Visual Outcomes of Pupilloplasty in Ocular Trauma and Iatrogenic Damage

Purpose: To report the visual outcomes of different techniques for iris pupilloplasty in eyes after traumatic and iatrogenic damage. Methods: 70 consecutive eyes with posttraumatic (80%) and postoperative (20%) iris damage were included. According to the preoperative diagnosis, the eyes were divided into three groups: mydriasis (50%), partial iris defects (24%), and iridodialysis (26%). Multiple techniques were performed: the Siepser slip-knot technique, the “lasso” technique, and suturing to the sclera. These techniques were combined in some cases. Results: The best improvement of visual acuity was found for the Siepser slip-knot technique with a median of 0.7 (SD ± 0.83) before surgery and 0.52 logMAR (SD ± 0.65) after surgery with regard to the surgical technique, and for mydriasis with a median of 0.7 (SD ± 0.75) before surgery and 0.52 logMAR (SD ± 0.49) after surgery with regard to preoperative diagnosis. Pupilloplasty was combined with additional surgery (corneal suturing, secondary intraocular lens implantation, anterior or pars plana vitrectomy) in 80% of cases. Apart from corneal suturing, all additional procedures ensured improvement in visual acuity. Conclusions: The slip-knot technique was the only suturing technique that resulted in a significant improvement in visual acuity. Other surgical procedures are usually needed in the majority of cases that undergo pupilloplasty, and they also give visual gain

Double‐needle yamane technique using flanged haptics in ocular trauma—a retrospective survey of visual outcomes and safety

To evaluate visual outcomes and safety of the double‐needle technique using flanged haptics (Yamane technique) in patients with aphakia caused by ocular trauma at a trauma referral center. Retrospective: Consecutive interventional case series of 30 patients who underwent the Yamane technique due to posttraumatic aphakia. The double‐needle technique using flanged haptics was combined with anterior vitrectomy (group A) in 14 patients, and with pars plana vitrectomy (PPV) (group B) due to retinal detachment, nucleus dislocation into the vitreous cavity, or intraocular lens (IOL) displacement in 16 patients. No intraoperative complications were noted. There was significant improvement in the visual acuity in both groups at the second postoperative visit. However, the visual acuity was significantly worse in the group treated with the Yamane technique combined with PPV. Silicone oil tamponade in PPV group was associated with worse visual acuity, whereas post lensectomy status was associated with poor visual function result in the anterior vitrectomy group. There was one case of slight IOL decentration and one retinal detachment during the postoperative follow‐up period in the group with PPV. In this case series, the Yamane technique applied in traumatized eyes was found to be an efficacious and safe procedure. Combining the Yamane technique with PPV due to posterior segment ocular trauma was associated with worse functional results in the follow‐up at three months. Further studies with longer follow‐up evaluations are required to verify long‐term complications

The utility of three-dimensional visualization during anterior segment surgery

Technika heads-up surgery staje się coraz bardziej powszechna i akceptowana. Pozwala ona wyeliminować ograniczenia narzucane przez stosowanie standardowego mikroskopu operacyjnego oraz minimalizuje zmęczenie, gdyż umożliwia operowanie w znacznie bardziej naturalnej i fizjologicznej pozycji ciała. Jednocześnie zaś nie wpływa negatywnie na jakość obrazu ani na technikę operacyjną. Znajduje coraz szersze zastosowanie nie tylko w chirurgii siatkówki i ciała szklistego, ale również przedniego odcinka oka. Wstępne obserwacje wyników chirurgicznego leczenia: zaćmy, stanów pourazowych, zeza oraz keratopatii pęcherzowej, z zastosowaniem techniki trójwymiarowej wizualizacji potwierdzają, że profil bezpieczeństwa zabiegu jest porównywalny z metodami konwencjonalnymi. Obrazowanie 3D wyróżnia się zaś walorami edukacyjnymi oraz możliwością wykonania zabiegu w trybie light-out surgery.The heads-up surgery is becoming more and more common and acceptable as it eliminates restrictions imposed by the use of a standard microscope, and minimizes surgeon's fatigue, and allows surgery in much more natural and physiological positions of the body. It also does not affect the image quality and surgical technique. It is increasingly used not only in retinal and vitreous surgery but also in procedures preformed on the anterior segment of the eye. Preliminary observations of the results of surgical treatment of cataracts, posttraumatic changes, strabismus and bullous keratopathy with three-dimensional (3D) visualization technologies, confirmed the safety profile of treatments as compared to conventional methods. Besides, 3D imaging is distinguished by educational values and enables the performance of the light-out operation