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Descemet's membrane detachment (DMD) is an uncommon, vision-threatening, ocular surface complication of cataract surgery. Among several treatment strategies, sulfur hexafluoride (SF6) descemetopexy is the standard of care. Herein, we report three cases of DMD after cataract surgery managed with SF6 descemetopexy, showing different outcomes. Anatomical success was achieved in cases 1 and 2 while intraocular pressure (IOP) was elevated in case 2. In case 3, despite SF6 descemetopexy, recurrent DMD was observed. Due to persistent corneal edema and possible corneal decompensation in case 3, Descemet's stripping automated endothelial keratoplasty was performed and a clear graft was found at the final visit. In conclusion, descemetopexy with 20 % SF6 is an effective and safe procedure for repairing DMD in most cases. Pupillary block with elevated IOP is another concern and prophylactic peripheral iridectomy is recommended. For recurrent DMDs, repeat descemetopexy could be considered. However, close monitoring is advocated since secondary management, such as endothelial keratoplasty, may be required. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study is to determine the recurrence rates in pterygium surgery with autograft transplantation and to investigate the factors affecting recurrence. Material and Methods: This study was carried out in our clinics between July 2015 and March 2017, and patients who had undergone pterygium surgery with autograft were examined retrospectively. Forty-six patient were included in the study. Demographic data of the patients, comorbidities, follow-up periods, complications, size of the pterygium, recurrence rate, rate of inflammation persisting in the autograft at week 2 were recorded. Results: Forty-six patients who had undergone pterygium operations with autografts were included in this study The mean age of the patients was 46.6±15.6 y. Recurrence was seen in 13.3% (6/46) patients during the mean follow-up period of 12.06±4.5 months. The mean period of time elapsed till recurrence was 4.3±1.3 months. The mean pterygium size was 3.9±0.6 mm. Discomfort still continuing at week 2 was seen with a rate of 22.2%. Regarding to the complications; Tenon cyst was seen in 6.7% (3/46), graft edema in %8.9% (4/46) and dellen was seen in 4.4% (2/46). Recurrence rate was 7.4% in females and while it was 22.2% in males, which was higher as compared to females. Conclusion: Pterygium surgery using conjunctival autograft is a safe and effective technique; and while recurrence can be seen with a low rate, recurrence is affected by factors including age, gender and size of the pterygium. [ABSTRACT FROM AUTHOR]

Purpose: Surgical management of ophthalmic Graves’ disease traditionally involves, in order, orbital decompression, followed by strabismus surgery and eyelid surgery. Nunery et al. previously described two distinct sub-types of patients with ophthalmic Graves’ disease; Type I patients exhibit no restrictive myopathy (no diplopia) as opposed to Type II patients who do exhibit restrictive myopathy (diplopia) and are far more likely to develop new-onset worsening diplopia following medial wall and floor decompression. Strabismus surgery involving extra-ocular muscle recession has, in turn, been shown to potentially worsen proptosis. Our experience with Type II patients who have already undergone medial wall and floor decompression and strabismus surgery found, when additional decompression is necessary, deep lateral wall decompression (DLWD) appears to have a low rate of post-operative primary-gaze diplopia. Methods: A case series of four Type II ophthalmic Graves’ disease patients, all of whom had already undergone decompression and strabismus surgery, and went on to develop worsening proptosis or optic nerve compression necessitating further decompression thereafter. In all cases, patients were treated with DLWD. Institutional Review Board approval was granted by the University of Kansas. Results: None of the four patients treated with this approach developed recurrent primary-gaze diplopia or required strabismus surgery following DLWD. Conclusions: While we still prefer to perform medial wall and floor decompression as the initial treatment for ophthalmic Graves’ disease, for proptosis following consecutive strabismus surgery, DLWD appears to be effective with a low rate of recurrent primary-gaze diplopia. [ABSTRACT FROM AUTHOR]

Refractive lenticule extraction is becoming the procedure of choice for the management of myopia and myopic astigmatism owing to its precision, biomechanical stability, and better ocular surface. It has similar safety, efficacy, and predictability as femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and is associated with better patient satisfaction. The conventional technique of small incision lenticule extraction (SMILE) involves docking, femtosecond laser application, lenticule dissection from the surrounding stroma, and extraction. It has a steep learning curve compared to conventional flap-based corneal ablative procedures, and the surgical technique may be challenging especially for a novice surgeon. As SMILE is gaining worldwide acceptance among refractive surgeons, different modifications of the surgical technique have been described to ease the process of lenticule extraction and minimize complications. Good patient selection is essential to ensure optimal patient satisfaction, and novice surgeons should avoid cases with low myopia (thin refractive lenticules), difficult orbital anatomy, high astigmatism, or uncooperative, anxious patients to minimize complications. A comprehensive MEDLINE search was performed using "small incision lenticule extraction," "SMILE," and "refractive lenticule extraction" as keywords, and we herein review the patient selection for SMILE and various surgical techniques of SMILE with their pros and cons. With increasing surgeon experience, a standard technique is expected to evolve that may be performed in all types of cases with optimal outcomes and minimal adverse effects. [ABSTRACT FROM AUTHOR]

Purpose To identify risk factors for ectasia after laser in situ keratomileusis (LASIK) by comparing the accuracy of the Ectasia Risk Score System (ERSS), Screening Corneal Objective Risk of Ectasia (SCORE) Analyzer, and percentage of tissue altered (PTA) in predicting the occurrence of ectasia. Setting Multiple centers in 8 countries. Design Retrospective case series. Methods Previously unpublished post-LASIK ectasia cases were analyzed. Consecutive patients who had LASIK performed at least 5 years previously with no resultant ectasia were used as controls. Axial maps from preoperative Orbscan IIz topographies were analyzed in a masked fashion, and examination files tested with the SCORE Analyzer. The PTA values and ERSS scores were generated using available preoperative and perioperative data. Only eyes with subjectively identified normal preoperative topography were tested with the PTA. Threshold values for the SCORE, ERSS, and PTA were more than or equal to 0, 4, and 40, respectively. Results Ectasia occurred in 31 eyes (22 patients); 79 eyes (44 patients) were used as controls. In all eyes, the sensitivity and specificity for predicting ectasia, respectively, were 67.7% and 79.7% for the ERSS and 64.5% and 100% for the SCORE. In eyes with normal topography (ectasia group, 12 eyes; controls, 64 eyes), the PTA yielded sensitivity of 33.3% and specificity of 85.9%. The area under the receiver operating characteristic curve was highest for SCORE (0.911) followed by the ERSS (0.844) and PTA (0.557). Conclusions The SCORE was most predictive of ectasia, achieving the best specificity; the ERSS had the best sensitivity. Further studies are required to validate the PTA as a screening metric for ectasia. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To compare visual outcome and cause of blindness between two groups of dogs undergoing phacoemulsification. Animals studied: Study population consisted of 35 Boston terriers (BT; 70 eyes) and 77 non‐Boston terriers (NBT; 154 eyes) that underwent bilateral phacoemulsification surgery. Procedures: Medical records were reviewed to determine visual outcome, complications leading to blindness and follow‐up. A Kaplan–Meier survival curve was used to estimate surgical success at 1 and 2 years postoperatively. Results: Eleven of 35 BT developed known vision loss, with 12 of 70 (17.1%) eyes becoming blind within one year of surgery, and 17 of 77 NBT developed known vision loss, with 19 of 154 (12.3%) eyes becoming blind within 1 year of surgery. No further vision loss was reported among those BT with a 2‐year follow‐up. In the NBT group, seven additional dogs, a total of 24 of 77 NBT developed vision loss, with a known total of 31 of 154 (20.1%) eyes becoming blind within two years of surgery. These results were not significantly different. The overall surgical success in both groups based on individual eyes was estimated to be between 80 and 90% at 1 year postsurgery and between 65 and 80% at 2 years postsurgery. Glaucoma was the leading cause of vision loss in both groups. Conclusions: There was no significant difference in visual outcomes between a group of BT and a group of NBT undergoing bilateral phacoemulsification at the University of Tennessee between 2002 and 2015. Glaucoma was the leading cause of vision loss in both groups. [ABSTRACT FROM AUTHOR]

