Matteo Forlini

Clear corneal incisions in bimanual microincision cataract surgery: Long-term wound-healing architecture

PURPOSE: To evaluate bimanual microincision cataract surgery (MICS) clear corneal incision (CCI) architectural features over the long‐term using anterior segment optical coherence tomography (AS‐OCT). DESIGN: Case series. SETTING: Institute of Ophthalmology, University of Modena, Modena, Italy. METHODS: Patients who had uneventful bimanual MICS in the previous 2 to 16 months were examined using AS‐OCT. Images were used to measure corneal thickness, incision length, incision angle, incidence of epithelial or endothelial gaping, misalignment, Descemet membrane detachment, and posterior wound retraction. RESULTS: Fifty‐two eyes (33 patients) were enrolled. Mean incision length and incision angle were, respectively, 1427.91 μm and 31.19 degrees for the right hand, 1440.63 μm and 31.54 degrees for the left hand, 1474.13 μm and 31.27 degrees for temporal incisions, and 1394.41 μm and 31.46 degrees for nasal CCIs. Posterior wound retraction was the only architectural feature found. Its prevalence was 7.10% at 2 to 3 months, 31.8% at 4 to 11 months, and 33.3% at 12 months. Fifty‐three percent of posterior wound retractions were in 1.8 mm CCIs and 47% in 1.4 mm CCIs. CONCLUSIONS: Bimanual MICS was not related to particular morphologic features of CCIs. The enlargement of 1 incision or construction of the incision with the dominant or the nondominant hand did not affect long‐term wound architecture. Posterior wound retraction was the only architectural feature; however, its prevalence seems substantially lower than with other surgical techniques. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Bottle cork and cap injury to the eye: a review of 34 cases

AimTo describe our series of bottle cork and cap injuries to the eye in order to report the visual impairment and clinical outcomes observed in 34 cases over an 8-year period.MethodsRetrospective review of the database of the Ophthalmology Institute of Modena from January 1999 to September 2007. All patients presented with closed-globe injury according to Kuhn et al.’s classification. All the cases were caused by sparkling wine: white in 24 cases and red in ten cases.ResultsThe incidence varied between six and two cases a year (average 3.89). Bottle cork and cap injuries represent 11% of all injuries admitted to our department in the period considered in our series. In details: nine patients recovered totally, 22 patients recovered partially, three patients had a severe visual outcome (<grade 3 according to trauma classification system, BCVA < 0.2). Five patients needed a surgical procedure. The most frequent ocular lesion was hyphema; the worst was retinal detachment due to a giant retinal tear and two patients suffered very severe visual impairment.ConclusionsTo our knowledge, this is the largest series of bottle cork and cap injuries to the eye published to date. This kind of injury can be potentially sight-threatening, leading to severe visual loss in a small percentage of cases. We highlight the need for preventative measures such as labelling or devices to regulate cork pressure.

Optic Nerve Aplasia and Microphthalmos: A Case Report

Optic nerve aplasia is an extremely rare anomaly that is usually associated with microphthalmos as well as with other ocular and extraocular anomalies. In this case report we describe a case of an occasional finding of unilateral complete aplasia of the optic nerve in girl at the age of 42 days, in association only with microphthalmos.

Modification Of Adjustable Macular Buckling With 29-g Chandelier Light For Optimal Positioning In Highly Myopic Eyes With Macular Hole.

Purpose: To evaluate the efficacy of the modification of Adjustable Macular Buckling device in the treatment of myopic macular hole retinal detachment with posterior staphyloma. Methods: Four consecutive patients suffering from myopic macular detachment with macular hole were treated using the macular buckling procedure. An Adjustable Macular Buckling device was used in all four cases and was modified using a 29-gauge optical fiber to illuminate its macular plate. Results: Optical coherence tomography showed successful retinal reattachment and closure of the macular hole after the buckling procedure. The macular plate of the buckling device was properly positioned in all four patients. No complications were observed. Conclusion: The modification of the macular buckling device improves the accuracy of its positioning by illuminating its macular plate.

