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To report a technique for fixating posterior chamber intraocular lenses (PCIOLs) to the sclera by passing sutures through the lens material.Cases in which PCIOLs were fixated to the sclera using trans-optic sutures were included in this series. Intra and post-operative complications were recorded, and lens position was assessed using slit-lamp examination.Fourteen cases were included in this series. In nine cases, the procedure was performed using 9-0 polypropylene in pseudophakic eyes to correct subluxation, centration, tilt or to replace a broken haptic. In five cases, this technique was used for primary PCIOL fixation using a flanged 6-0 polypropylene suture in aphakic eyes. In all cases, the lenses remained centered and stable at the end of follow-up, and no post-operative complications occurred.Trans-optic suturing is a safe and effective alternative method for fixation of IOLs in a variety of pseudophakic and aphakic clinical scenarios.

PURPOSE: To evaluate the optical performance and quality of vision of a novel optical design of a new trifocal intraocular lens (IOL) using a proprietary modified algorithm. METHODS: In this prospective, non-randomized, single-armed, single-center, open-label study, a total of 20 patients (40 eyes) who were candidates for multifocal lens implantation were recruited for implantation with the multifocal Intensity SL IOL (Hanita Lenses). Evaluation performed at 1 and 7 to 10 days and 1 and 3 months after implantation included corrected and uncorrected distance visual acuities at far, intermediate (80 cm), and near (40 cm). Monocular and binocular visual acuities, defocus curves, and contrast sensitivity were measured and questionnaires for grading subjective visual quality, satisfaction, and visual function were provided. RESULTS: Three months postoperatively, monocular uncorrected visual acuity for distance, intermediate, and near averaged 0.03 ± 0.11, 0.09 ± 0.09, and −0.22 ± 0.09 logMAR, respectively (Snellen 20/21.4, 20/24.6, and 20/12). Corrected monocular visual acuity for distance, intermediate, and near averaged −0.07 ± 0.06, 0.03 ± 0.09, and −0.25 ± 0.07 logMAR (20/17, 20/21.4, and 20/11.2), respectively. Binocular corrected visual acuity for distance, intermediate, and near was −0.1 ± 0.06, −0.02 ± 0.09, and −0.28 ± 0.04 logMAR (20/15.8, 20/19, and 20/10.5), respectively. Contrast sensitivity was similar to the normal population in photopic and mesopic conditions. Defocus curves showed that this IOL provided visual acuity of 20/28.9 or better between a defocus of +1.00 and −3.50 diopters. The Visual Function Index-14 questionnaire showed that patients reported high satisfaction. Patients specifically noted good quality of vision at near and intermediate distances. CONCLUSIONS: The Intensity SL IOL can provide good quality distance, intermediate, and particularly strong near vision after cataract surgery and independence from spectacles with good patient satisfaction. [ J Refract Surg . 2022;38(3):150–157.]

Timely management of aphakic children is critical for the rehabilitation of adequate visual gain. This study aims to evaluate the long-term efficacy of scleral contact lenses in terms of visual outcomes, complications, and compliance in aphakic children.Retrospective data review of children with congenital or acquired cataract, or subluxated crystalline lenses, who underwent lensectomy from 2004 to 2018 and who used scleral contact lenses for refractive correction. Collected data from the follow up period included recorded aphakic refraction and visual acuity, complications following scleral contact lens wear documented in the clinic and ophthalmic emergency room and compliance to lens wear according to parental feedback on every visit in the clinic.76% of cases, with final best corrected visual acuity (BCVA) of 20/40 or better achieved in seventeen eyes (34%). The rate of amblyopia was 50%. Strabismus developed in 56% of children, and those had less favourable visual outcomes (0.43 ± 0.4 LogMAR without strabismus and 0.8 ± 0.5 LogMAR with strabismus, p = 0.015). No corneal infections were documented during the follow up. Main adverse effect on the ocular surface was superficial punctate keratopathy (n = 16). Compliance was good in 48 children (96%)- except for two cases, the scleral lenses were tolerated well by all children.Scleral contact lenses are an effective means of visual rehabilitation in aphakic children after lensectomy and may be used long-term with good compliance of wear, excellent visual outcomes, and tolerable adverse events.

PURPOSE Intraocular lens (IOL) power calculation in eyes with keratoconus typically results in hyperopic postoperative refractive error. The purpose of this study was to investigate the visual and refractive outcomes in patients with keratoconus having cataract surgery with a toric IOL and compare IOL power calculation accuracy of conventional formulas and keratoconus-specific formulas. SETTING Ein-Tal Eye Center, Tel-Aviv, Israel. DESIGN Retrospective case-series study. METHODS Postoperative visual acuity and manifest refraction were examined. The error in predicted refraction and IOL power calculation accuracy within a range of 0.50 to 2.00 diopters (D) were compared between different IOL calculating formulas. RESULTS 32 eyes with keratoconus were included. Visual acuity improved in all cases, and subjective astigmatism decreased from -2.95 ± 2.10 D to -0.95 ± 0.80 D (P < .001). The mean absolute errors were as follows: Barrett True-K formula for keratoconus with measured or predicted posterior corneal power, 0.34 D; Barrett Universal II formula, 0.64 D; Kane formula, 0.69 D; Kane formula for keratoconus, 0.49 D; SRK/T formula, 0.56 D; Haigis formula, 0.72 D; Holladay 1 formula, 0.71 D, and Hoffer Q formula, 0.87 D. Barrett True-K formula with measured posterior corneal power, SRK/T formula, and Kane formula for keratoconus resulted in a prediction error within ±0.50 D of 87.5%, 59.4%, and 53.1%, respectively. CONCLUSIONS Cataract removal with a toric IOL significantly improves visual acuity and decreases astigmatism in keratoconic eyes with a topographic central relatively regular astigmatic component. Keratoconus-specific formulas resulted in lower mean error in predicted refraction compared with conventional calculating formulas. Using the posterior corneal power within the Barrett True-K formula for keratoconus improved IOL power prediction accuracy.

PURPOSE To examine the efficacy of preoperative administration of topical atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) for prevention of intraoperative floppy iris syndrome (IFIS). METHODS In this retrospective cohort study, patients who underwent cataract surgery by phacoemulsification between July 2019 and February 2020 in two hospitals were included. Both hospitals are located in central Israel, have similar patient demographics and employ similar surgical techniques. They, however, differ in policy of IFIS prevention. In Meir Medical Center no preventive medications are given pre-operatively, while in Shamir Medical Center patients at-risk for IFIS receive topical atropine 1% once daily and non-steroidal anti-inflammatory drugs (NSAIDs) thrice daily for 3 days preoperatively. RESULTS Overall, 207 eyes of 207 patients with history of alpha-antagonist use were included. Mean age was 74.9 ± 7.8 years and 82.1% (n = 170) were male. Among patients from the pretreating center 86.8% (n = 92/106) were pre-treated with either NSAIDs or atropine preoperatively, while in the non-pretreating center no treatment was prescribed (n = 0/101). IFIS rate among the non-pretreating center was 29.7% (n = 30/101) compared to 15.1% (n = 16/106) in the pretreating center (p = 0.012). When strictly comparing treated to untreated patients, the treated group had an IFIS rate of 12.0% compared to 30.4% among untreated (p = 0.001). Adjusted for age and gender results remain consistent (odds ratio 0.329 for treated patients, 95% confidence interval: 0.150-0.720; p = 0.005). CONCLUSIONS IFIS rates were significantly lower in the pretreating center compared to the non-pretreating center. When comparing strictly treated to untreated patients, differences were even more pronounced.

