Multi-component adjustable intraocular lenses: a new concept in pediatric cataract surgery.

The multi-component intraocular lens (IOL) (IVO; SAS, Strasbourg, France) is a novel approach to the treatment of pediatric cataract. Because the refractive requirements for pediatric eyes often change over time, current IOL technology does not easily allow refractive adjustments after the primary surgical intervention. The multi-component IOL concept allows easy, surgical refractive adjustments to the initial surgical implantation at any postoperative time period. Thus, both surgical implantation and enhancement surgery have been successfully accomplished in adult patients. A novel surgical approach to pediatric cataract surgery is described. At the time of the primary surgery, a two component IOL was implanted. At any postoperative time period, the front lens component, located in front of the capsular bag, could be easily surgically exchanged because the dioptric power requirements of the pediatric eye changed over time. Both primary and enhancement surgeries have been done in adult patients with good results. Implantations have occurred uneventfully in all cases with no intraoperative or postoperative complications. There was no statistically significant difference in the endothelial cell density, anterior chamber depth, and pachymetry readings preoperatively and 2 years postoperatively. There was no interlenticular fibrosis present. The multi-component IOL should provide a unique and greatly needed surgically adjustable approach to the treatment of pediatric cataract

New INTACS SK implantation in patients with post-laser in situ keratomileusis corneal ectasia.

In this case series, 2 patients with post-laser in situ keratomileusis corneal ectasia were included. Patients were treated with new intrastromal corneal ring segments, INTACS SK (severe keratoconus or steep "K") (Addition Technology, Inc, Des Plaines, IL) implantation. Two segments were inserted without any intraoperative or postoperative complications. Three months after the procedure, uncorrected visual acuity was improved in both patients from counting fingers preoperatively to 20/40 and 20/50, respectively. Best spectacle-corrected visual acuity improved from 20/40 to 20/32 and from 20/50 to 20/40. Manifest refraction improved from -8.75/-5.00 x 125 and -14.25/-6.50 x 33 preoperatively to -5.50/-2.25 x 125 and -8.25/-1.50 x 15 with an improvement in topographic findings. One year postoperatively, uncorrected visual acuity, best spectacle-corrected visual acuity, and topographic findings remained improved. In conclusion, new INTACS SK might be able to improve visual acuity in patients with post-laser in situ keratomileusis corneal ectasia

Transient peripheral edema following displaced corneal graft after descemet stripping automated endothelial keratoplasty (DSAEK): case presentation.

Descemet's Stripping with Automated Endothelial Keratoplasty (DSAEK) is constantly gaining popularity in the management of endothelial dysfunctions such as bullous keratopathy or Fuchs' dystrophy. A 36 year-old man with Fuchs' dystrophy underwent combined phacoemulsification and DSAEK of the right eye. Immediately postoperatively, corneal graft displacement and peripheral corneal edema which remained stable during the first postoperative month were evident on slit lamp examination. Three months after the procedure the peripheral edema had completely resolved and the patients' subjective symptoms were improved. The purpose of this case presentation is to demonstrate that corneal graft displacement after DSAEK can lead to peripheral corneal edema that can resolve without further intervention such as graft repositioning or replacement

Anterior chamber sulfur hexafluoride (SF6) injection for the management of postsurgery hypotony in glaucoma patients

Purpose:The purpose of this article was to describe a new technique involving the injection of sulfur hexafluoride (SF6) gas in the anterior chamber (A/C) for the management of hypotony in patients with previous glaucoma surgery.Materials and Methods:Seven patients were included in this prospective case series. All patients had advanced glaucoma that was managed surgically either by trabeculectomy (6 patients) or Ahmed valve (1 patient). All patients presented with intraocular pressure (IOP) <7 mm Ηg, shallow A/C, and ultrasound images of choroidal detachment and ciliary body detachment. Patients' hypotony was treated by 0.4 to 0.6 mL of 100% pure SF6 injection in the A/C followed by supine posture. The purpose of this injection was dual: To displace the ciliary body to its normal position and restore aqueous humor normal production, and to block aqueous humor outflow through bubble formation, causing an increase in IOP.Results:Surgical technique was successful in all 7 patients with IOP normalization (>10 mm Hg) and A/C depth increase within the first week after surgery.Conclusion:A new surgical technique of SF6 injection in the A/C for patients with choroidal detachment and hypotony shows promising results. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

Outcomes after accommodative bioanalogic intraocular lens implantation.

