Yannis Athanasiadis

“PhacoTracking”: An Evolving Paradigm in Ophthalmic Surgical Training

Motion analysis has been validated as a tool to evaluate surgical skill. We investigated a novel computer vision-based tool for the evaluation of surgical movements during cataract surgery. A prospective cohort analysis of 2 groups was performed. Ten videos of junior surgeons (ie, those with <200 cases) and 10 videos of senior surgeons (ie, those with >1000 cases) were analyzed. Movement parameters were measured over an entire procedure. Significant statistical differences were found between novice and expert surgeons for total path length (P = .002), number of movements (P = .05), and total time (P = .004). Our study has shown that computer vision-based motion analysis can be successfully applied to video recordings of cataract surgery to provide robust measurements of instrument motion. Further work needs to be done to evaluate its usefulness in training and feedback.

Subconjunctival triamcinolone acetonide in the management of ocular inflammatory disease.

PURPOSE To review the existing evidence that supports the subconjunctival use of triamcinolone acetonide (TA) in the treatment of various ophthalmic diseases. METHODS A literature search was performed for published articles about the pharmacokinetic (PK) and pharmacodynamic characteristics of triamcinolone, as well as its potential ophthalmic use, focused mainly in the subconjunctival mode of delivery. Search terms included corticosteroids, triamcinolone, ocular, subconjunctival, and ophthalmic. RESULTS Corticosteroids represent the mainstay of treatment of ocular inflammation, exerting their action by affecting multiple pathways of the inflammatory response, making them particularly effective in the majority of cases. However, due to the number and severity of the side effects associated with their use, they have to be given with caution. Corticosteroids can be given topically, subconjunctivally, intraocularly, and systemically to treat a variety of ocular diseases with specific pharmacological and PK characteristics. Triamcinolone is one of the most widely used corticosteroids in the treatment of ocular inflammation. This glucocorticoid used subconjunctivally was proven to be particularly safe and effective in some common and important inflammatory ophthalmic diseases such as anterior scleritis, uveitis, and corneal graft rejection. Further, there are other indications for its successful use where data exist, but somehow less abundant. CONCLUSIONS This article highlights the potential of TA to complement the treatment armamentarium of anterior segment inflammation.

Neodymium:YAG laser peripheral iridotomy as a possible cause of zonular dehiscence during phacoemulsification cataract surgery

Neodymium:YAG laser peripheral iridotomy as a possible cause of zonular dehiscence during phacoemulsification cataract surgery

Subconjunctival triamcinolone for the treatment of corneal graft rejection and new vessels

1367-0484/

Neuropathic Pain in Multiple Sclerosis Improved With Oral Famciclovir: A Case Report.

– see front matter 2008 British Contact Lens Association. Published by doi:10.1016/j.clae.2008.06.009 The authors present a 48-year-old woman who had a rejection episode 6 weeks after routine descemet stripping automated endothelial keratoplasty (DSAEK) for pseudophakic bullous keratopathy. Hourly topical prednisolone acetate (Pred Forte, Allergan) was started. Two weeks later the donor and host corneal oedema had not cleared and new vessels had grown into the interface (Fig. 1). The patient insisted on being compliant with her treatment regimen. A 20 mg subconjunctival injection of Triamcinolone Acetonide (TA) (Kenalog, Bristol-Myers Squibb) was given and the Pred Forte

Surgical iridotomy in aphakic eyes and eyes with anterior chamber intraocular lenses

Multiple sclerosis can be a debilitating disease that is often associated with neuropathic pain and discomfort in the trigeminal region. This can pose a therapeutic challenge as the benefits of the treatment options have to be outweighed against significant side effects. The authors present the case of a 67-year-old man, whose control of trigeminal neuralgia with botulinum toxin A injections was lost after an episode of herpes labialis and herpes zoster infection. The pain management of the patient during the episodes of herpes simplex and varicella zoster infections was greatly improved with famciclovir treatment, and subsequently control of trigeminal neuralgia was regained with botulinum toxin A injections. This case serves to highlight the potential association of multiple sclerosis with herpetic infections as well as the treatment challenges, especially management of pain, which they can possess.

