A 58-year-old Caucasian woman presented to the Bascom Palmer Eye Institute Emergency Department complaining of sudden loss of vision in the right eye 1 day prior. She denied pain or trauma to the right eye. Medical history was significant for poorly controlled type 2 diabetes mellitus, hypertension, hypercholesterolemia, and obesity.
The American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery are working with the American College of Physicians and the American Academy of Family Physicians to educate prescribers of tamsulosin (Flomax, Boehringer Ingelheim) about the association between the use of alpha blockers and intraoperative floppy eye syndrome.
Do pressure-independent factors play a role in glaucoma? That would seem to be the case, since the disease progresses in many patients despite IOP reduction. Enter a new line of thinking about the disease, neuroprotection, which was the topic of a symposium held here in conjunction with the World Ophthalmology Congress.
The newer generation of a dual-optic accommodating IOL (Synchrony, Visiogen) is easy to implant, centers well, provides good distance visual acuity, and demonstrates good safety in terms of potential posterior capsule opacification development, according to H. Burkhard Dick, MD.
Measuring the oxygen level of the retinal tissues may allow detection of retinal changes in patients with diabetes before structural changes in the capillaries occur, said Amani Fawzi, MD, Doheny Eye Institute, University of Southern California, Los Angeles.
The best results of surgery for the correction of congenital esotropia are achieved in children aged less than 12 months, according to Malcolm Ing, MD, chairman of the Division of Ophthalmology, University of Hawaii, Honolulu.
Adaptive optics scanning laser ophthalmoscope (SLO) imaging allows visualization of the minute details of the retina that were not visible previously and that can help explain visual disturbances, said Srinivas Sadda, MD, Doheny Eye Institute, University of Southern California, Los Angeles.
Patients who have masquerade syndromes-underlying disorders that present with signs and symptoms that appear to indicate idiopathic uveitis-are among the most challenging cases to ophthalmologists, said Scott Whitcup, MD.
Oral corticosteroid therapy is essential for ocular sarcoidosis. A sub-Tenon's triamcinolone infusion, however, is useful for older patients to avoid the side effects of corticosteroids. Managing ocular sarcoidosis often requires vitrectomy for fibrotic lesions and photocoagulation for ischemic retinopathy and macroaneurysms, said Nobuyuki Ohguro, MD, Osaka University Medical School, Osaka, Japan.
As new techniques in cataract surgery present so, too, do new complications and challenges in the management of such cases, said Gregg Kokame, MD, MMM, medical director of The Retina Center at Pali Momi, and clinical professor, Division of Ophthalmology, University of Hawaii School of Medicine, Honolulu.
There is much to be learned about nocturnal-and, more importantly, sleeping-IOP if ophthalmologists are going to optimize glaucoma therapies, said Yaniv Barkana, MD, Department of Ophthalmology, Assaf Harofeh Medical Center, Israel.
A new artificial iris implant (Dr. Schmidt Intraocularlinsen GmbH) provides patients with full or partial iris defects with good surgical results, such that it is difficult to differentiate the normal eye from the one that sustained trauma and underwent implantation of the artificial device.
The incidence of the development of cataracts is low after implantation of an implantable collamer lens (ICL), 1.96% over 5 years of follow-up. The common risk factors for cataract development in association with an ICL are patients aged more than 40 years, high myopia, surgeon learning curve, shallow anterior chamber depth, and male gender.
A technique for removing lens fragments that have fallen into the vitreous, developed by ophthalmologists in India, is a simple and effective surgical procedure, suggest results of a recent case series. The FAVIT technique was developed in 1999, and the recent series included cases performed with both a 900-μm phaco probe and a new modification, a 700-μm probe.
A study conducted in rabbit eyes showed that implantation of a hydrophilic IOL (Afinity Single Piece Collamer IOL, STAAR Surgical) presoaked in antibiotic may provide a method for delivering sustained, therapeutic intraocular concentrations of antibiotic following cataract surgery.
Wavefront aberrometry (ORange, WaveTec) used during cataract surgery seems to be an accurate tool for surgeons to predict postoperative visual outcomes. Intraoperative wavefront aberrometry may increase the accuracy of IOL power selection and help avoid postoperative refractive surprises.
