Preliminary Results of New Modification of Vertical Muscle Transposition to Enhance Abducting Force in Sixth Nerve Palsy.

Introduction: Since 1907, multiple transposition procedures have been established for the treatment of abducens paralysis. The purpose of the study was to determine where the transposed muscle should be reattached in order to increase the tangential force necessary to improve abduction. Methods: Retrospective case review of 12 consecutive patients with abducens paralysis who underwent transposition procedures between 2016 and 2019 was conducted. Vertical rectus muscles are transposed to the insertion of lateral rectus muscle; the temporal parts are joined and sutured to the sclera on top of the lateral rectus muscle in the middle of the insertion. The nasal parts are sutured to the sclera following the spiral of Tillaux. The muscle junction suture is placed 8 mm from the insertion, with the temporal parts of the vertical muscles bellies joined and sutured to the lateral rectus muscle. A full-tendon transposition was performed on 11 patients, a half-tendon transposition procedure on 1 patient. The minimum follow-up was 3 months. Results: The mean preoperative deviation was ET of 37° (range: ET 24° to ET 51°). The mean preoperative abduction limitation was 5 mm from midline (range: 7 to 1 mm). The postoperative mean deviation was ET of 2° (range: 0° to ET 5°). The postoperative mean abduction improvement was 5 mm past midline (range: 2-6 mm). There were no complications or signs of anterior segment ischemia. Conclusion: To achieve the maximal abductive force from the transposed muscles, we suggest that the vertical muscles be reattached as close as possible to the middle of the lateral rectus insertion.

Stabilization of refractive error and associated factors following small incision phacoemulsification cataract surgery.

BACKGROUND: Accumulating evidence suggests that refractive stabilization occurs rapidly following small incision cataract surgery. Nonetheless, many guidelines still suggest waiting four to 6 weeks before prescribing corrective lenses. This study was undertaken to supplement the existing literature regarding refractive stabilization, and evaluate multiple contributing factors that could dissuade clinicians from confidently correcting refractive error in the early post-operative course following routine cataract surgeries. METHODS: Adult patients undergoing phacoemulsification cataract surgery with uncomplicated surgeries and post-surgical courses at the Calgary Ophthalmology Centre (Calgary, Alberta, Canada) were included in this prospective observational case series. Exclusion criteria included known corneal dystrophies, infectious keratitis, complicated surgery or toric/multifocal IOLs. Data was collected at weekly intervals for a total of 6 weeks. Collected data included autorefraction, visual acuity, corneal pachymetry, and effective lens position. RESULTS: One hundred six eyes of 104 patients were included in this study. Post-operative sphere, cylinder and spherical equivalent were not significantly different at any post-operative week compared with week six, and 80-86% of patients were within 0.5D of last follow-up spherical equivalent at any week. The secondary outcomes of central corneal thickness, effective lens position and visual acuity did, however, exhibit significant differences between early post-operative weeks and last follow-up values. CONCLUSIONS: These data suggest that refractive error can be effectively measured and corrected as early as one-week post-operatively in the majority of patients, though other measures of post-operative stability including central corneal thickness, effective lens position and visual acuity can require up to 4 weeks to stabilize. Thus a conservative and pragmatic approach may be to wait until 4 weeks post-operatively prior to obtaining refractive correction following uncomplicated phacoemulsification cataract surgery.

Analysis of Efficacy and Safety of Pediatric Ahmed Glaucoma Valve (FP8) in Advanced Age Populations.

PRECIS: The FP8 glaucoma valve was demonstrated to be reasonably safe with reliable results in an advanced age patient population. PURPOSE: As life expectancy increases, a growing number of patients with glaucoma are of an advanced age. There are little to no data looking at glaucoma surgical treatment options in patients over the age of 85. Our study describes the safety and efficacy of the FP8 Ahmed glaucoma valve in this patient population. MATERIALS AND METHODS: This was a retrospective study of patients over 85 years of age undergoing FP8 Ahmed glaucoma valve implantation. Preoperative age, sex, intraocular pressure (IOP), and number of glaucoma medications were recorded. Primary outcome variables were IOP and number of medications. Secondary outcome variables included any intraoperative or postoperative complications. RESULTS: Mean IOP preoperatively was 26 mm Hg on an average of 3 glaucoma medications (n=56). IOP was significantly reduced at all time points in follow-up for an overall reduction of 42% at 1 year and 46% at 2 years. Mean IOP at 1 year follow-up was 15 mm Hg and 14 mm Hg at 2 years follow-up. Glaucoma medications were reduced from a mean of 3 preoperatively to 2 postoperatively. CONCLUSIONS: Implantation of an FP8 Ahmed glaucoma valve is a relatively safe procedure to achieve satisfactory IOP and decreased reliance on glaucoma medications in an advanced age population.

