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Background: A common type of strabismus known as concomitant exotropia (XT) occurs when mismatched eyes deviate outward and the angle of deviation is the same regardless of which eye is fixed. Among ophthalmologists, there is no agreement on non-surgical treatment options for XT. For those who suffer from strabismus, surgery is an option for correcting their visual axis and restoring their ability to see in both eyes simultaneously. Instead, then severing the muscle, muscle plication involves folding the muscle around itself and stitching it in place, essentially shortening and tightening the muscle. Muscle plication has been found to reduce the risk of anterior segment ischemia by protecting the anterior ciliary arteries. Objective: To hallmark the new guidelines options of concomitant exotropia management. Conclusion: Muscle-tightening techniques such as excision, plication, advancement, and transposition have been documented in the literature. Technical simplicity, the ability to reverse it, shorter operating times, reduced surgical trauma, and the preservation of anterior ciliary arteries are only a few of the many advantages of plication.

Initially, contact lenses were developed as the only viable option to provide improved vision for patients suffering from conditions which distortedthe corneal surface in an irregular fashion, rendering spectacle correction an unsatisfactory option. Developments in materials, fitting methods andmanufacturing technologies soon made contact lenses an appealing option for all spectacle wearers, particularly with the development of toricand multifocal lens options. Although the optical challenges of contact lenses appeared to be relatively straightforward in their early years, thedevelopment of improved in-vivo diagnostic and in-vitro metrology instrumentation led to a significantly greater understanding of the nature of theoptical errors (e.g. higher order wavefront aberrations) of the eye and contact lenses and the interactions between them when worn. The featuresof contact lenses having extremely steep curvatures and being aligned closely to the eye’s visual axis in all positions of gaze provide both uniquechallenges and opportunities for improving the visual performance of both physiological and pathological eyes, and have guided the efforts ofsignificant vison science research in more recent times.

Background The present study sought to observe the effect of retaining intact posterior capsule in congenital cataract surgery in children aged 4–8 years. Methods This is a retrospective case control study. Seventy-seven children (130 eyes) aged from 4 to 8 years who underwent cataract surgery were divided into two groups. In Group A, 50 eyes underwent phacoemulsification, intraocular lens implantation and posterior capsule capsulotomy combined with anterior vitrectomy. In Group B, 80 eyes underwent cataract phacoemulsification and intraocular lens implantation. The postoperative visual acuity and the rate of complications were compared. Results In all patients, cataract surgeries were performed evenly without intraoperative complications. The follow-up time ranged from 6 months to 42 months. No apparent visual axis opacity was detected in group A during the follow-up. By the last visit, apparent visual axis opacity was detected in 31 eyes (38.75%) in group B. Among them, 9 eyes (29.03%) with mild posterior capsule opacification (PCO) were treated with Nd:YAG laser, 3 eyes (9.68%) with thick proliferative membranes were treated with posterior capsule capsulotomy combined with anterior vitrectomy and proliferative membranes in 19 eyes (61.29%) were completely aspired and the posterior capsule was retained. During follow-up, only 2 (6.45%) eyes had PCO recurrence and were treated with Nd:YAG laser. The visual acuity was significantly higher than that before surgery in all patients. Conclusions For older children, the incidence of PCO will be low even if intact posterior capsule is retained. Either Nd:YAG laser or surgical treatment for PCO will be able to maintain good vision.

Aims: The aim of the study is to investigate the association between ocular dominance and central corneal thickness (CCT) among normal eyes. Settings and Design: A cross-sectional study was conducted in the outpatient department of a tertiary care center in Southern India. Subjects and Methods: Participants of the study included 87 outpatients and volunteers with bilateral nonpathological eyes. This study was performed according to the tenets of the Declaration of Helsinki. To determine the dominant eye, hole-in-card test was utilized. Masked of the ocular dominance result, an independent observer measured CCT at the visual axis with specular microscopy (CEM-530, Nidek, Canada) by noncontact modality. Three readings were obtained from each eye. The right eye was first examined. Average of the three CCT readings was used for analysis. Statistical Analysis Used: Statistical methods included paired t-test (for comparison of eyes within patient) and Chi-square test to assess the association between ocular dominance and CCT. A P < 0.05 was considered statistically significant. Results: The 87 volunteers studied were aged 37.6 ± 14.8 years and 62.1% were female. CCT was 525.5 ± 28.4 μm in the right eye and 534.8 ± 29.8 μm in the left eye. Right eye was dominant in 63 (72.4%) patients. CCT in the dominant eye was 528.0 ± 29.5 μm and was significantly thinner (P < 0.001) than the nondominant eye (532.2 ± 29.3 μm). This was true in 69.0% of the patients. However, thinner cornea in a person was not indicative of a dominant eye (P = 0.535). Conclusions: As with other populations, right eye dominance was seen in South Indian population among nonpathological eyes. CCT is predominantly thinner in the dominant eye. Yet, this result cannot be applied to an individual by labeling the eye with thinner cornea as dominant with precision.

