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   Table of Contents - Current issue
January-March 2019
Volume 9 | Issue 1
Page Nos. 1-59

Online since Friday, March 1, 2019

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Refractive cataract surgery – what we were, what we are, and what we will be: A personal experience and perspective p. 1
Ming Chen
DOI:10.4103/tjo.tjo_133_18  PMID:30993061
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Intraocular lens correction of presbyopia p. 4
Rebecca Sieburth, Ming Chen
DOI:10.4103/tjo.tjo_136_18  PMID:30993062
The continued development of intraocular lens (IOL) technology has led to a dramatic improvement in refractive outcomes. New and innovative ways of achieving the desired postoperative refractive goals continue to be developed. This article aims to review the currently available IOL modalities for correction of presbyopia at the time of cataract surgery, including reference to high-quality comparative studies, where available, and discussion of strengths as well as limitations of the currently available IOL technologies. It has been shown that multifocal compared to monofocal IOL was associated with higher rates of spectacle independence, but higher rates and severity of symptomatic glare as well as reduced contrast sensitivity. Within multifocal IOLs, diffractive compared to refractive IOLs tended to have better near vision and a lower rate of symptomatic glare. Extended depth-of-focus IOLs compared to diffractive multifocal IOL demonstrated equal or superior intermediate visual acuity, with less than or equal rates of glare. Accommodative IOLs represent a broad range of technologies that continue to develop, and new technologies offering opportunities for postoperative adjustment of refractive outcome are emerging.
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Step-by-step Descemet's membrane endothelial keratoplasty surgery p. 18
Shin-Yi Chen, Mark A Terry
DOI:10.4103/tjo.tjo_108_18  PMID:30993063
With the success of Descemet's stripping automated endothelial keratoplasty (DSAEK) technique providing better outcomes in visual prognosis and theoretically lower rejection rate than penetrating keratoplasty, DSAEK dominated the realm of endothelial keratoplasty for the past decade. However, Descemet's membrane endothelial keratoplasty (DMEK) has become more and more popular worldwide due to its even lower rejection rate, faster visual recovery, better visual outcome, and lower long-term endothelial loss. In this article, we demonstrate the techniques and nuances of DMEK surgery in detail for corneal specialists who are beginning their DMEK surgeries.
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Utilizing intraoperative aberrometry and digital eye tracking to develop a novel nomogram for manual astigmatic keratotomy to effectively decrease mild astigmatism during cataract surgery p. 27
Ming Chen, Michael Reinsbach, Nathan D Wilbanks, Chaokai Chang, Chen Cheng Chao
DOI:10.4103/tjo.tjo_6_18  PMID:30993064
PURPOSE: The purpose of the study is to develop a novel nomogram and validate with a retrospective comparative study for manual astigmatic keratotomy (MAK) with the assistance of intraoperative aberrometry (Optiwave Refractive Analysis [ORA]) and digital eye tracking (VERION) in mild astigmatic correction enhancement. SETTING: The study was conducted in Honolulu, Hawaii. DESIGN: This was a single-surgeon comparative study with retrospective data collection. METHODS: Sixty consecutive adult cataract surgery cases with regular astigmatism of 1.25 D or less were included for study from April 2016 to April 2017. VERION was used preoperatively in all cases. MAK was performed before phacoemulsification according to the surgeon's own nomogram. ORA then was utilized to obtain the axis and remaining cylinder power after phacoemulsification and intraocular lens implant implantation. MAK extension was performed for eyes with 1 D or more of remaining cylinder. Extensions were carried out slowly and slightly until the amount of cylinder was 1½ D or less under ORA. The mean degrees of extension plus the original MAK plan were calculated to develop the new nomogram. Sixty consecutive similar cases by the same surgeon using the surgeon's nomogram without using ORA/VERION for enhancement were reviewed from April 2015 to April 2016 for comparison. All patients included in this study signed the consent form. RESULTS: Using Alpins vector analysis for comparison, the proportion of patients with cylinder <0.5 D 3 months postoperatively was 87% in the ORA/VERION group compared to 70% in the non-ORA/VERION group (P < 0.05). Better than 20/25 best-corrected visual acuity was achieved more in the ORA/VERION group compared to non-ORA/VERION group. CONCLUSIONS: This novel nomogram developed by the surgeon may have better outcomes than the old surgeon's own nomogram. Further prospective control study is needed to validate the efficacy. If validated, those surgeons who do not have ORA/VERION can hopefully use this nomogram with greater success.
