At Retina World Congress 2022, Prof. Anat Loewenstein presented a talk entitled, “Targeting the Ang/Tie2 Pathway: Efficacy and Outcomes.” In her presentation, she discussed data for the bispecific molecule faricimab and its efficacy at targeting both the VEGF and Ang2 pathways while treating neovascular age-related macular degeneration (AMD) and diabetic macular oedema (DMO).

In my presentation, I showed how targeting both VEGF and Ang2 in a bispecific molecule—faricimab—can help in increasing the durability of the drugs we are using for both diabetic macular oedema and neovascular AMD.

So in my presentation, I showed how in studies for faricimab as compared to a comparator in neovascular macular degeneration. For a duration of two years, a very high percentage of the patients were able to maintain a longer duration interval between doses. And about more than three quarters of the patients were able to maintain a duration of more than three months, and about 45% a duration of four months. And this was maintained while the visual acuity outcomes were non inferior to the comparator.

In addition, a very important point that I emphasize is that there were no signals of significant side effects, no significant intraocular inflammation and no cases of vasculitis or occlusive vasculitis.

For diabetic macular oedema, similarly, about three quarters of the patients in the study, were able to be maintained on a three or four monthly interval. And about 50%—and this percentage increased to 60% in the second year—were able to be maintained on a 16-week interval. And that was when non inferiority of visual acuity and even a better drying of the retina as compared to the comparator again with no significant side effects.

Note: This transcript has been lightly edited for clarity.

Videos

Prof. Anat Loewenstein discusses data regarding the efficacy of faricimab at targeting both the VEGF and Ang2 pathways in patients with neovascular AMD and diabetic macular oedema.

Data reveals efficacy of bispecific targeting of VEGF, Ang2 pathways

The Yamane technique, first described by Shin Yamane and colleagues,

 is of use for intrascleral IOL fixation when a patient is aphakic without capsular support. It sparked my interest since I was seeking a solution for cases where iris fixation was not an option.

The technique offers an elegant and effective way to fixate the IOL in complex cases. I have had the opportunity to perform it several times and my first few cases provided me with some key takeaways as well as offering a unique perspective to identify areas for further improvement.

Thorough preparation, including practising in two wet labs before the first case, is a must, and the learning curve with the Yamane technique can be steep. However, it is also short. And whilst mastering a method usually requires a large number of cases, I have achieved great outcomes quickly by going back and reviewing videos and analysing my early experiences.

I was referred a patient with a posterior capsule tear during cataract surgery whose IOL had slipped nasally half inside and half outside the bag. The patient could no longer see well because the optic edge was now in the centre of the visual axis.

IOL exchange was scheduled. The dislocated IOL was carefully removed from the capsular bag and then cut into three pieces using 19g Packer/Chang IOL cutters (MicroSurgical Technology [MST]) for atraumatic removal from the anterior chamber. Following IOL removal, I inserted a CT Lucia lens (Zeiss) and both haptics into the anterior chamber.

I then sutured the main incision (which was larger than usual because of the IOL removal) with the intention of avoiding excess fluid leakage and maintaining the good pressure required for needle placement. I used a 23g Ahmed micro-grasper (MST) through the paracentesis for entry to grasp the haptics.

Placing the second haptic inside the anterior chamber made grasping and threading the haptic into the lumen of the needle much more challenging because the haptic slid into the angle. With hindsight, I should have left the trailing haptic outside of the eye; I will do so in the future.

In the next case, the patient’s lens had fallen into the posterior chamber during cataract surgery and the capsule was completely lost. During the pars plana vitrectomy and lensectomy, they endured a sector iridectomy. The patient presented to me with aphakia, no capsule, some loss of iris tissue and cystoid macular oedema.

I again elected to proceed with scleral fixation utilising the Yamane technique. This time, I used an AC maintainer included in the scleral IOL fixation solutions pack (SFP-1001, MST) to keep the eye firm.

The needle placements went well, and there was no fluid egress even with the trailing haptic exposed through the primary incision. The procedure went smoothly and as planned. The trailing haptic can also secure the IOL from falling back into the vitreous cavity, especially in this case because there was no capsular support and iris tissue was missing.

I proceeded with the iris repair, which required suturing of the sphincter. I used 23g Ahmed micro-tying forceps (MST) to hold each edge of the tear as I passed the needle (10-0 prolene suture on CTC-6 needle) through to complete the repair.