The objective of this study was to identify the factors that complicate the needle visualization in ultrasound-guided in-plane needling procedures. Forty-nine residents were recruited and randomized to insert the simulated blood vessel with four different views including Neutral (the long axis of the probe along the visual axis and the ultrasonic beam vertical to the surface of gel phantom), 45°-rotation (45° angle between the long axis of probe and the operator’s visual axis), 45°-tilt (45° angle between the ultrasonic beam and the surface of gel phantom) and 45°-rotation plus 45°-tilt of probe. Number of needle redirections, insertion time, and needle visibility were documented and compared for each procedure. When the residents faced with 45°-tilt view, the needle redirections (2 vs 0) and insertion time increased significantly (39 vs 16) compared with that of the Neutral view. When faced with 45°-rotation plus 45°-tilt view, the residents’ performance decreased further as compared with that of the 45°-tilt view and the Neutral view. However, there was no performance difference between the Neutral view and 45°-rotation view. In conclusion, during ultrasound-guided in-plane procedures, tilting the ultrasound probe may increase the difficulty of needle-beam alignment.

Introduction To determine if intraoperative manual centration of the intraocular lens (IOL) during cataract surgery results in better early post-operative centration. It is common practice for cataract surgeons to align intraocular lens centration to the visual axis by manual intraoperative manipulation of the intraocular lens. We aim to compare post-operative intraocular lens centration between intraocular lenses that were allowed spontaneous positioning in the capsular bag and IOLs that were manually centred during implantation. Materials and Methods One hundred and twenty-five consecutive eyes that underwent either femtosecond laser-assisted cataract surgery (FLACS) or phacoemulsification and IOL (monofocal/toric/multifocal) implantation by a single surgeon were included. Post-operative IOL centration at 4 weeks was assessed and measured on a slit-lamp by a masked observer. Results A total of 17 (13.6%) IOLs were off-centered to some extent at 4 weeks post-operatively. All the decentered IOLs were graded as minimal or mild (

Ectopia lentis or crystalline lens subluxation is one of the major criteria to diagnose Marfan syndrome. It may vary from mild lens subluxation to lens dislocation. Herewith is a case report of a 4-year-old autistic boy who had never been diagnosed with Marfan syndrome. He presented to the clinic after his parents noticed he had difficulty focusing on near objects. His bilateral best-corrected visual acuity was 6/60. On examination, there was bilateral lens subluxation superotemporally and lens equator blocking his visual axis. He was sent to the paediatric team and further Marfan workout showed dilated aortic root. He was then diagnosed with Marfan syndrome. He underwent bilateral lens aspiration, anterior vitrectomy, and iris-claw lens implantation. His postoperative bilateral visual acuity on day 1 was 6/30 and his best-corrected visual acuity 3 months after surgery was 6/9 for both eyes. In conclusion, ophthalmologists play an important role in diagnosing and managing Marfan syndrome. Early diagnosis is important to help preserve vision and improve quality of life.

PURPOSE: To report the change in globe axial length (AL) from the time of unilateral cataract surgery at age 1–7 months to age 10.5 years for infants enrolled in the Infant Aphakia Treatment Study, and to compare AL growth of operated eyes with that of fellow unoperated eyes. DESIGN: Comparative case series. METHODS: AL growth was analyzed relative to treated vs fellow eye, contact lens (CL) vs intraocular lens (IOL), visual acuity (VA) outcome, and the need for surgery for visual axis opacification. Eyes with glaucoma or glaucoma suspect were excluded from the primary analysis but reported separately. RESULTS: Fifty-seven patients have reliable AL data available at both visits. AL was shorter in treated eyes preoperatively (P < .0001) and at 10.5 years of age (P = .021) but AL growth was not different (4.7 mm, P = .99). The growth (70.2% up to age 5 and 29.8% from age 5 to 10.5) was similar in the CL and the IOL group (P = .79). Eyes grew 4.4 mm when visual acuity (VA) was better than 20/200, and 5.2 mm when VA was 20/200 or worse (P = .076). Eyes receiving additional surgery grew more than eyes not receiving additional surgery (P = .052). Patients with glaucoma showed significantly more eye growth (7.3 mm) than those without glaucoma (4.7 mm) and glaucoma suspects (5.1 mm) (P < .05). CONCLUSIONS: Eyes with glaucoma or poor VA often grew longer than the fellow eye. Overall, treated eyes grew similarly in the IOL and CL groups and also kept pace with the growth of the fellow eyes.

Background To measure the crystalline lens tilt in eyes with various degrees of myopia before cataract surgery using swept-source optical coherence tomography (SS-OCT). Methods We used SS-OCT (IOLMaster 700) to scan 131 emmetropic eyes (axial length 30 mm, respectively) as part of the routine preoperative examination before cataract surgery. SS-OCT involved B-scans along six meridians. The data were analyzed to assess the magnitude and orientation of the lens tilt and their correlation with other optical biometric parameters. Result The mean tilt was 3.36 ± 0.98° in emmetropic eyes, 3.07 ± 1.04° in mild/medium myopic eyes, and 2.35 ± 1.01° in high myopic eyes. Tilt correlated significantly and inversely with axial length (Pearson’s r = − 0.427, P 2 test, P Conclusion The magnitude of crystalline lens tilt decreased with increasing axial length. The direction of tilt was predominantly towards the upper outer quadrant in both eyes. The variability in the tilt orientation increased with increasing axial length. Trial registration NIH (clinicaltrial.gov), NCT03062085. Registered 23 February 2017.