Purpose: To determine the risk factors related to recurrence of pterygium after pterygium excision with limbal-conjunctival autograft.Study design: Retrospective, observational case series.Methods: The current study included 310 patients who underwent surgical removal of pterygium using limbal-conjunctival autografting. All surgery was performed by the same surgeon at a single Hospital from 2006 to 2011. Preoperative and postoperative patient data were collected. The patients were summoned to follow-up examinations. Procedures with at least 12 months of follow-up were included in the final analysis. Potential risk factors for pterygium recurrence were determined by Cox proportional-hazard linear analysis and recurrence-free survival time was evaluated using Kaplan-Meier method.Results: The overall recurrence rate was 5.2% during an average follow-up time of 20.1±8.6 months (range, 12-37 months). According to Kaplan-Meier evaluation, the estimated time to recurrence was 34.2 ± 0.5 months (95% confidence interval 33.3-35.0 months) for the whole population. Multivariate analysis showed that age < 45 years old (RR = 3.582, 95% CI 1.984-13.044, P = 0.047), recurrent type of pterygia (RR = 4.856, 95% CI 1.794-13.142, P = 0.002), and vertical size of pterygium > 6.7 mm (RR = 2.529, 95% CI 1.053-6.075, P = 0.038) were significantly associated with increased risk of recurrence.Conclusion: Our findings suggest that young age, recurrent type of pterygia, and larger pterygial tissue are risk factors for pterygium recurrence after surgical excision. Hence, early excision of pterygium is recommended to decrease the recurrence rate. [ABSTRACT FROM AUTHOR]

Purpose To compare the motility and complication rates of porous and nonporous implants after enucleation surgery. Methods Literature searches of the PubMed and Cochrane Library databases were last performed in February 2017 to identify studies published between 2003 and 2017 on outcomes after enucleation surgeries in which a variety implants were used. The searches were limited to the English language with abstracts and yielded 43 articles, which the Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel reviewed for relevancy. Twenty-five articles were considered to have met the search strategy, and the panel methodologist assigned ratings to them according to the level of evidence. Results Only 2 of the 25 articles identified met the criteria for level I evidence. Eighteen of the studies did not assess motility after enucleation surgery, and the 7 that did evaluate this metric involved porous implants. The studies that analyzed this outcome reported favorable results, but the results were not uniformly based on objective analysis. Both porous and nonporous implants were well tolerated, and complication rates were generally low for both types. Conclusions In keeping with increasing surgeon preference for porous implants, most studies identified in this literature search involved the use of this type of implant. These implants resulted in excellent motility after enucleation surgery, although many studies did not assess this outcome. Regardless of implant type, major complications were rare, and infection was exceptionally uncommon after enucleation. Given the paucity of data on motility and the absence of direct, objective comparisons of porous and nonporous implants, definitive conclusions about the impact of implant material on motility cannot be made. Since few studies evaluated nonporous implants, direct comparisons cannot be made definitively between implant types, and future investigations are needed to enable a critical assessment. [ABSTRACT FROM AUTHOR]

Purpose To report outcomes and complications of Boston type 1 keratoprosthesis (KPro) implantation in children. Design Retrospective, multicenter case series. Participants All children 16 years of age or younger who underwent KPro surgery at 3 ophthalmology centers in Canada between January 2010 and November 2014. Methods Records of patients having undergone KPro implantation were reviewed. Data on preoperative characteristics, surgical procedure(s) performed, and postoperative outcomes were collected and analyzed. Main Outcome Measures Intraoperative and postoperative complications, device retention, and best-corrected visual acuity (BCVA). Results The KPro was implanted in 11 eyes of 11 patients 0.9 to 15.5 years of age, with 6 being primary corneal procedures. Best-corrected visual acuity recorded before surgery ranged from 20/600 to light perception (LP), and vision in 2 eyes was fix and follow. All patients had been diagnosed with glaucoma and 6 eyes had glaucoma drainage devices (GDDs) inserted before KPro implantation. At last follow-up (mean, 41.8 months; range, 6.5–85.0 months), 2 eyes retained BCVA of 20/400 or better, whereas 5 eyes lost LP. Postoperative complications included retroprosthetic membrane (9 eyes), corneal melt (5 eyes), infectious keratitis (3 eyes), endophthalmitis (3 eyes), GDD erosion (2 eyes), and retinal detachment (5 eyes). The initial KPro was retained in 4 eyes (36.4%). Conclusions Boston type 1 keratoprosthesis implantation in children is associated with a substantially higher rate of complications, higher chance of device failure, and worse visual outcomes than observed in adults. In view of these results, the authors do not recommend the use of the KPro in the pediatric population. [ABSTRACT FROM AUTHOR]

Purpose To review the published literature on the safety and outcomes of Descemet membrane endothelial keratoplasty (DMEK) for the surgical treatment of corneal endothelial dysfunction. Methods Literature searches were last conducted in the PubMed and the Cochrane Library databases most recently in May 2017. The searches, which were limited to English-language abstracts, yielded 1085 articles. The panel reviewed the abstracts, and 47 were determined to be relevant to this assessment. Results After DMEK surgery, the mean best-corrected visual acuity (BCVA) ranged from 20/21 to 20/31, with follow-up ranging from 5.7 to 68 months. At 6 months, 37.6% to 85% of eyes achieved BCVA of 20/25 or better and 17% to 67% achieved BCVA of 20/20 or better. Mean endothelial cell (EC) loss was 33% (range, 25%–47%) at 6 months. Overall change in spherical equivalent was +0.43 diopters (D; range, –1.17 to +1.2 D), with minimal induced astigmatism of +0.03 D (range, –0.03 to +1.11 D). The most common complication was partial graft detachment requiring air injection (mean, 28.8%; range, 0.2%–76%). Intraocular pressure elevation was the second most common complication (range, 0%–22%) after DMEK, followed by primary graft failure (mean, 1.7%; range, 0%–12.5%), secondary graft failure (mean, 2.2%; range, 0%–6.3%), and immune rejection (mean, 1.9%; range, 0%–5.9%). Overall graft survival rates after DMEK ranged from 92% to 100% at last follow-up. Best-corrected visual acuity after Descemet’s stripping endothelial keratoplasty (DSEK) ranged from 20/34 to 20/66 at 9 months. The most common complications after DSEK were graft detachment (mean, 14%; range, 0%–82%), endothelial rejection (mean, 10%; range, 0%–45%), and primary graft failure (mean, 5%; range, 0%–29%). Mean EC loss after DSEK was 37% at 6 months. Conclusions The evidence reviewed supports DMEK as a safe and effective treatment for endothelial failure. With respect to visual recovery time, visual outcomes, and rejection rates, DMEK seems to be superior to DSEK and to induce less refractive error with similar surgical risks and EC loss compared with DSEK. The rate of air injection and repeat keratoplasty were similar in DMEK and DSEK after the learning curve for DMEK. [ABSTRACT FROM AUTHOR]

Purpose: To determine the indications, long-term clinical and visual outcomes, and complications of the aphakic snap-on type I Boston keratoprosthesis (KPro). Design: Retrospective, non-comparative case series. Methods: Forty-five eyes of 43 patients with type I aphakic snap-on KPros with at least 1 year of follow-up were included. The past medical histories, preoperative indications, best-corrected visual acuities (BCVAs), postoperative complications, and retention rates were analyzed. Results: The most common indication for KPro implantation was a failed corneal graft (89%). The mean preoperative BCVA was count fingers-hand motion (2.14±0.45 logarithm of minimum angle of resolution [logMAR]), which initially improved to 20/200 (1.04±0.85 logMAR; P<0.0001). At the last examination, 24 eyes (53%) maintained some visual gain, 22% retained their preoperative visual acuity, and 24% lost vision due to postoperative events and underlying ocular comorbidities. Postoperative complications included retroprosthetic membranes (8/45, 18%), corneal melts (5/45, 11%), glaucoma progression (6/45, 13%), and endophthalmitis or sterile vitritis (6/45, 13%). The KPro retention rate was 89%, with a mean follow-up of 51 months. The mean BCVA at the last visit was 20/1,400 (1.82±0.92 logMAR). Conclusion: Most patients experienced improved visual acuity after the implantation of the aphakic, snap-on type I KPro; however, the visual gains were not sustained over time, correlating with the onset of postoperative complications. [ABSTRACT FROM AUTHOR]