Purpose To describe the initial experience with the Assia Pupil Expander 200 (APX-200, APX Ophthalmology) in eyes that underwent phacoemulsification or intraocular lens repositioning surgery that required mechanical pupil expansion. Setting Department of Ophthalmology, Meir Medical Center, Kfar-Saba, and Ein-Tal Eye Center, Tel Aviv, Israel. Design Retrospective case series. Methods The APX-200 is a single-use device, intended for mechanical expansion of the pupil during intraocular surgery. Two devices are inserted through 2 opposite 19-gauge incisions using designated forceps. The surgical course and early postoperative follow-up was recorded in 50 eyes. Results The study included 50 consecutive eyes, with mean preoperative pupil diameter was 3.7 mm. The APX effectively dilated the pupils in all cases. No complication related to the use of the APX such as hyphema, iridodialysis, or Descemet membrane detachment were noted in this series. A central and round pupil was restored in all eyes at 1-month postoperatively, with 14 eyes (28%) having mild sphincter tears. Pupilloplasty was not required in any of the cases. Conclusions The APX-200 was an effective and safe device for pupil expansion during intraocular surgery.

Purpose To describe the technique of modified adjustable flange scleral fixation using 6-0 polypropylene sutures for repositioning of subluxated intraocular lenses (IOLs). Setting Center for Applied Eye Research, Meir Medical Center, and the Ein-Tal Eye Center, Israel. Design Case series. Methods Subluxated capsular-fixated posterior chamber IOLs are secured to the sclera using 6-0 polypropylene sutures looped around the IOL haptics. This method can be performed for any type of IOL: hydrophobic, hydrophilic, silicone, or poly(methyl methacrylate); 1-piece or 3-piece; and with either closed-loop or open-loop haptics. It can also be used in conjunction with capsular stabilizing devices. Results In the 18 cases performed, successful repositioning with stable and central fixation of the IOLs was achieved. One eye required a repeated surgery due to suture slippage. The eyes recovered relatively quickly with noted quiescence as early as 1 week postoperatively. Patients did not complain of ocular irritation from the subconjunctival flange up to the 6-month follow-up period. In 1 case, a flange was exposed postoperatively but the patient refused additional intervention and developed intraocular infection 7 months postoperatively. Conclusions The adjustable 6-0 polypropylene flanged technique for IOL repositioning and scleral fixation was a relatively quick and simple method for management of subluxated IOLs. Complete coverage of the flange by conjunctiva and Tenon layer must be confirmed at the end of surgery.

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 (

To assess the effect of hypotensive drugs on light absorbance, discoloration, opacification and precipitate formation of IOLs.In this laboratory study, four types of IOLs (two hydrophilic-acrylic-L1 and L2, and two hydrophobic-acrylic-B1 and B2) were soaked in solutions containing Timolol-maleate 0.5%, Dorzolamide 2%, Brimonidine-tartrate 0.2%, Latanoprost 0.005%, Brimonidine-tartrate/Timolol-maleate 0.2%/0.5% and Dorzolamide/Timolol-maleate 2%/0.5%. Non-treated IOLs and IOLs soaked in balanced salt solution (BSS) served as controls. All Treated lenses were sealed in containers and placed in an oven at 82 degrees Celsius for 120 days. Each IOL was examined using four different techniques: light microscopy imaging, light absorbance measurements at 550 nanometers through the optic's center, assessment of by a scanning electron microscope (SEM), and energy dispersive Xray spectrometry (EDX).Ninety-eight IOLs were included. All BSS-soaked IOLs appeared clear with no significant discoloration or precipitate-formation. Light absorbance in these lenses was comparable to that of non-soaked, non-heated IOLs. No calcium or phosphate were detected in either of these groups. Light absorbance differed significantly between the four treated IOL types. The drops most affecting light absorbance differed between IOLs. Gross examination revealed brown and yellow discoloration of all IOLs soaked in Dorzolamide and Brimonidine-tartrate solutions, respectively. SEM demonstrated precipitates that differed in size, morphology and distribution, between different IOL-solution combinations. EDX's demonstrated the presence calcium and phosphor in the majority of precipitates and the presence of sulfur in brown discolored IOLs.In vitro, interactions between hypotensive drugs and IOLs induce changes in light absorbance, discoloration and precipitate formation.

PurposeTo report a technique for fixating posterior chamber intraocular lenses (PCIOLs) to the sclera by passing sutures through the lens materialMethodsCases in which PCIOLs were fixated to the sclera using trans-optic sutures were included in this series. Intra and post-operative complications were recorded, and lens position was assessed using slit lamp examination.ResultsFourteen cases were included in this series. In 9 cases the procedure was performed using 9-0 polypropylene in pseudophakic eyes to correct subluxation, centration, tilt or to replace a broken haptic. In 5 cases this technique was used for primary PCIOL fixation using a flanged 6-0 polypropylene suture in aphakic eyes. In all cases the lenses remained centered and stable at the end of follow up, and no post-operative complications occurred.ConclusionTrans-optic suturing is a safe and effective alternative method for fixation of IOLs in a variety of pseudophakic and aphakic clinical scenarios.

PURPOSE: To assess visual outcomes and patient satisfaction for trifocal and extended depth of focus (EDOF) intraocular lenses (IOLs) compared to monofocal IOLs with and without monovision. METHODS: Consecutive patients underwent bilateral cataract extraction surgery and implantation of either monofocal IOLs, monofocal IOLs using monovision, EDOF IOLs, or trifocal IOLs. Patients with preoperative biometric data, postoperative refraction, and visual acuity who completed a questionnaire regarding satisfaction and side effects were included. Visual outcome, spectacle independence, patient satisfaction, and subjective photic phenomena were assessed. RESULTS: Each group comprised 50 patients (100 eyes). The mean postoperative uncorrected distance, intermediate, and near visual acuities (logMAR) were: 0.17 ± 0.14 (Snellen 20/30), not applicable, and not applicable for monofocal; 0.08 ± 0.12 (Snellen 20/24), not applicable, and 0.07 ± 0.12 (Snellen 20/23) for monovision; 0.03 ± 0.08 (Snellen 20/21), 0.08 ± 0.12 (Snellen 20/24), and 0.23 ± 0.17 (Snellen 20/34) for EDOF; 0.07 ± 0.09 (Snellen 20/23), 0.08 ± 0.11 (Snellen 20/24), and 0.02 ± 0.06 (Snellen 20/21) for trifocal. Spectacle independence was reported by 36%, 70%, 74%, and 92% of patients, respectively. Postoperative halos and/or glare were experienced by 2%, 6%, 14%, and 38%, respectively, of which 2%, 0%, 6%, and 10%, respectively, were functionally disturbing. A total of 64%, 72%, 78%, and 76%, respectively, would choose the same IOL again. CONCLUSIONS: Patient satisfaction rates were high in all groups. Trifocal IOLs were more effective in improving unaided whole range of vision, but were associated with a higher rate of photic phenomena. The EDOF IOL and monovision provided partial spectacle independence with less photic phenomena. [ J Refract Surg. 2019;35(7):434–440.]