Hydration of the anterior stroma in phacoemulsification cataract surgery

UNLABELLED We describe a simple technique to create a peripheral surgical iridotomy using a microvitreoretinal blade. The blade passes perpendicular to the iris dilator fibers to create a permanent opening. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

Reply to Yip et al

We describe a simple technique to hydrate the anterior stroma in cataract surgery using a 30-gauge needle. At the end of phacoemulsification, the needle is inserted into the stroma to create a watertight seal of the clear corneal incision.

Reply to: Costa DC et al

Sir, We read with great interest the paper by Yip et al1 concluding that laser peripheral iridotomy (LPI) for primary angle closure (PAC) is not independently associated with cataract progression. The authors mention that cataract surgery may be an alternative treatment for occludable angles, potentially addressing both PAC and cataract blindness with one procedure. The potential complications from intraocular surgery, though, are greater than those from LPI. However, LPI has complications such as intraocular haemorrhage and inflammation, intraocular pressure (IOP) spikes, glare, diplopia, and corneal damage. These are primarily not sight threatening, but have to be always taken into consideration. Another potential complication is cataract formation, and this has been extensively reviewed by Yip et al. Despite their conclusion, there is still some controversy on this matter, with some authors supporting the opposite.2, 3 Thus, one must always be aware of such a theoretical risk after LPI. Except for the disturbances in aqueous flow in patients undergoing LPI, we suggest that, using higher-energy settings, inaccurate focusing of the laser beam, excessive or undertreated post-LPI uveitis, previous intermittent angle-closure episodes with IOP elevation, and other anatomical parameters, yet to be recognised, could be considered as possible stimuli of crystalline lens disturbance with consequent opacification. A potential complication of Nd:YAG LPI was reported by us recently.4 This involves damage to the zonules with subsequent dehiscence during routine phacoemulsification cataract surgery, affecting an otherwise healthy female with narrow angles. Our paper includes reports suggesting the same effect of LPI (both with Nd:YAG and with argon lasers), resulting in spontaneous dislocation of the crystalline lens.4 We suggested that Nd:YAG LPI may be regarded as an isolated risk factor for structural zonular damage and instability of the crystalline lens, and appropriate precautions should be taken during intraocular surgery. Regardless of the opacification being the result of the LPI, age-related or of any other cause, zonular damage could have considerable implications in subsequent cataract surgery, especially in cases where the zonules are already compromised, such as in pseudoexfoliation syndrome, previous ocular trauma, and congenital systemic diseases like Marfans syndrome.5 Considering the large number of patients who would potentially benefit from prophylactic LPI, potential adverse sequelae of such a procedure must not be underestimated. More specifically, the possibility of cataract progression and zonular instability after LPI has important implications for patients at risk of angle closure. Choosing between primary cataract surgery and LPI is the main consideration in such cases. The therapeutic approach should be individualised and treatment benefits must always be balanced against eventual complications. Finally, we would like to congratulate the authors for their excellent contribution on a very important field of ophthalmology.

Very late onset orbital sarcoma and breast carcinoma following retinoblastoma treatment with radon seed brachytherapy

A 62-year-old Caucasian male with chronic narrow angle glaucoma who was known preoperatively to be taking the aa-1 antagonist, Alfusozin also underwent trabeculectomy surgery, but IFIS was anticipated. Before the sclerostomy, two limbal paracentesis incisions were made at the 3 and 9 o’clock positions using a 151 blade, through which iris hooks were used to draw the pupil into a fish mouth position (see Figures 2 and 3). The surgical peripheral iridectomy was easily performed on a taut superior iris. There was no spontaneous, flaccid iris prolapse. The hooks were removed after closure of the scleral flap and the two limbal side ports were hydrated. The iris returned to its preoperative position. The procedure was controlled and uncomplicated.