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A comparison of the contrast sensitivity function between age-matched phakic emmetropes and pseudophakic individuals with aspheric intraocular lenses p. 33
Undrakonda Vivekanand, Yogish Subraya Kamath
DOI:10.4103/tjo.tjo_122_17  PMID:30993065
PURPOSE: The purpose of this study is to compare the contrast sensitivity function (CSF) between eyes of age-matched individuals with aspheric intraocular lens (IOL) and emmetropia. METHODS: A prospective hospital-based case–control study in South India was conducted to study the CSF in the eyes of patients between the ages of 50–60 years. The CSF was compared between those with emmetropia and those implanted with an indigenous aspheric IOL. Twenty-five consecutive patients were recruited in both groups. The independent sample t-test was used for analysis. RESULTS: The mean age was 53.08 ± 1.96 years and 57.68 ± 2.85 years in normal emmetropes and emmetropic pseudophakic with aspheric IOL, respectively. The mean CSF showed a statistically significant difference (P < 0.000) between the normal emmetropic eyes and pseudophakic eyes with the values being 1.91 and 1.572, respectively. CONCLUSION: The CSF was significantly better in the eyes of age-matched normal emmetropes when compared to those with an aspheric IOL implanted.
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Accuracy of new and standard intraocular lens power calculations formulae in Saudi pediatric patients p. 37
Fouad Raja an-Nakhli
DOI:10.4103/tjo.tjo_71_18  PMID:30993066
PURPOSE: The purpose of this study is to compare the accuracy of new generation formulas to standard formulas for intraocular lens (IOL) power calculations in pediatric patients. SUBJECTS AND METHODS: This retrospective case series compared the postoperative refractions to the predicted refractions after lensectomy and IOL implantation in pediatric patients. Four new generation formulas (Haigis, Holladay II, Olsen, and Barrett Universal II) were compared to four standard formulas (Holladay I, Hoffer Q, SRK/T, and SRKII) 4. The absolute prediction error (APE) was calculated as the absolute difference between the actual postoperative spherical equivalent and predicted spherical equivalent). The Friedman test was used to evaluate the difference between formulas. P < 0.05 was statistically significant. RESULTS: The study sample was comprised 44 eyes from 29 patients (20 males and 9 females) with median age at surgery of 2.85 years (2.04–6.14 years). The Holladay I and II, Barrett Universal II, SRK/T, SRKII, Olsen, and Hoffer Q formulas had comparable median APE (MedAPE) of 1.32 D (0.51–2.11 D), 1.34 D (0.82–1.94 D), 1.28 D (0.73–1.85 D), 1.26 D (0.60–2.08 D), 1.16 D (0.54–1.16 D), 1.34 D (0.80–1.98 D), and 1.27 D (0.63–2.08 D), respectively (P = 1.0). The Haigis formula had the statistically highest MedAPE of 2.00 D (1.27–3.04 D) (P < 0.001). More than 70% of eyes were within ±2.0 D for the Holladay I and II, Barrett Universal II, SRK/T, SRKII, Olsen, and Hoffer Q formulas. Fifty percent of eyes were within ±2.0 D for the Haigis formula. CONCLUSION: New generation IOL formulas do not outperform standard IOL formulas in predicting postoperative refraction for pediatric patients.