At the end of the case, I saw that the IOL was not perfectly centred even though I had been careful with the scleral measurements, so I pulled the haptic to one side to centre the optic. I then trimmed the excess haptic material and mushroomed and reburied the tip. The IOL was perfectly centred and there was no tilt at all.

Sometimes it can be difficult to mark accurately because the limbus is not always clearly defined. One can miss by half a millimetre due to difficulty in identifying a clear entry point. In this case, even though one marks at 2.5 mm, this may not actually be 2.5 mm from the limbus.

I believe this is what happened during the second case described above when I realised that the IOL was not well centred. One needle entered further from the limbus than the other, which affected the IOL positioning. Of note, each needle pass is performed by a different hand and at a different angle —it is difficult to be perfectly symmetrical but awareness of the issue certainly helps.

To know exactly where the positioning and entry points are (2.5 mm posterior to the limbus and 2 mm across), I like to open the conjunctiva and measure directly on the sclera to see as much as I can. Surgeons who have experience with this technique can go through the conjunctiva, but I feel it is less stressful when you have better visibility to watch the needle pass under the sclera before making the turn.

The sclera can also be held to prevent the eye from rotating, which helps with the needle tunnelling. If going directly through conjunctiva, the scleral tunnel is not visible. Finally, when turning the needle to enter the eye, go deep and not shallow: turn and go straight down and then come back up to visualise the bevel of the needle.

Keep in mind that the needles will be passed by both hands and that each hand will act differently: one comes forward while the other goes back. There are going to be differences between your hand positions, which is not a big problem, but one need to be mindful of this and make adjustments to get the same result from both hands. This is something that can be practiced with simulation model eyes.

Fixation of the globe is very important; otherwise the eye rotates, so the hand positions should be thought out ahead of time.

One might think that the haptic should thread directly into the needle, but in my experience, it is the opposite: threading the haptic is much easier if the needle is aimed toward the haptic while holding the haptic still. I use the 30g thin-wall needles with specialist holders from the scleral IOL fixation solutions pack (MST), which allow for manoeuvrability and control during this delicate step. To manipulate the haptic, my preferred micro-instrument is the 23g Ahmed micro-grasper (MST), which is a versatile micro-instrument for the anterior chamber.

My final recommendation would be to choose your cases wisely and have retina support available. Always prepare your equipment in advance.

I opt for the CT Lucia IOL (Zeiss) with PVDF haptics, which I find has the right proportion of flexibility and resistance to breaking. I also use the scleral IOL fixation solutions pack (MST), which includes the essential elements to perform the technique, including three 30g thin-wall needles with silicone hubs, two specialist needle holders, an AC maintainer, a marker and a calliper.

The Yamane technique can be easy to learn if one is prepared and well equipped. Even if things do not go perfectly the first couple of times, practice will help you learn from your mistakes and it will get easier!

Dr Amin is chief of complex anterior segment surgery at Westchester Medical Center, New York, United States. She has no financial disclosures relevant to this article.

1. Yamane S, Sato S, Maruyama-Inoue M, Kadonosono K. Flanged intrascleral intraocular lens fixation with double-needle technique. 

Articles

Practice makes perfect when adopting this method for intrascleral IOL fixation.

Mastering the Yamane technique: Key learnings from first cases

The PEARL [phase] 2 study was looking at the compound OC-02 in treating dry eyes. This is a nasal spray that is used twice a day.

Their primary endpoints were to look at increasing Schirmer's, as well as eye discomfort score. By using this nasal spray twice a day, in four randomized groups — so three different concentrations of OC-02 versus placebo — they found that the Schirmer scores were significantly higher in the drug arms, especially the highest drug concentration. And the eye irritation score was also improved most with the highest concentration of the drug.

This molecule is very similar to the OC-01 molecule, which has been FDA approved and marketed. This particular molecule, because of OC-01 being on the market already, is not going to be licensed in the US for marketing.

The take home message is that the use of the cholinergic agonists as a nasal spray to stimulate the trigeminal nerve is a reasonable mechanism to help treat dry eyes. It's novel; it's different than putting eyedrops in your eyes. It may be beneficial for patients who have trouble putting eyedrops in their eyes. A lot of people are used to using nasal sprays for allergies, for example. And so this modality of treatment, as well as a new mechanism, may have extensive benefits for the patients.

The study's primary endpoints were to look at increasing Schirmer's scores, as well as eye discomfort score.