A disposable pupil expansion device (Malyugin, MicroSurgical Technology) was evaluated in a series of 30 consecutive eyes of 21 patients taking tamsulosin (Flomax, Boehringer Ingelheim Pharmaceuticals) at the time of cataract surgery. The experience showed the device was easy to insert and remove. It maintained a 6.0-mm round pupil without causing significant iris trauma and allowed the surgeries to be completed without significant complications.
Micro transscleral pars plana vitrectomy using high-speed, 25-gauge instruments is an effective new way to handle an old challenge: performing phacoemulsification in patients with very shallow anterior chambers.
A polyethylene glycol-based ocular sealant is being developed as a synthetic bandage for clear corneal incisions to prevent wound gape, hypotony, and intraocular contamination. Preclinical and early clinical study results support its efficacy and safety.
A randomized, masked, clinical trial evaluated the integrity of phacoemulsification incisions by measuring ingress of ocular surface fluid using trypan blue as a quantifying tracer. The results favored use of either a 2.2-mm microcoaxial or 2.8-mm standard coaxial incision versus smaller bimanual incisions.
The internal controls and responsiveness to changes in vacuum with a new integrated phacoemulsification platform (Stellaris Vision Enhancement System, Bausch & Lomb) have made high-vacuum coaxial microincision surgery a safe and efficient procedure. The system also helps decrease the amount of excess energy added to the eye beyond what is needed to remove a cataract.
Twenty-gauge vitrectomy has been the standard management technique for pediatric cataract for many years. Recent success with 25-gauge instruments, however, opens the door for ophthalmologists to have confidence when handling complex anterior segment surgeries in children.
A new video overlay system (Surgical Media Center, Advanced Medical Optics) uses specialized media software for intraoperative video capture and customizable playback. The system offers high-storage capacity, creates DVD quality recordings, and has comprehensive playback and editing options. These features make it appropriate for quality assurance documentation and as a tool for self-improvement, teaching, and creating video and slide presentations.
A new micro-coaxial surgical system (Intrepid, Alcon Laboratories), featuring a low-compliant fluid management system with low-compliant tubing, suppressed surge and maintained an equivalently satisfactory stable chamber during quadrant removal at a lower bottle height-up to 35 cm less-compared with another fluidics management system by the same manufacturer (Infiniti, Alcon Laboratories), 90 cm compared with 125 cm.
Repositioning using scleral suturing and iris suturing of IOLs and IOL exchange result in similar outcomes for lenses that have decentered or dislocated. Repositioning of the lenses can be associated with redislocation, and IOL exchange can be associated with retinal detachment and development of endophthalmitis. The preferred approach should be individualized to each patient by considering several factors, the most important of which are the material and position of the lens.
Anterior segment optical coherence tomography (AS-OCT) performed preoperatively with a proprietary system (Visante, Carl Zeiss Meditec) in patients with very shallow anterior chambers who are undergoing cataract surgery improves the safety of the procedure. AS-OCT allows surgeons to modify the surgical strategy. Double filling with cohesive and dispersive ophthalmic viscoelastic devices can preserve the surgical space.
Visualization during cataract surgery in patients with corneal opacities can be improved using relatively simple techniques of capsular staining and dimming of the microscope light.
Toxic anterior segment syndrome (TASS) outbreaks occurring at four cataract surgery centers in Canada launched a comprehensive investigation to identify the possible cause(s). Use of a specific brand of textured surgical gloves (Triumph LT, Medline) was identified as a factor, and new cases of TASS have been avoided since use of that particular product was discontinued.
The use of 25-gauge transconjunctival chandelier endoillumination during cataract surgery in patients with severely opacified corneas is proving to be a boon for surgeons and patients alike. The technique facilitates clear intraocular visualization, and because the chandelier does not have to be held in place, the surgeon can perform capsulorrhexis and subsequent manipulations bimanually as usual.
Radial optic neurotomy and peeling of the internal limiting membrane seems to be a surgical treatment for retinal venous occlusive disease that can obtain permanent reperfusion of the retina, in contrast to intravitreal drugs that have only a temporary effect.
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