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Purpose To assess the attitudes and beliefs held toward immediate sequential bilateral cataract surgery (ISBCS), including estimating the incidence of European Society of Cataract and Refractive Surgeons (ESCRS) members currently performing ISBCS, exploring the barriers of ISBCS implementation, and assessing the relevance of these findings to practice in the United Kingdom. Setting European consultant members of the ESCRS. Design Survey-based questionnaire. Methods The survey was sent and collected electronically. An initial screening question directed the rest of the survey; participants were asked to rate the importance of several factors with regard to performing ISBCS. Free text options were also available. Descriptive analysis was performed. Results Of the 2200 recipients, 303 (13.7%) responded, of which 247 were eligible for analysis. Of the 247 eligible respondents, 166 (67.2%) reported performing ISBCS, 71 (28.7%) said they did not perform ISBCS, and 10 (4.0%) said they had previously done so but have since stopped. Of those who were currently practicing ISBCS, the three most important factors to consider were all directly related to infection risk. Of those who did not perform ISBCS, the most important reasons for not performing the surgery were a risk for endophthalmitis (69.0%) and the medicolegal issues should ISBCS go wrong (57.8%). The most common reason for stopping ISBCS was that the respondent no longer believed in the benefit of ISBCS (n = 4). Conclusions The survey reflects ophthalmologists' concerns regarding infection and medicolegal risks; however, reports of bilateral endophthalmitis are extremely rare when the correct recommendations are followed. The findings from this survey could be used to inform service provision of ISBCS in the U.K., taking into consideration the voices of colleagues overseas.

Keratoprosthesis (KPro) is the last resort for corneal blindness. Boston KPro I and osteo-odonto-keratoprosthesis (OOKP) have the most favorable outcomes for their respective indications. Recently, better outcomes have been achieved for these 2 devices mainly because of improvements in postoperative care and modifications in complication management through years of experience and research. Unfortunately, some patients cannot benefit from these KPros due to lack of access to devices, trained surgeons, or both. Boston KPro I is heading toward a more affordable variation particularly for patients in developing countries. In addition, more patients with severely compromised ocular surface will be candidates for Boston KPro II variants. Biosynthetic or synthetic OOKP analogues will make the operation less complex and suitable for patients without canine tooth.

To review and compare the published reports of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty (DSEK/DSAEK) procedures with regard to endothelial cell density/loss, best spectacle-corrected visual acuity, central corneal thickness, subjective outcomes (patient's reported satisfaction/preference), and postoperative complications.A thorough search was conducted in the databases including AMED, EMBASE, Cochrane Database of Systematic Reviews, and MEDLINE without date restrictions. Systematic reviews, meta-analysis, randomized controlled trials, case series, and audits comparing DMEK and DSAEK were included.DMEK is superior to DSAEK for the following outcomes: visual acuity, central corneal thickness, and patient satisfaction. There was a statistically significant difference in the mean spectacle-corrected visual acuity at 6 months for DMEK (mean = 0.161, SD = 0.129) and DSAEK eye (mean = 0.293, SD = 0.153) conditions; t (297) = 8.042, P0.0001. The pooled mean difference was -0.13 (95% confidence interval, -0.16 to -0.09) and I = 44%, indicating better visual acuity for DMEK. Mean postoperative endothelial cell density showed statistically no significant difference in the mean values for DMEK (mean = 1855, SD = 442) and DSAEK eye (mean = 1872, SD = 429) conditions; t (336) = 0.375, P = 0.708. A higher proportion of patients prefer DMEK to DSAEK. However, DSAEK is superior to DMEK with respect to the need for rebubbling as the rebubbling rate was higher in the DMEK group.Although DMEK is associated with a higher rate of rebubbling, better visual outcomes were seen in DMEK.

Purpose To evaluate the safety and efficacy of tacrolimus eye drops as adjunctive therapy in the treatment of severe corneal endothelial rejection after penetrating keratoplasty refractory to corticosteroids. Methods In this prospective interventional case series, 11 eyes of 11 patients assessed for severe corneal endothelial rejection, with an inadequate response to topical, local, and systemic corticosteroids, were treated with either 0.01% or 0.05% tacrolimus eye drops 4 times daily. Improvement in signs of rejection, visual function, and development of complications were monitored. Results The duration of steroid treatment before intervention was 8.1 ± 1.4 days (range = 7-11). Patients were subsequently administered topical tacrolimus 0.01% or 0.05% qid. The time to clinical improvement was 10.3 ± 3.4 days (range = 3-17). The time to rejection reversal was 27.8 ± 16.3 days (range = 7-52). After 3 months, 10 patients (90.8%) demonstrated clinical improvement, and complete restoration of graft clarity was achieved in 5 patients (45.4%). In responsive cases, steroid therapy was successfully tapered off after 60.2 ± 19.7 days (range = 36-93). The best spectacle-corrected visual acuity improved from 1.7 ± 0.9 to 0.8 ± 0.5 logMAR (P = 0.0016). Reported side effects included stinging on drop instillation and punctate epithelial keratopathy. Conclusions Tacrolimus eye drops may be able to play an adjunctive therapeutic role in patients with severe corneal endothelial rejection refractory to conventional steroid treatment. Controlled studies are needed to further investigate the role of tacrolimus in this setting.

