncorrected (UCVA) and Best corrected visual acuity (BCVA), contrast sensitivity, posterior capsular opacification (PCO), optical aberrations, analysis of point spread function (PSF) and modulation transfer function (MTF). The study included 2102 eyes of 1358 patients aged 45 to 75 years (mean age 62.6 years ± 5.6 SD). The mean preoperative BCVA was 0.56 ± 0.26 logMAR. At 1 year follow up, the mean postoperative UCVA and BCVA were 0.11 ± 0.09 and 0.02 ± 0.03 logMAR, respectively. At the end of 6 months, around 1487 (93%) eyes had BCVA of 20/20 and better than 20/30 in 100% of the eyes. Mild posterior capsule opacification (PCO) was observed in 56 patients, but none required Nd YAG laser capsulotomy. There was reduction in ocular spherical aberration and Higher order aberrations (HOAs) as compared to pre operative. This explains better contrast sensitivity obtained by MTF and PSF values. The study shows that the Aktis SP IOL is safe, effective, and stable lens that could be inserted through 2.2 mm incision with satisfactory visual and refractive outcomes, even in late post-operative period.

Vitrector-assisted anterior capsulorhexis in adult intumescent cataract.

Performing capsulorhexis in white intumescent cataracts during phacoemulsification surgery is challenging for cataract surgeons because of high intralenticular pressure and reduced red reflex. Capsulorhexis extension to the periphery of the lens is a common occurrence due to lens intumescence. We used a vitrectomy cutter to create an initial tear in the anterior capsule and simultaneously remove a part of milky fluid coming out of the intumescent lens. Once the lens was decompressed, capsulorhexis was completed using capsulorhexis forceps. This technique helped in controlling capsulorhexis in eyes with intumescent cataracts by reducing the intralenticular pressure and thereby preventing unexpected radial capsular tear.

An unusual presentation of uveo-meningeoencephalitic syndrome.

INTRODUCTION: Unilateral uveo-meningeoenchephalitic syndrome is a relatively rare entity. Our case highlights the importance of keeping this entity in mind when a unilateral picture suggestive of Vogt Koyanagi Harada syndrome crops up. CASE: A 34-year-old male came with chief complaints of blurring of vision in the right eye since two days with a prodrome of intense headache and redness in the right eye. On examination, the vision in the right eye was counting fingers close to face and 20/20 in the left eye. Clinical examination suggested unilateral uveo-meningeoenchephalitic syndrome which was confirmed on multimodal imaging. OBSERVATIONS: This case highlights the fact that though uveo-meningeoenchephalitic syndrome is bilateral, by definition; the initial presentation may still be unilateral and a prompt diagnosis and treatment can prevent the involvement of the other eye. CONCLUSION: Any case presenting with signs of symptoms suggestive of Vogt Koyanagi Harada should be treated as Vogt Koyanagi Harada even though the initial presentation may be unilateral. A prompt diagnosis and early treatment will ensure that the other eye does not get involved. Early Vogt Koyanagi Harada may just present with choroidal hyperpermeability and multiple septate pockets of SRF without any vitreous cells or anterior segment inflammation.

Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty as a Treatment Modality for Recalcitrant Post-Laser in situ Keratomileusis Epithelial Ingrowth.

The purpose is to present the outcomes of anterior lamellar keratoplasty for a case of post-laser in situ keratomileusis (LASIK) epithelial ingrowth. A 40-year-old male patient presented with epithelial ingrowth 14 years after primary LASIK with a microkeratome blade in the right eye following trauma. Multiple stromal bed washing was done over a period of 3 years, but recurrence of epithelial ingrowth was seen every time. Femtosecond laser-assisted anterior lamellar keratoplasty was performed in the right eye. Twelve months after the procedure, the patient's corrected distance visual acuity improved to 6/9, and no recurrence was noted. Femtosecond laser-assisted anterior lamellar keratoplasty is an effective treatment modality in cases of recurrent recalcitrant epithelial ingrowth seen after LASIK.

A novel method of tunnel creation using intraoperative optical coherence tomography-guided deep anterior lamellar keratoplasty.