Purpose To evaluate the use of the 2nd generation capsular anchor in the treatment of subluxated crystalline and synthetic intraocular lenses. Setting Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel. Design Prospective interventional study. Methods This study evaluated the 2nd generation capsular anchor, a 3-dimensional polymethyl methacrylate (PMMA) intraocular implant designed to anchor the lens capsule to the sclera. All surgeries were performed by a single surgeon. Intra and post-operative complications were recorded. Best corrected visual acuity, lens centration and lens tilt were assessed at the final follow up of three months. Results Ten eyes of 10 patients were included in this study. Average age was 56.2 (22-87). The reasons for the lack of zonular support were pseudoexfoliation in 3 cases, trauma in 3 cases, Marfan, Ectopia lentis and pathologic myopia (1 case each). In one case PXF and a history of recent trauma co-existed. Eight of the ten surgeries were due to subluxation of crystalline lenses and 2 due to subluxation of intraocular lenses. Vision improved in all patients after surgery. Centration of the IOLs was excellent in all patients at the 3rd post-operative month. One patient developed a retinal detachment at the 3rd post-operative week and underwent successful surgery, and one patient developed macular edema at the 5th post-operative month which resolved with topical medication. Conclusion The 2nd generation capsular anchor, designed to provide significant improvements over the 1st generation device, is effective in fixating the capsular bag to the scleral wall in cases with inadequate capsular support.

Purpose To describe the technique and outcomes of modified adjustable flange intrascleral fixation using 6-0 polypropylene sutures in primary scleral fixation in a variety of intraocular lenses (IOLs) and capsular stabilizing devices. Setting Center for Applied Eye Research, Meir Medical Center, Israel. Design Case series. Methods Laboratory studies were performed to test the feasibility of passing 6-0 polypropylene sutures through hydrophobic and hydrophilic IOLs. The durability of the IOL, suture, and created flange was tested. IOL implantation was performed first on porcine eyes with assessment of IOL position. Surgery was then performed using this adjustable flange technique using a variety of IOLs, including hydrophilic, hydrophobic, and poly(methyl methacrylate) aniridic IOLs and the capsular anchor (AssiAnchor) to stabilize the capsular lens in eyes with compromised zonular fibers. Results Surgery was performed on 9 eyes. Both hydrophobic and hydrophilic IOLs together with the 6-0 polypropylene suture were sufficiently durable in laboratory tests. Intrascleral fixation of 3 hydrophobic IOLs and 1 hydrophilic IOL was successfully achieved in 4 aphakic eyes. Stable and secure capsular bag fixation using the AssiAnchor was achieved in 4 eyes. Fixation of an aniridia IOL was also performed with success in 1 eye. All cases had stable and securely fixated IOLs and good postoperative recovery at 3 months follow-up. There was improvement in uncorrected distance visual acuity postoperatively in all cases. Conclusions The modified adjustable flange technique for scleral fixation using polypropylene 6-0 was effective, relatively quick, and technically simpler and safer than alternative methods in the management of aphakia and zonular instability.

Purpose To describe and discuss the presentation and management of 4 cases of late (17 to 20 years) postoperative spontaneous posterior capsule rupture (PCR) and intraocular lens (IOL) subluxation in eyes implanted with the same hydrophilic 1-piece IOL. Setting Center for Applied Eye Research, Meir Medical Center and the Ein-Tal Eye Center, Israel. Design Case series. Methods Four patients presented with spontaneous rupture and posterior dislocation of the same design IOL (B-Lens) 17 to 20 years after implantation. No trauma or any other direct causative factor was identified in any of the cases. Results Of the 4 cases reported, the IOLs were successfully repositioned to the ciliary sulcus and sutured to the scleral wall (1 case) or the iris (2 cases), and the IOL was stable in the sulcus without the need for further sutured fixation in 1 case, with effective vision restored in all cases. Conclusions Spontaneous PCR is a rare postoperative complication and has not been reported, to the authors' knowledge, in cases without predisposing factors. A mechanism of late capsular tear was not confirmed, but the specific design of the IOL might have been a contributing factor.

PURPOSE: To evaluate different calculation approaches for toric intraocular lens (IOL) calculation in cases with high posterior corneal astigmatism (PCA). METHODS: Consecutive patients who underwent cataract extraction with implantation of toric IOLs by a single surgeon were reviewed. Eyes with measured PCA of 0.80 diopters (D) or greater were included. Errors in the predicted postoperative refractive astigmatism were calculated for the Abulafia-Koch formula, vector summation of anterior keratometry with posterior tomography, and the Barrett toric calculator using predicted and measured PCA. RESULTS: One hundred seventy-three consecutive cases of toric IOL implantation were reviewed. Seventeen eyes (10%) had PCA of 0.80 D or greater and were investigated. The mean absolute error was the lowest with Barrett's measured PCA (0.55 ± 0.38) followed by Barrett's predicted PCA mean absolute error (0.65 ± 0.31), vector summation (0.69 ± 0.33), and the Abulafia-Koch formula (0.80 ± 0.36). The rate of eyes with prediction errors within 0.25 D or less was the highest for Barrett's measured PCA (29.4%) followed by Barrett's predicted PCA (5.9%) and no eyes for the Abulafia-Koch formula and vector summation. The mean centroid prediction errors were lowest for Barrett's measured PCA and Barrett's predicted PCA (0.14 ± 0.66 @70, 0.14 ± 0.73 @179, respectively), followed by vector summation (0.35 ± 0.70 @5), and the Abulafia-Koch formula (0.39 ± 0.80 @179). CONCLUSIONS: The results suggest that in cases of high PCA, the Barrett toric calculator using direct measurements of PCA may have a potential advantage over predicted PCA in toric IOL calculations and vector summation of the anterior and posterior corneal astigmatism. [ J Refract Surg . 2020;36(12):820–825.]