To evaluate the outcomes after Wichterle Intraocular Lens-Continuous Focus (Medicem, Kamenné Zehrovice, Czech Republic) accommodative bioanalogic intraocular lens implantation. In this prospective case series, 50 eyes of 25 patients (mean age: 65.3 ± 8.4 years; range: 53 to 83 years) were included. All patients underwent routine cataract surgery and Wichterle Intraocular Lens-Continuous Focus implantation. Mean follow-up was 11.44 ± 2.46 months (range: 9 to 17 months). Both monocular uncorrected and corrected distance visual acuity statistically and significantly (P < .05) improved from 0.31 ± 0.17 (20/63 Snellen) (range: counting fingers to 0.7) to 0.74 ± 0.19 (20/25 Snellen) (range: 0.2 to 1) and from 0.61 ± 0.19 (20/32 Snellen) (range: 0.2 to 1) to 0.82 ± 0.13 (20/25 Snellen) (range: 0.4 to 1), respectively. Target postoperative refraction was -0.5 diopters (D) and preoperative and 1-year postoperative spherical equivalent refraction were 0.72 ± 2.71 D (range: -7.25 to 2.37 D) and -0.24 ± 0.65 D (range: -1.0 to 1.0 D), respectively. No eyes lost lines of corrected distance visual acuity during the follow-up period, whereas 88% of patients gained one or more lines of corrected distance visual acuity. Uncorrected intermediate and near visual acuity were J2 (Snellen 20/25) or better in 72% of patients. No complications occurred intraoperatively or postoperatively. The evaluation of the mean values of root mean square of third and fourth order higher-order aberrations at 1 year postoperatively revealed a mean negative spherical aberration of -0.18 ± 0.13 μm. Wichterle Intraocular Lens-Continuous Focus accommodative bioanalogic IOL implantation provides satisfactory visual acuity for far, intermediate, and near distances and the promising results remain stable throughout the follow-up period

Thin LASIK flap creation using the SCHWIND Carriazo-Pendular microkeratome.

To study the outcomes of LASIK after intended thin flap creation using the SCHWIND Carriazo-Pendular microkeratome with the 90-microm head. Forty-seven eyes of 26 patients (mean age 28.78+/-6.98 years) underwent LASIK with a superior hinge flap using the 90-microm head of the SCHWIND Carriazo-Pendular microkeratome. Evaluation included flap parameters (thickness, diameter, hinge size), complications, and visual outcome. No intraoperative or early postoperative complications were observed. The mean flap thickness was 79.88+/-6.94 microm (range: 70 to 93 microm). Mean flap diameter was 9.25+/-0.45 mm (range: 8.5 to 11 mm) whereas mean hinge size was 4.63+/-0.66 mm (range: 3 to 6.5 mm). No eye lost lines of best spectacle-corrected visual acuity, and all eyes were emmetropic within one diopter postoperatively. The SCHWIND Carriazo-Pendular microkeratome with the 90-microm head seems to have increased accuracy in intended creation of thin flaps

Secondary pseudomyopia induced by amisulpride.

To report a case of pseudomyopia induced by antipsychotic drug administration. A 30-year-old woman was referred to our ophthalmology department complaining of blurred vision, especially at distance, in both eyes. The patient had been prescribed antipsychotic drugs (haloperidol and biperiden) as treatment for her schizophrenic symptoms and had recently undergone a change of treatment to amisulpride. She had a manifest refraction of -4.00/-1.00 × 180 in the OD and -3.75/-1.25 × 175 in the OS whereas her cycloplegic refraction was -1.75/-1.00 × 180 in the OD and -1.00/-1.25 × 175 in the OS, respectively. A diagnosis of likely drug-induced pseudomyopia was made. Therefore, the patient was advised to visit her psychiatrist, who added an extra 2 mg of biperiden, an anticholinergic agent, to the pre-existing amisulpride treatment, achieving a cessation of the visual symptoms a few days later. Pseudomyopia can be induced by the antipsychotic drug amisulpride. Additional treatment with anticholinergic agents can be used to eliminate this side effect