Investigating efficacy of OC-02 to stimulate the trigeminal nerve for the treatment of dry eyes

At ARVO 2022, Dr Steven Yeh reviews the results of the Phase 3 PEACHTREE and AZALEA integrated study, revealing significant BCVA gains and low adverse event incidence in the Xipere (triamcinolone acetonide injectable suspension, Bausch + Lomb) arm.

Dr Yeh is a professor of ophthalmology and the Director of Retinal Disease and Uveitis at the Stanley M. Truhlsen Eye Institute at the University of Nebraska Medical Centre.

This integrated analysis looked at patients who received macular oedema for noninfectious uveitis. In PEACHTREE specifically, we treated patients with macular oedema due to noninfectious uveitis. And the AZALEA study looks specifically at safety in this cohort of patients.

And in this study, we looked at the efficacy signals as well as the safety signals, integrating these two cohorts of patients. What we found is that patients who received Xipere showed a significant best corrected visual acuity gain of up to two to three lines of visual acuity improvement at the week 24 time point when we combined the clinical trial data.

This is also reflected in reduction of macular oedema, specifically found that patients who received Xipere showed approximately 150 micron reduction in central subfield thickness, and this was sustained for the duration of the trial.

The other aspect that's very important related to this new technique for the treatment of posterior segment conditions is safety. What we found is that intraocular pressure rates were very favourable. In the Xipere arm specifically, about one in eight individuals showed elevation of intraocular pressure, compared to the slightly higher one and seven of individuals in the patients who were in the sham control arm.

When we broke this down further to the patients in the sham arm who received rescue therapy, we found that 25% of individuals who receive local intravitreal therapies showed an elevation of intraocular pressure, which is really compelling when we think about Xipere as a therapy that's nuanced, and a new technique for the treatment of macular oedema due to noninfectious uveitis.

Other adverse events were very well tolerated, and we're very excited about both the efficacy outcomes, as well as the safety variables as well. Again, visual acuity is very important to all of our patients and again, is related to the quality of life and what patients care about most. This is a new drug delivery technique that we're really looking forward to not only for uveitis, but other posterior segment conditions in the future.

The Phase 3 integrated PEACHTREE and AZALEA study data revealed strong safety and efficacy for triamcinolone acetonide via suprachoirodal injection.

Integrated study: Phase 3 PEACHTREE, AZALEA indicate significant BCVA gains, CST reduction

Ora's Caitlin Black, senior director and therapeutic area head of medical devices, discusses exciting new presbyopia IOL technology coming down the pipeline.

Hi, my name is Caitlin Black, senior director and therapeutic area head of medical devices at Ora. We are a full-service clinical development organization overseeing both drug and device clinical trials.

Just returning from ASCRS, I am most excited about the innovation in presbyopia. Presbyopia is the so-called "final frontier" in refractive surgery, and there are many advancements that are providing additional options to presbyopic patients.

We know that worldwide, 1.7 billion people are affected with presbyopia and they currently have limited options. Their quality of life is diminished due to the decreased visual acuity, and many are looking to be free of glasses or obtain spectacle independence.

Since 1949, when IOLs first for implanted we've seen many advancements in IOL technology, including multifocal accommodating IOLs, pinhole IOLs, and extended depth of focus IOLs. Now we're really focused on patient-reported outcomes in our medical trials.

At Ora we work very closely with our sponsors to design study protocols that take into consideration patient's quality of life. We do this through integrating quality of life questionnaires, supplements and being mindful of patient objectives when they enter a clinical trial for a premium IOL.

At Ora we partner with many sites, we have 800 sites that we partner with worldwide and we have individuals on the ground working in 25 countries. This allows us to have really high-quality oversight and monitoring of the clinical trials, which ultimately proceeds with high quality outcomes.

We know that there are many exciting advancements coming in presbyopic IOLs, many IOLs that are currently available outside of the US are entering clinical trial in the United States. I think the next challenge as more lenses become available will be to properly select the technology for the patient for individualized patient outcomes.

Ora's Caitlin Black, senior director and therapeutic area head of medical devices, talks about the next generation of ophthalmic device therapies and diagnostics, clinical trial updates and new innovations that are most exciting for presbyopia treatment.

Advancing IOL technology for treatment of presbyopia

A new treatment for cataract has shown extremely positive results in laboratory tests, giving hope that the condition, that currently can only be cured with surgery, could soon be treated with drugs.