To present updated risk factors, anatomical and visual outcomes and a surgical approach to posteriorly dislocated intraocular lenses (IOL). A retrospective case series review of patients presenting with posteriorly dislocated IOL to the vitreous was performed. All cases were managed surgically with pars plana vitrectomy (PPV) followed by IOL repositioning and refixation or IOL exchange. Clinical characteristics, risk factors for IOL dislocation, visual outcomes and intraoperative and postoperative complications were investigated. Forty patients with posteriorly dislocated IOL underwent 3-port PPV and lens retrieval at an average of 6.5 years after cataract surgery. The main causes of IOL dislocation were previous PPV, myopia, pseudoexfoliation syndrome, ocular trauma and recurrent intravitreal injections. The existing IOL was repositioned and secured in 90% of the cases. Visual acuity improved in 34 patients, maintained in 5 and deteriorated in 1. All IOLs were central and stable at final follow-up. Posterior intraocular lens dislocation is becoming more prevalent. The main underlying causes found in this series were previous vitrectomy, myopia and recurrent intra-vitreal substance injections. Visual acuity improved in most cases after lens repositioning; however visual outcome is often limited due to associated ocular co-morbidities despite adequate lens position. Despite complete lack of zonular support, a posteriorly dislocated IOL can often be preserved by repositioning and fixation of the lens in the posterior chamber. Pathologies primarily associated with this type of lens malposition include history of vitrectomy, high myopia and multiple intravitreal substance injections.

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.

PURPOSE: To compare ocular measurements of three optical biometry devices and their application in intraocular lens (IOL) power calculations. METHODS: One hundred and forty eyes which had undergone cataract extraction surgery with preoperative biometry with OA­-2000, IOLMaster-500, and Lenstar-LS900 were enrolled. Biometry measurements of the three devices were compared. The deviation of the postoperative refraction from the preoperative refractive target was calculated with different formulas (Barrett Universal II, Hoffer Q, Holladay I, and SRK/T). Errors in the predicted astigmatism using the Barrett toric calculator were calculated for the toric IOLs. Additional 6465 eyes in which the IOLMaster-500 failed to measure axial length (AL) were reviewed. The percentage of successful measurements using the OA-2000 in those eyes was calculated. RESULTS: High agreement was found between the three devices for AL, anterior chamber depth, and average keratometry measurements (interclass correlation confidents: 1.000, 0.970, and 0.998, respectively, P

Purpose:Fracture of a three-piece polyimide–elastimide intraocular lens at the optic–haptic junction following blunt trauma is a possible complication after cataract surgery. We report a case of an isolated posterior chamber intraocular lens fracture caused by direct ocular blunt trauma.Case:A 51-year-old patient underwent blunt orbital trauma caused by a raw chicken egg that was thrown at him, as he was walking. The posterior chamber intraocular lens was found in the anterior chamber, with a broken optic–haptic junction. The intraocular lens was exchanged, followed by iris fixation and pupilloplasty, with satisfactory postoperative anatomical and optical outcomes.Discussion:The three-piece polyimide–elastimide intraocular lens was fractured at the optic–haptic junction. Although the fractured intraocular lens surface had a regular appearance, it has been previously reported that the polyimide haptic’s durability is probably inferior to that of polymethylmethacrylate. Therefore, it is highly susceptible to shear stress induced by a blunt trauma.Conclusion:To our knowledge, this is an uncommon report of an implanted posterior chamber polyimide–elastimide intraocular lens fracture following blunt orbital trauma. Intraocular lens exchange and fixation had successful optical and anatomical results.

To compare the accuracy of intraocular lens power prediction for eyes with average keratometry (K) readings greater than 46.00 diopters (D) and lower than 42.00 D.Ein-Tal Eye Center, Tel-Aviv, Israel.Retrospective case series.Eyes having cataract extraction surgery with steep and flat preoperative corneal curvatures determined with the Lenstar-LS900 device were enrolled. Refractive prediction errors for the Barrett Universal II, Haigis, Hill-RBF, Hoffer-Q, Holladay 1, Holladay 2, Olsen, and SRK/T formulas were compared. Optimized K values for the SRK/T formula were back-calculated for each group. Validation was performed using an additional dataset.The study comprised 171 eyes (79, K reading46.00 D; 92, K reading42.00 D). For K readings greater than 46.00 D, myopic errors were noted using the SRK/T and Hill-RBF formulas and hyperopic errors using the Olsen C-constant and Haigis (-0.31 D, -0.17 D, 0.18 D, and 0.17 D, respectively). The percentage of eyes with an absolute error within ±0.50 D from target refraction ranged from 60.8% (SRK/T) to 83.0% (Hill-RBF). For K readings lower than 42.00 D, myopic errors were seen using the Haigis, Hill-RBF, Hoffer-Q, and Olsen-C formulas (-0.31 D, -0.14 D, -0.22 D, and -0.17 D, respectively) and a hyperopic error using the SRK/T formula (0.16 D). The refractive prediction within ±0.50 D ranged between 75.0% (Haigis) and 96.7% (Barrett Universal II).Power calculation for eyes with flat corneas and steep corneas requires the use of specific formulas for accurate postoperative results. An adjustment method of the SRK/T formula is proposed.

We report a case of successful intraocular foreign body/traumatic cataract removal and anterior segment reconstruction surgery of a patient’s eye that suffered penetrating injury 65 years earlier. Surgery was not recommended by ophthalmologists that she had earlier consulted. The patient opted for surgery to improve cosmesis due to leukocoria, but the level of regained vision exceeded expectations of both the patient and the surgeon. This case adds further evidence that the duration of occlusion time has no effect on visual potential in patients out of amblyogenic age. The ethical considerations of operating on such an eye with poor prognosis after traumatic injury are also discussed. To our knowledge, our patient has the longest reported duration (65 years) between the time of injury and successful surgery with good outcome.

Background Temperature profiles at the corneal wound of coaxial mini-incision (2.4 mm) cataract surgery and sleeveless micro-incision (1.1 mm) cataract surgery were compared. Design Prospective, controlled, paired-eye clinical trial conducted in a tertiary care hospital Participants Twenty patients with mild to moderate bilateral nuclear sclerotic cataract. Methods Twenty patients underwent bilateral cataract surgery within a one-month period. One eye was operated on by conventional coaxial mini-incision (2.4 mm) phacoemulsification. The second eye underwent microincision surgery using a naked phacoemulsification tip and a specialized 19-gauge anterior chamber maintainer as the sole fluid source (Tri-MICS technique). Patients had moderate bilateral cataracts with no other anterior segment pathology. Temperature at the corneal wound was constantly recorded using infrared thermal imaging. Main Outcome Measures Temperatures at the corneal wound Results Mean temperatures at the corneal surgical wound were not significantly different between the coaxial and sleeveless groups (31.1 °C ± 2.3 vs. 31.0 °C ± 2. 0; P = 0.89). There was also no difference in maximum temperatures reached during phacoemulsification. Temperatures did not rise above 40 °C during any surgery and there were no corneal burns. Final visual acuity and intra- and post-operative complication rates were similar between the two groups. Conclusions The temperature profile at the surgical wound using a micro-incisional sleeveless phacoemulsification technique is comparable to that of the conventional coaxial mini-incision method.