Background: While loteprednol etabonate (LE) suspension 0.5% is approved for the treatment of postoperative ocular inflammation, there have been no reported studies of its use in glaucoma patients undergoing canaloplasty. Methods: This was a retrospective medical chart review conducted at a single US center. Data were collected on patients with glaucoma who underwent canaloplasty with or without cataract surgery, and were prescribed LE suspension 0.5% postoperatively. Outcomes evaluated included postsurgical inflammation (anterior chamber [AC] cells and flare), intraocular pressure (IOP), number of IOP-lowering medications, and postsurgical complications. Results: Data were collected on 204 patients (262 eyes) with a mean (SD) age of 71.6 (11.3) years. The most frequent LE dosing regimens at day 1, week 1, and month 1 postsurgery were QID (92.3%; 241/261), TID (52.6%; 133/253), and QD (65.5%; 78/119), respectively. Inflammation (AC flare and cells), mostly mild, was noted in 33.2% (86/259) of eyes on postoperative day 1 and 8.6% (21/244) of eyes at month 1. Mean IOP and mean number of IOP-lowering medications were significantly reduced from baseline (P<0.001) at all time points postoperatively. Complete (no IOP-lowering medication) or qualified (use of #2 IOP-lowering medications) surgical success was achieved in 78.8% and 90.6% of eyes, respectively, at month 6 and 63.4% and 92.7% of eyes at month 36. The most frequently observed postoperative complication was hyphema in 48.7% (126/259) eyes at day 1, which decreased to 0.4% (1/244) of eyes by month 1. IOP $30 mmHg was noted in 13 (5.3%) eyes at postoperative week 1 and rarely thereafter, and no patient discontinued therapy because of an IOP increase. Conclusion: These real-world data suggest that canaloplasty with or without cataract surgery managed postoperatively with LE suspension 0.5% is effective and safe in the glaucoma patient. [ABSTRACT FROM AUTHOR]

In femtosecond laser-assisted cataract surgery, the parameter such as horizontal spot spacing and energy level can be adjusted. Although there have been several studies reported on various laser systems, showing the effects of varying energy levels and horizontal spot spacing on lens capsulotomy cut edges, none have been reported on the Catalys laser system (Abbott Medical Optics, Inc., Santa Ana, CA). The aim of this study is to evaluate, using scanning electron microscopy (SEM), the quality of the cut edges of the laser lens capsulotomy obtained using the Catalys Laser System, using different horizontal spot spacing and energy levels, and to determine the ideal parameters based on SEM results. Fifty rabbit capsulorhexis specimens from a femtosecond laser with different spot spacing and energy settings were divided into five groups randomly. Spot spacing was 3 um and laser pulse energy was 4 uJ in group 1. The respective values were 5 um and 2 uJ in group 2, 5 um and 4 uJ in group 3, 5 um and 6 uJ in group 4, and 7 um and 4 uJ in group 5. All samples were evaluated using SEM to compare the number of tags per capsulotomy and the laser emission time. Group 1 had a significantly lower tag formation than groups 3 and 5 (P = 0.042 and 0.021, respectively). Although the laser emission time increased about 1.5 sec as the spot spacing increased from 3 to 7 um, the quality of the cut was smoother in group 1 because of overlapping effect of photodisruption cavities. There was no significant difference between groups 2, 3 and 4 at different laser energy settings. In an ex-vivo study, samples from an energy setting of 10 uJ showed increased irregularity and damage. The degree of irregularity was higher at increasing spot spacing and laser energy settings, with abundant tag formation. Dense spot spacing with low-energy settings provide a better cut quality, which is probably correlated with the reduction in anterior capsular tear complications. [ABSTRACT FROM AUTHOR]

Purpose: Stickler syndrome is an autosomal dominant inherited disorder that is well known to be highly associated with the development of rhegmatogenous retinal detachment. In this study, we report the case of a family affected by Stickler syndrome in which rhegmatogenous retinal detachment developed in 5 eyes of 3 siblings. Case Series: For treatment, we performed vitreous surgery on 1 eye of the eldest son, and bilateral scleral buckling surgery on the 2 younger children. A good postoperative outcome was obtained on the 4 eyes that underwent scleral buckling surgery, yet the prognosis was poor on the 1 eye that underwent vitrectomy due to redetachment of the retina and corneal complication. Since vitreous surgery was quite difficult due to strong vitreoretinal adhesion, we created an artificial posterior vitreous detachment via the bimanual technique combined with encircling. For the scleral buckling surgery, broad scleral extrusion was needed to seal multiple retinal breaks. Conclusions: The findings of this study showed a high prevalence of rhegmatogenous retinal detachment in a single family with Stickler syndrome. In these cases, scleral buckling surgery was effective for treating the detached retina, and some prophylactic treatment, such as laser photocoagulation to prevent the occurrence of rhegmatogenous retinal detachment, should be considered for such cases in the future. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to describe and compare modified hang-back recession with the conventional hang-back recession in large angle comitant exotropia (XT).Methods: A prospective, interventional, double-blinded, randomized study on adult patients (>18 years) undergoing single eye recession-resection for large angle (>30 prism diopters) constant comitant XT was conducted between January 2011 and December 2015. Patients in Group A underwent modified hang-back lateral rectus recession with adjustable knot while in Group B underwent conventional hang-back recession with an adjustable knot. Outcome parameters studied were readjustment rate, change in deviation at 6 weeks, complications and need for resurgery at 6 months.Results: The groups were comparable in terms of age and preoperative deviation. The patients with the modified hang back (Group A) fared significantly better (P < 0.05) than those with conventional hang back (Group B) in terms of lesser need for adjustment, greater correction in deviation at 6 weeks and lesser need for resurgery at 6 months.Conclusion: This modification offers several advantages, significantly reduces resurgery requirement and has no added complications. [ABSTRACT FROM AUTHOR]

Importance This study highlights the efficacy and safety of trabeculectomy in Victoria, Australia. Background Trabeculectomy is currently the gold standard in glaucoma surgery. However, its role has been increasingly questioned because of its associated risks and complications. This audit aimed to assess the efficacy and safety of trabeculectomy surgery in the state of Victoria, Australia. Design A cross-sectional, retrospective and voluntary statewide audit of trabeculectomy surgery by individual surgeons in 2012 with 24 months follow-up. Participants Twenty-four surgeons in the state of Victoria submitted data on 227 trabeculectomies. Methods Basic preoperative and perioperative data were collected. Post-operative data collected included intra-ocular pressure measurements, glaucoma medications, associated complications and subsequent surgery up to 24 months post-trabeculectomy. Main Outcome Measures The main outcome measures were post-operative intra-ocular pressure and surgical complications. Results At 12 months, the mean intra-ocular pressure was 12.6 ± 4.1 mmHg (range 3-28 mmHg). A total of 91% of eyes had an intra-ocular pressure ≤18 mmHg with or without ocular hypotensive medications. One-third of eyes that were phakic at the time of trabeculectomy underwent cataract extraction within the 24 months of follow-up. Eyes that underwent combined cataract extraction and trabeculectomy (23% of trabeculectomies) had a significantly higher mean 12-month intra-ocular pressure than eyes that underwent trabeculectomy alone (13.9 vs. 12.2 mmHg, P = 0.01). At 24 months, there were no cases of blebitis/endophthalmitis. Conclusions and Relevance The Victorian Trabeculectomy Audit demonstrates excellent efficacy and safety results that are comparable with international standards. Combined cataract extraction and trabeculectomy tended to result in a higher mean post-operative intra-ocular pressure than trabeculectomy alone. [ABSTRACT FROM AUTHOR]

Purpose To assess the currently recommended percentage tissue altered (PTA) metric for its ability to screen for ectasia after laser in situ keratomileusis (LASIK). Setting Gavin Herbert Eye Institute, University of California, Irvine, California, USA, and Rothschild Foundation, Paris, France. Design Retrospective case series. Methods The study used a LASIK database created by 1 surgeon for LASIK cases with normal preoperative topography that had a minimum follow-up of 24 months with complete preoperative and intraoperative data to permit the calculation of PTA values to detect eyes at risk for developing ectasia. Results Of the eyes, 593 eyes had complete data and met the inclusion criteria. Based on measured flap thickness, 126 eyes (21%) had a PTA value of 40% or more (mean 44) and a percentage of that flap thickness accounted for the PTA (mean 66.7%; range 34% to 92%). The mean attempted laser ablation was 79.8 μm ± 29.2 (SD), and the mean residual bed thickness was 304.4 ± 29.2 μm (range 212 to 369 μm). No eye developed ectasia over a mean follow-up of 30 months. Conclusions The current PTA calculation when applied to a LASIK population with normal preoperative topography and flap thickness measured with ultrasound did not predict the risk for ectasia. Differences between study populations and assumptions might have accounted for the different outcomes obtained in the initially published PTA study. [ABSTRACT FROM AUTHOR]

