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Purpose: To compare the visual outcomes and complication rates between the extra-ocular needle-guided haptic insertion technique (XNIT) and the conventional handshake (HS) technique of scleral fixation intra-ocular lens (SFIOL). Methods: In this retrospective study, we retrieved data of those patients who had undergone SFIOL surgery from January 2018 to May 2022 at our institute for aphakia following either a complicated cataract surgery or an ocular trauma and had a minimum follow-up of 3 months. Results: Of the 156 eyes, the HS technique was done in 80 eyes and the remaining 76 eyes with XNIT. At 3 months follow-up visit, there was no significant difference in the median best corrected visual acuity (BCVA) (P = 0.988) and uncorrected visual acuity (UCVA) (P = 0.765) between the two techniques. There was no statistically significant difference between pre-operative median BCVA and post-operative UCVA in XNIT (P = 0.961) and the HS technique (P = 0.831) at 3 months follow-up visit. The complication rates between the two techniques were minimal and comparable. The most common post-operative complication was corneal edema. The incidence of cystoid macular edema was slightly more in the XNIT group but not statistically significant (P = 0.05). Two patients in the HS group developed retinal detachment, which settled after repeat surgery. Conclusion: The newer XNIT technique was found to be as safe and effective as compared to the conventional HS technique. [ABSTRACT FROM AUTHOR]

Purpose: Trabeculectomy surgery is a commonly performed procedure for treatment of glaucoma. While the goal is to lower intraocular pressure, over-filtration may cause hypotony with ocular structural changes and vision loss. Observations: A 53-year-old woman with primary open-angle glaucoma was referred to our service for further evaluation. The patient previously underwent trabeculectomy 9 years prior and was found to have a cataract and hypotony maculopathy in the right eye. Treatment options included cataract surgery alone, bleb revision alone, or combined cataract extraction and bleb revision. Biometry revealed corneal astigmatism in the right eye, and significant disparity in axial length between the two eyes. Since the axial length and corneal astigmatic changes were presumed to be at least partially reversible, measurements from the non-operative left eye influenced the lens selection for the hypotonous right eye. The patient underwent combined phacoemulsification and bleb revision. While IOP increased and hypotony was partly reversed, there was hyperopic and astigmatic refractive surprise after surgery.The patient subsequently underwent intraocular lens exchange using biometric values of the previously hypotonous eye and met the target post-operative refractive goal. Conclusions and importance: This case demonstrates changes to the axial length and ocular structure following longstanding hypotony maculopathy may be permanent, even after restoration of normotensive intraocular pressure.

Purpose: To compare the visual outcomes and complication rates between the extra-ocular needle-guided haptic insertion technique (XNIT) and the conventional handshake (HS) technique of scleral fixation intra-ocular lens (SFIOL). Methods: In this retrospective study, we retrieved data of those patients who had undergone SFIOL surgery from January 2018 to May 2022 at our institute for aphakia following either a complicated cataract surgery or an ocular trauma and had a minimum follow-up of 3 months. Results: Of the 156 eyes, the HS technique was done in 80 eyes and the remaining 76 eyes with XNIT. At 3 months follow-up visit, there was no significant difference in the median best corrected visual acuity (BCVA) (P = 0.988) and uncorrected visual acuity (UCVA) (P = 0.765) between the two techniques. There was no statistically significant difference between pre-operative median BCVA and post-operative UCVA in XNIT (P = 0.961) and the HS technique (P = 0.831) at 3 months follow-up visit. The complication rates between the two techniques were minimal and comparable. The most common post-operative complication was corneal edema. The incidence of cystoid macular edema was slightly more in the XNIT group but not statistically significant (P = 0.05). Two patients in the HS group developed retinal detachment, which settled after repeat surgery. Conclusion: The newer XNIT technique was found to be as safe and effective as compared to the conventional HS technique.