The results have been published in the peer-reviewed journal 

Investigative Ophthalmology and Visual Science.

A team of international scientists, led by Dr Barbara Pierscionek, deputy dean (Research and Innovation) in the Faculty of Health, Education, Medicine and Social Care at Anglia Ruskin University (ARU), have been carrying out advanced optical tests on an oxysterol compound that had been proposed as an anti-cataract drug.

According to a news release from ARU, in laboratory trials, treatment with the oxysterol compound VP1-001 showed an improvement in refractive index profiles – a key optical parameter that is needed to maintain high focusing capacity – in 61% of lenses. This means that the protein organization of the lens is being restored, resulting in the lens being better able to focus. This was supported by a reduction in lens opacity in 46% of cases.

“This study has shown the positive effects of a compound that had been proposed as an anti-cataract drug but never before tested on the optics of the lens,” Dr Pierscionek, who is also a member of the Medical Technology Research Centre at ARU, said in the release.

Dr Pierscionek added that it is the first research of this kind in the world.

“It has shown that there is a remarkable difference and improvement in optics between eyes with the same type of cataract that were treated with the compound compared to those that were not,” she said in the release.

Moreover, Dr Pierscionek said in the release that the research has shown that there is a remarkable difference and improvement in optics between eyes with the same type of cataract that were treated with the compound compared to those that were not.

“Improvements occurred in some types of cataract but not in all indicating that this may be a treatment for specific cataracts,” she concluded in the statement. “This suggests distinctions may need to be made between cataract types when developing anti-cataract medications. It is a significant step forward towards treating this extremely common condition with drugs rather than surgery.”

1. Pierscionek, B; et.al; Oxysterol compounds in mouse mutant αA- and αB-crystallin lenses 2 can improve the optical properties of the lens. Investigative Ophthalmology & Visual Science. Published May 16, 2022.

An investigator at Anglia Ruskin University is leading work on an anti-cataract drug, which has had positive results in lab tests.

Approaching pharmaceutical treatment for cataracts

BRIM Biotechnology Inc. has entered into a new strategic partnership with Ora Inc. for the late-stage clinical development of lead drug candidate BRM421 for dry eye syndrome (DES).

According to a news release, BRIM intends to initiate Phase 3 clinical studies with Ora’s support later this year.

BRM421 is based on BRIM’s proprietary stem cell regenerative Pigment Epithelium-Derived Factor (PEDF) derived Short Peptide (PDSP) technology platform, which underpins several products in its pipeline and has the potential to be effective in multiple therapy areas and indications. The functional domain of PEDF chosen to generate PDSPs can be used to treat DES by speeding up the cornea repair process through stimulation of corneal stem cell proliferation and differentiation, anti-inflammation and meibomian gland recovery.

Dry Eye Syndrome is a chronic disease that affects the productivity and quality of life of 1.52 billion people worldwide.

 The COVID-19 pandemic has further exacerbated the problem, as prolonged time in front of screens is a risk factor for the disease.

Other risk factors include aging, eye surgeries, dry environments, long-term wearing of contact lenses, and autoimmune diseases. Unlike current treatments, BRM421 is a novel, first-in-class regenerative peptide therapy which, if successful, could offer patients full relief of symptoms plus repair the damage to the cornea.

George Oursler, senior vice president anterior segment at Ora, noted that the company has been passionate about addressing the challenges of DES and honoured to be working with the BRIM team to bring this treatment closer to patients.

“The PDSP technology platform is unlike any currently available treatment for dry eye, and the evidence from studies completed thus far show strong potential that BRM421 can repair the corneal damage and alleviate the DES symptoms rapidly,” he said in the news release. “We are excited to leverage the deep expertise Ora has in bringing new ocular health therapies to market to shape the upcoming Phase 3 trials for BRM421 and advance this novel DES therapy closer to approval.”

Dr Haishan Jang, president and CEO of BRIM, explained that the new partnership builds on the success of the companies’ previous collaboration for Phase 2 trials and will help to speed the progression of BRM421 through late-stage clinical development towards regulatory filing.

“BRIM’s translational science expertise, together with Ora’s extensive and successful track record in ophthalmic product development, will undoubtedly accelerate our timelines,” he said in the news release. “With this new agreement in place we intend to initiate Phase 3 studies in Q4 this year and are thrilled at the prospect of bringing this potentially transformative treatment to patients sooner.”