Purpose To investigate the accuracy of 7 intraocular lens (IOL) calculation formulas in predicting refractive outcome in eyes with axial lengths (AL) equal to or less than 22.0 mm and to evaluate factors contributing to prediction errors. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, and private practice, Mesa, Arizona, USA. Design Retrospective case series. Methods Eighty-six eyes of 67 patients were included. Seven IOL calculation formulas were evaluated: Barrett Universal II, Haigis, Hill-RBF, Hoffer Q, Holladay 1, Holladay 2, and Olsen. The refractive prediction error was calculated as the difference between the postoperative refraction and the refraction predicted by each formula. The mean refractive prediction error and median absolute error were also calculated. Results The Hoffer Q and Holladay 2 formulas produced myopic refractive prediction errors of −0.22 diopter (D) and −0.23 D, respectively, and the Olsen formula produced a hyperopic refractive prediction error of +0.27 D (all P < .05). Without adjustment of the mean refractive prediction errors to zero, the only difference between formulas was that Hill-RBF had a statistically significantly smaller median absolute error than Hoffer Q ( P < .05). With adjustment of the mean refractive prediction errors to zero, there were no statistically significant differences in the median absolute errors between the 7 formulas ( P = .076). Conclusions The Hoffer Q and Holladay 2 formulas produced slightly myopic refractive prediction errors, and the Olsen formula produced hyperopic refractive prediction errors. When the mean numerical refractive prediction error was adjusted to zero, no statistically significant differences in the median absolute error were found between the 7 formulas. [ABSTRACT FROM AUTHOR]

Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc.), the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of filtering surgery using the EX-PRESS device on intraocular pressure (IOP), flare count, anterior chamber (AC) depth, and the corneal endothelium in primary open-angle glaucoma (POAG), including normal-tension glaucoma (NTG). Patients and methods: The study comprised 63 consecutive patients with POAG or NTG. They underwent complete ophthalmologic examinations, including measurement of visual acuity (VA), IOP, flare count, AC depth, and cell density of the corneal endothelium (CE). Two outcomes were used for surgical success: outcome 1 was defined as a ≥20% reduction in the IOP from the preoperative value, with an IOP ≥ 5 mmHg but ≤18 mmHg, and outcome 2 was defined as a ≥20% reduction in the IOP, with an IOP ≥ 5 mmHg but ≤15 mmHg. Results: The IOP significantly decreased from 17.7 preoperatively to 12.4 mmHg postoperatively ( P < 0.0001). The success rates for outcome 1 at 24 months were 81.3 and 46.7% for POAG and NTG, respectively ( P = 0.0065); the corresponding success rates for outcome 2 were 79.4 and 46.7% ( P = 0.0120). The flare count significantly increased on postoperative day 1 ( P = 0.0002) but recovered to insignificant levels by day 3 ( P = 0.0686). A transient decrease in AC depth was observed by 4 weeks after surgery ( P = 0.0017). The CE changed from 2529 preoperatively to 2428/mm at 24 months ( P = 0.0089). Conclusion: The advantage of filtering surgery using the EX-PRESS device includes reduced inflammation, and the disadvantages include loss of the CE and reduced effectiveness of NTG. [ABSTRACT FROM AUTHOR]

Purpose: To determine adherence to face-down positioning (FDP) among patients who underwent vitrectomy and gas tamponade for macular hole (MH) repair. Method: A total of 69 patients (37 females and 32 males) who underwent primary vitrectomy for MH repair were studied. Nurses recorded whether the patient complied with FDP each time they examined the patient. FDP score was obtained from the nursing records; patients were given a score of 1 if they complied with the FDP and 0 if they did not. The score was recorded four times per day for the first 3 postoperative days. A perfect FDP score was 12. Results: The mean ± standard deviation of the FDP scores was 10.6±1.8 (range: 4-12). Overall, 32 (46.4%) patients scored a perfect 12, and 7 (10.1%) patients scored ,8. Failure of the MH closure was observed in only one patient (1.4%), who showed the poorest adherence to FDP (score =4). Consequently, the closure rate in patients with FDP score ,7 (2/3, 66.7%) was significantly lower than in patients with an FDP score ≥7 (66/66, 100%) (P,0.05, Fisher's exact probability test). Conclusion: While adherence to FDP after MH surgery was better than that observed after vitrectomy for rhegmatogenous retinal detachments in our previous study, the percentage of patients with FDP scores ,8 did not differ. Statistically, the poor adherence to FDP can negatively impact the effectiveness of the surgery for MH repair. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the clinical course after early surgical treatment with excision of retinal hemangioblastomas (RHs) before development of major complications. Methods Interventional case series of four eyes (four patients) with a peripheral RH that had not yet been treated by laser or cryotherapy prior to surgery. All eyes underwent 23-gauge vitrectomy with lesion excision. One patient underwent ligation of the feeder vessel prior to lesion excision. Best-corrected visual acuity and clinical course were assessed during a follow-up period of at least 4 years. Results Four patients (mean age 27.3 years; range 19-32) were included, of whom two had von Hippel-Lindau syndrome. Visual acuity improved in three patients (mean 4.8 lines; range 3-10) and remained stable at 0.0 logMAR in one patient. There were no intraoperative complications. Postoperative complications included transient mild vitreous haemorrhage ( n = 2), and local epiretinal membrane formation at the excision location ( n = 1). At 4 years postoperatively, there were no long-term complications. There was one case of a new lesion, which was effectively treated with laser. Conclusion Vitrectomy with RH excision seems to be an effective approach for larger RHs and could be considered an early treatment option in selected cases. Postoperative complications were limited in scope of this case series. Important points to consider during vitrectomy are effective closure of feeder and draining vessels as well as complete removal of posterior hyaloid and epiretinal membranes in order to avoid postoperative vitreous haemorrhage and proliferative vitreoretinopathy. [ABSTRACT FROM AUTHOR]