Purpose of review To describe the practice of and recent developments in the osteo-odonto-keratoprosthesis. Recent findings Formal psychological assessment and support have been described. A sub-aqua system for fashioning the osteo-odonto-keratoprosthesis lamina; adoption of thicker laminae; use of bisphosphonate drugs; advances in laminar imaging; and use of bone augmentation and bone morphogenetic protein have been described for prevention, detection, and management of laminar resorption. Two systems of optical cylinders available commercially. A stepladder approach to buccal mucous membrane overgrowth onto the optical cylinder has been described, including use of mitomycin-C. Orbital decompression has been used for cosmetic improvement. Detection of glaucoma may be aided by an intraocular pressure sensor, whereas surgical treatment is mainly by way of glaucoma drainage devices, as endolaser ciliary ablation and recti muscle disinsertion and reinsertion not having prolonged and significant long-term beneficial effect. Sublingual timolol has been described. The use of endoscopy has been proposed for preoperative evaluation of the posterior segment, ciliary ablation and for vitreoretinal surgery although wide-angle viewing systems remains standard practice. Summary The osteo-odonto-keratoprosthesis is the procedure of choice for rehabilitation of corneal blindness for end-stage ocular surface disease, serving a completely different patient group to the Boston Type 1 KPro.

To evaluate anterior segment optical coherence tomography (AS-OCT) in the preoperative simulation of postoperative iris-fixated phakic intraocular lens (pIOL) position in the anterior chamber.Farabi Eye Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran.Case series.Using AS-OCT, the pIOL position was simulated preoperatively in 2 ways and compared with the actual postoperative pIOL position. For preoperative evaluations, the simulator was placed on the posterior pigmented epithelium of the iris. Then, the simulation was performed with the simulator placed in the middle of the iris tissue. The following distances were measured: from the center of the pIOL to the endothelium, from the edge of the pIOL to the endothelium, and from the posterior surface of the pIOL to the crystalline lens.The study examined 26 eyes (16 patients). Although all distances in both simulation methods (except the lens vault in the first method of simulation) were highly correlated (all P.009), only the results with the simulator placed in the middle of the iris tissue were not statistically different from the corresponding postoperative measurements (P=.209 and P=.564 for distance from endothelium to the center and the pIOL edge, respectively).Using the pIOL template of the AS-OCT system for preoperative simulation of iris-fixated pIOLs improved the criteria for patient selection for implantation of these pIOLs. The simulator should be placed in the middle of the iris tissue for preoperative simulation.No author has a financial or proprietary interest in any material or method mentioned.

PURPOSE To evaluate the clinical results of a mechanical keratectomy with mitomycin C (MMC) and extended wear contact lens (EWCL) for the treatment of corneal haze after photorefractive keratectomy (PRK) of high myopia. SETTING Eye Research Center, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Iran. METHODS : In a retrospective interventional case series, we enrolled 15 eyes of 9 patients who previously underwent PRK for high myopia and developed corneal haze and regression. Mechanical removal of corneal haze was done by using a surgical blade number 15. Then, MMC (0.02%) was used for 2 minutes. An EWCL was applied for 1 month. The main outcome measures were uncorrected visual acuity, best-corrected visual acuity, spherical equivalent (SE), and corneal haze grade. All patients were followed for a minimum of 6 months. RESULTS The mean age of the patients was 25.66 ± 7.03 years; 7 patients were men and 2 patients were women. The mean best-corrected visual acuity before superficial keratectomy was 20/80 (range, 20/200-20/50) and improved to 20/20 after treatment (P < 0.05). Thirteen eyes (86.6%) achieved an uncorrected visual acuity of at least 20/40. The mean preoperative SE was 3.91 ± 1.30, and the mean final postoperative SE was -0.85 ± 1.19 (P < 0.05). Eight eyes (53%) were within 1 diopter of emmetropia. Corneal haze in all patients declined to a trace haze or complete clearness. No recurrence occurred during the mean follow-up time of 12 months. CONCLUSIONS Superficial keratectomy with MMC and EWCLs is effective in reducing persistent and refractory corneal haze after PRK.

We describe a simple method for evaluating the adequacy of the capsule for implantation of a foldable intraocular lens (IOL) during phacoemulsification complicated by a posterior capsule tear. After cortical lens material clean-up and anterior vitrectomy (if required), 3 knots of 10-0 nylon are tied to the trailing haptic of the IOL using a 3/1/1 configuration. Then, the IOL is inserted into the sulcus. If it is unstable when the surgeon tries to deepen or shallow the anterior chamber, gently pulling the nylon thread will prevent posterior IOL dislocation. Two further attempts to implant the IOL in the other meridians of the capsule are made. The results of using this technique in 10 eyes of 10 patients are reported. Optic decentration occurred in 1 case (10%). No postoperative dislocation was observed, and no patient required surgery for IOL decentration during the follow-up.

Air-assisted donor preparation for DMEK Venzano al. have described a technique of Descemet membrane air-bubble separation. We also use an air-assisted (reverse big bubble) technique to prepare Descemet membrane for Descemet membrane endothelial keratoplasty. In our method, a corneoscleral button is placed endothelial side up on a Barron donor punch and fixed by grasping the outer scleral edge with a 0.12 forceps. A 27-gauge bevel-up needle attached to a 2 mL syringe filled with air is inserted into the posterior stroma with the entry point located just outside Schwalbe line. The needle is advanced to the central cornea. Air is gently injected to make a big bubble, detaching Descemet membrane from the posterior stroma. Injecting into the endothelial side-up corneoscleral button allows us better visualization and makes the procedure more feasible, less instrument dependent, and less traumatic. Venzano et al. reported a high success rate of Descemet membrane detachment with their method. This high rate of success might be related to the older age (mean Z 78 years) of donors. In our experience, we found that air-assisted Descemet membrane dissection is more difficult in young patients (younger than 40 years) and attempts to make a complete detachment may lead to Descemet membrane rupture. In our first 10 cases, with a mean age of 32 years, an incomplete detachment (smaller than 8.0 mm diameter) occurred in 2 cases and Descemet membrane rupture occurred in 1 case. We now prefer older donors with higher endothelial cell counts for this technique.