Purpose To compare the accuracy of different methods that consider posterior corneal curvature in toric intraocular lens (IOL) calculations. Setting Ein-Tal Eye Center, Tel-Aviv, Israel. Design Retrospective comparative case series. Methods Consecutive cases of toric IOL implantation and preoperative measurements by optical biometry with optical low-coherence reflectometry (OLCR) (Lenstar LS 900) and a Scheimpflug camera (Pentacam) were retrospectively reviewed. Five methods of toric IOL calculation were compared as follows: (1) anterior corneal astigmatism using OLCR, (2) application of the Baylor nomogram, (3) posterior tomography combined with anterior corneal measurements using vector summation, (4) the Scheimpflug camera's true net power, and (5) total corneal refractive power. Toric IOL astigmatic power and axis, aiming for the lowest residual astigmatism, were selected according to these methods. Simulated residual refraction was calculated for each method based on manifest refraction and measured IOL alignment more than 3 weeks after surgery. Results The study included 115 eyes of 92 patients. The median simulated residual astigmatism was lower when based on vector summation of anterior and posterior astigmatisms than with calculations based on anterior corneal measurements only, application of the Baylor nomogram, true net power, and total corneal refractive power readings (0.49 diopters [D] versus 0.70 D, 0.60 D, 0.64 D, and 0.76 D, respectively) (P Conclusions Residual astigmatism after toric IOL implantation can be reduced by appropriate consideration of the posterior corneal astigmatism. Using methods that take into account the effect of the posterior cornea in toric IOL calculations is suggested. Financial Disclosures Drs. Assia and Kleinmann are consultants to Hanita Lenses, Israel. Dr. Abulafia received a speaker's fee from Haag-Streit AG. No other author has a financial or proprietary interest in any material or method mentioned.

PURPOSE To present a surgical approach for the treatment of unstable anterior chamber intraocular lenses (ACIOLs). METHODS We present a series of 8 patients who underwent iris fixation of an unstable open-looped ACIOL associated with progressive corneal damage. The loops of the intraocular lens were firmly fixated to the iris using 9-0 or 10-0 polypropylene sutures. In 2 cases, iris fixation was associated with penetrating keratoplasty. The other cases were performed using a relatively closed-system technique. RESULTS All procedures were uneventful, with no intraoperative or postoperative complications. Suture fixation effectively prevented anterior-posterior or propelling movement. The ACIOLs in all cases were stable and well centered at the end of follow-up. CONCLUSIONS Fixation of an existing unstable angle-supported ACIOL to the iris is an effective and simple alternative to intraocular lens exchange and posterior chamber fixation.

To evaluate and compare the accuracy of different methods to measure and predict postoperative astigmatism with toric intraocular lens (IOL) implantation.Ein-Tal Ophthalmology Center, Tel-Aviv, Israel.Retrospective case series.Postoperative corneal astigmatism was measured with 3 devices (IOLMaster 500; optical low-coherence reflectometry [OLCR]-based Lenstar LS 900; Atlas topographer) and compared with the manifest astigmatic refractive outcome in patients with toric IOLs. The error in the predicted residual astigmatism was calculated by vector analysis according to the measurement and calculation method used to predict the required toric IOL cylinder power.The centroid errors in predicted residual astigmatism were against the rule with the Alcon and Holladay toric calculators (0.53 to 0.56 diopter [D]), were lower with the Baylor nomogram (0.21 to 0.26 D), and were lowest for the Barrett toric calculator (0.01 to 0.16 D) (P.001). The Barrett toric calculator had the lowest median absolute error in predicted residual astigmatism (0.35 to 0.54 D, all devices) compared with the Alcon and Holladay toric calculators with or without the Baylor nomogram (P.021). The Barrett toric calculator and the OLCR device achieved the most accurate results; 75.0% and 97.1% of eyes were within ±0.50 D and ±0.75 D of the predicted residual astigmatism, respectively.Prediction of astigmatic outcomes with toric IOLs can be improved with appropriate measuring devices and methods to establish the required toric IOL power.

PURPOSE: To compare the findings of three corneal measuring devices for calculating surgically induced astigmatism (SIA) during cataract extraction. METHODS: Patients’ records were retrospectively reviewed to identify patients who had corneal astigmatism measurements before and at least 1 month after cataract surgery through 2.4-mm corneal incisions by all three tested devices (Lenstar LS900, Haag-Streit, Koeniz, Switzerland; IOLMaster 500, Carl Zeiss Meditec, Dublin, CA; and Atlas topographer, Carl Zeiss Meditec). Vector analysis was used to calculate the SIA for each measuring device. RESULTS: Seventy eyes of 49 patients were included. All three measuring devices had similar SIA results: the median SIAs were 0.45 diopters (D) for the Lenstar, 0.41 D for the IOLMaster, and 0.47 D for the Atlas topographer ( P = .884). CONCLUSIONS: The three evaluated anterior corneal measuring devices produced similar results in measuring SIA. [ J Refract Surg. 2015;31(4):244–247.]

Purpose To evaluate and compare the accuracy of formulas and methods for calculating the intraocular lens (IOL) power for eyes with an axial length (AL) greater than 26.0 mm. Setting Ein-Tal Eye Center, Tel-Aviv, Israel. Design Retrospective case series. Methods The postoperative refraction results in myopic eyes with an AL over 26.0 mm were compared with the predicted refractions calculated using standard formulas (Holladay 1, SRK/T, Hoffer Q, and Haigis) with optical IOL constants, User Group for Laser Interference Biometry constants, and an AL-adjustment method and using new-generation formulas (Barrett Universal II, Holladay 2, and Olsen). Results In 76 (71.7%) of 106 eyes, the IOL was 6.0 diopters (D) or more (Group A) and in 30 eyes (28.3%) was less than 6.0 D (Group B). In Group A, the SRK/T, Hoffer Q, Haigis, Barrett Universal II, Holladay 2, and Olsen methods met the benchmark criteria of having a prediction error of ±0.5 D in at least 71.0% of eyes and ±1.0 D in 93.0% of eyes. In Group B, only the Barrett Universal II formula and the Holladay 1 and Haigis formulas using the AL-adjusted method met those criteria. Conclusion When selecting IOLs for high and extreme myopia, choosing appropriate formulas and methods can yield accurate refractive results that meet benchmark criteria. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Background To evaluate the accuracy of predicted refraction using multifocal intraocular lenses (IOLs) with power calculation based on two biometric devices and multiple IOL power calculation formulas. Design A retrospective study conducted in a private practice ophthalmology clinic. Participants Seventy-three eyes of 48 patients were evaluated. Methods Consecutive cases of eyes that had undergone successful cataract surgery with an implantation of a multifocal IOL (SN6AD1, Alcon Laboratories, Inc., Fort Worth, TX, USA) by a single surgeon were enrolled. Patients were meticulously screened for suitability for a multifocal IOL implantation according to our clinic guidelines. Two biometric measurement devices (IOLMaster-500 [Carl Zeiss Meditec AG, Jena, Germany] and Lenstar-LS900 [Haag-Streit AG, Koeniz, Switzerland]) were used under strict validation criteria to evaluate the predicted refraction errors for the Holladay 1, SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal II and Olsen formulas. Main Outcome Measures Predicted refractive sphere equivalent (RSE) errors. Results The measurements obtained from the two biometric devices were highly correlated. The standard deviation of the error in predicted RSE and the median absolute error were similar for the IOLMaster and the Lenstar devices using all formulas, ranging from 0.27 dioptres (D) to 0.31D and from 0.15D to 0.21D, respectively. A high percentage of eyes had an error in predicted RSE within ±0.5D from target refraction, ranging from 86.3% to 93.2%. Conclusions High accuracy can be achieved in multifocal IOL power calculations by appropriate patient selection, precise biometry and appropriate IOL calculation formulas.