One of the merits of recently introduced exoscopes, including ORBEYE, is that they are superior to a conventional microscope in terms of ergonomic features. Taking advantage of it, the retrosigmoid approach can be performed in the supine position using ORBEYE. We report a consecutive series of 14 operations through the retrosigmoid approach in the supine position using ORBEYE. Fourteen consecutive patients who underwent surgery through the retrosigmoid approach for cerebellopontine (CP) angle lesions in the supine position using ORBEYE were targeted, and surgical outcomes and complications were examined. We evaluated the posture of the operator and the surgical field during this approach compared with those using a conventional microscope. In all 14 cases, all operative procedures were accomplished only using the ORBEYE. There were no operative complications due to this approach. Using ORBEYE, even when the angle of the operative visual axis was horizontal, the operators could manipulate in a comfortable posture. They were not forced to be in an uncomfortable posture that extended their arms, as is often the case with a conventional microscope. Therefore, they could use shorter surgical instruments. As the cerebellum shifted downward with gravity even using slight retraction during this approach, the working space of the surgical field was easily secured. Through this approach, the operators can perform stable microsurgery of CP angle lesions in a comfortable posture. This approach can reduce the burden on the operator and the patient, leading to a refined surgical procedure.

A 55-year-old female presented with binasal visual field defects and normal neuro-ophthalmic examination. Slit-lamp examination demonstrated posterior subcapsular cataracts that were located temporally in the visual axis. Due to the location of the nodal point in the eye, her visual field defect was contralateral to the opacity. Her visual field defects resolved after cataract surgery.

Posterior capsule opacification (PCO) is the most common complication arising from the corrective surgery used to treat cataract patients. PCO arises when lens epithelial cells (LEC) residing in the capsular bag post-surgery undergo hyper-proliferation and transdifferentiation into myofibroblasts, migrating from the posterior capsule over the visual axis of the newly implanted intraocular lens (IOL). The developmental pathways underlying PCO are yet to be fully understood and the current literature is contradictory regarding the impact of the recognised risk factors of PCO. The aim of this review is firstly to collate the known biochemical pathways that lead to PCO development, providing an up-to-date chronological overview from surgery to established PCO formation. Secondly, the risk factors of PCO are evaluated, focussing on the impact of IOLs’ properties. Finally, the latest experimental model designs used in PCO research are discussed to demonstrate the ongoing development of clinical PCO models, the efficacy of newly developed IOL technology, and potential therapeutic interventions. This review will contribute to current PCO literature by presenting an updated overview of the known developmental pathways of PCO, an evaluation of the impact of the risk factors underlying its development, and the latest experimental models used to investigate PCO. Furthermore, the review should provide developmental routes for research into the investigation of potential therapeutic interventions and improvements in IOL design in the aid of preventing PCO for new and existing patients.

Purpose: To report intra- and postoperative surgical outcome using the bag-in-the-lens (BIL) technique in paediatric cataract surgery. Methods: In a retrospective case series, we studied the outcomes of children aged

Cataract, a clouding of the lens, is the most common cause of blindness in the world. It has a marked impact on the wellbeing and productivity of individuals and has a major economic impact on healthcare providers. The only means of treating cataract is by surgical intervention. A modern cataract operation generates a capsular bag, which comprises a proportion of the anterior capsule and the entire posterior capsule. The bag remains in situ, partitions the aqueous and vitreous humours, and in the majority of cases, houses an intraocular lens (IOL). The production of a capsular bag following surgery permits a free passage of light along the visual axis through the transparent intraocular lens and thin acellular posterior capsule. Lens epithelial cells, however, remain attached to the anterior capsule, and in response to surgical trauma initiate a wound-healing response that ultimately leads to light scatter and a reduction in visual quality known as posterior capsule opacification (PCO). There are two commonly-described forms of PCO: fibrotic and regenerative. Fibrotic PCO follows classically defined fibrotic processes, namely hyperproliferation, matrix contraction, matrix deposition and epithelial cell trans-differentiation to a myofibroblast phenotype. Regenerative PCO is defined by lens fibre cell differentiation events that give rise to Soemmerring's ring and Elschnig's pearls and becomes evident at a later stage than the fibrotic form. Both fibrotic and regenerative forms of PCO contribute to a reduction in visual quality in patients. This review will highlight the wealth of tools available for PCO research, provide insight into our current knowledge of PCO and discuss putative management of PCO from IOL design to pharmacological interventions.

Introduction: Secondary capsular opacification is prevalent in children after cataract surgery, but for its treatment in children, few options exist. Poor cooperation precludes the use of neodymium yttrium-aluminium-garnet (Nd: YAG) capsulotomy in children. Surgery in the form of membranectomy is mostly resorted to, in case of a thick visually significant posterior capsular opacification (PCO). However, in case of thin PCO in the visual axis, Nd: YAG capsulotomy could act as a non-invasive alternative. Materials and Methods: Medical records of patients aged 1–16 years who underwent YAG capsulotomy under general anaesthesia between January 2007 and December 2016 were reviewed. Here, we present a case series of 18 eyes that underwent Nd: YAG capsulotomy under general anaesthesia at our centre. Eighteen eyes of 14 patients had undergone the laser procedure. All the patients were administered general anaesthesia in the laser room, and the procedure was performed in the sitting position on the slit-lamp laser delivery system. Results: The mean age at primary surgery for cataract was 2.15 ± 2.4 years. Of the 18 eyes, 1 (5.5%) was a traumatic cataract, all others being congenital cataracts. The mean age at Nd: YAG laser capsulotomy was 4.05 ± 2.38 years. The mean pre-procedural visual acuity was 0.654 ± 0.278 logMAR units and post-procedural visual acuity was significantly better at 0.502 ± 0.55 logMAR units, with P = 0.009. Conclusion: This, to our knowledge, is the largest reported series on patients who have undergone Nd: YAG laser capsulotomy under general anaesthesia. Although controversy exists on the positioning of patients during the procedure under general anaesthesia, we have successfully done 14 patients in the sitting position with no anaesthesia-related complications. Nd: YAG laser capsulotomy could be considered as a non-invasive alternative to membranectomy for PCO in children.

