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Scleral and iris fixation of intraocular lenses (IOL) are useful in the treatment of surgical or traumatic aphakia, luxation, and subluxation of IOL if the patient does not present appropriate capsular support. However, there is no consensus in the literature about which of these 2 methods is safer and better. The authors performed a literature review searching the main postoperative outcomes obtained with the use of each surgical method. Scleral and iris fixation of IOL are efficient in correction of the patients’ visual acuity, even though each technique presents distinct complications which depend especially on the experience of the surgeon with the performed surgical method. It is important to understand that individuals submitted to scleral or iris fixation present previous preoperative complications in their eyes. Besides, both procedures are very complex, involving intense manipulation of the eye globe. The success rate of these surgical techniques is highly variable and has a close relation to the preoperative conditions of the patient’s eye and the improvement of the surgeon’s learning curve.

Purpose: To evaluate the effect of topical instillation of pegaptanib sodium upon inflammatory angiogenesis induced in the rabbit cornea by alkaline cauterization. Methods: Inflammatory angiogenesi...

PURPOSE To compare direct and indirect LASIK flap thickness measurements using ultrasound and Scheimpflug technology. METHODS Eighty-two eyes treated with laser-assisted in situ keratomileusis refractive surgery using a femtosecond laser (IntraLase FS150) were prospectively included in the study. Flap thickness was set to 115 μm. Corneal flap thickness was measured using the direct method-ie, ultrasound pachymetry immediately after flap construction in the presence of cavitation bubbles-and indirect methods, with subtraction of intraoperative post-lift corneal thickness measured using ultrasound pachymetry (intrastroma) from preoperative central corneal thickness using ultrasound (Indirect-US) or Scheimpflug thinnest pachymetry (Indirect-Scheimpflug). RESULTS Mean flap thickness was overestimated using the indirect methods, Indirect-US and Indirect-Scheimpflug (122.6 ± 24.5 μm and 128.1 ± 26.1 μm, respectively; P < 0.0060 and P < 0.0001, respectively). There were no significant correlations between the direct and indirect methods. Indirect-Scheimpflug was significantly higher (P = 0.0122) than Indirect-US. The closest average flap thickness compared with the set parameter of 115 μm was that of the direct method (115.6 ± 8.6 μm; 95% confidence interval: -1.3 to 2.5; P = 0.5163). The direct method provided the lowest SD of all groups (SD: 8.64). CONCLUSIONS The direct method of flap thickness measurement was the most comparable to the set parameter compared with the indirect subtraction methods. Additional studies are needed to determine which method allows for the most accurate measurement of flap thickness.

Purpose. To develop a mobile app that allows capturing and editing of photographs, performs image transposition and projection of a protractor with 360° axis markings, and permits accurate visualization of programmed alignment for the positioning of toric intraocular lenses (IOLs). Methods. In this prospective case series study, a codesign methodology was chosen to develop the Eye Axis Check application. After app development, measurements were obtained and comparisons were made between manual marks and toric IOL alignment without and with the app in 30 eyes that had undergone cataract surgery with toric IOLs. The mobile app was made available to 15 ophthalmic surgeons in different cities to assess its usability. Results. The users approved the developed application for its ease of use and utility. The mean difference between the markings made manually and those made with the app was 1° (±2°; range: 0°–5°), and the mean difference between the IOL position and the assessment made by the app was 3° (±3°; range: 0°–12°). Upon comparison of the agreement between the app measurements and the manual measurements for the IOL angle, no significant differences were found, and an excellent concordance (0.997) and a strong positive linear correlation (0.995) were observed. Conclusion. A mobile app for preoperative planning and intraoperative toric IOL alignment was developed and revealed to be useful and easy to use.

Dense brunescent cataracts represent a major challenge for surgeons. We performed a literature review focusing on surgical challenges dense brunescent cataracts present. All relevant literature was...

According to the World Health Organization, cataract is the major cause of reversible visual impairment in the world. It is present as the cause of decreased visual acuity in 33% of the visual impaired citizens. With the increase of life expectancy in the last decades, the number of patients with cataract is expected to grow for the next 20 years. Nowadays, the only effective treatment for cataracts is surgery and its surgical outcomes have been increasingly satisfactory with the technological advancement.

Aims: Evaluate the effect of LASSBio-596, structurally designed as a new hybrid of thalidomide, on inflammatory corneal angiogenesis. Methods: Eighteen rabbits were submitted to an alkaline cauterization in the right cornea. The animals were randomly allocated to three groups: vehicle, dexamethasone and LASSBio-596. Drugs were administered by eyedrops 3 times a day for 21 days. Evaluations were performed on days 3, 6, 9, 12, 15, 18 and 21 after cauterization. At these time points, digital images of the cornea were captured in a standard fashion. The angiogenic response was measured using software that was developed specifically for this purpose. It calculated the following parameters: neovascularization area (NA), total vascular length (TVL) and blood vessel number (BVN). Results: It was observed that dexamethasone significantly decreased NA, TVL and BVN during all assessments. From the NA the angiogenesis rate (AR) was calculated in each group. Therefore, dexamethasone completely inhibited the inflammatory corneal angiogenesis with an AR of –0.001 ± 0.006 mm2/day, which was significantly lower (p < 0.001) than that observed after treatment with vehicle (0.078 ± 0.024 mm2/day) and LASSBio-596 (0.054 ± 0.012 mm2/day). Although LASSBio-596 reduced angiogenesis in relation to vehicle, according to NA, TVL and BVN values, this difference was not statistically significant. However, it was found that the AR as measured in the LASSBio-596 group was significantly lower (p < 0.05) than that seen in control animals, indicating a potential antiangiogenic effect. Conclusion: We conclude that topical application of LASSBio-596 at 1.0% has a potential inhibitory effect on inflammatory corneal angiogenesis in rabbits.

