Unilateral Urrets-Zavalia syndrome after Implantable Collamer Lens implantation: a case report and review of the literature

Background Fixed dilated pupil after ophthalmic surgery or Urrets-Zavalia syndrome occurs after anterior segment surgery and usually relates to postoperative elevation of intraocular pressure. Urrets-Zavalia syndrome results in complaints of glare, halo, and photophobia. Retention of the viscoelastic agent during Implantable Collamer Lens implantation can result in postoperative elevation of intraocular pressure and Urrets-Zavalia syndrome. However, reversibility of pupillary dilatation is possible in some cases. Case presentation A 20-year-old Thai man with myopic astigmatism in both eyes underwent Implantable Collamer Lens implantation in the right eye. The preoperative slit-lamp examination of both eyes was normal, and no ectatic changes were detected from corneal tomography. One hour after the uncomplicated surgery of the right eye, intraocular pressure increased to 48 mmHg and was immediately controlled with antiglaucoma medications. Postoperative pupillary dilatation was detected, presumably due to effect of preoperative application of mydriatic drops. At postoperative day 1, the right pupil remained dilated but still reactive to light and pilocarpine 2% eye drops. Two weeks later, the left eye underwent the Implantable Collamer Lens implantation and showed neither postoperative increase in intraocular pressure nor postoperative pupillary dilatation. Two months after surgery, the dilatation of the right pupil partially reversed. Conclusions The findings of the right eye suggested diagnosis of Urrets-Zavalia syndrome. Compared with former reports, we noted an association between immediate control of elevation of postoperative intraocular pressure, light reactivity of the dilated pupil, and reactivity to pilocarpine 2% eye drops as potential predictors for reversibility of Urrets-Zavalia syndrome.

Intra-operative control of positive vitreous pressure in a graded manner by pars plana sutureless, small gauge trocar-cannula

Background: The purpose of this paper is to delineate a technique of using a 23G, single, sutureless transconjunctival pars plana sclerotomy to facilitate anterior segment surgery in eyes with increased positive vitreous pressure (PVP) ascribe to predisposing or intraoperative factors. Methods: We have implemented this technique in five eyes when PVP was anticipated before the surgery because of risk factors or it was encountered during anterior segment surgery. Different case scenarios in which PVP occurs during the surgery comprising phacolytic glaucoma, corneal tear repair combined with cataract surgery with IOL in a case with traumatic corneal injury, anterior capsule rupture and secondary glaucoma, Trabeculectomy in case of uveitic glaucoma, routine phacoemulsification cataract surgery with PVP encountered during surgery were addressed by using this technique. Results: The new technique outlined by the authors consists of passing sutureless 23 G trocar cannula which enables controlled and gradual efflux of clear watery fluid, resulting in passive vitreous decompression with minimal risk of vitreous traction and retinal breaks. Once PVP is reduced, anterior segment surgery can be safely completed without risk of developing devastating complications. Conclusions: This sutureless single port pars plana trocar cannula technique is minimally invasive, safe, effective and fast technique which can cause reduction of PVP intraoperatively in a controlled and graded manner, thereby minimizing complication rates in difficult case scenarios.

Ocular Surface Changes Associated with Ophthalmic Surgery

Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combination with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface.

Application of Femtosecond Laser in Anterior Segment Surgery

Femtosecond laser (FSL) is a near-infrared laser that can create reliable and reproducible tissue cutting with minimal damage to adjacent tissue. As the laser can also create incisions with various orientations, depths, and shapes, it is expected to be a useful tool for anterior segment surgery, such as cornea, refractive, and cataract surgery. In this review, the authors will introduce the application of FSL in various anterior segment surgeries and discuss the results of studies regarding the efficacy and safety of FSL in cornea, refractive, and cataract surgery. Experimental studies regarding the potential use of FSL will also be introduced. The studies discussed in this review suggest that FSL may be a useful tool for improving the prognosis and safety of surgeries of the anterior segment.

Intraoperative fundus inspection during surgery

Introduction: We describe a technique of intraoperative fundus visualization during anterior segment surgery using an anterior chamber air bubble. Methods: An air bubble that occupies one-half to two-thirds of the anterior chamber is injected via existing corneal incisions at any time during surgery. By focusing downwards and looking through the air bubble, an upright image of the posterior pole of the fundus is seen. The technique is demonstrated in a series of cases in the form of photos and supplementary video files. Results: Visualization of the fundus can be safely and effectively performed regardless of the lens status (phakic/pseudophakic/aphakic) of the eye. This technique allows the posterior pole and up to mid-peripheral fundus to be quickly inspected at any stage of surgery. Conclusion: This technique may help surgeons to briefly inspect the fundus in cases of unusual light reflex or following complicated surgery without any additional instrumentation.