Significance Decades of research have shown that, when measured in laboratory conditions, saccadic eye movements are not only variable, due to noise in sensory-motor pathways, but also inaccurate, displaying systematic biases toward smaller movement amplitudes (hypometria) or toward the mean location of the targets (central tendency). Here, we show that such biases are explained by a probabilistic strategy to find the optimal balance of bias and variance that minimizes the expected costs of saccadic errors. Our findings indicate that the oculomotor system possesses a probabilistic representation of its own sensorimotor uncertainty and uses that representation to adjust the parameters of each saccade., Saccades are rapid eye movements that orient the visual axis toward objects of interest to allow their processing by the central, high-acuity retina. Our ability to collect visual information efficiently relies on saccadic accuracy, which is limited by a combination of uncertainty in the location of the target and motor noise. It has been observed that saccades have a systematic tendency to fall short of their intended targets, and it has been suggested that this bias originates from a cost function that overly penalizes hypermetric errors. Here, we tested this hypothesis by systematically manipulating the positional uncertainty of saccadic targets. We found that increasing uncertainty produced not only a larger spread of the saccadic endpoints but also more hypometric errors and a systematic bias toward the average of target locations in a given block, revealing that prior knowledge was integrated into saccadic planning. Moreover, by examining how variability and bias covaried across conditions, we estimated the asymmetry of the cost function and found that it was related to individual differences in the additional time needed to program secondary saccades for correcting hypermetric errors, relative to hypometric ones. Taken together, these findings reveal that the saccadic system uses a probabilistic-Bayesian control strategy to compensate for uncertainty in a statistically principled way and to minimize the expected cost of saccadic errors.

Background To evaluate the visual outcome and complications of surgical membranectomy with modified incision and capsulotomy microscissors in patients with persistent pupillary membrane (PPM). Methods We enrolled eight eyes with PPM in six patients and performed surgical membranectomy with modified incision located near the limbus and corresponding to the middle of the densest membrane strands. Strands near the collarette of the iris were then cut using capsulotomy microscissors and thick strands were removed with capculorhexis forceps. Complications during or after surgery were evaluated, and uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were compared pre- and post-surgery. Results The mean age of the patients at surgery was 9.5±3.4 years (range, 5.3 to 13.8 years). Bilateral PPMs were found in two patients, small anterior capsular cataracts not locating on the visual axis in three eyes, and deprivational amblyopia in four eyes. There were no traumatic cataracts, endophthalmitis, corneal opacities, or other complications in patients during or after modified surgical membranectomy. After a mean follow-up period of 5.8±0.4 (range, 5.0 to 6.0) months, UCVA was significantly improved from 0.23±0.14 to 0.36±0.20(P=0.026), and BCVA was also significantly improved from 0.32±0.22 pre-operatively to 0.56±0.25 post-operatively (P=0.006). Conclusions Surgical membranectomy with modified incision and capsulotomy microscissors may be a safe approach to clear the visual axis of patients with PPM. However further treatments were needed in amblyopic eyes after surgery.

Background and objectives: the aim of this study was to analyze the efficacy of a modified “amnion-assisted conjunctival epithelial redirection (ACER)” technique for the treatment of partial limbal stem cell deficiency (LSCD). Materials and methods: the medical records of three patients with partial LSCD who underwent corneal surface reconstruction with modified ACER following superficial keratectomy were retrospectively studied. Briefly, in this technique, an inner amniotic membrane (AM) layer was applied on the corneal surface to promote corneal re-epithelialization. The outer AM layer was applied as a barrier to prevent the invasion of conjunctival epithelial cells into the cornea before the corneal surface was completely covered by corneal epithelial cells derived from the remaining intact limbal stem cells. Results: in all three cases, the outer AM layer successfully kept the conjunctival epithelium away from the corneal surface and prevented an admixture of conjunctival epithelial cells with corneal epithelial cells. In all three patients, the cornea was completely re-epithelized with epithelial cells derived from the remaining healthy limbal stem cells, and a clear visual axis was maintained without recurrence for a mean follow-up period of 37.3 ± 8.6 months. Conclusions: the preliminary results suggest that modified ACER appears to be a viable option for patients with partial LSCD.

This study aims to describe a new universal method to identify the relative three-dimensional directions of visual, pupillary, and optical axes of the eye and the angles between them using topography elevation data. The method was validated in a large clinical cohort, and ethnical differences were recorded. Topography elevation data were collected from 1992 normal eyes of 966 healthy participants in Italy, Brazil, and China. The three main axes were defined as follows: optical axis (OA) was defined as the optimal path of light that passes through the ocular system without refraction. The pupillary axis (PA) line was defined using X and Y coordinates of the pupil centre with the chamber depth, in addition to the centre of a sphere fitted to the central 3 mm diameter of the cornea. The visual axis (VA) was taken by its best approximation, the coaxially sighted corneal light reflex. The alpha angle was measured between the VA and OA, and the kappa angle between the VA and PA. The average values of kappa and alpha angles were 3.41 ± 2.84 and 6.04 ± 2.43 in the Italian population, 2.6 ± 1.53 and 5.87 ± 2.3 in the Brazilian population, and 2.09 ± 1.22 and 3.85 ± 1.48 in the Chinese population.

