C K Patel

Postoperative intraocular lens rotation: a randomized comparison of plate and loop haptic implants.

OBJECTIVE To compare the postoperative rotation of plate and loop haptic implants of spherical power to ascertain the optimal design appropriate for toric intraocular lenses (IOLs). DESIGN Randomized, controlled trial. PARTICIPANTS Forty-eight patients attending for routine cataract surgery by phacoemulsification. METHOD Patients with cataract as the only ocular disease were randomly implanted with plate or loop haptic implants after uncomplicated phacoemulsification. The baseline position of the IOL was determined from a video frame acquired at the conclusion of surgery. Postoperative IOL position was documented using digital retroillumination images at 2 weeks and 6 months after surgery. Capsular fusion patterns were recorded using slit-lamp biomicroscopy. Correlation of IOL rotation with axial length, capsular contraction, and fusion was attempted. MAIN OUTCOME MEASURES Early IOL rotation, occurring between surgery and 2 weeks after surgery, was graded as mild (<10 degrees), moderate (10 degrees < to <30 degrees), or severe (>30 degrees) by a semiobjective online comparison of the images. Late IOL rotation, occurring between 2 weeks and 6 months, was measured more precisely using software developed specifically for the study. RESULTS Twenty-three patients were allocated the loop haptic and 25 the plate haptic IOL. The groups were comparable for demographic variables and numbers of patients excluded from analysis (P > 0.05). Five (24%) of 21 of plate haptic IOLs underwent severe early rotation compared to 2 (9%) of 22 loop haptics (P = 0.36). The median late rotation was 6.8 degrees for loop haptics compared to 0.6 degrees for plate haptics (P = 0.0073). Between 2 weeks and 6 months, anticlockwise rotation had occurred in 16 (89%) of 18 loop haptic IOLs compared to 11 (52%) of 21 plate haptic IOLs (P = 0.0081). CONCLUSIONS Plate haptic IOLs show greater rotational stability than do loop haptics made from polypropylene once capsular fusion has taken place. Loop haptics invariably rotate anticlockwise after 2 weeks.

Iris-claw intraocular lenses to correct aphakia in the absence of capsule support.

PURPOSE: To evaluate the indications, postoperative visual efficacy, and complication rate after intraocular implantation of an iris‐claw aphakic intraocular lens (IOL). SETTING: Oxford Eye Hospital, Oxford, United Kingdom. DESIGN: Case series. METHODS: This chart review comprised eyes with no capsule support that had anterior iris‐fixation IOL implantation for aphakia between 2001 and 2009. RESULTS: The study comprised 116 eyes (104 patients). Iris‐claw IOLs were inserted during primary lens surgery in 18 eyes (15.5%), during an IOL exchange procedure for dislocated posterior chamber IOLs in 19 eyes (16.4%), and as a secondary procedure in 79 eyes (68.1%). The mean follow‐up was 22.4 months (range 3 to 79 months). The final corrected distance visual acuity (CDVA) was 6/12 or better in 68.9% of all eyes and in 47 of 53 eyes (88.7%) with no preoperative comorbidity. Complications included wound leak requiring resuturing in 2.6% of eyes, postoperative intraocular pressure rise in 9.5% of eyes (glaucoma escalation 0.8%), and cystoid macular edema in 7.7% of eyes (0.8% chronic). Iris‐claw IOL subluxation occurred in 6.0% of eyes from 5 days to 60 months postoperatively; all the IOLs were repositioned. Corneal decompensation occurred in 1.7% of eyes; 0.8% had retinal detachments. CONCLUSIONS: Iris‐claw IOL implantation for aphakia gave a good visual outcome and can be used for a wide range of indications. Postoperative complication rates were comparable to, if not better than, those with conventional anterior chamber IOLs. Correct implantation technique is critical in avoiding postoperative IOL subluxation. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Variation in anaesthesia for the laser treatment of retinopathy of prematurity--a survey of ophthalmologists in the UK.

PurposeLaser treatment for retinopathy of prematurity (ROP) may be associated with systemic stress for the infant. No national consensus on the optimum method of anaesthesia for the treatment of ROP currently exists. This study ascertains the anaesthetic practices employed for the treatment of ROP by ophthalmologists in the United Kingdom (UK), and also their attitudes towards these practices.Materials and methodsA postal questionnaire was sent to 46 consultant ophthalmologists identified as performing treatment for ROP in the UK. The consultants were asked to estimate the annual number of babies with ROP that they treated with laser, what methods of anaesthesia they employed, for comments regarding the arrangements for, and types of anaesthesia employed and whether they believed that the neonatal stress response to laser treatment was associated with a significant risk of systemic complications.ResultsIn all, 35 (76%) questionnaires were returned. A total of 30 (86%) respondents reported performing laser treatment for ROP. Of these, 15 (50%) used general anaesthesia for all cases and 11 (37%) intravenous sedation combined with topical anaesthesia for all cases. Oral sedation combined with topical anaesthesia, rectal chloral hydrate and paracetamol combined with topical anaesthesia, intravenous ketamine combined with topical anaesthesia, and subtenons local anesthesia were used by one (3%) respondent each. There were no ophthalmologists using subconjunctival or topical anaesthetic alone or treating without anaesthesia.ConclusionThis survey reveals considerable variation in practice among UK ophthalmologists regarding the anaesthetic methods employed in the treatment of ROP, and their beliefs regarding the systemic stress associated with treatment.