Background: Post-operative endophthalmitis is a rare and dreaded complication in ophthalmic operations because it often induces irreparable vision loss. Although many ophthalmological studies aimed at reducing the rate of endophthalmitis have been performed around the world, controversy continues to surround some issues, including the choice of antimicrobials and their route of administration, duration and timing. The aim of this study is to investigate some of these unresolved issues. Methods: A systematic review and meta-analysis of randomized controlled trials and observational studies was performed. The PubMed, EMBASE, Cochrane Library and Clinical Trials databases were searched to identify studies published until Feb. 2016. The relative risk (RR) for each clinical outcome data is presented with 95% confidence intervals (CIs). Pooled estimates of effects were calculated using random-effect models. Results: Thirty-four studies from twenty-four reports involving 1264797 eyes were included in this analysis. Endophthalmitis occurred, on average, in one out of 6177 eyes when intracameral vancomycin/moxifloxacin were used and in one out of 1517 eyes when intracameral vancomycin/moxifloxacin were not used. The relative risk (95% CI) of endophthalmitis was reduced to 0.20 (0.10, 0.42) when intracameral antibiotics were used (p<0.0001). The subconjunctival injection of antibiotics was not superior to other administration routes included in this study (RR = 1.67, 95% CI (0.55, 5.05), p = 0.36). A statistically significant difference was found in the rate of endophthalmitis between the use and lack of use of topical antibiotics (RR = 0.65, 95% CI (0.43, 0.99), p = 0.04). However, no statistically significant difference was found in microbial isolation rates between these groups (RR = 0.77, 95% CI (0.34, 1.75), p = 0.53). When long-term and short-term use of topical antibiotics before surgery were compared, a statistically significant difference was found in microbial isolation rates (RR = 0.57, 95% CI (0.44, 0.74), p<0.0001). Conclusions: This meta-analysis concluded intracameral antibiotics are effective at preventing endophthalmitis in ocular surgery. A randomized controlled trial confirms the efficacy of cefuroxime but recent large cohort studies support the efficacy of vancomycin/moxifloxacin intracamerally. Intracameral antibitoics are superior to subconjunctival injections but that irrigation antibitoic data are not of enough quality to make a comparison. Different results were found in two clinical outcomes between the use or lack of use of topical antibiotic therapy, we did not find sufficient evidence to conclude that its use prevents endophthalmitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Retro-bulbar anesthesia is one of the most common regional blocks used for intraocular surgeries. Complications associated with regional blocks may be limited to the eye or may be systemic. CASE REPORT: After a retro-bulbar block for glaucoma surgery, a 60-year-old man developed loss of consciousness, apnea with hypotension and bradycardia-features of brainstem anesthesia. We present the clinical features, treatment and comments on how to prevent the problem as well as a review of the literature on reported cases. CONCLUSION: Although it is rare, treating physicians should be aware of the potentially lethal consequences of retro-bulbar block, understand measures to reduce the risks and early recognition and treatment. Facilities where ophthalmic surgeries are performed under local anesthesia should be properly equipped and staffed for advanced resuscitation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to evaluate the results of modified sleeve in phacoemulsification of cataract in completely vitrectomised eyes, Materials and Methods: Twenty-five previously completely vitrectomized eyes of 23 patients having visually significant cataract were included. After through evaluation they underwent phaco-emulsification by phaco chop with a modified sleeve via temporal clear corneal incision. The modified sleeve was made by creating a small round port of approximate 1 × 1 mm size at the proximate end of the sleeve in line with the already existing ports. This port faced the posterior capsule while performing phacoemulsification. Patients were observed for any intraoperative complications.Result: The most common indication for pars plana vitrectomy in our study group was vitreous hemorrhage due to diabetic retinopathy [13 out of 25 eyes (52%)]. Intraoperative findings included miosis [seen in 3 (12%) eyes] and posterior capsular plaque [seen in 2(8%) eyes]. No other significant intraoperative complications (posterior capsular tear, dropped nucleus) were observed. Average effective phaco time was 33 sec. (±15.11).Conclusion: Though cataract surgery in postvitrectomized eyes is a challenging situation, modified sleeve prevents anterior chamber fluctuation and avoids complications arising out of it, making the surgery safe. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the clinical results after deep anterior lamellar keratoplasty (DALK) assisted by the femtosecond laser with big-bubble technique for keratoconus.Methods: A case series of 22 eyes in 19 patients with keratoconus was enrolled in the study. The 500-kHz VisuMax femtosecond laser (Carl Zeiss Meditec AG, Jena, Germany) was used to create a vertical side cut on donor and recipient corneas. Intraoperative and postoperative complications, uncorrected visual acuity, best-corrected visual acuity, corneal curvature, and central corneal thickness were evaluated in all patients.Results: Big-bubble and naked Descemet's membrane (DM) were successfully achieved in twenty eyes (90.9%). Intraoperative macroperforation of DM occurred in two cases and converted to full-thickness keratoplasty. The mean follow-up time was 18.8 ± 5.3 months. The best-corrected visual acuity was increased from 0.3 to 1.0, mean corneal curvature was 43.0 ± 2.3D, and mean central corneal thickness was 508.9 ± 60.1 μm (range, from 430 to 600 μm) postoperatively.Conclusion: Our results indicate that femtosecond laser-assisted DALK with big-bubble technique is an accurate, safe, and effective method to treat the patients with keratoconus. [ABSTRACT FROM AUTHOR]

Managing large iridodialysis that may occur during phacoemulsification is challenging. I describe how a procedure to reposit a prolapsed iris while the anterior chamber is markedly inflated by a current of infusion fluid may inadvertently lead to large iridodialysis, and discuss how to avoid such a complication. I describe a fast and efficient technique for managing large iridodialysis both immediately, once it occurs, or as a secondary maneuver. My technique involved fixing the iris periphery back to its root at the anterior chamber angle using 10-0 polypropylene suture with two straight needles introduced directly through the cornea at distant points, and an insulin syringe as a guide track to a point 1.5 mm from the limbus at the base of a triangular scleral flap that was designed to be centered on the area of iridodialysis. I confirmed the simplicity, efficacy, and safety of my technique through a 1-year follow-up period. [ABSTRACT FROM AUTHOR]

The study aims to report the surgical outcome of a retractor redirection procedure for involutional entropion repair for Asians. The study included all cases diagnosed with involutional entropion and significant ocular irritation who presented from 2008 to 2012. Sixty-seven eyelids in 54 patients were included in this study. All cases were operated on by one surgeon and had a minimum of 12-months follow-up. Success was defined as cases showing no recurrence of entropion with forceful eyelid squeezing postoperatively. A retrospective chart review was performed to assess the success rate, recurrences and complications of the procedure. During a mean follow-up period of 26.2 months (range, 12–53 months), 5 patients died during the study period. Two eyelids (3%) of one patient had a recurrence at 34 months postoperatively. One eyelid (1.5%) with a significant horizontal laxity developed postoperative ectropion and required a secondary horizontal shortening procedure. No other postoperative complications or dissatisfaction were reported. The retractor redirection procedure aims to repair the retractors and prevent orbicularis muscle overriding via inserting the retractors to the anterior lamellae. It yields a long-term success rate of 95.5% and is an effective technique for correcting involutional entropion. [ABSTRACT FROM PUBLISHER]