Results and complications of surgeons-in-training learning bimanual microincision cataract surgery

Purpose To evaluate visual outcomes and complications of bimanual microincision cataract surgery performed by surgeons in training. Setting Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy. Design Prospective case series. Methods The corrected distance visual acuity (CDVA), astigmatism, corneal pachymetry, and endothelial cell count were evaluated before and 7 and 30 days after bimanual MICS performed by surgeons in training. Intraoperative and postoperative complications were also recorded. Results Three surgeons in training performed bimanual MICS in 150 eyes of 131 patients. There were 18 intraoperative complications (12.0%) (10 iris traumas [6.6%]; 4 capsule ruptures without vitreous loss [2.7%]; 3 capsule ruptures with vitreous loss [2.0%]; 1 intraocular lens [IOL] implantation in the sulcus due to zonular laxity [0.7%]). There were 5 postoperative complications (3.3%) (2 iris prolapses [1.3%]; 1 IOL loop malposition [0.7%]; 1 narrowing of anterior chamber [0.7%]; 1 capsulorhexis phimosis [0.7%]). Thirty days postoperatively, the mean CDVA improvement was 0.53 ± 0.20 (Snellen decimal) (P < .05), the mean decrease in astigmatism was 0.09 ± 0.54 diopter (P = .29), and the mean increase in corneal pachymetry was 7.42 ± 22.01 &mgr;m (P = .12). There was statistically significant endothelial cell loss (mean 496.50 ± 469.66 cells/mm2) (P < .05). Conclusions Bimanual MICS performed by surgeons in training was safe and effective. Visual outcomes and complication rates were similar to those reported for coaxial cataract surgery performed by surgeons in training. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Comparative Analysis Of Retinal Reattachment Surgery With Or Without Internal Limiting Membrane Peeling To Prevent Postoperative Macular Pucker

Purpose: To determine whether internal limiting membrane (ILM) peeling during pars plana vitrectomy for rhegmatogenous retinal detachment reduces the incidence of epiretinal membrane (ERM) formation. Methods: In this retrospective study, preoperative, intraoperative, and postoperative data from all eyes undergoing pars plana vitrectomy for rhegmatogenous retinal detachment between January 2007 and December 2013 was analyzed. All cases with at least 1-year of follow-up were included. Data collection included vision, intraoperative complications, occurrence of ERM, and spectral domain optical coherence tomography characteristics. The OCTs were retrieved for all eyes and were graded by a single masked grader. Results: Out of 159 eyes recruited, ILM peeling was done in 78 eyes (49%). Overall occurrence of ERM was 20%. Seven eyes (9%) in ILM peeling group and 25 eyes in the non-ILM peeling group (31%) showed ERM (P = 0.001). Postoperative vision was significantly better in eyes that had ILM peeling (0.48 ± 0.4 logarithm of the minimum angle of resolution [20/63] vs. 0.77 ± 0.6 logarithm of the minimum angle of resolution [20/125], P = 0.003). In multivariable models adjusting for type of tamponade, ILM peeling reduced the likelihood of ERM formation by 75% (P = 0.01). Conclusion: Internal limiting membrane peeling during pars plana vitrectomy for rhegmatogenous retinal detachment significantly reduces ERM formation in the postoperative period and is associated with better visual and anatomical outcomes.

Long-term follow-up for bimanual microincision cataract surgery: comparison of results obtained by surgeons in training and experienced surgeons

Purpose To determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons. Patients and methods Eighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software. Results Out of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343±0.246 logMAR for Group A, and 0.388±0.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P<0.05). In Group A, mean PCO score was 0.163±0.196, while for Group B, it was 0.057±0.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358±175 µm and 1,437±256 µm and 141.8°±6.4° and 148.7°±5.1°. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B. Conclusion B-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less experienced surgeons. Corneal incisions were shorter and less angled in surgeons in training in comparison with results obtained by expert surgeons.