The big bubble technique has become the technique of choice for performing deep anterior lamellar keratoplasty (DALK) since its inception in 2002. The main challenge with this technique is in achieving a big bubble while preventing inadvertent perforation of the Descemet's membrane. Although femtosecond lasers have increased the safety, accuracy, and predictability of corneal dissection in DALK, the challenge of achieving a big bubble still exists. To overcome this challenge, Zeimer Z8 Femto LDV has launched a new software module for DALK, which has an added advantage of real-time optical coherence tomography-assisted femtosecond tunnel creation for achieving a big bubble.

Bilateral Toric Phakic Intraocular Lens Implantation for Correction of High Myopic Astigmatism in a Patient with Marfan Syndrome with Lens Coloboma: A Case Report.

Marfan syndrome (MFS) is known to cause significant refractive error. Treatment options are limited in this condition for correcting refractive error. Clear lens exchange is done in these cases, but complication rates are high. Loss of accommodation is another concern in these young adults. We report toric phakic intraocular lens (pIOL) implantation in improving the uncorrected visual acuity (UCVA) in a known case of MFS with lens coloboma. A 22-year-old female patient with MFS with inferior lens coloboma underwent bilateral toric pIOL implantation in the same sitting. Pre- and post-operative UCVA and best-corrected visual acuity were assessed. Central and peripheral vaulting of the pIOL in relation to the natural lens was also assessed. UCVA improved from 20/500 to 20/20 in the right and 20/550-20/20 in the left eye. Marked central vaulting with partial peripheral vaulting was achieved. There were no post-operative complications. Phakic IOL implantation surgery could be an effective approach to achieve excellent uncorrected refractive outcome in patients with MFS to treat high myopia.

Precision Pulse Capsulotomy During Combined Penetrating Keratoplasty With Cataract Surgery and Intraocular Lens in Small Nondilating Pupil.

OBJECTIVE: To demonstrate precision pulse capsulotomy (PPC) in an open-sky procedure and to evaluate its use during triple procedure keratoplasty in small nondilating pupils. METHODS: This single-center retrospective case series study included 10 eyes (from 10 patients) with corneal opacity and poorly dilated pupils who were scheduled to undergo triple procedure keratoplasty. The main outcome measures were capsulotomy performance of the PPC device and intraoperative complications. Secondary outcome measures included postoperative best-corrected visual acuity, intraocular pressure, and other postoperative complications. RESULTS: Complete free-floating capsulotomy was achieved in all 10 eyes. There were no cases of anterior capsule tears or tags. There were no postoperative complications that occurred in association with the PPC device. CONCLUSIONS: The PPC device facilitates creation of a smooth, round, and appropriately sized anterior capsulotomy in open-sky surgeries, particularly in presence of small nondilating pupils.

Hypermature Intumescent Cataract in Advanced Keratoglobus.

We report a rare case of bilateral keratoglobus with hypermature intumescent cataract in a 55-year-old woman. Clinical examination and corneal topography confirmed generalized corneal bulging and global corneal thinning. A Pentacam® (Oculus Optikgerate, Wetzlar, Germany) demonstrated bilateral diffuse corneal thinning (368 µm in the right eye and 371 µm in the left eye). Phacoemulsification was performed in the right eye after thorough workup and modification of the surgical technique. This case report helps in better understanding of the challenges of cataract surgery and intraocular lens selection in a keratoglobus patient, and stresses the need for both thorough preoperative planning and intraoperative surgical modifications.

Visual outcomes after refractive laser corneal surgery and phakic IOL in amblyopic eyes.

PURPOSE: To evaluate the outcomes of laser corneal surgery and phakic IOL surgery in adult amblyopic eyes. METHODS: Retrospective assessment was done in 688 amblyopic eyes 640 patients who underwent LASIK or phakic IOLs. Ophthalmological evaluation included measurement of uncorrected (UDVA) and corrected (CDVA) distance visual acuities. Analysis of modulation transfer function (MTF) was also done post-operatively as a measure of contrast sensitivity. Patients completed follow-up examinations at 1 day, 3 day, 3 months and 12 months after surgery. RESULTS: The mean patient age was 24.30 ± 3.04 years with 59% females. The CDVA of amblyopic eyes improved significantly from the mean preoperative level of 0.48 ± 0.18 to 0.59 ± 0.18 at 12 months. There was improvement in the contrast sensitivity at all spatial frequencies. Refractive errors were corrected in both LASIK and phakic IOL group, but there was no clinically significant difference in visual outcomes between each group. CONCLUSION: Laser vision correction and phakic IOL surgery for amblyopic eyes are promising alternative methods for improving visual outcomes in adult refractive amblyopia patients who have failed with conventional approaches.