(1) Background: The purpose of the study is to present a simple theoretical account of the effect of translation of coma and spherical aberrations (SA) on refractive error and higher order aberrations. (2) Methods: A computer software algorithm was implemented based on previously published methods. The effect of translation (0 to +1 mm) was analyzed for SA (0 to +2 &micro, m) and coma (0 to +2 &micro, m) for a circular pupil of 6 mm, without any rotation or scaling effect. The relationship amongst Zernike representations of various aberrations was analyzed under the influence of translation. (3) Results: The translation of +0.40 &micro, m of SA (C[4,0]) by +0.25 mm with a pupil diameter of 6mm resulted in induction of tilt (C[1,1]), &minus, 0.03D defocus (C[2,0]), +0.03D astigmatism (C[2,2]) and +0.21 &micro, m coma (C[3,1]). The translation of +0.4 &micro, m of coma (C[3,1]) by +0.25 mm with a pupil diameter of 6 mm resulted in induction of tilt (C[1,1]), &minus, 0.13D defocus (C[2,0]) and +0.13D astigmatism (C[2,2]). A theoretical quantitative relationship between SA, coma, astigmatism and defocus is presented under the influence of translation. (4) Conclusion: The results can act as a guide for the clinician, in order to readily assess theoretical impact of wavefront map translation from pupil center to the visual axis. The resultant refractive coupling has to be taken into consideration especially when treating eyes with an abnormal corneal shape and/or large pupil center to corneal vertex chord.

Objectives: Although the Frankfort Horizontal (FH) and sella-nasion were routinely used as craniofacial reference planes, the inter-individual orientations were changeable when related to true horizontal (HOR). Natural head position (NHP) is a reproducible, standardized position, with the head in an upright posture and eyes focused on a point in the distance at eye level so that the visual axis is horizontal. The natural head position has importance in anthropological as well as in orthodontic fields, as this position has a relatively fixed relationship to the true horizontal and vertical planes. However, NHP is clinically not simple and it takes long time to be recorded, in addition to a deficiency in the tools utilized in the NHP and lack in the staff training. This paper aims to shed the light on different methods of NHP registration and reproduction. Data and Sources: A literature review of English articles was performed using PubMed, Scopus, and Google Scholar to search for natural head position in orthodontics. Conclusions: NHP is affected by many factors, and it is different in walking state than in static state. There are various cephalometric or photographic methods for NHP recording. Keywords: Reproducibility of natural head position, True horizontal, True vertical plane.

Objective: This study aims to identify clinical and therapeutic surgical particularities and postoperative complications encountered in children suffering from Down syndrome and congenital cataract, as well as the existence of a correlation with associated systemic anomalies. Methods: A retrospective interventional study that analyzes cases of congenital cataracts operated on a group of 14 children with Down syndrome, respectively on 26 eyes, was performed. The age of the children at the time of the surgery, the presence of associated ocular and systemic anomalies, the employed surgical technique, the frequency and the type of postoperative complications, were examined. Results: Cataracts present at birth, with recommendations for surgical treatment, were rare among children suffering from Down syndrome, but their frequency increased with age. Most children had systemic anomalies, but also other, usually multiple, ocular anomalies. The rate of postoperative complications was higher than among children with congenital cataracts, but without Down syndrome. In six cases, more than one complication/ case was identified. It was not possible to establish a clear correlation between the number and type of the postoperative complication and the systemic anomalies, nor was it possible to establish a correlation with the functional visual outcomes, because those children had other important ocular anomalies as well. Conclusions: Congenital cataracts with recommendations for surgical treatment in children suffering from Down syndrome have a low incidence, but an increase in frequency can be noticed with age. The recommended surgical technique is the one that involves maneuvers for the prevention of visual axis re-opacification. Per primam implantation is definitely indicated. The risk of postoperative complications is high, in terms of both frequency and number, with the possibility that more than one complication occurs, unrelated to a particular systemic anomaly, in one patient.

This study compared one-year postoperative outcomes of laser refractive surgery combined with laser asymmetric keratectomy (LAK) and laser in situ keratomileusis (LASIK)for myopia correction in middle-aged patients (aged 40–49 years) with a total corneal thickness deviation (summed across four directions) ≥ 80 microns. The control group (n = 26; 52 eyes) underwent LASIK; the comparison group (n = 26; 52 eyes) underwent combined laser refractive surgery and LAK. Age, spherical equivalence, uncorrected visual acuity (near and far), corneal irregularity on the Orbscan map, sum of corneal thickness deviations in four directions, corneal thickness distribution, distance between the maximum posterior elevation (best-fit sphere; BFS) and visual axis, and postoperative blurring scores were analysed retrospectively between the groups. Both groups had similar preoperative findings. Postoperatively, the sum of corneal thickness deviations in four directions (p = 0.000), distance between maximum posterior elevation (BFS) and visual axis (p = 0.003),blurring score (p = 0.001), and corneal irregularity in the 3.0 and 5.0 mm zones on the Orbscan map (p = 0.033 and p

The point of centration for refractive surgery is a theme of great importance that generates considerable discussion among specialists and surgeons in the field. Notably, any changes in light can alter the size of the pupil, and the visual axis of the fixation line to the fovea is unique in each patient. A variety of options have been described in the literature with respect to centration in refractive surgery, and the results differ among these methods. No consensus has been established regarding the ideal refractive surgery technique for evaluation of centration in each patient that will yield a satisfactory surgical result. RESUMO O ponto de centralização da cirurgia refrativa é tema de grande importância e gera muita discussão entre especialistas e cirurgiões da área. Afinal, qualquer alteração na luz pode alterar o tamanho da pupila, além disso, o eixo visual da linha de fixação para a fóvea é particular em cada paciente. Existem opções para centralização em cirurgia refrativa com resultados diferentes na literatura. Ainda não há consenso sobre a melhor técnica em cirurgia refrativa que avalie cada caso específico visando um resultado cirúrgico final satisfatório.