Nisa Silva,1,&ast; André Ferreira,1,2,&ast; Natália Ferreira,1 Bernardete Pessoa,1,3 Angelina Meireles1,3 1Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, 4099-001, Portugal; 2Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, 4200-319, Portugal; 3Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, 4050-313, Portugal&ast;These authors contributed equally to this workCorrespondence: Nisa SilvaDepartment of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto, 4099-001, PortugalTel +351 22 207 7500Email nisapinhosilva@gmail.comBackground: The main options for intraocular lens (IOL) placement without capsular bag support and/or zonular weakness are iris-fixated IOL and scleral-fixated IOL (SFIOL).Purpose: To describe the surgical technique and the outcomes of intrascleral knotless zigzag suture fixation of Akreos AO60 foldable IOL.Methods: Retrospective cohort study of consecutive cases.Results: Ninety-nine eyes of 92 patients were retrospectively studied. The mean age was 72.1± 15.2 years (range 18– 94), and the median follow-up duration was 19.5 months (range 3– 81). The best-corrected visual acuity improved from a mean±SD of 1.34± 0.70 logarithm of the minimum angle of resolution (logMAR) units at baseline to 0.49± 0.56 logMAR at the end of follow-up (p< 0.001). The mean±SD final SE was − 1.24± 1.82 diopters. The mean±SD prediction error was − 0.51± 1.16 diopters. The overall perioperative complications rate was 44.4% (n=44). The rate of complications requiring invasive treatment was 19.2% (n=19). The most common perioperative complications were ocular hypertension (OHT, 20.2%, n=20), and cystoid macular edema (CME, 15.2%, n=15). The rate of IOL dislocation was 7% (n=7).Conclusion: This knotless technique avoids the risks of haptics fixation but is more prone to IOL dislocation in cases of suture deterioration. Past ophthalmic history needs to be carefully considered in candidates who underwent SFIOL implantation.Keywords: intraocular lens, scleral fixation, knotless, cataract, lens luxation

Cataract is the most frequent cause of avoidable childhood blindness in the world with a global economic cost of estimated at US$5000 million over 10 years. Unlike adult onset cataract, visual deprivation secondary to cataract in infancy or early childhood will interfere with neural development; delay in management can lead to profound amblyopia and poor post-operative visual outcome. Childhood cataract may occur in isolation or be secondary to a variety of genetic, infective or metabolic diseases. It can be present at birth or develop subsequently. Neonatal screening programmes for congenital and infantile cataract are well established in developed countries and prevention of blindness from childhood cataract is a World Health Organisation priority, with access to surgical management becoming increasingly available worldwide. Midwives, primary care staff and paediatricians will come across childhood cataract infrequently in their professional lives but are at the frontline in the battle against the blindness from visual deprivation amblyopia caused by childhood cataract. The risk factors, symptoms and signs which should lead to suspicion of cataract, the practicalities of detecting cataract, post-operative issues, and longer-term optical and visual rehabilitation are reviewed. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration (AMD) is the leading cause of visual impairment in the western world, causing significant reduction in quality of life. Despite treatment advances, the burden of visual impairment caused by AMD continues to rise. In addition to traditional low vision rehabilitation and support, optical and electronic aids, and strategies to enhance the use of peripheral vision, implantable telescopic devices have been indicated as a surgical means of enhancing vision. Here we examine the literature on commercially available telescopic devices discussing their design, mode of action, surgical procedure and published outcomes on visual acuity, quality of life, surgical complication rates and cost effectiveness data where available.Funding Article processing charges were funded by VisionCare Inc. [ABSTRACT FROM AUTHOR]

Purpose: To compare primary intra-ocular lens (IOL) implantation with use of press-on spherical lens for aphakia correction following unilateral infantile cataract removal. Methods: Sixty infants with a unilateral cataract underwent cataract surgery and were randomly assigned to the IOL (A group) or no IOL group (B group). Residual refractive error was corrected with spectacles in the A group and a press-on spherical lens was used to treat aphakia in the B group. Grating visual acuity (VA) was measured and patients were followed for up to 1 year. Results: LogMAR VA in the operated eyes of both groups was significantly better 1 year than 1 month after surgery. Mean logMAR VA difference between 1 year and 1 month after surgery was higher in the A group (0.457 ± 0.110) than in the B group (0.323 ± 0.114, p < 0.0001). Serious inflammation occurred significantly more often in the A group than in the B group (p = 0.007). Visual axis opacity occurred more often in the A group than in the B group (pupillary membrane: A: six eyes, 20%, B: none, p = 0.024; lens reproliferation: A: 10 eyes, 33%, B: two eyes, 7%, p = 0.021). Glaucoma occurred equally in both groups (p = 0.612). No other complications occurred. Conclusions: Primary IOL implantation appears to be a relatively safe, effective optical correction strategy following unilateral cataract extraction in this age group. Patients for whom an IOL is not suitable can be treated with a press-on spherical lens for optical correction. [ABSTRACT FROM AUTHOR]