Cataract surgeons are sometimes challenged with a patient who has an unstable anterior chamber intraocular lens (AC IOL). Over time, an unstable AC IOL can lead to significant complications. This problem is most often addressed with an IOL exchange using an appropriately sized AC IOL or a posterior chamber IOL with iris or scleral fixation. We present a technique of 2-point iris fixation of unstable AC IOLs as a simpler and less traumatic alternative. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose To compare the clinical classification of anterior capsule opacification (ACO) after femtosecond laser–assisted cataract surgery with the mean density values of ACO provided by rotating Scheimpflug device (Pentacam HR) densitometry software and to determine which densitometry method correlates best with the clinical classification. Setting Ophthalmology Department, Donostia University Hospital, Donostia-San Sebastian, Spain. Design Prospective comparative study. Methods Femtosecond laser–assisted cataract surgery was performed using the Victus platform between June 2014 and March 2015. Inclusion criteria were age between 55 years and 85 years, a pupil diameter larger than 6.0 mm in full mydriasis, no intraoperative complications, a curvilinear anterior capsulotomy without tears, and an intraocular lens in the correct intracapsular position at the end surgery. The ACO was measured by a clinical classification ranging from 0 to 4. In addition, ACO density was measured with the Scheimpflug device using 3 densitometry methods (area, linear, and peak). Results The study comprised 32 eyes of 32 patients. Area and linear densitometry values provided by the Scheimpflug device had a strong correlation with the values obtained by clinical classification, whereas peak densitometry values had a very weak correlation at 6 months (area densitometry: Spearman ρ = 0.78; P < .0005; linear densitometry: ρ = 0.73; P < .0005; peak densitometry ρ = 0.21; P = .2). Conclusion The Scheimpflug device provided an objective measurement of ACO after cataract surgery. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose To compare the clinical outcomes and complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) with a transscleral-sutured intraocular lens (IOL) and solitary DSAEK. Setting Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. Design Retrospective case series. Methods Cases with simultaneous transscleral-sutured IOLs or post-transscleral–sutured IOLs and solitary DSAEK cases were studied. The logMAR acuity, astigmatism, endothelial cell density (ECD), graft survival rate, and complications (eg, IOL dislocation, cystoid macular edema [CME]) were analyzed. Results Thirty-seven DSAEK cases with simultaneous transscleral-sutured IOLs or post-transscleral–sutured IOLs and 147 solitary DSAEK cases were evaluated. The logMAR corrected distance visual acuity (CDVA) improved significantly at 24 months, from 1.34 ± 0.49 (SD) to 0.48 ± 0.38 after DSAEK with transscleral-sutured IOLs and from 1.17 ± 0.69 to 0.17 ± 0.25 after solitary DSAEK. The logMAR CDVA after DSAEK with transscleral-sutured IOLs was significantly worse than that with solitary DSAEK at 6, 12, and 24 months ( P < .01). The postoperative astigmatism with DSAEK with transscleral-sutured IOLs was significantly higher than with solitary DSAEK because of the larger sclerocorneal incision ( P < .02). There were no significant differences in ECD or graft survival rates between DSAEK with transscleral-sutured IOLs and solitary DSAEK. The incidence of CME in DSAEK with transscleral-sutured IOLs (4/37 eyes [11%]) was higher than with solitary DSAEK (2/147 [1.4%]) ( P = .02). The CME resolved with topical diclofenac and sub-Tenon injection of triamcinolone acetonide in all eyes. Conclusion The graft survival rates after DSAEK with transscleral-sutured IOLs were equivalent to those after solitary DSAEK, although the incidence of CME was higher than after solitary DSAEK. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the effects of photorefractive keratectomy (PRK) combined with corneal wavefront–guided ablation profiles and hyperaspheric ablation profiles on changes in higher-order aberrations (HOAs). Setting Yonsei University College of Medicine and Eyereum Clinic, Seoul, South Korea. Design Comparative observational case series. Methods Medical records of patients who had corneal wavefront–guided hyperaspheric PRK, corneal wavefront–guided mild-aspheric PRK, or non-corneal wavefront–guided mild-aspheric PRK were analyzed. The logMAR uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), and changes in corneal aberrations (root-mean-square [RMS] HOAs, spherical aberration, coma) were evaluated 1, 3, and 6 months postoperatively. Results The records of 61 patients (96 eyes) were reviewed. There was no statistically significant difference in logMAR UDVA or MRSE between the 3 groups at any timepoint. Corneal RMS HOAs were significantly smaller in the corneal wavefront–guided hyperaspheric group and the corneal wavefront–guided mild-aspheric group than in the noncorneal wavefront–guided mild-aspheric group at each timepoint. Corneal spherical aberration was significantly smaller for corneal wavefront–guided hyperaspheric PRK than for noncorneal wavefront–guided mild-aspheric PRK 6 months postoperatively. Changes in corneal spherical aberration (preoperatively and 6 months postoperatively) in corneal wavefront–guided hyperaspheric PRK were significantly smaller than in corneal wavefront–guided mild-aspheric PRK ( P = .046). Corneal coma was significantly smaller with corneal wavefront–guided hyperaspheric PRK and corneal wavefront–guided mild-aspheric PRK than with noncorneal wavefront–guided mild-aspheric PRK 3 months and 6 months postoperatively. Conclusion Corneal wavefront–guided hyperaspheric PRK induced less corneal spherical aberration 6 months postoperatively than corneal wavefront–guided mild-aspheric PRK and noncorneal wavefront–guided mild-aspheric PRK. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Objective: Silicone oil (SO) is an invaluable tool in the management of complex retinal detachments (RDs). Injection of silicone oil is associated with a variety of ocular complications specially when it is kept for a long time and its removal is endangering retinal re-detachment. The objective of this study was to determine the frequencies of different ocular complications associated with silicone oil injection in our setup. Study Design: Case series. Place and Duration of Study: This study was conducted at Vitreo-retina division of Al-Shifa Trust Eye Hospital, Rawalpindi from January 2014 to June 2014. Material and Methods: A total of 30 patients were included in the study who underwent pars-planavitrectomy (PPV) with silicone oil injection for complex retinal detachments. The patients who had reached between 3 months & 6 months of their postoperative period and were presenting with some complications related to silicone oil injection were included in the study. Their records were reviewed and pre-operative data were collected regarding state of the eye preoperatively. Then the post-operative complications were noted. The descriptive and analytical statistics of different variables were measured using SPSS-17.0 software. Results: Out of thirty patients included in our study 23 (76.7%) were male and 7 (23.3%) were female. The mean age was 21.53 ± 16.004 years and range was 66 years. The mean pre-operative intra-ocular pressure ( IOP) was 14.0 ± 2.150 mmHg and range 8 mmHg and the mean post-operative IOP was 24.93 ± 13.889 mmHg and range 45 mmHg (p=0.001. The pre-operative PVR grade-C was absent in 12 (40%) patients and was present in 18 (60%) patients and post-operative PVR grade-C was absent in 24 (80%) patients and was present in 6 (20%) patients (p=0.004; McNemar test). Band keratopathy was seen in 8 (26.7%) and corneal decompensation in 2 (6.7%) patients. Emulsification of silicone oil was seen in 14 (46.7%) patients. Rubeosisiridis was present in 2 (6.7%) patients. Conclusion: Apart from other complications, raised intraocular pressure is a significant postoperative complication of eyes with silicone oil injection, so should be kept in mind because if not addressed properly it may lead to irreversible blindness in these cases. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare two daily disposable lenses to reduce lens-induced discomfort (CLD) among different populations of symptomatic wearers.Methods: This was a multicenter, crossover, study. Subjects were contact lens wearers reporting CLD. Subjects (76) were randomly assigned to wear Nelfilcon A (NF) then Delefilcon A (DF)- group A- or vice-versa (group B). Tear break-up time (TBUT), corneal (CS) and conjunctival staining (CJS) were graded at every visit. Subjects'symptoms were evaluated with Contact Lens Dry Eye Questionnaire (CLDEQ-8) and a research questionnaire (Université de Montréal).Results: Compared to baseline (BL), TBUT did not vary (BL) 6.7+2.1s vs. 6.7+1.8s (NF) vs. 6.4+1.9 (DF) (F=1.69; p=0.201) NF wearers were more at risk of developing moderate CJS (odds ratio 14.324; 95% CI 3.103-66.126) and more likely to show increased CS (odds ratio 8.754; 95% CI 2.181-35.146). Comfortable hours of wear reported at BL (7.6+2.3h) did not improve significantly with NF lenses (8.5+ 2.6h; F=1.095; p=0.394) but increased by 22% with DF lenses (10.7+3.0h; F=2.434; p=0.031). The total CLDEQ-8 score was improved with DF lenses (BL 17.2 vs. NF 16.1, p=0.397; vs. DF 8.3, p<0.001), especially on more symptomatic subjects. In the end, 92% of patients preferred to switch over DD lenses, 78% selecting DF material for the future.Conclusion: Outcome from switching CLD wearers to DD lenses is material related. It seems that initial severity of the symptoms could be also a factor to consider. [ABSTRACT FROM AUTHOR]

Purpose: To investigate how initial HEMA and silicone-hydrogel (SiHy) contact lens fit on insertion, which informs prescribing decisions, reflect end of day fit.Methods: Thirty participants (aged 22.9±4.9 years) were fitted contralaterally with HEMA and SiHy contact lenses. Corneal topography and tear break-up time were assessed pre-lens wear. Centration, lag, post-blink movement during up-gaze and push-up recovery speed were recorded after 5,10,20min and 8h of contact lens wear by a digital slit-lamp biomicroscope camera, along with reported comfort. Lens fit metrics were analysed using bespoke software.Results: Comfort and centration were similar with the HEMA and SiHy lenses (p>0.05), but comfort decreased with time (p<0.01) whereas centration remained stable (F=0.036, p=0.991). Movement-on-blink and lag were greater with the HEMA than the SiHy lens (p<0.01), but movement-on-blink decreased with time after insertion (F=22.423, p<0.001) whereas lag remained stable (F=1.967, p=0.129). Push-up recovery speed was similar with the HEMA and the SiHy lens 5-20min after insertion (p>0.05), but was slower with SiHy after 8h wear (p=0.016). Lens movement on blink and push-up recovery speed was predictive of the movement after 8h of wear after 10-20min SiHy wear, but after 5 to 20min of HEMA lens wear.Conclusions: A HEMA or SiHy contact lens with poor movement on blink/push-up after at least 10min after insertion should be rejected. [ABSTRACT FROM AUTHOR]

Background/Aim. Infantile esotropia (ET), entitled as congenital ET, is defined as an alternating, cross-fixational ET that occurs within the first 6 months of life. The aim of this study was to determine the long-term motor and sensory outcomes after surgical correction of patients with infantile ET. Methods. Medical records of 108 consecutive children who had bimedial rectus recession (BMR) initially for ET were reviewed retrospectively. The patients were divided into 3 groups: the group I, surgery before one-year old; the group II, surgery between one and two-year old; the group III, surgery after two-year old. Results. No significant differences were determined among the groups for preoperative mean angle of deviation and refractive error (p > 0.05, for both). Development rate of dissociated vertical deviation (DVD) was greater (40%) in the group I, and the relationship between the rate of DVD and the timing of the initial surgery was statistically significant (p = 0.03). Risk for additional surgery was significantly greater in patients with a younger mean age at initial surgery (p = 0.01). Although measurable stereopsis rate was higher in the group I (35%, 32.4%, 27.8%, respectively) the difference among the groups was insignificant (p = 0.80). Conclusion. Patients with ET have limited potential of high grade stereoacuity despite the early alignment of eyes. Early surgery also has potential effects for the development of both inferior oblique overaction and DVD earlier. [ABSTRACT FROM AUTHOR]

