January 2019


In the Journal of Cataract & Refractive Surgery January 2019

Phacoemulsification in co-existing corneal opacities

Namrata Sharma, MD, Deepali Singhal, MD, Prafulla Kumar Maharana, MD, Rebika Dhiman, MD, Himanshu Shekhar, MD, Jeewan Titiyal, MD, Tushar Agarwal, MD

For patients in which a cataract is accompanied by a corneal opacity, most practitioners opt to perform a triple procedure. But in some cases such as those with secondary glaucoma, healed viral keratitis and deep vascularization graft survival is poor. Instead, practitioners may be able to increase visual acuity and allow patients to function better day to day by performing cataract surgery alone. However, to attain maximum visual outcome in these cases practitioners need a comprehensive understanding of the difficulties that can arise, they must go though proper patient selection and also opt for the right technique. Investigators here considered surgical modifications for phacoemulsification in cases of co-existing corneal opacity and tackled case selection.

Optical and visual quality after small incision lenticule extraction (SMILE)

Anders Gyldenkerne, MD, Anders Ivarsen, MD, Jesper Hjortdal, MD

In this prospective study, investigators considered how SMILE patients with myopia or myopic astigmatism fared in terms of residual refraction, higher order aberrations, and visual acuity. Prior to the SMILE procedure, the 51 eyes had a mean spherical equivalent of –7.08 D. At the 3-month postoperative mark uncorrected distance visual acuity was –0.03 logMAR, and the mean spherical equivalent had decreased to –0.17, while optical scatter was up by 0.22 and coma had increased by 0.1 micrometer. There were no significant changes in spherical aberration. Residual refraction was found to be significantly predictive of uncorrected distance visual acuity. However, uncorrected distance visual acuity was not associated with either scatter or corneal higher order aberration. Investigators concluded that even though both scatter and corneal higher aberrations significantly increased after SMILE, patient-reported visual symptoms decreased. They also determined that analysis of residual refraction can play an important role in predicting postoperative uncorrected distance visual acuity and that residual refraction is important for visual quality.

Evaluation of crystalline lens and intraocular lens tilt using a swept-source optical coherence tomography biometer

Li Wang, MD, Rodrigo Guimaraes de Souza, MD, Mitchell Weikert, MD, Douglas Koch, MD

Investigators in this retrospective case series used OCT to examine the tilt of both the crystalline lens and IOL. Included here were 333 patients. Investigators found that for tilt magnitude the repeatability was 0.1 degrees and for tilt direction was 3 degrees. An anterior tilt of the nasal portion with a mean tilt magnitude of 3.7 degrees was found for both the crystalline lens and the IOL. Both eyes had mirror symmetry. IOL tilt magnitude was 1.2 degrees greater than the tilt of the crystalline lens. Investigators concluded that excellent repeatability of crystalline lens tilt measurements can be attained with an OCT biometer. Postoperative IOL tilt could be determined by extrapolating from preoperative lens tilt. Magnitude of tilt is greater in eyes with larger angle alpha as well as short eyes.

In the Journal of Cataract & Refractive Surgery January 2019 In the Journal of Cataract & Refractive Surgery January 2019
Ophthalmology News - EyeWorld Magazine
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