Opacification of the posterior capsule caused by residual lens epithelial cells (LEC) is still the most frequent long-term complication of cataract surgery. Beside the opacification of the visual axis with posterior capsule opacification (PCO), resulting in a decrease in visual function, fibrotic changes may also have a mechanical effect on intraocular lens (IOL) position such as axial shift, decentration, tilt and capsule striae. In this article, two types of capsular fibrosis are explored, on the one hand the anterior capsule fibrosis and on the other hand PCO. Results from clinical trials concerning their causes, natural course, incidence, influencing factors and possible methods of prophylaxis are presented.摘要: 残留的晶状体上皮细胞 (LEC) 所致的后囊混浊仍是白内障术后最常见的远期并发症。除了由后囊混浊 (PCO) 导致的视轴区混浊引起视功能下降外, 纤维化改变也可对人工晶状体 (IOL) 的位置产生机械影响如视轴移位、偏心、倾斜和囊袋条纹。, 本文探讨了2种类型的囊袋纤维化, 一种是前囊纤维化, 另一种是后囊混浊(PCO), 从临床试验结果阐述了病因、自然病程、发病率、影响因素及可能的预防方法。关于囊袋纤维化预防与管理的综述摘要残留的晶状体上皮细胞(LEC)所致的后囊混浊仍是白内障术后最常见的远期并发症。除了由后囊混浊(PCO)导致的视轴区混浊引起视功能下降外,纤维化改变也可对人工晶状体(IOL)的位置产生机械影响如视轴移位、偏心、倾斜和囊袋条纹。本文探讨了2种类型的囊袋纤维化,一种是前囊纤维化,另一种是后囊混浊(PCO),从临床试验结果阐述了病因、自然病程、发病率、影响因素及可能的预防方法。.

The superior colliculus (SC) is a layered midbrain structure involved in directing both head and eye movements and coordinating visual attention. Although a retinotopic organization for the mediation of saccadic eye-movements has been shown in monkey SC, in human SC the topography of saccades has not been confirmed. Here, a novel experimental paradigm was performed by five participants (one female) while high-resolution (1.2-mm) functional magnetic resonance imaging was used to measure activity evoked by saccadic eye movements within human SC. Results provide three critical observations about the topography of the SC: (1) saccades along the superior-inferior visual axis are mapped across the medial-lateral anatomy of the SC; (2) the saccadic eye-movement representation is in register with the retinotopic organization of visual stimulation; and (3) activity evoked by saccades occurs deeper within SC than that evoked by visual stimulation. These approaches lay the foundation for studying the organization of human subcortical – and enhanced cortical mapping – of eye-movement mechanisms.

Background: Optic nerve sheath diameter (ONSD) as measured by optic nerve sheath ultrasonography (ONSU) is used as a surrogate marker of intracranial pressure (ICP), especially in resource-limited settings. There is a growing interest in the use of ONSU in emergency and high-altitude setups. Notwithstanding multiple studies done on this subject, there is a paucity of data regarding standardization of techniques and comparison of ONSU with computed tomography (CT). Materials and Methods: Thirty-five patients with a diagnosis of high-altitude cerebral edema were enrolled in the study. ONSD was measured in all patients using ONSU, along visual and coronal axis, and CT scan. We repeated ONSU in these patients on days 3, 7, 10, and 15 (day of discharge). Correlation between visual and coronal axis as well as CT scan was analyzed. Results: The correlation of visual to coronal and coronal to visual was equally significant (both correlation coefficients being R 2 = 0.983). Correlation of ONSD by visual axis to CT scan was better than coronal axis (correlation coefficient R 2 = 0.986 vs. 0.96, respectively). Conclusion: In our study, we found a strong correlation between the visual and coronal axes. Thus, either of the two axes can be used for monitoring ICP. However, it has been found that measurements along the coronal axis are challenging, especially in the emergency setup. ONSD measured along visual axis correlated better with CT scan as compared to the coronal axis.

The purpose is to present a new refined surgical technique for mild-to-severe acquired myogenic ptosis correction under local anaesthesia (LA) as day cases with resection of myotarsal (MT) flap and demonstrate the safety and efficacy of the technique. MT flap consists of 2 mm tarsal strip with attached levator complex - levator muscle, its aponeurosis, and Müller muscle. This is a retrospective personal series of 400+ patients, who underwent surgical correction with MT flap resection of 8-24 mm under LA mostly as day cases. No patient had any complication. Results were satisfactory as assessed on these criteria: (i) elevation of the lid at least above the visual axis; (ii) normal contours of the lid without distortion, with the eyelid conforming to the contours of the globe; (iii) static and dynamic symmetry of upper eyelids; (iv) formation of a normal and symmetrical lid fold; (v) healthy comfortable ocular surface and cornea; and (vi) patient and surgeon satisfaction with the aesthetic outcome. Resection of the MT flap is a safe and effective, microsurgical technique of ptosis correction, yielding satisfactory results without complications, with ergonomic advantages of the inclusion of a tarsal strip. The versatility of the MT flap extends to its use for correction of upper lid retraction, and for formation of the posterior lamina of full thickness small to subtotal lower lid reconstructions.