Purpose: Surgical repair of retinal attachment or macular hole frequently requires intraocular gas. This necessitates specific postoperative positioning to improve outcomes and avoid complications. However, patients struggle with correct positioning. We have developed a novel sensor to detect the position of the gas bubble in the eye and provide feedback to patients in real time. In this paper, we determine the specificity and sensitivity of our sensor in vitro using a model eye. Methods: We assessed the reliability of our sensor to detect when a gas bubble has deviated off a model retinal break in a model eye. Various bubble sizes representing the intraocular kinetics of sulfur hexafluoride gas and varying degrees of deviation from the correct position were tested using the sensor attached to a mannequin head with a model eye. Results: We recorded 36 data points. The sensor acted appropriately in 33 (91.7%) of them. The sensor triggered the alarm every time the bubble deviated off the break (n=15, sensitivity =100%). However, it triggered the alarm (falsely) 3/21 times when the bubble was correctly positioned over the retinal break (specificity =86%). Conclusion: Our device shows excellent sensitivity (100%) and specificity (86%) in detecting whether intraocular gas is tamponading a retinal break in a model eye. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to analyze the effects of uneventful phacoemulsification surgery on choroidal thickness (CT) using spectral domain optical coherence tomography (SD-OCT). Methods: In this prospective study, 38 eyes of 38 patients having phacoemulsification surgery were included. All patients underwent detailed ophthalmologic examination, including preoperative axial length (AXL) measurement with optical biometry and intraocular pressure (IOP) measurement preoperatively and 1 month postoperatively. The CT was measured perpendicularly at the fovea and 1.5 mm temporal, 3.0 mm temporal, 1.5 mm nasal, and 3.0 mm nasal using SD-OCT preoperatively and 1 month postoperatively. Changes in the CT after surgery and correlation of this change with age, AXL, preoperative IOP, and IOP change were evaluated. Results: There was a statistically significant increase in the CT at all regions evaluated. This increment was more prominent in the nasal and subfoveal regions. The IOP decreased significantly 1 month after surgery (16.14±4.94 mmHg vs 13.91±4.86 mmHg; P<0.001). The change in IOP was correlated with the CT changes at all regions, whereas age, AXL, and preoperative IOP had no significant correlations with the changes in CT. Conclusion: Phacoemulsification surgery may cause significant increase in CT, which is correlated with surgery-induced IOP change in the short term. Long-term follow-up of eyes having phacoemulsification surgery may provide further insight into the effects of cataract surgery on the choroid. [ABSTRACT FROM AUTHOR]

Purpose: Valved cannulas are a recent addition to small-gauge pars plana vitrectomy (PPV) and provide stable intraocular fluidics. The goal of this study was to compare outcomes and postoperative complication rates of valved vs nonvalved cannula small-gauge PPV for repair of retinal detachments (RDs) complicated by Grade C proliferative vitreoretinopathy (PVR). Methods: A retrospective chart review of 364 consecutive eyes with either valved or nonvalved cannula PPV for RD repair was performed. The primary outcomes were single surgery and final anatomic success and change in best-corrected visual acuity for repair of RDs complicated by Grade C PVR. Results: We identified 36 eyes in the valved group and 31 eyes in the nonvalved group with Grade C PVR RD. The single surgery success was 83% vs 77% (P=0.555) and the final anatomic success was 94% vs 87% (P=0.404) in the valved vs nonvalved eyes, respectively. The mean final visual acuity gain was -0.36 logarithm of the minimum angle of resolution (logMAR; approximate Early Treatment Diabetes Retinopathy Study [ETDRS] score =17 letters) in valved eyes vs -0.33 logMAR (approximate ETDRS score =16 letters) in nonvalved eyes (P=0.81). Postoperative complication rates including postoperative day 1 hypotony, hypertony, and anterior chamber fibrin formation; postoperative retention of intraocular or subretinal perfluorocarbon liquid; and subsequent epiretinal membrane peel were not statistically different between groups. Conclusion: Valved cannula PPV yields equivalent visual acuity and anatomic outcomes without increased postoperative complication rates compared to traditional nonvalved cannula PPV for Grade C PVR-associated RD repair. [ABSTRACT FROM AUTHOR]

We report the clinical features and management of a patient with severe bilateral infectious keratitis developing after simultaneous bilateral small-incision lenticule extraction. A 39-year-old man was referred to our emergency department 2 days after a small-incision lenticule extraction procedure for moderate myopia. He reported decreased vision, photophobia, and pain bilaterally. Visual acuity was counting fingers in the right eye and hand motion in the left eye. Slitlamp examination showed multiple white corneal infiltrates at the corneal cap–stromal bed interface. The interface was first rinsed with povidone–iodine 10.0% and then with vancomycin (50 mg/mL). Fortified antibiotics eyedrops administration was initiated. Cultures showed Streptococcus pneumonia. Anterior segment spectral-domain optical coherence tomography scans were performed daily. Once the infection was controlled 4 days later, corticosteroids eyedrops were begun. Three months postoperatively, the patient had a corrected distance visual acuity of 20/32 in the right eye and 20/25 in the left eye. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned. [ABSTRACT FROM AUTHOR]

Objective: Traumatic orbital encephalocele is a rare but severe complication of orbital roof fractures. We describe 3 cases of orbital encephalocele due to trauma in children. Methods: Retrospective case series from the University of Wisconsin – Madison and Medical College of Wisconsin. Results: Three cases of traumatic orbital encephalocele in pediatric patients were found. The mechanism of injury was motor vehicle accident in 2 patients and accidental self-inflicted gunshot wound in 1 patient. All 3 patients sustained orbital roof fractures (4 mm to 19 mm in width) and frontal lobe contusions with high intracranial pressure. A key finding in all 3 cases was progression of proptosis and globe displacement 4 to 11 days after initial injury. On initial CT, all were diagnosed with extraconal hemorrhage adjacent to the roof fractures, with subsequent enlargement of the mass and eventual diagnosis of encephalocele. Conclusion: Orbital encephalocele is a severe and sight-threatening complication of orbital roof fractures. Post-traumatic orbital encephalocele can be challenging to diagnose on CT as patients with this condition often have associated orbital and intracranial hematoma, which can be difficult to distinguish from herniated brain tissue. When there is a high index of suspicion for encephalocele, an MRI of the orbits and brain with contrast should be obtained for additional characterization. Imaging signs that should raise suspicion for traumatic orbital encephalocele include an enlarging heterogeneous orbital mass in conjunction with a roof fracture and/or widening fracture segments. [ABSTRACT FROM PUBLISHER]

Purpose: To assess early variations in central and paracentral corneal epithelial and non-epithelial thicknesses after uneventful clear corneal incision phacoemulsification. Materials and Methods: Twenty patients with a senile cataract underwent coaxial phacoemulsification through a 2.75-mm-wide corneal incision created at 180° in a prospective cohort pilot study. Corneal sublayer thickness measurements were obtained with Fourier-domain optical coherence tomography (FD-OCT, Cirrus HD-OCT, Carl Zeiss Meditec, Inc., Dublin, CA) before and after 1 week and 1 month postoperatively. Central measurements were performed in the middle of the FD-OCT scan and in the 3-mm corneal diameter (paracentral 180° and 0° locations). Epithelial, non-epithelial and total corneal pachymetry were measured at the central and paracentral locations. Results: No significant changes in epithelial thickness were seen 1 week postoperatively. However, 1 month postoperatively, the central, 180°, and 0° paracentral epithelial thicknesses (52.7 ± 3.8, 53.1 ± 5.4, and 52.7 ± 5.3 µm, respectively) decreased significantly (p < 0.01) compared to preoperatively (57.2 ± 4.8, 58.0 ± 5.7, 56.6 ± 5.3 µm, respectively). The 1-week central, 180°, and 0° paracentral non-epithelial corneal thicknesses (515.5 ± 39.6, 534.3 ± 45.6, and 521.3 ± 36.9 µm) were significantly (p < 0.01) higher than preoperatively (486.2 ± 34.7, 498.2 ± 33.8, 497.5 ± 32.3 µm, respectively). The non-epithelial corneal thickness increase was significantly (p = 0.02) greater after 1 week in the central (29.3 ± 17.2 µm) and the 180° paracentral (36.1 ± 28.7 µm) locations than at the 0° paracentral location (23.8 ± 16.5 µm). Conclusions: Immediate postoperative corneal edema following phacoemulsification irregularly affects the cornea at the sublayer level. The initial central and paracentral non-epithelial thickening is compensated by subsequent central and paracentral epithelial thinning. These initial changes occurred more markedly closest to the main incision over the entrance pupil, which may have visual implications. [ABSTRACT FROM PUBLISHER]

