Safety of EVO ICL Implantation With an Ophthalmic Viscosurgical Device-Free Technique in the Early 24 h After Surgery

Purpose: To compare the safety of the non-ophthalmic viscosurgical device (OVD) technique with that of the minimum OVD technique in EVO Implantable Collamer Lens (EVO-ICL) implantation.Methods: A total of 180 eyes of 90 consecutive patients were enrolled in the study, of which 100 eyes of 50 patients were treated with non-OVD technique, with a 55% success rate. The remaining 80 eyes of 40 patients were treated with min-OVD technique, so they were classified into the min-OVD group. Preoperative and postoperative intraocular pressure (IOP) measurements were collected and analyzed at 1, 2, 3, and 24 h. Visual acuity, corneal endothelial cell density (ECD), and corneal densitometry 24 h postoperatively were evaluated.Results: No significant difference was found in visual outcomes (P = 0.54) or ECD (P = 0.78) between the two groups. The operation time was significantly shorter in the non-OVD group (P < 0.0001). The IOP was significantly higher at 1 h (P < 0.0001), 2 h (P < 0.0001) and 3 h (P = 0.0045) postoperatively in the min-OVD group. The non-OVD group had significantly lower IOP than the min-OVD group at 1 h (P = 0.01) and 2 h (P = 0.013) postoperatively. The temporal corneal densitometry in the non-OVD group were significantly lower than those in the minimum group (P = 0.0063) 1 day after surgery.Conclusion: The non-OVD technique is safe and efficient for ICL implantation. It can be a safer method of ICL implantation in that it completely eliminates ophthalmic viscoelastic devices related complications without causing additional complications in short term.

Removing residual cortical material during cataract surgery: Visco polishing and the grindstone effect as a new surgical technique

Purpose To describe a new technique for removing residual cortical material adjacent to posterior lens capsule during cataract surgery with the help of cohesive ophthalmic viscosurgical devices. Methods In this technique, if there are still cortical remnants and lens epithelial cells left after the routine irrigation–aspiration and polishing at the final steps of cataract surgery, the capsule is filled to about one-third with a highly viscous cohesive ophthalmic viscosurgical device. Rinsing is performed from the anterior chamber with the water jet directed tangentially to the ophthalmic viscosurgical device bolus and towards the posterior capsule, which creates a turbulence creating a “grindstone effect”. The ophthalmic viscosurgical device bolus transforms into a ball and starts to rotate very quickly within the capsule, grinding away the cortical remnants. Results In the first series of 62 cases, there were no intra-operative or post-operative complications. At day 1 there was no corneal oedema and no hypertension of intraocular pressure. Visual outcomes were good with a mean best corrected distance visual acuity of −0.01 ± 0.11 logMAR. Conclusion This technique appears to be effective and fast in removing persistent cortical remnants from the surface of the posterior capsule, while minimising risks such as capsule aspiration during irrigation/aspiration. There is limited pressure and mechanical force applied on the capsule; the anterior chamber and the corneal endothelium remain safe since the ophthalmic viscosurgical device stays inside the capsular bag to its high cohesiveness and molecular weight. More data on a larger cohort of patients is planned to confirm these results and evaluate long-term effects on posterior capsule opacification.

Pure ICL Implantation: A Novel Ophthalmic Viscosurgical Device-Free Method

Purpose. To assess the clinical efficiency of a novel ophthalmic viscosurgical device-free (OVD-free) method for intraocular collamer lens (EVO-ICL) implantation in myopic eyes. Methods. In this study, 40 patients underwent ICL implantation for both eyes: one eye underwent traditional ICL implantation, and the other eye underwent OVD-free (pure) ICL implantation. Preoperative and postoperative UDVA, BCVA, equivalent spherical degree (SE), IOP, visual quality index, subjective visual quality scale, corneal endothelial cell density (ECD), operation time, and complications were compared between and within the traditional and pure ICL implantation groups. Results. Increased IOP >22 mmHg 2 h after surgery was noted in 8 eyes (20%) in the traditional group, but not in the pure group (0%, P < 0.001 ). Increased IOP relative to baseline was significantly higher at 2 h after surgery for the traditional group compared with the pure group ( P < 0.001 ). UDVA, BCVA, and SE were significantly improved in the pure group compared with those in the traditional group 1 day ( P < 0.001 , P = 0.003 ) after implantation, but not 1 week or 3 months after. Modulation transfer function cut-off frequency (MTF cut-off), Strehl ratio (SR), and OV20% were significantly better in the pure group than in the traditional group 1 day after implantation ( P = 0.013 , P = 0.009 , and P = 0.004 ). No significant difference in ECD changes within or between groups was observed ( P > 0.05 ). The operation time for the pure group (2.897 ± 0.346 min) was significantly shorter than that for the traditional group (4.444 ± 0.656 min; P < 0.001 ). No complications were reported for either group during the observation period, except early IOP elevation in the traditional group. Conclusions. The pure ICL implantation method was associated with faster visual acuity recovery, shorter operation time, and more stable intraocular pressure. Pure ICL represents a safe and convenient method for ICL implantation compared with the traditional method, completely eliminating OVD-related complications without causing additional complications.