Most glaucoma surgeries achieve intraocular pressure (IOP) reduction by penetrating the sclerotrabecular wall. Deep sclerectomy surgery aims to enhance aqueous drainage without penetrating the globe and also aims to avoid some of the severe complications associated with violating ocular integrity; however, this procedure is difficult to perform manually in a safe and effective way. CO2 laser has been suggested as a tool to facilitate deep, effective ablation over the ocular drainage system to reduce IOP without penetrating the eyeball in a procedure called CO2 laser-assisted sclerectomy surgery. In this study, the authors report the rationale of choosing this type of laser, the development of the laser delivery and control systems (IOPtiMate; IOPtima, Tel Aviv, Israel) and the experimental and clinical experience to date.

Intraocular lens (IOL) implantation in cases lacking sufficient capsular support is challenging to the anterior segment surgeon. If the anterior capsule is intact and with no tears at the capsulorhexis margin, then a sulcus fixation is preferred by most surgeons; however, square-edged one-piece hydrophobic lenses should be avoided. If there is no capsular support to ascertain stable fixation, then other alternatives are used, such as scleral fixation of a three-piece IOL, either by suturing or by placing the haptics in a scleral tunnel, iris fixation using sutures or iris claw lenses, and anterior chamber angle supported IOLs.

PURPOSE To evaluate the efficacy and safety of CO2 Laser-assisted Sclerectomy Surgery (CLASS) in primary and pseudoexfoliative open-angle glaucoma. MATERIALS AND METHODS Single-arm, open-label study included data from 9 medical centers located in 7 countries. Subjects underwent nonpenetrating CLASS procedure with a CO2 laser system (IOPtiMate). Intraocular pressure (IOP) and number of medications were measured at baseline, 1, 2, 4, and 6 weeks, and 3, 6, 12, 24, and 36 months. Complete success was defined as 5≤IOP≤18 mm Hg and at least 20% IOP reduction with no medications, and qualified success as the same with or without medications at 12, 24, and 36 months. RESULTS A total of 111 consecutive eyes were enrolled in the study, 14 were excluded from the study due to protocol deviation or operator error. The mean age was 69.3±12.8 and 73.9% were whites. Percent change in IOP from baseline at 1, 2, and 3 years was, respectively, 45.1%, 46.8%, and 42.5% (P

Evaluation of the medical data of patients with orbital and adnexal lymphoma. Cohort study of all cases diagnosed with orbital or adnexal lymphoma at Meir Medical Center between 1993 and 2007. Twenty-six patients, with intraorbital or subconjunctival masses with orbital involvement, were examined and followed up between 1 and 8 years. Examined data included: clinical presentation, age, gender, imaging, tumor location, surgical management, and pathological diagnosis. Presenting signs and symptoms included proptosis, eyelid lesions, tearing, chemosis, decreased visual acuity, ptosis, pain, squint, and optic nerve compression. In five cases, lymphoma was misdiagnosed on neuroimaging. Bone changes were seen in four patients. All cases were B cell lymphomas; with the majority (22 cases) of small B cell type; consisting of primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and two cases of small cell lymphoma. One small cell lymphomas was of follicular type on a background of CLL, and the other was CLL/SLL type. Fourteen cases were primary orbital disease, and 12 cases were systemic disease. Macroscopic appearance of lymphoma at open biopsy was characteristic in most cases. Flow cytometry phenotyping gave rapid reliable diagnosis of the disease. Epiphora or chemosis in the presence of an orbital mass should alert the ophthalmologist to suspect lymphoma. Lymphoma may be easily misinterpreted on neuroimaging for other diseases. Bone changes seen on CT are more common than is generally perceived. Macroscopic appearance at open biopsy was characteristic.

To investigate the effect of modern vaginal labor using epidural anesthesia on the intraocular pressure (IOP) and on the mean ocular perfusion pressure (MOPP) in healthy women.In this prospective observational study, eligible candidates were healthy pregnant women for vaginal delivery with epidural anesthesia, with a singleton pregnancy, who were admitted to the delivery room in the first phase of the first stage of labor. Demographic data as well as medical and obstetric history were obtained at baseline, followed by performance of a biomicroscopic examination. IOP, maternal heart rate, systolic blood pressure, and diastolic blood pressure were measured in the first, second and third stages of labor, 24±2 and 48±2 hours postpartum. IOP was not measured during the contraction phase of stage 2. MOPP was expressed as the difference between the arterial blood pressure and the IOP. Measurements were performed throughout the different stages of labor and were compared with baseline values.Thirty healthy white women were enrolled. Four women dropped out due to unexpected cesarean sections. The average age was 31.8±4.7 years. Nineteen participants received oxytocin during delivery. Twenty-three women were placed in a supine position, whereas 3 in a left decubitus position. No statistically significant changes were recorded in IOP (P=0.50) or MOPP (P=0.17) throughout the different stages of vaginal labor in this study.Vaginal delivery under epidural anesthesia is unlikely to cause significant damage to the optic nerve in healthy women.

Purpose of the study The purpose of the study was to investigate results of selective laser trabeculoplasty (SLT) performed directly on the sclera without a gonioscopy lens. Design Interventional case series, prospective, randomized, masked, controlled clinical trial. Methods Setting: Meir Medical Center, Kfar-Saba, Israel. Study population Adults with uncontrolled primary open angle or pseudoexfoliation glaucoma randomized into 2 groups. Intervention The controls underwent conventional SLT with 100 spots delivered using a gonioscopy lens for 360 degrees of the trabecular meshwork. The study group underwent irradiation using the same parameters with the laser applications administered on the perilimbal sclera. Study visits: 1 hour, 1, 7, 30, 60, 180, and 365 days postprocedure. Main outcome measures Intraocular pressure (IOP) and side effects. Results Thirty adults were randomized into 2 groups. The mean (±SD) pretreatment IOP was 20.21±3.19 mm Hg for the study group (n=14) and 21.14±2.98 mm Hg for the controls (n=14; P =0.43), dropping to 15.50±3.77 and 15.00±4.08 mm Hg (P =0.74) after 6 months and to 16.00±3.31 and 14.00±2.45 mm Hg (P =0.22) after 12 months. The average IOP reduction after 6 and 12 months was 23.4% and 20.83% for the study group and 27.1% and 33.77% for the controls (P=0.528). Success (a decrease of ≥15% at 6 months with no additional medications, laser, or glaucoma surgery) was achieved in 12 (85.7%) study patients and 9 (69.2%) controls (P=0.385). Complications were mild and transient (n=30), although significantly higher in the controls (n=15; P Conclusions SLT applied directly to the perilimbal sclera may be as efficacious as the conventional procedure for 1 year.