DES currently has no cure and requires continual disease management. Artificial tears with demulcents can retain surface moisture and immune modulators can help to control inflammation, allowing the body’s natural healing processes to repair damage. However, for moderate to severe patients, these types of treatments are often not enough to control discomfort unless there is a way to further speed up the healing process.

“Regenerative peptide, BRM421, has a unique mechanism of action which stimulates the proliferation and differentiation of corneal limbal stem cells which, as a result, speeds up corneal repair and heals ocular wounds in DES patients.

 BRM421 is on track to become the first DES treatment with rapid and total relief,” concluded Dr Jang.

1. Dry Eye disease clinical markets 2021-2029: Marketed and Pipeline Drugs, clinical trials, upcoming and regulatory events, epidemiology, licensing and acquisition deals, drug revenues. Dry Eye Disease Clinical Markets 2021-2029: Marketed and Pipeline Drugs, Clinical Trials, Upcoming and Regulatory Events, Epidemiology, Licensing and Acquisition Deals, Drug Revenues. 

https://www.prnewswire.com/news-releases/dry-eye-disease-clinical-markets-2021-2029-marketed-and-pipeline-drugs-clinical-trials-upcoming-and-regulatory-events-epidemiology-licensing-and-acquisition-deals-drug-revenues-301328151.html

2. Ping-Yen Yuang, MD, Yeou-Ping Tsau, et.al; Topical BRM421 Ophthalmic Solution improves signs and symptoms of moderate to severe dry eye patients in clinical trials. Investigative Ophthalmology & Visual Science June 2021, Vol. 62, 1335.

Strategic alliance combines resources to develop treatment option for dry eye syndrome

Patients with dry eye disease associated with Sjögren’s syndrome worried about the ability to complete daily tasks and the prospects of reduced vision or blindness,

 according to research by Dr Evan Michaelov from the Department of Ophthalmology, Schulich School of Medicine and Dentistry, London, Canada, and colleagues.

They also reported non-adherence to dry eye therapy related to cost.

Dry eye disease that is associated with Sjögren’s syndrome often is more severe than that not related to the syndrome. The symptoms include ocular irritation, vision disturbances, and difficulty performing visual tasks, the investigators pointed out, and they noted the importance of patient engagement in their treatment plan.

“Self-care in dry eye disease includes involves daily, proactive instillation of ocular lubricants, topical anti-inflammatory agents, intake of dietary supplements as well as environmental and behavioral modifications,2” they stated.

Dr Michaelov and colleagues conducted a cross-sectional study in which an anonymous electronically distributed survey was sent to members of the Southwestern Ontario chapter of the Sjögren’s Society of Canada, and the survey then was given to patients with a diagnosis of Sjögren’s syndrome. The goal was to identify factors that affected adherence to treatment of dry eye disease in this patient population.

The patients who completed the questionnaire reported have difficulty with visual tasks, such as driving, and diminished enjoyment in daily activities resulting from dry eye symptoms. About 80% and 50%, respectively, were concerned about reduced quality of life and blindness.

“The most common reasons for non-adherence were cost of therapy and forgetting to instill drops. Drop rationing to reduce cost of therapy was endorsed by 83% of respondents,” the investigators said. “Only 3% of respondents had private insurance for non-prescription agents required to treat DED.”

About 25% of the participants also admitted to not telling their eye care provider about non-adherence with treatment. Age was found to contribute significantly to not instilling drops.

According to the investigators, this is the first study to report on the financial burden experienced by patients with dry eye associated with Sjögren’s syndrome in Canada.

“This paper identified strategies used by patients to reduce the cost of therapy and its impact on adherence to treatment,” they concluded. “Patients may be reluctant to disclose challenges regarding adherence to dry eye disease therapy, as well as fears of worsening quality of life.”

1. Michaelov E, McKenna C, Ibrahim P, et al. Sjögren’s syndrome associated dry eye: impact on daily living and adherence to therapy. 

2022;11:2809; https://doi.org/10.3390/jcm11102809

2. McDonald M, Patel D, Keith M, Snedecor D. Economic and humanistic burden of dry eye disease in Europe, North America, and Asia: a systematic literature review. 

In a paper, investigators identified strategies used by patients to reduce the cost of therapy and its impact on adherence to treatment. Patients may be reluctant to disclose challenges regarding adherence to dry eye disease therapy, as well as fears of worsening quality of life.

