Background: Femtosecond laser astigmatic keratotomy (FSAK) and toric intraocular lens (IOL) implantation have been studied individually for comparison to treat astigmatism at cataract surgery. We report a case of surgically induced high corneal astigmatism by laser thermal keratoplasty (LTK) in a patient with cataract who was successfully treated with simultaneous combination of FSAK and toric IOL implantation with femtosecond laser-assisted cataract surgery (FLACS). This is the first report of both procedures combined simultaneously, with or without history of LTK.
Case Description: A 68-year-old male presented with a history of LTK with two enhancements each eye in 2004, with subsequent surgically induced high corneal astigmatism, and with age-related nuclear cataract of both eyes. IOL master demonstrated +7.71 diopters of astigmatism at 163 degree right eye and +3.29 diopters of astigmatism at 4 degree left eye. After extensive discussion of the risks and benefits, the patient agreed to undergo FLACS with FSAK with two 61 degrees of relaxation incisions (RIs) and toric IOL (Alcon SN6AT9) right eye; FLACS with toric IOL (Alcon SN6AT7) alone left eye. At 2-year follow-up, uncorrected visual acuity was 20/30 right eye, 20/25 left eye. His best corrected visual acuity was 20/25 (+0.25 +1.00 axis 21) right eye and 20/20 (plano +0.25 axis 90) left eye; his best corrected near visual acuity was J1+ with add +2.50 diopters right eye and left eye.
Conclusions: Patients with age-related cataract and LTK induced high corneal astigmatism can hardly be sufficiently treated with FSAK or toric IOL alone at the time of cataract surgery. An effective way is to combine large FSAK and toric IOL of the highest cylindrical power of T9, in our case, simultaneously, which can achieve an excellent long term visual outcome.
Background: To assess the safety and efficacy of supracapsular implantation with optic capture of the posterior chamber intraocular lens in Chinese children with aphakic after traumatic cataract.
Methods: It was a retrospective case series study. Fifteen cases (15 eyes) Chinese children received supracapsular implantation with optic capture of the posterior chamber intraocular lens. Pre- and post-operative visual acuities were recorded. Intra- and post-operative complications were observed. The follow-up period ranged from 7 to 43 (28.7±7.2) months.
Results: Implantation of optic capture of the posterior chamber intraocular lens was successfully performed in 15 eyes. The best corrected visual acuity (BCVA) ranged from 0.3 to 1.0 (0.61±0.19). No optic axis opaque was found in 15 eyes with optic capture. The major complications of optic capture were iris posterior synechia and intraocular lens (IOL) precipitates. Intraocular dislocation was found in one case three weeks after the operation.
Conclusions: Supracapsular implantation with optic capture of the posterior chamber intraocular lens is safe and effective for the treatment of traumatic cataract in Chinese children.
Abstract: The goal of ophthalmology residency training is to produce competent ophthalmologists. Appropriate assessments must be employed to ensure this goal is met. Valid and reliable workplace-based assessments are designed to assess competence in the many domains required of a good ophthalmologist. These assessments increase standardization and objectivity as compared to simple observational feedback. When used appropriately, workplace based assessments not only provide measures of competence but also facilitate effective formative feedback and enhance learning.
Abstract: This article reviews the history of the femtosecond laser in ophthalmology and its subsequent introduction into the field of cataract surgery. It discusses the innovations that this technology has brought to the field. The article also describes the current system of teaching cataract surgery to ophthalmology residents in the United States and then examines how femtosecond laser-assisted cataract surgery (FLACS) can be a beneficial part of residency education.
Background: To present a surgical technique using a rigid intraocular lens as endocapsular supporting device in manual small incision cataract surgery (MSICS) for treating mild-moderate subluxated cataracts.
Methods: In our technique, a single-piece rigid polymethyl methacrylate (PMMA) lens was implanted in the bag following the nucleus removal, with its axis vertical to the zonular dialysis. This endocapsular-implanted IOL stretched the bag and provided sufficient stability and lens centration. This technique was performed in 19 eyes with subluxated cataracts, with zonulysis of ≤120 degree and nuclear sclerosis of grade ≤3. Mean follow-up time was 9.8 months.