Long-term analysis of IOL stability of the Lewis technique for scleral fixation

Purpose To demonstrate that in case of absence of capsular support intraocular lens (IOL) scleral fixation is both effective and stable over years. Methods A total of 13 eyes from 13 patients who underwent an IOL scleral fixation according to Lewis suturing technique between January 2001 and December 2008 were studied. Patients underwent a complete ophthalmologic evaluation. The IOL stability was assessed using slit-lamp and anterior segment optical coherence tomography (AS-OCT) examination. The IOL stability was evaluated in terms of centration and tilting. All the knots were photographed and their integrity assessed. Results Follow-up was 60–129 months. Eleven knots appeared evident and undamaged, 6 knots were eroded, and 9 knots were not detectable. All IOLs were stable in the sulcus. Two patients presented a slight decentration of the IOL at the slit-lamp examination, while the AS-OCT demonstrated slight tilting of the lenses in 4 patients. Conclusions The Lewis technique for IOL scleral fixation is an optimal surgical technique in case of absence of capsular support. No IOL luxation in the vitreous chamber has been reported; only 2 of the 10 patients with at least one eroded knot presented a minimal decentration of the lens with no influence on visual acuity. Although knot erosion is not an uncommon occurrence, IOL remains stable in the long term, probably due to a fibrotic process around the suture, and the IOL haptics, which prevent IOL dislocation.

Chemical injury treated with autologous limbal epithelial stem cell transplantation and subconjunctival bevacizumab

Background Limbal stem cell (LSC) deficiency leads to corneal opacity due to a conjunctivalization of the corneal surface. LSC transplantation, which can be followed by corneal keratoplasty, is an effective procedure to restore corneal transparency; however, a common cause of failure of this procedure is neovascularization (NV). Methods A 59-year-old man with a 21-year history of a corneal chemical burn caused by phosphoric acid in his left eye was examined. He presented with unilateral total LSC deficiency with severe conjunctivalization and a corrected distance visual acuity that was limited to hand motion. Results We reported the short-term in vivo efficacy of subconjunctival bevacizumab for progressive corneal NV in a patient with LSC deficiency that underwent LSC transplantation. Four months after autologous LSC transplantation and 1 month after the second subconjunctival bevacizumab injection, the patient’s corrected distance visual acuity was 1/10. Conclusion Subconjunctival injection of bevacizumab can reduce the corneal NV, reducing conjunctival inflammation and supporting restoration of a stable ocular surface that is able to counteract graft failure, with no toxicity for the transplanted LSC.

Retropupillary Iris-Claw Intraocular Lens in Ectopia Lentis Due to Marfan Syndrome

Background: Surgical treatment of ectopia lentis in Marfan syndrome cases represents a great challenge for ophthalmic surgeons due to zonular weakness, capsular instability and postoperative aphakia correction. We report three cases of surgical treatment of ectopia lentis due to Marfan syndrome and our approach to aphakia correction by implantation of the retroiridally fixated iris-claw intraocular lens. Methods: Prospective interventional case series. All patients underwent extraction of the subluxated lens with or without combined vitrectomy. Aphakia correction was performed using the Iris-claw intraocular lens, positioned retroiridally by traditional enclavation of both haptics into iris midperiphery. Patients were followed-up for 6 months. Intraocular lens power was calculated using the SRK-T formula. Diagnosis of Marfan syndrome was confirmed in all cases by molecular diagnosis. Genomic DNA from peripheral blood samples of the patients and their relatives was isolated and screened for fibrillin-1 gene mutations by PCR. Results: In all cases Iris-claw intraocular lens implantation was carried out uneventfully. In the postoperative period intraocular lens was stable and correctly centered. There were no signs of excessive or prolonged inflammation or any other complications. Intraocular pressure was normal. Conclusion: Our results suggest that the retroiridally fixated Iris-claw intraocular lens is a very attractive alternative in cases lacking capsular support. It is safe and offers maximal aesthetical and functional results since visual acuity was significantly improved in all patients. However, further evaluation with longer follow-up of a bigger population is desirable.