Modified capsulorhexis for fluid-filled mature cataracts

Background: The aim of this study was to develop a modified capsulorhexis technique featuring a new maneuver for the removal of subcortical fluid in fluid-filled mature cataracts to avoid high intralenticular pressure. Methods: This prospective interventional study included 33 eyes with mature cataracts and evidence of subcapsular fluid spaces by slit lamp examination. For each patient, 20% mannitol was administered intravenously according to the bodyweight 1 h preoperatively. Under peribulbar anesthesia, a 2.2-mm main incision was made, and the anterior chamber was filled with a dispersive ophthalmic viscosurgical device. Using a bent-tip cystotome, a 2-mm curved incision was made in the center of the anterior capsule, which released subcortical fluid and was drained through compression of the posterior lip of the main incision using a spatula. Then, fine gentle milking in all quadrants around the puncture on the anterior lens capsule from the periphery toward the site of puncture using the blunt-edged spatula further assists drainage of subcortical fluid and breaks fine septa inside the lens to remove fluid from intralenticular fluid pocket collections. Results: The study included 15 (45.5%) men and 18 (54.5%) women with a mean ± standard deviation (SD) of age of 63.2 ± 5.33 and 64.4 ± 6.21 years, respectively. The modified capsulorhexis technique was performed for 33 intumescent cataracts. Capsulorhexis was completed in all cases; capsulorhexis was easy in 31 (94%) eyes and difficult in 2 (6%) eyes. In the two difficult cases, radial extension occurred in one eye, and it was retrieved using the Little technique; the other case with radial tear was completed successfully using a retinal micro scissor from the other edge of the capsulorhexis until reaching an oval, continuous capsulorhexis. Conclusions: This modified capsulorhexis technique with compression on the posterior lip of the main incision and capsule milking allowed for a safe, continuous curvilinear capsulorhexis. Further comparative studies are necessary to confirm our preliminary results. How to cite this article: Ghoneim EM. Modified capsulorhexis for fluid-filled mature cataracts. Med Hypothesis Discov Innov Ophthalmol. 2021 Summer; 10(2): 17-24. https://doi.org/10.51329/mehdioptometry1422

Outcomes after surgical removal of anterior epi-capsular plaque associated with persistent pupillary membranes in children

Introduction: Anteriorepi-capsular plaque (ACP) is usually eccentric and is associated with persistent iris strands arising from the collarette. Outcomes of lens preserving ACP peeling along with removal of persistent pupillary membrane (PPM) strands have seldom been reported with only a few cases within some case series appearing in the literature. Herein we aim to report outcome after surgical removal of ACP associated with PPM in children. Methods: Research was done in three different Institutes. Charts were reviewed for all children who had undergone ACP removal surgery from 2010. Age at surgery, gender, preoperative best corrected visual acuity (BCVA), preoperative refraction, morphologic details of ACP, intraoperative complications, ophthalmic viscosurgical device use, age at last follow-up, postoperative complications, and postoperative BCVA were reviewed. Results: A total of 16 patients, 10 male and 6 female, were included in study. Age at surgery ranged from 2 to 86 months old. Age at last follow up visit ranged from 2 to 14 years old. Postoperative complications were not observed in any of the 16 patients. Specifically, in all patients the crystalline lens remained clear at the last follow up visit. Conclusions: Congenital ACP of the lens associated with PPM and clear lens can be safely surgically removed with a very low risk of iatrogenic cataract in the early period after surgery.

OPHTHAMIC VISCOSURGICAL DEVICE PROCEDURES : A MIRACLE TOOL FOR SURGICAL CATARACT MANAGEMENT.

Introduction: Ophthalmic viscosurgical devices have remained an indispensable part of the cataract surgery armamentarium now for decades. Their use has been for forming the anterior chamber and protection of the corneal endothelium. Viscodissection and viscodelineation have been described by authors . We designed a study to evaluate the usefulness of ophthalmic viscosurgical device procedures in our phacoemulsication cases . Aim: The study documents the use of ophthalmic viscosurgical device procedures as an added step to facilitate cataract removal. Methods: Twenty ve consecutive cases of cataract with nuclear sclerosis one or two withor without any grade of posterior subcapsular opacication were enrolled. The cases were performed by a single operator. Phacoemulsication was performed as per protocol. Ophthalmic viscosurgical device procedures were performed as an additional step. Subjective and objective assessments were done post operatively. Results: The use of ophthalmic viscosurgical device procedures reduced the total phaco energy used per case. Discussion: Ophthalmic viscosurgical device procedures are advocated as an adjunct to power modulations to reduce the total phaco energy used per case. Conclusion: In the era of increasing sophistication ophthalmic viscosurgical device procedures represent an exciting paradigm shift towards minimalization and efcacy.