Cost of treatment discourages adherence for patients with dry eye disease associated with Sjögren’s syndrome

 covered a variety of revelations from ARVO 2022, from advancing IOL technology for the treatment of presbyopia to the safety and efficacy of triamcinolone acetonide via suprachoirodal injection and the stimulation of the trigeminal nerve for the treatment of dry eye disease via OC-02. 

At Retina World Congress, Prof. Anat Loewenstein presented data regarding the efficacy of faricimab at targeting both the VEGF and Ang2 pathways in patients with neovascular AMD and diabetic macular oedema.

In the surgical realm, Dr Joseph W. Fong and Dr Ahmed A. Sallam discussed the use of a chandelier to shed light on vitreous opacities during cataract surgery. In addition, Dr Abha Amin wrote about mastering the Yamane technique in IOL fixation.

The Yamane technique, first described by Shin Yamane and colleagues,1 is of use for intrascleral IOL fixation when a patient is aphakic without capsular support. It sparked my interest since I was seeking a solution for cases where iris fixation was not an option.

Shedding light on vitreous opacities during cataract surgery

Cataract surgery can be difficult to perform when dense vitreous opacities are present, due to the absence of the red reflex. Even when cataract surgery is combined with vitrectomy, this difficulty still exists because, in many cases, the view is too poor to permit vitrectomy to clear the vitreous opacities before removal of the cataract.

Dr Joseph Fong and Dr Ahmed A. Sallam, both from the Harvey & Bernice Jones Eye Institute at the University of Arkansas for Medical Sciences in Little Rock, Arkansas, United States, shared their pearls for improving the visualisation in these eyes using retroillumination techniques that include a 25-gauge chandelier or a light pipe.

An end-of-week review of what happened in ophthalmology from 21 May to 27 May.

Weekly review in ophthalmology: 21 May - 27 May

Reviewed by Dr Joseph W. Fong and Dr Ahmed A. Sallam

A chandelier is directed horizontally toward the lens. 

Retroillumination configurations using the chandelier

The doctors described two configurations using the 25-gauge chandelier. In the first, the chandelier was directed down towards the vitreous. In the case being demonstrated, the patient had a dense vitreous haemorrhage due to diabetic retinopathy. Dr Fong advised that the view can often be improved in this scenario by extinguishing the room and microscope lights and by depending only on the retroillumination provided by the chandelier.

In a second case, Drs Fong and Sallam demonstrated the view achieved when the chandelier was directed horizontally or towards the lens. “Directly illuminating the lens from behind provides the surgeon with crisp and detailed visualisation of the lens structure and is often very helpful in cases where vitreous haemorrhage is very dense,” Dr Fong said.

In another case of a patient with a dense vitreous haemorrhage from diabetic retinopathy, Dr Fong showed how to maximise use of the light pipe. As in the previous case using the chandelier, maximum visualisation was achieved when the lights from the microscope and rooms were turned off.

Dr Fong explained that a light pipe has an advantage compared with a chandelier because an experienced vitreoretinal surgeon has real-time control over the position of the light pipe at all times intraoperatively. However, use of the light pipe means that the surgeon has to perform the procedure using one hand, which is a major disadvantage.

The surgeon does have the option of removing the light pipe to chop the nucleus using both hands. After the chop procedure is completed, the light pipe can be re-inserted to facilitate a better view of the cortex to be removed.

“The chandelier and light pipe are both great options to achieve retroillumination and optimal visualisation during these challenging cataract surgeries,” Dr Fong said. “Using the chandelier has an advantage over the light pipe in that the surgeon can use both hands throughout cataract surgery. This frees the surgeon from concerns about the position of the light source and facilitates his or her concentration on the details of the challenging surgery.”

Another challenging surgical scenario is encountered in cases of active endophthalmitis. Dr Fong demonstrated insertion of a light pipe into a trocar to retroilluminate the lens during the capsulorhexis. The light pipe was then inserted through the limbal side port to illuminate the lens during phacoemulsification.

“These retroillumination techniques can be used to conquer cataract surgery when many different types of vitreous opacities are present,” Dr Fong concluded.

This article is adapted from Dr Fong and Dr Sallam’s presentation at the American Academy of Ophthalmology Annual Meeting in New Orleans, Louisiana, US. Drs Fong and Sallam have no financial interests in any aspect of this report.

Physicians offer pearls for improving visualisation in eyes using retroillumination techniques.