Purpose To analyse risk factors and visual performances of glaucomatous eyes with glistening in the intra-ocular lens ( IOL). Methods Prospective study performed between November 2010 and April 2011 and involving 67 consecutive glaucomatous eyes (47 patients), who previously had a phacoemulsification with a hydrophobic acrylic IOL implanted in the capsular bag. Glistening was classified in three groups of severity grade: G0 (<50 microvacuoles per mm2), G1 (50-150 microvacuoles per mm2), and G2 (>150 microvacuoles per mm2). All eyes underwent a best-corrected visual acuity evaluation ( BCVA, Log MAR scale), a complete clinical examination, a visual field test, a contrast sensitivity evaluation and a wavefront analysis of high-order aberrations ( HOAs) using a Shack- Hartmann aberrometer. Eyes with a posterior capsular opacification and a BCVA>0.30 Log MAR were excluded. Results Twenty six eyes (38.8%) had a grade 0, 12 eyes (17.9%) a grade 1 and 29 eyes (43.3%) a grade 2 of glistening severity grade. The mean follow-up after cataract surgery was 35.2 ± 24.2 months and was significantly higher for G1 and G2 groups (p < 0.001). A higher number of topical glaucoma medication were associated with a higher glistening severity grade (p < 0.05). G1 and G2 groups had significantly lower mean contrast sensitivity values at high spatial frequencies and significantly higher loss variance ( LV) values of the visual field test (p < 0.05). There was no significant difference in mean BCVA between groups (p = 0.455). Conclusions In glaucomatous eyes, glistening increased with time was associated with the number of topical glaucoma medications daily instilled and altered visual performances. It should be a consideration for glaucoma patients who are more likely to develop glistening within the IOL optic. [ABSTRACT FROM AUTHOR]

Introduction Limited resources in low- and middle-income countries (LMICs) drive tremendous innovation in medicine, as well as in other fields. It is not often recognized that several important surgical tools and methods, widely used in high-income countries, have their origins in LMICs. Surgical care around the world stands much to gain from these innovations. In this paper, we provide a short review of some of these succesful innovations and their origins that have had an important impact in healthcare delivery worldwide. Review Examples of LMIC innovations that have been adapted in high-income countries include the Bogotá bag for temporary abdominal wound closure, the orthopaedic external fixator for complex fractures, a hydrocephalus fluid valve for normal pressure hydrocephalus, and intraocular lens and manual small incision cataract surgery. LMIC innovations that have had tremendous potential global impact include mosquito net mesh for inguinal hernia repair, and a flutter valve for intercostal drainage of pneumothorax. Conclusion Surgical innovations from LMICs have been shown to have comparable outcomes at a fraction of the cost of tools used in high-income countries. These innovations have the potential to revolutionize global surgical care. Advocates should actively seek out these innovations, campaign for the financial gains from these innovations to benefit their originators and their countries, and find ways to develop and distribute them locally as well as globally. [ABSTRACT FROM AUTHOR]

Abstract: Silicone gel-like polymers have been proposed to replace the cataractous lens and therewith restore both vision and accommodation. Lens replacement is associated with opacification of the capsular bag due to the lens epithelial cell response. In this study, the in vivo effectiveness of a 5 min treatment with actinomycin D and/or cycloheximid to prevent the development of capsular opacification after filling the capsular bag with a silicone polymer as an accommodating lens was studied. It was found that treating the inside of the capsular bag with a solution containing actinomycin D reduced the development of visible capsular opacification for three months. In some animals, the lens capsules were completely clear, indicating the potential of this method. Side effects of the treatment in the form of visible cornea opacification occurred and ranged from mild to severe in some animals, while in other animals no toxicity occurred. This indicates that a safe application of the cytotoxic substances is feasible. In view of the side effects and the fact that not all lens capsules of the animals treated with actinomycin D were clear, improvements in the methods used are necessary and seem to be possible. [Copyright &y& Elsevier]

A method originally developed for corneal topography (using discrete sources and Zernike polynomials) was extended to estimate the geometry of ocular surfaces internal to the eye. The approach was tested in simulation as a candidate method for phakometry. Purkinje images from the anterior surface of an intra-ocular lens (IOL) (aligned and decentered) were simulated using the Navarro eye. The ‘full’ Navarro eye and a simplified eye were assumed for recovery purposes. Root mean square (RMS) errors and (anterior) IOL radii of curvatures (best-fit spheres) were estimated. The robustness of the method to axial shifts in lens position (both eye models) along with assumed refractive index (simplified eye only) was tested. When axial shifts were ignored, RMS errors for the full eye were sub-micron (<0.8 μm), and radii of curvature errors were ∼1 μm. Axial shifting increased these errors linearly. The n = 1.32 error curve (simplified eye) matched the full eye error curves closely (for both RMS error and IOL lens radius), although the RMS error curve exhibited some asymmetry for a decentered IOL. The nominal refractive index ( n = 1.3305) was sub-optimal in all cases. The resulting method is a potentially useful way to estimate the geometry of the internal ocular surfaces. [ABSTRACT FROM AUTHOR]