We describe a technique for image-guided femtosecond laser–assisted cataract surgery in a case of Peters anomaly type 2. The femtosecond laser technology enabled reliable construction of a complete capsulotomy despite central corneal opacification and a tented anterior capsule. Use of an image-guided femtosecond laser for cataract extraction in Peters anomaly type 2 is a safe method for removing these complex cataracts while preserving capsular and corneal integrity. Financial Disclosure Dr. De la Cruz is a consultant to Alcon Surgical, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Purpose:To evaluate the visual performance of different types of intraocular lens (IOL) in eyes submitted to femtosecond laser (FSL) cataract surgery and to analyze whether this technology could result in spectacles independence.Design:Retrospective comparative case series.Methods:Consecutive eyes that were scheduled for FSL cataract surgery were included in this study. After one month postoperative, patients were divided into two groups: cases that required prescription for eyeglasses and cases that did not require prescription. In addition, the patients were analyzed according to the type of IOL that was implanted (monofocal, monofocal toric, multifocal and multifocal toric).Results:Thirty-five cataract surgeries were analyzed. Twenty-three eyes had a monofocal IOL implanted, and 12 had a multifocal IOL implanted. After 1 month, 12 cases required prescription (Group 1), and 23 did not require prescription (Group 2). The proportion of eyes that did not require corrective lenses was significantly greater (P = 0.02) in eyes that received multifocal IOL (91.67%) compared with those that received monofocal IOL (47.83%). Additionally, 100% of eyes that received multifocal toric IOL did not require eyeglasses at one month postoperatively.Conclusion:The FSL surgical precision associated with modern IOL technology may be an important factor related to vision satisfaction after cataract surgery.

Objective: To evaluate the introduction of the femtosecond laser (FSL) to perform the key steps of the traditional cataract surgery process and the operational difficulties and safety of this new technology during routine use in an operating room in Brazil. Methods A retrospective study was conducted using the first cases operated on at a single center using the laser platform LenSx/Alcon with a soft contact lens patient interface.All patients underwent a detailed preoperative assessment.The anterior capsulotomy, nuclear fragmentation, and corneal incisions were created with the FSL; then, the surgery was completed following the standard phacoemulsification procedure. The main outcome measurements were difficulties and complications related to the learning curve and an analysis of postoperative uncorrected distance visual acuity (UDVA). Results: Of 31 patients (40 eyes), 9 patients had FSL cataract surgery in both eyes.The mean age was 64 ± 12 years (ranging from 42 to 82), the mean cataract nuclear sclerosis was grading 2 ± 0.6 (ranging from 1 to 4), and the preoperative mean UDVA in logMAR was 0.4 ± 0.2 (ranging from 0.1 to 1.3). Anterior capsulotomy was complete in all patients, and scissors were not needed to cut off any intact portion. The postoperative corneal incisions were not completely linear and showed some irregularities. Laser phaco-fragmentation was effective, with the division of the nucleus into smaller segments easily performed before phacoemulsification.After 1 month, the postoperative mean UDVA in logMAR was 0.1 ± 0.1 (ranging from 0.0 to 0.4) (P < 0.0001). Conclusion: With increasing surgical cases and experience, the phacoemulsification steps are performed precisely and effectively with FSL pretreatment, resulting in a safe learning curve. RESUMO Objetivo: Avaliar a introdução do laser de femtossegundo (FSL) para realizar etapas fundamentais da cirurgia de catarata tradicional e as dificuldades e segurança desta nova tecnologia na rotina de um centro cirúrgico no Brasil. Métodos: Um estudo retrospectivo foi realizado com os primeiros casos operados em um único centro usando a plataforma de laser LenSx/Alcon, sendo utilizado lentes de contato gelatinosa na interface do paciente. Todos os pacientes foram submetidos a uma avaliação pré-operatória detalhada. Capsulotomia anterior, fragmentação nuclear e incisões na córnea foram criados com a FSL, em seguida, a cirurgia foi concluída com procedimento de facoemulsificação padrão. As principais medidas de desfecho foram dificuldades e complicações relacionadas à curva de aprendizado e análise da acuidade visual pós-operatória não corrigida à distância (UDVA). Resultados: Dos 31 pacientes (40 olhos), 9 realizaram cirurgia de catarata em ambos os olhos com FSL. A média de idade foi de 64 ± 12 anos (variando de 42 a 82), a média de classificação da catarata através da esclerose nuclear foi 2 ± 0,6 (variando de 1 a 4) e UDVA pré-operatória em logMAR foi de 0,4 ± 0,2 (variando de 0,1 a 1,3). A capsulotomia anterior foi completa em todos os pacientes e não precisou usar da pinça para cortar qualquer porção intacta. Incisões corneanas pós-operatórias não foram lineares, mostrando ainda algumas irregularidades. A facofragmentação a laser foi eficaz, com a divisão do núcleo em segmentos menores facilmente realizados antes da facoemulsificação. Após 1 mês de pós-operatório, UDVA em logMAR foi de 0,1 ± 0,1 (variando de 0,0 a 0,4) (P < 0,0001). Conclusão: Com o aumento do volume dos casos cirúrgicos e ganho de experiência, passos precisos da facoemulsificação são realizados com o pré-tratamento com o FSL, resultando em uma segura curva de aprendizagem.