Canadian Opinions on Refractive Surgery and Approaches to Presbyopia Correction.

PURPOSE: To explore the opinions of Canadian ophthalmologists on refractive and presbyopia-correcting surgeries. METHODS: We distributed an online survey to the Canadian Ophthalmological Society members, covering laser refractive surgery (LRS), femtosecond laser-assisted cataract surgery (FLACS), lenticular refractive surgery (lenRS) that includes cataract refractive surgery (CRS) with premium intraocular lens (IOL) implantation, and presbyopia correction. RESULTS: There were 68 (7.6%) total respondents. Most respondents would not consider LRS (62.5%) nor FLACS (73.9%) for themselves. Male sex and performance of LRS or FLACS was significantly associated with consideration of these procedures for self. Most respondents (59.3%) would consider lenRS for themselves. The top method of personal presbyopia correction was spectacles, chosen by 52.5%. CONCLUSIONS: When surveying the wide body of Canadian ophthalmologists, most respondents preferred spectacle correction of presbyopia and would consider lenRS, but not LRS or FLACS for themselves. Surgeons performing these procedures were more likely to consider them for self.

Opinions on corrective refractive surgery.

OBJECTIVE: To investigate public perception that ophthalmologists are hesitant to undergo refractive surgery by determining the personal opinions of ophthalmologists on different surgical options. DESIGN: Prospective cross-sectional survey. PARTICIPANTS: Members of the American Society of Cataract and Refractive Surgery electronic mailing list. METHODS: An online survey administered from July to August 2014. RESULTS: There were 396 (5.7%) respondents: 204 (51.5%) would undergo laser refractive surgery (LRS) and 192 (48.5%) would not. Of the 228 (57.6%) with refractive error, 121 (53.1%) would have LRS, with 83 (36.4%) already having had the procedure done. Top reasons against LRS include existing contraindications, worry about intolerable side effects, and worry about complications. 179 (45.3%) would undergo lenticular refractive surgery (lenRS), with 22 (12.3%) having already had this done. Among those who said yes, most preferred a monofocal intraocular lens (IOL; 59 [33.0%]), whereas those who said no thought Toric IOLs to be superior (82 [38.0%]). 184 (46.6%) would undergo femtosecond laser-assisted cataract surgery (FLACS); the main reason against FLACS was concern regarding efficacy, followed by safety. Pearson χ2 analysis found that younger age and higher number of LRS procedures performed were associated with increased willingness to undergo LRS. Furthermore, willingness to undergo LRS was positively correlated with willingness to undergo lenRS. CONCLUSIONS: Ophthalmologists indeed are willing to undergo corrective refractive procedures. There is an approximately 50-50 divide on whether or not they would undergo LRS. Slightly less than half of ophthalmologists would personally undergo lenticular surgery, which includes cataract refractive surgery and FLACS.

Evaluation of occupational ocular trauma: are we doing enough to promote eye safety in the workplace?

OBJECTIVE: The aim of this study was to document the use of eye personal protective equipment (PPE) by patients who had sustained an eye injury in the workplace and to evaluate the characteristics and outcomes of these patients. DESIGN: Case-control study. PARTICIPANTS: All adult patients who had sustained an eye injury in the workplace and presented to the urgent ophthalmology clinic of a tertiary care hospital from October 1, 2013, to November 30, 2014, were eligible for inclusion. METHODS: Medical records were reviewed to obtain occupational eye injury data, including etiology, type, and severity of injury as per the Ocular Trauma Score. Use of eye PPE at the time of injury was recorded. Outcome data, including disposition, duration of follow-up, and return to baseline best-corrected visual acuity, were also recorded. RESULTS: One hundred sixty-nine patients were included in this study. The median age of the cohort was 31 years (range, 17-68 years), and 92.9% were male. Chemical exposure (31.4%), grinding (17.9%), and injuries sustained by a sharp-object, metal, or nail (13.1%) were overall the most common etiologies of injury. Eye PPE was not worn by 66.9% of the cohort, with 33.1% of the cohort sustaining an occupational eye injury despite the use of eye PPE. CONCLUSIONS: Use of eye PPE among workers who sustain an eye injury in the workplace remains low; yet, its use does not preclude a significant proportion of such workers from injury. Increasingly advocating for both the use and appropriate selection of eye PPE in the workplace is an important public health initiative that should therefore be encouraged.