A dynamic model of ocular accommodation is used to simulate the stability and dynamic performance of accommodating intraocular lenses (A-IOLs) that replace the hardened natural ocular lens that is unable to change focus. Accommodation simulations of an older eye with A-IOL materials having biomechanical properties of a younger eye illustrate overshoots and oscillations resulting from decreased visco-elasticity of the A-IOL. Stable dynamics of an A-IOL are restored by adaptation of phasic and tonic neural-control properties of accommodation. Simulations indicate that neural control must be recalibrated to avoid unstable dynamic accommodation with A-IOLs. An interactive web-model of A-IOL illustrating these properties is available at http://schorlab.berkeley.edu. [Copyright &y& Elsevier]

Abstract: Cataract surgery is routinely performed to replace the clouded lens by a rigid polymeric intra-ocular lens unable to accommodate. By implanting a silicone gel into an intact capsular bag the accommodating properties of the natural lens can be maintained or enhanced. The implantation success of accommodating lenses is hampered by the occurrence of capsular opacification (PCO) due to lens epithelial cell (LEC) growth. In order to prevent LEC proliferation, a treatment regime using actinomycin D, cycloheximide and water was developed. The effectiveness of treatment was analyzed using an in vitro, MTT-based cell culture system and an ex vivo pig eye model in which the implanted lens-in-the-bag is cultured as a whole. LEC were exposed to treatment solutions for 5min, then the cells were allowed to recover and to re-colonize the substratum. MTT conversion by cells was transiently inhibited by cycloheximide dissolved in water and by water alone. Exposure to actinomycin D resulted in a lasting inhibition of MTT conversion and consequently cell proliferation. These in vitro data could not be fully reproduced in the ex vivo pig eye model due to essential differences between both models. Treatment with actinomycin D containing solutions, however, resulted in a nearly complete absence of cells on the capsular wall. The pig eye model is a promising approach to further evaluate the effects of peri-surgical treatment during the accommodating intra-ocular lens implantation. [Copyright &y& Elsevier]

This study was performed to elucidate the correlation between added lens refill material and enhanced lens power as well as the correlation between lens refilling volume and accommodative amplitude as determined by equatorial stretching ofex vivorefilled pigs’ lenses.Nine porcine lenses were refilled with increasing amounts of silicone oil. After each refill step, the lens power, the lens power change, and the lens thickness were measured both in the relaxed state and with a 3-mm larger ciliary body diameter. In addition, the spherical aberration of the refilled lenses was also quantified.Injection of 0.04 mL silicone material into the relaxed lens enhanced the lens power by 1 D. A 0.54-mm increase of the lens thickness in relaxed lenses added 1 D to the lens power. Increasing the lens refilling volume decreased the lens power changes measured at 3-mm ciliary body stretch. Spherical aberration was positive in the refilled lenses and increased with increasing lens refilling volume.The correlation found between the refilling volume and the lens power (0.04 mL D−1), as well as the correlation between the lens thickness and the lens power (0.54 mm D−1), might be important factors to be controlled in conjunction with surgery, as these also determine the lens power in the presence of this refill material. An increasing lens filling volume is associated with decreasing accommodative amplitude. The positive spherical aberration of refilled porcine lenses presents a sharp contrast to the negative aberration of natural pigs’ lenses. Different lens contours and the transition from a gradient to a homogeneous refractive index might be responsible for this change in spherical aberration. [ABSTRACT FROM AUTHOR]

An investigation of the pricing of implantable prosthetic devices in Australia reveals some alarming practices. A governmental mechanism exists to prop up the pricing of 7500 listed devices to levels that are unacceptably high by world standards. Private hospitals and doctors are able, legally, to profit by marking up the cost of these devices from the market price to this artificially inflated price. Even the open market prices of implantable prosthetic items, such as intra-ocular lenses, are high by international standards. In a time of budgetary constraint for health spending and rapidly increasing use of these devices, these issues urgently need to be addressed in Australia. [ABSTRACT FROM AUTHOR]