Corneal autograft patches for covering exposed transscleral sutures

This article details the authors' experience with a relatively unknown technique for covering exposed ends of transscleral sutures. During combined transscleral suturing of a posterior chamber intraocular lens (PC IOL) with a penetrating keratoplasty, buttons from the excised recipient cornea are sutured with 10-0 nylon over the protruding suture ends. This technique has been used successfully in four cases

Videokeratography findings in children with vernal keratoconjunctivitis versus those of healthy children

Purpose: To determine videokeratographic topography of eyes with vernal keratoconjunctivitis (VKC) and to assess whether the severity of the VKC is related to the presence of changes compatible with keratoconus. Participants: Seventy-six persons aged 6 to 21 years: 40 patients with VKC and 36 healthy controls. Design: A comparative, observational case series. Methods: We examined 76 persons, of whom 40 were patients with VKC and 36 were control subjects, and compared the outcomes of videokeratography (VKG) patterns (EyeSys Laboratories, Houston, TX), numerical corneal indices, and spherical equivalent refraction. Main Outcome Measures: Corneal topographic patterns, corneal numeric indices, and corneal mirror imagery. Results: We found many more abnormal patterns on VKG among the VKC patients than expected when compared with 'normal' eyes (P = 0.02 for the right eye and P = 0.001 for the left eye). Videokeratography allowed us to define a subgroup of patients with infraclinical keratoconus. A trend of superior corneal steepening ('superior keratoconus') was also found. Conclusions: Vernal keratoconjunctivitis patients have more abnormal corneal topographic patterns than non VKC controls. Videokeratography may help decide how to follow-up and treat a presumed self-limiting disease

New methodology for measuring intraocular lens performance using acuity reserve

PURPOSE: To validate a new methodology of intraocular lens (IOL) assessment using acuity reserve analysis via area under the curve (AUC) to assess intermediate vision. SETTING: Study 1 was conducted at 17 sites in Australia, Chile, and Europe. Study 2 was conducted at 15 sites in Australia, Brazil, and Europe. DESIGN: Post hoc analyses of defocus curve results from 2 clinical trials (study 1: single-arm investigation of the AcrySof IQ PanOptix Trifocal IOL [model TFNT00; Alcon Research LLC]; study 2: comparative investigation of AcrySof PanOptix Trifocal IOL vs the AT LISA Trifocal IOL [model 839MP; Carl Zeiss Meditec AG]). METHODS: Acuity reserve was calculated using AUC compared with visual demand (logMAR) at various distances. Study 1 validated the model; study 2 compared acuity reserve, for a range of defocus levels, for the 2 IOLs. RESULTS: The defocus curve (study 1 [149 patients; 298 eyes]) showed good visual acuity (ie, >20/25) at all defocus levels; the AUC estimate showed 2 lines or more of reserve at -2.50 diopters. Comparative post hoc analysis (study 2 [182 patients]) demonstrated significantly improved acuity reserve with PanOptix IOL vs AT LISA IOL at 20 to 40 days postoperatively (P < .001) and 120 to 180 days postoperatively (P < .001). CONCLUSIONS: Acuity reserve analysis using AUC represents a new methodology for comparative IOL assessment, providing additional detail beyond defocus curve analysis. This method demonstrated that the PanOptix Trifocal IOL was superior to the AT LISA Trifocal IOL (model 839MP) for visual acuity at near to intermediate distances with visual acuity reserve analysis

Herpes simplex virus keratitis after laser in situ keratomileusis

PURPOSE: To report two cases of herpes simplex virus (HSV) keratitis after laser in situ keratomileusis (LASIK). METHODS: Interventional small case series. Two patients underwent uneventful LASIK. History of herpes labialis in one patient and herpetic eye disease >10 years prior to intervention in the other patient was reported. Both patients developed stromal herpetic keratitis 6 weeks and 2 years after the procedure, respectively. RESULTS: Treatment consisting of topical steroid drops and topical and systemic antiviral therapy was administered. Recurrences of the herpetic keratitis were seen after tapering of the topical steroids; four and three recurrences were observed, respectively. Final visual acuity was >6/9 in both cases. CONCLUSIONS: Herpetic keratitis after LASIK is an uncommon, possibly under-reported, entity. Even patients without history of herpetic eye disease can present with this complication. Oral antiviral prophylaxis may be appropriate when performing LASIK on patients with a history of ocular or systemic HSV infection

Management of subluxated capsular bag-fixated intraocular lenses using a capsular anchor

We describe the use of the capsular anchor (AssiAnchor) to manage a subluxated intraocular lens (IOL) in the capsular bag. The anchor comprises 2 prongs that hold the anterior lens capsule and a central rod that is sutured to the scleral wall, enabling centration of the IOL-capsular bag complex. Six pseudophakic patients presenting with subluxated posterior chamber IOLs in the capsular bag were operated on using the device. The anchor was used successfully in all cases, although in 2 cases only 1 prong was placed under the capsulorhexis edge. In 1 eye, 2 anchors were used 1 month apart following repeated traumatic zonular injury. The capsular bag holding the IOL remained centered and stable throughout the follow-up period. The anchoring device, which was originally designed to preserve the lens capsule and stabilize subluxated crystalline lenses, can also be used to treat subluxation of a capsular bag-fixated IOL. Dr. Assia is the inventor of the AssiAnchor, has a licensed patent of the anchor, and is consultant to Hanita Lenses. Dr. Lapid-Gortzak is a consultant to and speaker for Alcon Surgical, Inc., Hanita Lenses, Orca Surgical, and Sanoculis Ltd.; a speaker for Santen; and a consultant to Icon. Drs. Ton and Naftali have no financial or proprietary interest in any material or method mentione

Mobile ultra-clean unidirectional airflow screen reduces air contamination in a simulated setting for intra-vitreal injection

The aim of this study is to determine whether the use of a mobile ultra-clean laminar airflow screen reduces the air-borne particle counts in the setting of a simulated procedure of an intra-vitreal injection. A mobile ultra-clean unidirectional airflow (UDF) screen was tested in a simulated procedure for intra-vitreal injections in a treatment room without mechanical ventilation. One UDF was passed over the instrument tray and the surgical area. The concentration of particles was measured in the background, over the instrument table, and next to the ocular area. The degree of protection was calculated at the instrument table and at the surgical site. Use of the UDF mobile screen reduced the mean particle concentration (particles > 0.3 microns) on the instrument table by a factor of at least 100.000 (p < 0.05), and over the patient's eye by at least a factor of 436 (p < 0.05), which in clinical practice translates into significantly reduced air contamination. Mobile UDF screen reduces the mean particle concentration substantially. The mobile UDF screen may therefore allow for a safer procedural environment for ambulatory care procedures such as intra-vitreal injections in treatment room