Pure ICL Implantation: A Novel Ophthalmic Viscosurgical Device-Free Technique

Background: To assess the clinical efficiency of a novel ophthalmic viscosurgical device-free (OVD-free) method for intraocular collamer lens (EVO-ICL) implantation in myopic eyes.Methods: In this retrospective cohort study, 40 eyes underwent standard ICL implantation, and 40 eyes underwent OVD-free (Pure) ICL implantation. Preoperative and postoperative uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), equivalent spherical degree (SE), intraocular pressure (IOP), visual quality index, subjective visual quality scale, corneal endothelial cell density (ECD), operation time, and complications were compared between and within the standard and pure ICL implantation groups. Results: Increased IOP > 22 mmHg 2 h after surgery was noted in 19 eyes (47.5%) in the standard group, but not in the pure group (0%, P < 0.001). Increased IOP relative to baseline was significantly higher at 2 h and 1 day after surgery for the standard group compared with the pure group (P < 0.001). LogMAR UDVA and LogMAR BCVA were significantly improved in the pure group compared with those in the standard group 1 day (P < 0.001) and 1 week (P < 0.001) after implantation, but not after 3 months (P = 0.747 and P = 1.000, respectively). SE was significantly lower in the pure group than in the standard group 1 day after implantation (P = 0.003). No significant differences in SE were observed at any time point between groups (P = 0.285, P = 0.460). Optical Quality Analysis System (OQAS) II visual quality indicators, such as the modulation transfer function cut-off frequency (MTF cut-off), Strehl ratio (SR), and OQAS under different contrast values [OQAS values (OVs) 20], were significantly better in the pure group than in the standard group 1 day after implantation (P = 0.013, P = 0.009, and P = 0.004, respectively). SR, OV20%, and OV9% were significantly better in the pure group than in the standard group 1 week after implantation (P = 0.003, P = 0.047, and P = 0.002, respectively). No significant difference in ECD changes within or between groups was observed (P > 0.05). The operation time for the pure group (2.897 ± 0.346 min) was significantly shorter than that for the standard group (4.444 ± 0.656 min; P < 0.001). No complications were reported for either group during the observation period, except early IOP elevation in the standard group.Conclusions: The pure ICL implantation method was associated with faster visual acuity recovery, a shorter operation time, and more stable intraocular pressure. Pure ICL represents a safe and convenient method for ICL implantation compared with the standard method, completely eliminating OVD-related complications without causing additional complications.

A Modified Femtosecond Laser Technique for Anterior Capsule Contraction Syndrome

Anterior capsule contraction syndrome (ACCS) is a rare, late complication of cataract surgery, associated with impairment of visual function. In this paper, we describe a new surgical technique to treat ACCS by femtosecond laser procedure. The femtosecond laser was used to perform an anterior capsulotomy with a customized size, in order to avoid IOL damage. After ophthalmic viscosurgical device injection in the anterior chamber, the anterior capsule flap was separated from the IOL surface by gentle hydrodissection. This manoeuvre enabled an easy and safe removal of the fibrotic material by vitreal microscissors. Our technique allowed a complete removal of the fibrotic material and opening of the capsule, with immediate complete visual acuity recovery without IOL damage. In conclusion, femtosecond laser appears to be safe and effective for treatment of ACCS with long-lasting efficacy.

Clinical outcomes of management of posterior capsule rupture with air bubble techniques

AIM: To introduce a new surgical technique, air-bubble technique for the management of posterior capsule rupture (PCR) and to evaluate the safety and efficacy of the technique. METHODS: A retrospective case series analysis of 24 eyes of 24 patients, in which the air bubble technique was used for the management of PCR, was performed. Once PCR occurred, a dispersive ophthalmic viscosurgical device (OVD) was injected into the tear. And small volumes (0.2-0.3 mL) of air bubbles were injected beneath the OVD. The air bubble served as a physical barrier and supported the posterior capsule. RESULTS: After surgery, none of the patients had serious complications during the follow-up period of 1y. Extension of the PCR size occurred in only 2 cases, and additional OVD injection was required only in 3 cases. Air bubbles imparted great stability to the nuclear pieces and the posterior capsule. CONCLUSION: The air-bubble technique may be considered a safe and effective procedure for managing a PCR. It may be of value to the inexperienced cataract surgeon.