Vitrectomy without postoperative posturing for idiopathic macular holes

Purpose:  To determine the success of vitrectomy with ILM peeling and C3F8 tamponade for macular holes without the need for postoperative face‐down posturing.

Pseudohypopyon after intravitreal triamcinolone injection for the treatment of pseudophakic cystoid macular oedema

Intravitreal triamcinolone injection is a safe and effective treatment for cystoid macular oedema (CMO) caused by uveitis,1 diabetic maculopathy,2 central retinal vein occlusion,3 and pseudophakic CMO.4 Potential risks include glaucoma, cataract, retinal detachment, and endophthalmitis. We present a case of pseudohypopyon and sterile endophthalmitis following intravitreal triamcinolone injection for the treatment of pseudophakic CMO. An 88 year old woman underwent phacoemulsification surgery which was complicated by posterior capsule rupture. Anterior vitrectomy with implantation of a silicone intraocular lens into the sulcus was performed. Postoperatively, CMO developed. This failed to respond to treatment with topical dexamethasone, topical ketorolac, and posterior sub-Tenon triamcinolone injection, limiting visual acuity to 6/24 at 7 months following the cataract surgery. An intravitreal injection of triamcinolone acetonide (4 …

Non-contact ultra-widefield imaging of retinopathy of prematurity using the Optos dual wavelength scanning laser ophthalmoscope

AimsThe purpose of this report is to demonstrate that a non-contact ultra-widefield dual wavelength laser camera (Optos) is able to capture high-quality images in retinopathy of prematurity (ROP).Materials and methodsWe conducted a retrospective review of patients attending the Oxford Eye Hospital with ROP between 1 August 2012 and 16 November 2012 that underwent standard clinical assessment. Anterior segment imaging, where relevant, was performed with Retcam. Retinal imaging was then performed with Optos, using a modified ‘flying baby position’.ResultsThe Optos scanning laser ophthalmoscope was able to acquire ultra-widefield fundal images in nine ROP subjects. The images obtained show clear views of the different stages of ROP features at the posterior pole and peripheral retina. Regression of ROP features were identified, following laser and intravitreal bevacizumab treatment. Additionally, ‘skip areas’ missed by initial laser treatment could be identified in the peripheral retina.ConclusionThe Optos ultra-widefield scanning laser ophthalmoscope is capable of acquiring clinically useful high-quality images of the fundus in ROP subjects. The imaging technique could potentially be used in monitoring ROP progression and documenting ROP regression following treatment.

Repair of macular fold following retinal reattachment surgery

Here the management of a macular fold complicating retinal reattachment surgery is discussed. The macular fold was repaired by a technique similar to that used in retinal translocation surgery. Direct injection into the macular fold was performed, which caused a linear, rather than the intended concentric, detachment of the retina. Permanent flattening of the macula fold was achieved and the best‐corrected Snellen visual acuity was 6/12 at 6 months. The importance of intervention, advantages and disadvantages of this technique and alternative methods of managing such cases are discussed. It may be prudent to consider peripheral, rather than direct, injection into the macular fold to detach the macula in such cases.

Noncontact High-Resolution Ultra–Wide-Field Oral Fluorescein Angiography in Premature Infants With Retinopathy of Prematurity

IMPORTANCE We report for the first time, to our knowledge, the acquisition of noncontact ultra-wide-field oral fluorescein angiograms in premature infants with retinopathy of prematurity. OBSERVATIONS High-resolution oral fluorescein angiograms were successfully obtained in 3 consecutive premature infants with retinopathy of prematurity at the Oxford Eye Hospital, Oxford, England, using the Optos Panoramic 200MA imaging system (Optos PLC). CONCLUSIONS AND RELEVANCE Noncontact ultra-wide-field oral fluorescein angiograms captured using the Optos Panoramic 200MA fluorescein angiographic system provide a safe and alternative method for evaluating the retinal vasculature in premature infants with retinopathy of prematurity.

Posterior chamber compartments demonstrated by optical coherence tomography, in silicone‐filled eyes, following macular hole surgery

Purpose:  To report visualization with optical coherence tomography of a prefoveal space in silicone oil‐filled eyes following surgery for idiopathic macular hole.

Imaging the Macula Through a Black Occlusive Intraocular Lens

B lack occlusive intraocular lens (IOL) insertion has been shown to be an effective treatment for intractable diplopia, visual confusion, and poor cosmesis resulting from leukokoria. A significant disadvantage of occlusive IOL insertion is that conventional funduscopy is not possible, preventing the detection of posterior pole disease. Here we describe a patient in whom we made the novel discovery of successful macular imaging through an occlusive IOL using an infrared light–based scanning laser ophthalmoscope/optical coherence tomography (OCT) scanner. We suggest that this report is likely to fundamentally change the current thinking on occlusive IOLs and to promote their use in the management of these patients.