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A novel minimal fluid technique for effective and safe lens hydrodissection during cataract surgery p. 43
Hung-Yuan Lin, Ya-Jung Chuang, Ting-Yu Lin, Ming Chen, Pi-Jung Lin
DOI:10.4103/tjo.tjo_137_18  PMID:30993067
Traditional hydrodissection may cause posterior capsule rupture (PCR) if excessive fluid accumulates. In this study, we describe the successful application of a novel minimal fluid hydrodissection technique in 100 consecutive cataract surgery cases. This technique separates the nucleus from the capsule utilizing low hydrostatic pressure and precise kinetic movement of a small volume (around 0.2 cc) of balanced salt solution. There were no instances of PCR. This technique is suitable for a range of cases, including femtosecond laser-assisted cataract surgery and posterior subcapsular cataract.
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Lens exchange for management of accommodative intraocular lens tilting p. 46
Masoumeh Mohebbi, Ali Banafsheh Afshan, Bahman Inanloo, Amin Nabavi
DOI:10.4103/tjo.tjo_12_18  PMID:30993068
Accommodative intraocular lens (IOL) tilting, the so-called Z syndrome, is a rare complication of Crystalens (Bausch and Lomb) implantation. We report a significant IOL tilting and subsequent high lenticular astigmatism due to posterior capsular fibrosis 2 months after uncomplicated cataract surgery and Crystalens (AT50AO) implantation. The attempt to correct IOL position with neodymium-yttrium-aluminum garnet laser was unsuccessful, and Crystalens exchange with in-the-sulcus, three-piece monofocal IOL was performed. Accommodative IOL tilting could occur early after the surgery. Laser capsulotomy may be the first intervention to restore IOL position, but patients with a higher amount of lenticular astigmatism may require surgical intervention and IOL exchange.
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Laser treatment of silicone intraocular lens opacification associated with asteroid hyalosis p. 49
Yun Ji Lee, Sang Beom Han
DOI:10.4103/tjo.tjo_65_18  PMID:30993069
An 86-year-old Asian man with asteroid hyalosis presented with decreased vision in the left eye. He underwent phacoemulsification and implantation of silicone intraocular lens (IOL) in the left eye 18 years ago, and also received neodymium:yttrium–aluminum–garnet (Nd:YAG) laser 3 years ago. At presentation, his corrected visual acuity (CVA) was 20/1000 in the left eye. Slit-lamp examination showed white-gray membranous deposits on the posterior IOL surface. The deposits were removed using Nd:YAG laser treatment. One week later, his CVA improved to 20/30, and opacity of the posterior IOL surface was removed. Six months later, his CVA was 20/30, and visual axis was clear. This case suggests that Nd:YAG laser treatment can be a viable option in some patients with posterior surface opacification of silicone IOL associated with asteroid hyalosis, especially in those who are a poor candidate for IOL exchange due to old age or compromised general condition.
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Intralenticular foreign body: A case report and literature review p. 53
Yen-Chun Lin, Chin-Liang Kuo, Yan-Ming Chen
DOI:10.4103/tjo.tjo_88_18  PMID:30993070
The purpose of this manuscript was to provide a better understanding of patients with intralenticular foreign bodies (FBs) and also to review the reported cases, including clinical presentation, diagnosis, management, and visual outcome. A 50-year-old male was referred to our clinic with suspected intraocular FB. Under slit-lamp examination, a full-thickness corneal wound with localized corneal edema at the temporal lower peri-limbal area was revealed. Seidel test did not indicate any wound leakage. The corresponding iris was depigmented, but there was no penetrating hole. The anterior chamber was deep with cells, but the lens, vitreous, and fundus were normal. B-scan ultrasonography and orbital computed tomography were performed, but no intraocular FB was detected. On the 2nd day, a zonal cortical cataract and posterior subcapsular cataract formed rapidly. Left-eye bare vision dramatically decreased from 20/100 to counting fingers. One month later, the patient received elective extracapsular cataract extraction. A fine metal thread was completely embedded in the lens; the lens and FB were removed together during the operation. The posterior capsule was not injured; an intraocular lens was implanted in the capsular bag. Two months postoperatively, left-eye vision had returned to 20/25. No adverse events were noted during the follow-up period. In addition to the case report, some 28 previously reported cases of intralenticular FB are reviewed here. Patient demographics, time and course of management, and visual outcome are all summarized and compared.
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