Results: All eyes had endocapsular IOL implantation during surgery. Intraoperative extension of the dialysis did not occur in any eye. The IOL was placed in the bag in all but 1 case, in which dislocation of the IOL haptic into the vitreous occurred. Though the IOL was slightly decentered in 3 cases, it kept stable. All patients were asymptomatic.
Conclusions: This approach provides a simplified and practical strategy for surgically managing subluxation with mild-moderate zonular loss.
Abstract: Training in residency programs is highly competitive, it requires the formation of competent physicians that achieve the performance standards that were declared for their technical skills, attitudes and interpersonal abilities. The use of simulation and technology on the medical education has increased considerably. Particularly in ophthalmology the simulators used are: live models from animal or cadavers, mannequins, wet laboratories, simulated patients, part-task moles, laser or surgical models, and more recently, virtual reality (VR). VR places a person in a simulated environment that has a specific sense of self-location, where the participant interacts with the objects within the setting. Teaching with VR refers to the use of the available resources in technology and visualization of structures to improve the educational experience of medical students, residents and physicians in professional continuous development programs. Several authors highlight the benefits of assessing trainees with the tools, they argue that the key contribution of this model is in the formative assessment. Rather than evaluating and putting a score on student’s grades, VR provides a powerful experience for the acquisition of skills. A conclusion is the need to develop studies to document the effects that it has on knowledge, skills and behaviors, and to patient related outcomes.
Abstract: Cataract surgery is one of the most commonly performed surgeries among the elderly today. The volume of cataract surgeries has dramatically increased in the past few decades due to technological advancements leading to decreased morbidity, better overall outcomes, and increased expectation for correction of refractive error and spectacle independence after cataract surgery. The number of cataract surgeries is expected to continue to rise with the increase of the elderly population. Thus, accurate predictions of intraocular lens (IOL) power and the ability to correct for any postoperative refractive errors are critical. Despite the improved ability of cataract surgeons to accurately calculate IOL power, postoperative refractive errors still do occur due to various reasons such as imperfect preoperative measurements, toric-lens misalignment, and existing or surgically-induced astigmatism. The aim of this article is to review the various surgical options, including intraocular and corneal refractive surgical approaches, to correct post-operative refractive errors after cataract surgery.
Background: Surgically induced astigmatism (SIA) and corneal high-order aberrations (HOAs) are the two main causes of poor visual quality after cataract surgery. Changes in the parameters of corneal HOAs after cataract surgery and their effects on and relationships with changes in corneal curvature have not yet been reported. This study aimed to explore changes in anterior, posterior and total corneal curvature, astigmatism and HOAs after microincision cataract surgery.
Methods: Sixty-one age-related cataract patients (61 eyes) were included in this prospective study. The total, anterior and posterior corneal astigmatism and corneal HOAs were analyzed by anterior segment optical coherence tomography (AS-OCT) and iTrace before, one day, one week and three months after 2.2 mm temporal microincision coaxial phacoemulsification to evaluate the changes in anterior, posterior and total corneal curvature, astigmatism and corneal HOAs.
Results: The mean J0 and J45 values of anterior, posterior and total corneal curvature obtained by AS-OCT showed no statistically significant difference between preoperatively and any postoperative follow-up. SIA occurred on the anterior, posterior and total corneal surfaces and showed no statistically significant difference at any postoperative follow-up. No significant changes in 3rd-order oblique trefoil, vertical coma or 4th-order spherical aberrations were observed after surgery except for a significant increase in horizontal coma at postoperative day 1 (POD1).
Conclusions: There were no significant changes in corneal curvature after 2.2 mm temporal microincision coaxial phacoemulsification, and the corneal HOAs were not changed significantly except for the increase in horizontal coma at POD1, which may be one of the main reasons of poor visual quality at POD1 in some cataract patients who have good uncorrected or corrected distance vision.
