It is important to consider both corneal and intraocular approaches to resolve such a case. One treatment option is a LASIK procedure. It is possible, even 20 years after the initial refractive procedure, to lift the LASIK flap and apply a new treatment on the residual estromal bed. However, this approach is neither typical nor easy to execute in such cases because of the length of time elapsed since the first LASIK procedure, which puts the integrity of the previous flap at risk. There is also a greater possibility of epithelial growth in the interface because of the manipulation of a long-ex ..read more

A 52-year-old woman presented with a history of cataract surgery performed 3 months prior. The patient presented with a refractive surprise of +2.00 −2.5 × 75. Her uncorrected distance visual acuity (UDVA) was 20/80 (Snellen) and the corrected distance visual acuity (CDVA) was 20/30. A detailed history revealed that the patient had undergone a laser in situ keratomileusis (LASIK) procedure approximately 20 years ago. Case sheets revealed that a +24 diopter (D) monofocal foldable intraocular lens (IOL) was implanted, and on clinical evaluation, it was found to be well placed in the capsular bag ..read more

IOL calculations in eyes that have undergone prior corneal refractive surgery can pose several challenges to the refractive surgeon. Particularly in cases of prior myopic laser vision correction, as seen in this patient, hyperopic refractive surprises can arise after cataract surgery due to underestimations of the final IOL power. Alterations in the keratometric index (ratio between the anterior and posterior corneal surfaces), inaccurate extrapolation of central corneal curvature values from steeper paracentral corneal points by modern-day keratometers and topographers, and erroneous predicti ..read more

Our analysis included almost 900 patients across 6 random clinical trials. The main conclusion was that NSAIDs with or without topical steroids were superior to topical steroids alone in preventing PCME in patients with diabetes without macular edema before surgery. We previously found similar results for nondiabetic patients in a systematic review and meta-analysis1 performed before the conclusion of the PREMED study.2,3 ..read more

In a public health system, such as the United Kingdom's National Health Service (NHS), “time is money.” Thus, it was reassuring for our group that over the 5-year duration of the Nderitu and Ursell study,1 the increase in operating room efficiency and surgical techniques enabled a timesaving of 3 minutes per case ..read more

The reference I used to make the Ciliary Sulcus Pad Injector was the needle injector produced by Rumex Co. I was not aware of the Trimarchi injector, which is very similar to the Rumex needle injector ..read more

We describe a surgical technique for fine-tuning the centration of a transscleral-sutured modified capsular tension ring (CTR)–intraocular lens–capsular bag complex using a partial-thickness scleral tethering suture placed posterior to the external episcleral portion of a transscleral suture loop. The technique can be used for adjusting the centration of any intraocular supporting or prosthetic device that is transsclerally sutured in a “hanging” technique, such as capsular tension segments, modified CTRs, capsular anchoring devices, or iris prostheses ..read more

In the course of clinical practice, we noted that patients who had taken oral clarithromycin to treat bronchitis showed considerable reduction of intraocular lens (IOL) precipitates and subjective improvement in visual function. Thus far, methods for cleaning IOLs are limited to surgical intervention (eg, scraping or IOL extraction). Regardless of attempts to surgically clean IOLs by scraping, precipitates immediately return; therefore, IOL extraction and reimplantation remains the sole approach for recovery of visual function ..read more

Yamane et al.1 described the flanged double-needle technique for secured transscleral fixation of an intraocular lens (IOL). Effortless externalization of the trailing haptic is a concern, and various modifications have been described.2–5 The handshake technique to facilitate trailing haptic externalization has been described for a glued variant of the secondary IOL fixation method.6,7 Kusaka et al.8 described a riveting technique for iridodialysis repair in which the flanged and riveted ends of the suture hold the peripheral iris tissue in place ..read more

Sugiura et al.1 described a new device, the Ciliary Sulcus Pad Injector (Duckworth & Kent Ltd.), for ciliary sulcus suture fixation. They sought to show the superiority of this new instrument compared with preexisting techniques2,3 for ciliary sulcus suture fixation of an intraocular lens (IOL). In both ab interno fixation and ab externo fixation, the needle is blindly inserted in the ciliary sulcus, leading to a high risk for complications (eg, ciliary body bleeding). Sugiura et al. developed the Ciliary Sulcus Pad Injector as a safer instrument for piercing the ciliary sulcus ..read more