Purpose To evaluate complications of different types of orbital implants following enucleation for retinoblastoma. Methods We performed a retrospective chart study of all patients that underwent enucleation as treatment of retinoblastoma between April 1991 and June 2013. Events of implant exposure, extrusion (defined as a complete loss of the implant, or a major exposure that could not be closed) and socket abnormalities were analysed for association with implant type and influence of additional external beam radiation therapy ( EBRT) and/or chemotherapy. Results A total of 224 enucleations in 216 patients (eight bilateral) were identified. Mean age at surgery was 1.9 (median 1.5) years. Of the 219 included enucleated eyes, 20 were not replaced by a primary implant and 18 were replaced by an Allen implant. Scleral wrapped hydroxyapatite ( HA) and acrylic implants (polymethylmethacrylate) were inserted in, respectively, 79 and 102 cases. In the total population, 29 treatment or implant-specific events (13.2%) were registered. Main complications were implant exposure n = 10 (4.6%) and extrusion n = 6 (2.7%). The acrylic/sclera group had less exposures or extrusions (5 of 102, 4.9%) compared to the HA/sclera group (10 of 79, 12.7%), although this difference did not quite reach statistical significance (p = 0.06). Additional treatment (chemotherapy and/or EBRT for the fellow eye) was administered in 78 cases (35.8%). The overall complication rate in the entire study population was significantly higher (16.7% versus 5.7%) in the group exposed to additional therapy ( OR 3.3; 95% CI 1.30-8.36 p = 0.008). This negative effect of additional therapy was also significant in the combined acrylic/ HA group (OR 2.9; 95% CI 0.97-8.46 p = 0.048). Conclusion Our results suggest a favourable outcome for acrylic implants compared to the HA implant. Additional treatment with chemotherapy and/or EBRT is associated with an increased risk of complications. [ABSTRACT FROM AUTHOR]

Bleb-related infection ( BRI) is one of the serious complications of glaucoma filtering surgery. This literature review is aimed at the evaluation of recent studies related to BRI. The review presented and discussed risk factors, and clinical and laboratory diagnosis emphasizing advances in diagnostic techniques to detect and distinguish the disease as well as to initiate immediate intensive antibacterial treatment. Clinical features of recognized prognostic factors of visual outcome were also presented. The studies showed that the prognosis of blebitis is usually good, unless infection has progressed to endophthalmitis that would signify a poorer prognosis. Despite prompt and intensive treatment of patients with bleb-related endophthalmitis, the outcomes remain unsatisfactory especially with virulent organisms and low initial visual acuity. It has been recommended that early detection and treatment of risk factors and thorough patient education are indispensable in ensuring best prognosis in post-trabeculectomy patients. [ABSTRACT FROM AUTHOR]

Dry eye is the most common complication after laser in situ keratomileusis (LASIK). The major cause of LASIK-associated dry eye is corneal nerve damage. Early identification and treatment of post-operative dry eye are essential to prevent further ocular surface damage. This article reviews the recent studies of LASIK-associated dry eye, including clinical features, aetiology, risk factors, evaluations and treatment. The applications of novel technologies in LASIK-associated dry eye evaluation like anterior segment spectral-domain optical coherence tomography (SD-OCT) and corneal confocal microscopy are also introduced in this review. [ABSTRACT FROM AUTHOR]

Introduction: To investigate whether a previous history of vitrectomy affects sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.Materials and Methods: This study retrospectively reviewed two groups, a vitrectomized group (seven consecutive cases) and an initial vitrectomy group (82 consecutive cases), who underwent 23-gauge transconjunctival sutureless vitrectomy at Jikei University School of Medicine Daisan Hospital in Tokyo. Factors affecting sclerotomy self-sealing were examined using multiple regression analysis. The criterion variable was massage time, and independent variables were age, surgical time, axial length, vitreous incarceration, history of vitrectomy, preoperative intraocular pressure (IOP), and postoperative IOP.Results: Age (F = 10.4) was the only significant factor. History of vitrectomy was not a significant factor (F = 0.06).Conclusions: Previous history of vitrectomy does not affect sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy. [ABSTRACT FROM AUTHOR]

Background/aims To evaluate the Boston type 1 keratoprosthesis (KPro-1) in treatment of eyes with primary congenital glaucoma. Methods A retrospective review was performed of every eye with congenital glaucoma that was treated with a KPro-1 at a tertiary eye care centre between 1 January 2008 and 1 July 2014. The main outcome measures were visual outcome, prosthesis retention and postoperative complications. Results Six eyes of six patients met the inclusion criteria. This included two paediatric patients, aged 6 months and 6 years, and four adults who were 27- 33 years of age. Preoperatively, the best corrected visual acuity (BCVA) was worse than 20/400 in every eye. Three eyes had hand motions and one eye had light perception vision. After a mean follow-up period of 31 months (range 16-51 months), three eyes (50.0%) had a BCVA that was ≥20/400. Overall, the BCVA improved in four eyes (66.7%), and remained the same in two eyes (33.3%). The device was retained in six eyes (83.3%). One or more complications occurred in five eyes (83.3%) and included sterile corneal ulceration (three eyes), retroprosthetic membrane formation (three eyes), progressive glaucomatous optic neuropathy (two eyes), device extrusion (one eye) and an epiretinal membrane (one eye). Conclusions The Boston KPro-1 has an excellent prognosis for retention in eyes with congenital glaucoma. The visual prognosis remains guarded due to the high prevalence of pre-existing ocular comorbidity and the common occurrence of sight-threatening postoperative complications. [ABSTRACT FROM AUTHOR]

Aims To evaluate long-term outcomes and complications of trabeculectomy for normal tension glaucoma (NTG) with contemporary surgical techniques. Methods Retrospective consecutive, non-comparative case series of 131 eyes of 98 patients undergoing trabeculectomy between 2007 and 2013 in a dedicated NTG clinic. Data collected during routine clinical care were analysed. Assessment of clinical outcomes included intraocular pressure (IOP) reduction, bleb function, final visual acuity, evidence of glaucoma progression, postoperative complications and further surgical intervention. Surgical failure was defined as a failure to meet specified IOP-related criteria, the need to undergo further glaucoma surgery for raised IOP or loss of light perception vision. A further analysis was also performed which considered failure as glaucoma progression following surgery. Outcomes were evaluated using Kaplan-Meier life-table analysis. Results The cumulative percentages of unqualified success as defined by a ≥30% reduction of IOP from baseline preoperative maximum (95% CI; IOP of all eyes: mean±SD) at 1, 2, 3 and 4 years after surgery were 91.1% (84.1% to 95.1%; 9.7±2.9 mm Hg), 74.1% (63.7% to 81.8%; 10.3±3.0 mm Hg), 64.8% (52.7% to 74.6%; 10.6±2.5 mm Hg) and 62.1% (49.3% to 72.6%; 10.2±2.1 mm Hg), respectively. At 2 years of follow-up there was no significant association between either previous cataract surgery or ethnicity and failure. Cumulative percentages of unqualified success at 4 years after surgery as defined by a filtering trabeculectomy bleb or absence of glaucoma progression were 91.6% (83.2% to 95.9%) and 92.3% (81.3% to 97.0%), respectively. Postoperative complications such as early (2.3%) and late (0.8%) hypotony were significantly lower than suggested by the current literature. Conclusions Trabeculectomy in NTG patients undertaken using contemporary surgical techniques and intensive postoperative management is associated with more successful long-term outcomes and fewer complications than the currently available literature suggests. [ABSTRACT FROM AUTHOR]

Purpose To identify the location of the inferior oblique muscle (IOM) origin with reference to the lacrimal caruncle in order to facilitate safer oculofacial surgery by preventing morbidity associated with IOM injury. Methods Thirty-seven intact orbits of 20 embalmed Asian cadavers were dissected. The location of the medial border of the IOM origin was determined with respect to the apex of the lacrimal caruncle. In addition, the size of the IOM origin and the anteroposterior distance from the inferior orbital rim to the anterior border of the IOM origin were measured. Results The IOM origin was located at a mean distance of 1.2 mm lateral and 11.2 mm inferior to the apex of the lacrimal caruncle. In half of the orbits, the IOM origin was situated just on the vertical line through the apex of the lacrimal caruncle. The mean length and width of the IOM origin were 4.3 and 2.7 mm, respectively. The mean anteroposterior distance from the inferior orbital rim to the IOM origin was 1.9 mm. Conclusions The lacrimal caruncle is easily identifiable and a reliable external landmark for prediction of the IOM origin. The IOM origin is located approximately where the vertical line through the apex of the lacrimal caruncle intersects the inferior orbital rim. The findings of this anatomical study of the exact location of the IOM origin can help to improve the safety of oculofacial surgery. [ABSTRACT FROM AUTHOR]