WOS: 000429421300002, PubMed ID: 29576890, Objectives: The aim of this study was to evaluate the outcomes of pediatric developmental cataract surgery with primary intraocular lens (IOL) implantation. Materials and Methods: Patients between 2 and 16 years old who underwent cataract surgery with primary IOL implantation were retrospectively evaluated. Age at time of surgery, pre-and postoperative best corrected visual acuities, postoperative ocular complications, and any accompanying ocular pathologies were obtained from the patients' charts. Mean refractive changes and degree of myopic shift were analyzed according to the age groups. Operated eyes were also compared with the fellow eyes in unilateral cases. Results: A total of 101 eyes of 65 patients were included. The average age at time of surgery was 76 +/- 40 months and the average follow-up period was 44 +/- 30 months. Among the 78 eyes that could be assessed for visual acuity improvement, 66 (84.6%) of them showed >= 2 lines of improvement. The difference in the mean refractive change between the 2-5 years old and 8-16 years old age groups was found to be statistically significant. However, the mean refractive change per year was not found to be significant between the same age groups. In unilateral cases, the operated eyes showed a greater myopic change than the fellow eyes, with no statistically significant difference. The most common postoperative complication was visual axis opacity. Conclusion: Good visual outcomes can be achieved following pediatric cataract surgery with primary IOL implantation. Optic axis opacities were the most common postoperative complications. Overall, refractive changes following surgery are inevitable, and more prominent in younger age groups.

Presbyopia corrections traditionally have been approached with attempts to exchange power, either at the cornea or the lens planes, inducing multifocality, or altering asphericity to impact the optical system. Treatments that affect the visual axis, such as spectacle and contact lens correction, refractive surgeries, corneal onlays and inlays, and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye. Their aim is instead to enhance ‘pseudoaccommodation’ by facilitating an extended depth-of-focus for which vision is sufficient. There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution, rather than a ‘vision correction’ solution that compromises other components of the optical system. Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia. While the theoretical justification of scleral surgical procedures remains controversial, there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia. Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s, and this remains an active area of research. In this article, we discuss the historic scleral surgical procedures, the two scleral procedures currently available, as well as an outlook of the future for the scleral surgical space for treating presbyopia.

We describe our technique for the management of late-onset liquefied after-cataract (LAC) to ensure long-term visual axis clarity. The densely adherent anterior capsular rim over the intraocular lens (IOL) optic was released with the help of microvitreoretinal blade, and multiple relaxing radial incisions were made on the capsular rim to facilitate easy access to the capsular bag. A thorough capsular bag lavage was performed with the help of bimanual irrigation-aspiration. Posterior continuous curvilinear capsulorhexis (PCCC) was performed after complete aspiration of fluid after-cataract to prevent recurrence. This technique was successfully performed in 14 cases. Postoperatively, IOL was stable and an uncorrected distance visual acuity of >20/32 was achieved in all cases. No recurrence was observed in any case over a follow-up of 1 year. Our technique of capsular bag lavage with PCCC is safe and effective for the management of LAC with optimal visual and anatomical outcomes.

Persistent pupillary membranes (PPMs) are a common congenital anomaly seen in 95% of neonates. Extensive PPMs, occluding the visual axis and resulting in reduced visual acuity, are relatively uncommon. We describe a case of bilateral total PPM in a 36-year-old female who presented with complaints of blurred vision in both the eyes. Dense pupillary membranes obscuring the visual axis need early surgical treatment. It is essential that the lens status remains clear along the visual axis both before and after pupilloplasty.

Purpose: To study the time course of interface healing and its correlation with visual acuity, modulation transfer function (MTF), and aberrations after myopic small-incision lenticule extraction (SMILE) correction. Methods: Seventy-eight eyes of 78 patients (1 eye per patient) with a mean age of 25.7 years and mean spherical equivalent (SE) of −3.74D, undergoing bilateral SMILE procedure, were included in this study. On postoperative day 1, 2 weeks, and 3 months, dilated retroillumination photographs were taken and morphology of corneal interface was graded by comparing them with 5 standard templates representing 5 grades of interface roughness (IRG): IRG – 0 (clear), IRG – 1 (mild), IRG – 2 (moderate), IRG – 3 (severe), and IRG – 4 (severe IRG with Bowman's folds in visual axis). Pearson's correlations were computed to study correlation associations, and Wilcoxon signed-rank test was used for intragroup comparison of means. P ≤ 0.05 was considered statistically significant. Results: At 3 months, 90.70% eyes were Grade 0 while 9.30% eyes still had Grade 2 interface granularity. Mean IRG significantly improved from 2.47 ± 0.57 at day 1 to 0.62 ± 0.53 at 3 months (P = 0.00). At day 1, pre-SE showed a significant positive correlation with IRG; however, mean postoperative corrected distant visual acuity (CDVA, in decimal), corneal Strehl ratio (SR), and MTF showed weak but significant negative correlation with IRG (r2 = 0.28 for SE, −0.052 for CDVA, −0.017 for SR, and −0.39 for MTF, respectively, P < 0.05 for all correlations). At 2 weeks and 3 months, corneal MTF continued to show a significant negative correlation, whereas other parameters did not show any correlation with IRG. Conclusion: Visual quality and corneal MTF may be significantly affected by the IRG in the immediate postoperative period after SMILE and may take 3 months or more for complete recovery.