Purpose To report our experience with intra-silicone oil (SO) injection of antiviral agents for treatment of viral retinitis and to review the relevant literature. Design Two case reports and a literature review. Participants Two patients with viral retinitis and SO tamponade. Methods Two patients with viral retinitis were treated with intravitreal injections of low-dose ganciclovir (2 mg/0.05 ml), foscarnet (1.2 mg/0.05 ml), or both after retinal detachment repair with SO tamponade, in addition to systemic antiviral therapy from 2014 through 2015. The literature on the use of intraocular antiviral agents in the setting of SO vitreous substitute was reviewed. Main Outcome Measures Clinical outcomes after administration of intra-SO antiviral therapy. Results A patient with progressive outer retinal necrosis received 5 intra-SO injections of low-dose ganciclovir and foscarnet after surgery over 6 weeks. Another patient with acute retinal necrosis received weekly low-dose foscarnet injections into his SO-filled eye for 8 weeks after surgery. Significant retinitis regression with long-term retinitis control was achieved in both patients throughout follow-up. No articles reporting the administration of soluble antiviral agents into an SO-filled human eye were identified. Conclusions Our preliminary findings indicate that administration of low-dose ganciclovir and foscarnet into an SO-filled eye may be used as adjunctive treatment for viral retinitis. Further studies are needed to confirm these results.

Developing a one-second automatic glaucoma treatment using trans-scleral laser trabeculoplasty (LTP) without a gonioscopy lens Purpose: Developing an LTP device for delivering multiple simultaneous trans-scleral applications of low energy laser irradiation to the trabecular meshwork (TM) for reducing Intraocular Pressure (IOP). Methods: Concept proof: A randomized, masked, controlled one was performed on open angle glaucoma patients. The control group underwent conventional SLT (100 laser spots through a gonioscope for 360 degrees directly on the TM). The trial group underwent irradiation by the same laser at the same irradiation parameters on the sclera overlying the TM. Topical glaucoma therapy was not changed during the 12 months trial. Feasibility trial: Using optimized laser parameters, 60 discrete applications were administered on similar locations of patients’ sclera. Results: Concept proof: Trans-scleral applications: (N=15), IOP decrease from 20.21 mmHg before treatment to 16.00 (27.1%) at one year. The corresponding numbers for the control group (n=15), were 21.14 mmHg and 14.30 (23.4%). There was no statistical difference between the two groups in IOP reduction. The complications rate was significantly higher in the control group. Trial 2: IOP was reduced from an of 25.3 mmHg to 19.3 (23.7%) in the 11 patients. Conclusions: Laser coherency, lost in tissue transmission, is not required for the therapeutic effect. The new method will possibly enable treatment of angle closure glaucoma as well as simultaneous applications of all laser spots to the sclera. When used conjointly with target acquisition, will make feasible an automatic glaucoma treatment in less than one second.

Background To assess the surgical procedure, safety and stability of a next generation injectable telescope prosthesis in a rabbit model. Methods After removal of the crystalline lenses of eight New Zealand White rabbits, the next generation device was randomly implanted in one eye, and the available telescope prosthesis (Normal device) was implanted in the fellow eye. Operative parameters (incision, capsulorrhexis size and operative time), intraoperative and postoperative complications rates, endothelial cell density changes and the distance between the corneal endothelium and the telescope (central clearance distance) were measured and compared between the groups. Results Incision size and capsulorrhexis size were smaller, and operative time was shorter in the next generation group in comparison with the Normal group. No difference was found in the intraoperative and postoperative complication rates between the groups. Endothelial cell density loss observed in the next generation group was less than the loss in the Normal group, but the difference was not significant statistically. The central clearance distance was significantly larger in the next generation group in comparison with the Normal group (P = 0.001). Conclusions The next generation telescope was implanted through a smaller incision, with a shorter surgical time and a larger central clearance distance in the rabbit eyes, in comparison with the Normal group. The next generation device may allow reduced trauma to the corneal endothelium, better control during surgery and induce less astigmatism while preserving the optical advantages of the Food and Drug Administration-approved telescope prosthesis.

PURPOSE To carry out a pilot study comparing the size of various types of metallic intraocular foreign bodies as imaged on computed tomographic (CT) scan to their actual size, and to determine the features of different types of metals on CT scan. METHODS Metallic foreign bodies of predetermined standardized sizes were prepared from iron, silver, copper, aluminium, and lead. The metallic pieces/shards were each inserted into the vitreous of a cow's eye and helical CT scan (MX twin, Picker) was performed to image the intraocular foreign bodies, using soft tissue and bone window settings. Slice section thickness was 1.3 mm, with intervals of 0.6 mm. Milliampere per second was 265 and pitch 0.7. RESULTS The size of all types of metals as measured on CT was larger than the actual size. Iron was enlarged by a factor of 2.29, silver 1.77, copper 1.26, and aluminum 1.17. All metals had features including central core, ring density, and artifacts which varied for each type of metal, giving each one a characteristic appearance CONCLUSIONS Helical CT scan could be useful in estimating the type and size of an intraocular metal foreign body made from iron, silver, copper, aluminium, or lead.

Young children are prone to develop amblyopia after penetrating injury. We sought to evaluate the management of penetrating corneal injury without intraocular foreign body (IOFB) in childrenor=7 years old and to assess the long-term visual acuity results.A retrospective chart review was performed in 2 ophthalmology departments to identify childrenor=7 years old with penetrating corneal injury from sharp objects that had follow-up of18 months. Data retrieved included all details from the initial examination, surgical procedures, amblyopia prevention measures, and final visual acuity.Twenty children eligible for the study were identified. The mean age was 4.3 years, and mean follow-up time was 58 months. The corneal wound size range was 1-10 mm, with 8 eyes having woundsor=6 mm. All patients required primary surgical management. Traumatic cataract extraction was performed at the primary operation in 6 eyes, with intraocular lens (IOL) implantation in 4 eyes. Additional surgical procedures were performed in 12 eyes. Yttrium-Aluminum-Garnet (YAG) capsulotomy was performed in 3 eyes with secondary cataract. Twelve patients required spectacle or contact lens correction, and 11 patients had patching for amblyopia prevention. At the end of follow-up, visual acuity was 20/40 or better in 14 eyes, 20/50 to 20/100 in 4 eyes, no light perception (NLP) in 1 eye, and unknown in 1 eye.Proper management of penetrating corneal injury in young children can result in excellent visual rehabilitation. Major measures include prompt traumatic cataract extraction with either primary or secondary IOL implantation, opening of posterior capsular opacification with YAG laser, correction of refractive errors, and patching for amblyopia prevention.