Comparative Evaluation of Visual Outcomes After Bilateral Implantation of a Diffractive Trifocal Intraocular Lens and an Extended Depth of Focus Intraocular Lens.

OBJECTIVES: To compare visual outcomes and clinical performance of diffractive trifocal and extended depth of focus (EDOF) intraocular lenses (IOLs). METHODS: This prospective, consecutive, nonrandomized, comparative study of 6-month duration included assessment of 160 eyes of 80 patients (40 patients in each group). The patients had bilateral cataract surgery with implantation of a trifocal (FineVision Micro F; PhysIOL SA, Liège, Belgium) or EDOF IOL (TECNIS Symfony; Abbott Medical Optics, Inc., Abbott Park, IL) in both eyes. Ophthalmological evaluation included measurement of monocular uncorrected distance visual acuity (UDVA) and corrected distance VA (CDVA), uncorrected intermediate VA (UIVA) and distance-corrected intermediate VA (DCIVA), uncorrected near VA (UNVA) and distance-corrected near VA (DCNVA). Analysis of point-spread function and modulation transfer function was also performed postoperatively, and quality of vision and spectacle-dependence questionnaires were assessed. RESULTS: There was no statistically significant difference between groups in monocular UDVA (P=0.65), CDVA (P=0.82), and binocular UDVA (P=0.81). The monocular UIVA, monocular DCIVA, and binocular UIVA were also comparable among the two groups (P=0.70, 0.74, and 0.81, respectively). Monocular UNVA, DCNVA, and binocular UNVA were statistically and significantly better for the trifocal group than for the EDOF (P=0.01, P=0.009, and P=0.001, respectively). There were no differences in visual symptoms and quality among groups. CONCLUSIONS: Trifocal IOL had a clear advantage over EDOF IOLs in near VA, while both IOLs showed excellent performance in distance and intermediate VA. Both IOLs provided high percentage of spectacle independence and patient satisfaction with minimal level of disturbing photic phenomena.

Ocular manifestations in patients with cerebrovascular accidents in India: a cross-sectional observational study.

PURPOSE: To assess ophthalmic manifestations in patients with stroke and emphasize the importance of a formal screening for visual problems in stroke patients in hospital and rehabilitation settings. METHODS: This was a cross-sectional study of 50 newly diagnosed patients with stroke with Glasgow Coma Scale (GCS) > 8 examined within 3 days of onset. A detailed ophthalmic examination was performed for each patient including visual acuity, fields, ocular motility, slit lamp and fundus examination, line bisection tests and cranial nerve assessment. Radiological investigations were reviewed and anatomically correlated. RESULTS: A total of 50 patients (41 male and nine female) were included in the study. Mean age of the stroke cohort was 51.36 years. Twenty-nine patients (58%) had a subcortical stroke, while 42% (n = 21) patients had a cortical stroke. Nineteen patients (38%) demonstrated visual field defects. Twenty-one patients (42%) had a gaze palsy. Vertical gaze palsy (n = 8) was more common in cortical stroke, while internuclear ophthalmoplegia (n = 2), horizontal gaze palsies (n = 4) and Parinaud's syndrome (n = 1) were seen more commonly in those with subcortical stroke. Twenty-four percent (n = 12) patients had nystagmus. Twelve percent (n = 6) patients had diplopia. Thirty-eight percent (n = 19) patients had convergence insufficiency. Sixteen patients (32%) complained of visual impairment. Retinal abnormalities were seen in 58% (n = 29) of patients. CONCLUSIONS: Ophthalmic manifestations were seen in 90% of stroke survivors. Their presence in majority of the patients in our cohort suggests that earliest routine ophthalmic examination should be mandatory in all patients with acute stroke.