We describe the use of topography-guided transepithelial phototherapeutic keratectomy (PTK) to restore excellent uncorrected distance visual acuity (UDVA) in an eye with extremely irregular topography as a result of a severe complication during laser in situ keratomileusis (LASIK) flap creation. Three months before the patient presented to our clinic, the microkeratome cut outward during LASIK flap creation, amputating the partially cut flap across the visual axis. Without a flap cut into the preserved one half of the cornea, complete flap amputation was not considered a safe option. Topography-guided transepithelial PTK was used to regularize the cornea and treat the resulting irregular astigmatism. Six months postoperatively, the cornea remained stable and the UDVA was 6/6+2.

Introduction and importance This case describes a novel technique combining a mini-conjunctival limbal autograft (CLAU) with a deep anterior lamellar keratoplasty (DALK) in a case of chemical injury sequelae. Case presentation A 19-year-old female presented with total limbal stem cell deficiency (LSCD) and a vascularized corneal scar in the visual axis of the left eye, 4 years following a chemical injury. In order to treat the LSCD and simultaneously visually rehabilitate the patient, a mini-CLAU with DALK was carried out. Two separate one clock-hour CLAUs were harvested from the right eye and secured in the left. The graft was clear in the initial postoperative period and maintained its clarity over 15 months of follow period with a visual acuity of 20/30 with scleral contact lenses. The mini-CLAUs sustained a stable and well epithelialized corneal surface during the same period. Clinical discussion The use of the mini-CLAUs instead of the traditional CLAU circumvents the complication of an iatrogenic LSCD in the donor eye as the size of the donor grafts is smaller (1–2 clock hours versus 6–8 clock hours). Despite the smaller size, these grafts are efficacious in maintaining a well epithelialized corneal surface even in cases of total LSCD. The autologous nature of the graft defers the need for immunosuppression and its peripheral location facilitates ease of the surgical technique when combined with a keratoplasty. Conclusion This novel single-staged procedure is an effective technique to reestablish a stable ocular surface and to visually rehabilitate cases of chronic chemical injury with good long-term outcomes., Highlights • Severe ocular burns need both corneal and limbal transplantation. • Anterior lamellar keratoplasty is preferred over penetrating grafts. • Mini-conjunctival limbal grafts can be obtained safely from the healthy fellow eye. • The need for long-term systemic immunosuppression is minimized in this approach. • This combined technique leads to good and sustainable functional recovery.

PurposeTo identify causes of symptomatic band keratopathy, and assess the results and long-term recurrence rates following chelation with topical ethylene-diamine-tetra-acetic acid (EDTA).Patients and methodsA retrospective review of surgical logbooks identified patients managed by EDTA chelation for symptomatic band keratopathy from 2009 to 2015.ResultsWe identified 108 cases; 89 case notes were available for analysis. Most cases of band keratopathy were idiopathic (36%). The most commonly identified underlying diagnosis was long-term topical glaucoma therapy (27%). Median presenting visual acuity was 6/18 (range 6/6-NPL) with the visual axis affected in 97.8% of cases. Treatment involved corneal epithelium removal, recurrent application of topical EDTA, and subsequent debridement. The mean duration of the operation was 20 min (range 10-45). Mean initial follow-up time was 40 days, and the visual axis was clear in 97.8%. Visual acuity was maintained or improved in 79.8%, with 13.5% improving by two lines or more. The mean length of follow-up was 581 days (median 374, maximum 2438). Twenty-five eyes (28.1%) showed localised recurrence of calcium with a mean time of 546 days (median 374), but only four cases required repeat EDTA chelation. The median time between operations was 430 days. Thirty-two per cent of the recurrence cases were associated with hypotony or chronic presence of silicone oil.ConclusionsChelation of calcium with topical EDTA is a safe and effective treatment for band keratopathy. Visual acuity improves in most eyes and while the rate of recurrence is moderate, the need for retreatment is low (4.5% overall).

Background: Carotid endarterectomy (CEA) using conventional surgical microscope has been already established as golden standard. Recently, exoscope was introduced into the field of neurosurgery, and various merits of it have been reported. We report the experiences of exoscopic CEA using a movable 4K 3D monitor and discuss the feasibility of it. Methods: We report a consecutive series of 15 cases of exoscopic CEA for internal carotid artery (ICA) stenosis using a movable 4K 3D monitor between January 2020 and April 2021. We utilized ORBEYE as an exoscope system and a 31-inch movable 4K 3D monitor, which was installed in the Maquet Moduevo ceiling supply unit. Results: In all 15 cases, the procedures were accomplished only using the ORBEYE. There were no operative complications due to the use of the exoscope. In response to the operative site, the 4K 3D monitor was moved to face the operator. Even when the angle of the visual axis of the exoscope against the horizontal plane was small during the surgical manipulation in the distal portion of ICA, the operator was able to maintain a comfortable posture. Conclusion: Using the movable 4K 3D monitor, exoscopic CEA can be performed ergonomically. The operator can manipulate the distal portion of the ICA or proximal portion of the common carotid artery in a comfortable posture and face the monitor by adjusting its position.