Purpose To describe a new device for repositioning and scleral fixation of the capsular bag of subluxated lenses in experimental models. Setting Laboratory for Experimental Microsurgery, Meir Medical Center, Kfar-Saba, Israel. Methods The capsular anchoring device is a poly(methyl methacrylate) 1-plane implant consisting of 2 handles that grasp the edges of the capsulorhexis and a base for scleral fixation with a single 10-0 or 9-0 polypropylene suture. A temporary safety suture can be used to facilitate manipulations and prevent loss of the device through the zonular defect until it is secured to the scleral wall. The device was implanted in porcine eyes and living rabbit eyes. An animal model of lens subluxation was achieved by tearing about one third of the zonules. Capsule centration, implant stability, and inflammatory reaction were evaluated 2 to 4 weeks after implantation in the living model. Results The device was implanted in 7 porcine eyes and 9 living rabbit eyes. A lens subluxation model was created in 4 porcine eyes and 2 rabbit eyes. The device effectively pulled the capsular bag to the center and remained stable up to 4 weeks thereafter. Very large zonular dialysis (>5 hours) was managed using 2 devices. Successful intraocular lens implantation was done repeatedly in the presence of the device. The implant was well tolerated in all rabbit eyes. Histopathological examination of the enucleated eyes revealed no inflammatory reaction or adhesions. The margin of the anterior capsulorhexis remained intact in all cases. Conclusions Experimental studies of a capsular anchoring device for subluxated lenses confirmed the safety and efficacy of the new device. A capsular tension ring can also be inserted separately to further stabilize the capsular bag.

To examine the role of the water-soluble antioxidants glutathione and ascorbic acid in the irrigating solution on corneal endothelial cells following exposure to high-intensity ultrasound energy.Goldschleger Eye Research Institute, Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel.Thirty-two rabbit eyes were subjected to prolonged exposure to the phacoemulsification device in the anterior chamber. The eyes were divided into 4 groups that differed only in the composition of the irrigating solution applied to the eyes: balanced salt solution (BSS) BSS Plus BSS containing additional soluble components including glutathione, BSS with 10(-3) M of oxidized glutathione (GSSG), and BSS with 10(-2) M of ascorbic acid. Specular microscopy was performed preoperatively and 1 week after surgery.The BSS group exhibited the highest endothelial cell loss (19.3%), followed by the BSS Plus group (10.6%), the GSSG group (5.2%), and the ascorbic acid group (0.9%). An overall difference was found between the groups (F = 11.046, P.0001), and all groups demonstrated a statistically significant difference from the control BSS group (P.02, P = .001, and P.0001, respectively).Damage to the cornea is largely due to the free radicals generated by high-intensity ultrasound energy during phacoemulsification. Adding the antioxidants ascorbic acid and GSSG to the irrigation solution significantly reduced the endothelial corneal cell damage. Ascorbic acid in the concentration of 10(-2) M had the highest protective effect; thus, it should be evaluated for clinical use.

Purpose To evaluate and compare the accuracy of 2 toric intraocular lens (IOL) calculators with or without a new regression formula. Setting Ein-Tal Eye Center, Tel-Aviv, Israel, and the Lions Eye Institute, Nedlands, Western Australia, Australia. Design Retrospective case series. Methods A new regression formula (Abulafia-Koch) was developed to calculate the estimated total corneal astigmatism based on standard keratometry measurements. The error in the predicted residual astigmatism was calculated by the Alcon and Holladay toric IOL calculators with and without adjustments by the Abulafia-Koch formula. These results were compared with those of the Barrett toric calculator. Results Data from 78 eyes were evaluated to validate the Abulafia-Koch formula. The centroid errors in predicted residual astigmatism were against-the-rule with the Alcon (0.55 diopter [D]) and Holladay (0.54 D) toric calculators and decreased to 0.05 D ( P x -axis], P = .776 [ y -axis]) and 0.04 D ( P x -axis], P = .726 [ y -axis]) with adjustments by the Abulafia-Koch formula. The Alcon and the Holladay toric calculators had a higher proportion of eyes within ±0.50 D of the predicted residual astigmatism with the Abulafia-Koch formula (76.9% and 78.2%, respectively) than without it (both 30.8%). There were no significant differences between the results of the Abulafia-Koch-modified Alcon and the Holladay toric calculators and those of the Barrett toric calculator. Conclusion Adjustment of commercial toric IOL calculators by the Abulafia-Koch formula significantly improved the prediction of postoperative astigmatic outcome. Financial Disclosure Dr. Abulafia received a speaker's fee from Haag-Streit AG. Dr. Barrett has licensed the Barrett Toric Calculator to Haag-Streit AG. Dr. Koch is a consultant to Alcon Laboratories, Inc., Abbott Medical Optics, Inc., and Revision Optics, Inc. Dr. Hill is a paid consultant to Haag-Streit AG and Alcon Laboratories, Inc. None of the other authors has a financial or proprietary interest in any material or method mentioned.

We aimed to report a simple technique that involves modified anterior (to the limbus) elongated corneal incisions in order to reduce the incidence and severity of intraoperative floppy iris syndrome (IFIS) and related complications. This was a retrospective study of phacoemulsification cataract surgeries performed by a single surgeon on patients receiving tamsulosin or alfuzosin between 1 January 2009 and 31 July 2012 at Meir Medical Center, Kfar-Sava, Israel. We recorded preoperative gender, age, α-antagonist medication, coexisting pseudoexfoliation (PXF), and intraoperative use of ophthalmic viscosurgical devices (OVDs), pupil size, complications, IFIS grading and the need for additional operative strategies to manage IFIS. Elongated corneal incisions were performed approximately 1 mm anterior to the limbus. Ninety-three eyes of 81 men were included. Mean age was 76.5 years (range 55 to 96 years). Forty-seven eyes (40 patients) had documented use of alfuzosin and 45 eyes (40 patients) of tamsulosin. One patient received both. The overall rate of IFIS was 22.6 % (n = 21). Eyes of patients who were treated with alfuzosin had a milder grading (p

Marfan syndrome is a widespread disorder of connective tissue. It is characterized by systemic and ocular features due to mutations in the fibrillin gene. Awareness and prompt recognition of the ocular complications of Marfan syndrome may enable improvement and preservation of sight. Studies have been performed in the last few years that enable a better understanding of the genetics of the syndrome, earlier diagnosis, and improvement in the surgical techniques and options.