Subinternal limiting membrane hemorrhage post-Ahmed glaucoma valve in vitrectomized eye.

Glaucoma drainage devices are mostly used for refractory glaucoma. Early postoperative complications include flat anterior chamber, choroidal effusion, and suprachoroidal hemorrhage. An 8-year-old male patient with a prior history of vitreous surgery for traumatic vitreous hemorrhage, presented to us with angle recession glaucoma in his right eye. His intraocular pressure (IOP) was 44 mmHg despite maximum antiglaucoma medication. Ahmed glaucoma valve (AGV) surgery was performed to control his IOP. In the early postoperative period, the patient developed premacular subinternal limiting membrane (ILM) hemorrhage, which did not resolve even after 4 weeks. Vitreoretinal intervention involving removal of the thickened ILM and sub-ILM bleed had to be performed. To the best of our knowledge, no case has been reported with sub-ILM bleed post aqueous humor shunts. Here, we report a case of premacular sub-ILM bleed following AGV in vitrectomized eye.

Active cyclotorsion error correction during LASIK for myopia and myopic astigmatism with the NIDEK EC-5000 CX III laser.

PURPOSE: To investigate the predictability and accuracy of active cyclotorsion compensation during LASIK for myopia with astigmatism. METHODS: Fifty-two eyes of 26 patients were divided into two groups; one group (30 eyes) underwent primary LASIK with torsion error correction (TEC [TEC group]) and 22 eyes underwent LASIK without TEC (control group). The NIDEK EC-5000 CX III excimer laser was used for all treatments. All eyes were targeted for emmetropia. Manifest refraction spherical equivalent (MRSE), refractive outcomes, and dispersion and predictability of manifest refractive cylinder were compared between the TEC and control groups. A P value < .01 was considered statistically significant. All outcomes are reported at 3 months postoperatively. RESULTS: Statistically significantly lower cylinder dispersion and mean manifest refractive cylinder postoperatively were demonstrated in the TEC group (P < .01). Final refractive cylinder for the TEC group was -0.21 +/- 0.16 diopters (D) (range: -0.62 to 0.00 D) and -0.56 +/- 0.34 D (range: -1.25 to 0.00 D) for the control group. No statistically significant differences in mean MRSE or safety (defined as a loss of 2 or more lines of best spectacle-corrected visual acuity) was noted between groups. CONCLUSIONS: LASIK with active cyclotorsion error correction increases the accuracy of cylinder correction.

Comparison of cross cylinder ablation using the optimized ablation transition zone and the torsion error detector for correction of astigmatism.

PURPOSE: To compare the safety and efficacy of laser in situ keratomileusis (LASIK) in correcting high myopic astigmatism using two different ablation profiles using the Nidek EC-5000 CX II laser). METHODS: Fifteen patients (25 eyes) had LASIK for compound myopic astigmatism, using the Optimized Ablation Transition Zone (OATz) ablation profile and activated torsion error detection (TED). Results were compared with those obtained with a cross cylinder ablation profile for myopic astigmatism. RESULTS: For eyes treated with TED, on postoperative day 7, 76% had visual acuity equal to or better than baseline best spectacle-corrected visual acuity (BSCVA) and 56% of eyes had overcorrected astigmatism. On postoperative day 20, none of the eyes had residual astigmatism more than 1.00 D and 72% eyes were within +/-0.50 D cylinder; 92% of eyes had residual astigmatism within 30 degrees of the preoperative axis and 12% remained astigmatically overcorrected at 20 days. Eighty-eight percent of eyes were either fully corrected or had mild myopic astigmatism. Comparison of results with cross cylinder ablation showed that 24% had overcorrection and 60% of patients with high astigmatism were overcorrected up to 1.75 D and developed hyperopic astigmatism in the opposite axis. Results with the cross cylinder ablation profile were good up to 2.00 D of myopic astigmatism. CONCLUSIONS: Correction of astigmatism using the OATz profile and TED with the Nidek EC-5000 CX II laser produced good results in high as well as pure astigmatism treatments, compared to the cross cylinder ablation profile. Ablation depth was greater in OATz with TED-based corrections. Overcorrections were less with OATz with TED, and residual astigmatism was at the same baseline axis, thereby increasing patient satisfaction.