Cataract & Refractive

Visual results reported by 60 kHz users in the US and Europe show that all-laser LASIK patients have better visual results in the first three months following surgery

Microincision cataract surgery (MICS) and phacoemulsification result in similar visual outcomes and early endothelial cell loss.

Senior doctors have accused the independent sector treatment centre (ISTC) scheme for NHS cataract services of being an expensive over-reaction to the need to increase the rate of cataract surgery in the UK.

The annual cumulative cell loss in eyes implanted with toric iris-fixated phakic intraocular lenses (IOLs) is two to three times greater than in normal eyes without surgery.

Phaco-trabeculotomy in addition to deep sclerectomy can offer significant reductions in intraocular pressure (IOP).

Manual small incision cataract surgery (MSCIS) with trypan blue staining of the anterior capsule is a safe and effective method of cataract extraction for patients with phacolytic glaucoma.

The ICARE anterior chamber phakic intraocular lens (IOL) with angle-supported haptics was designed five years ago by Corneal Laboratories (France) and attained the CE mark for demonstrating good efficacy and stability of refractive outcomes for the correction of high myopia. However, the safety profile of the lens was compromised by a number of anatomical limitations: a high vaulting that placed the optic too close to the endothelium and, because of the overall design of the lens, accurate sizing was difficult. In our clinic, in a series of 44 cases of conventional ICARE implantations, there were three reports of ovalisation and two of endothelial cell density decrease, which necessitated the removal of the lens.

Carl Zeiss Meditec has received FDA clearance to market the laser keratome applications of it's Visumax femtosecond laser system.

Removal of soft cataracts with Aqualase (Alcon), theoretically carries less risk to the posterior capsule than phacoemulsification.

Could phakic IOLs some day emerge as the dominant refractive surgical approach, particularly considering the past problems with early innovations? This is a difficult question to answer but one that has been debated over recent years.

As with any IOL implantation technique, there are some potential complications that must be considered. In general, the number of complications is low, and most of them are either easy to avoid or easy to repair

The US Navy is proceeding with a programme allowing LASIK with IntraLase flap creation in naval aviators.

A rising number of phakic IOLs are steadily making their way into clinics, with each one offering its own unique property to set it apart from the competition. Documented studies will tout the benefits of each lens and, in many cases, will compare phakic lenses in head-to-head studies. Naturally, all studies are important and the benefits a particular kind of lens affords in a certain type of patient, is absolutely critical if a surgeon is to make an informed decision on his or her choice of lens. However, just as important as the choice of lens, is the surgical technique employed to implant the lens. A good technique will, amongst other things, reduce the incidence of potential complications that could ensue as a result of surgery and it will lead to a faster recovery time.

A new fixed combination of dexamethasone and netilmicin offers an effective and safe way to control ocular inflammation after cataract surgery.

An update of the ESCRS and ASCRS survey on the most common complications involving foldable IOLs.

Alcon has received FDA approval for the AcrySof ReSTOR intraocular lens (IOL) for the correction of aphakia following cataract surgery in patients with or without presbyopia.

Pre-soaked IOLs may provide an excellent way to deliver fourth-generation fluoroquinolones to prevent endophthalmitis.

Research into the remarkable workings of the human eye have led to the acknowledgement of the presence of inherent higher order aberrations (HOAs) of the cornea, such as coma and spherical aberration. These aberrations are known to lead to optical degradation with the most significant culprit being spherical aberration.

Refinements in lens technology have probably acted as the greatest catalyst for the recent upsurge in interest that has been witnessed in multifocal intraocular lenses (MIOLs). Coupled with the CE and FDA approvals of several second generation MIOLs, the number of refractive lens exchange (RLE) procedures that have been conducted in individuals over the age of 45 years seeking spectacle independence, has soared.

Although presbyLASIK is still, by no means, perfect, it seems to present a good solution for certain cases, particularly in myopes and hyperopes.

At three months, 88% had monocular uncorrected near vision of J2 or better and 95% had J3 or better. A total of 84% were able to read newspaper-sized print without spectacles and 84% were satisfied or very satisfied with the results

I am not convinced that using two very different types of lenses in one patient is the best way to maximize the visual system

The femtosecond laser has the potential to be the ultimate corneal incision device - the possibilities are nearly limitless

Managing patient expectations, matching the lens and the right lens power to the right patient, showing the patient you care and keeping the patient fully informed are all key strategies to securing patient satisfaction.

We take a look at some interesting developments in the fast-moving area of presbyopia research and development.

The surgeon does not change gloves in between cases but simply rinses with 0.5% chlorhexidine/70% isopropyl alcohol solution. Despite the simplicity of this, the rates of infection in Dr V hospitals is lower than US rates

The wavefront guided approach has certainly yielded the best outcomes in my practice; patient satisfaction rate is very high, while the retreatment rate is extremely low at 2.3%

Its almost time to close the door on 2006 and welcome another new year. But, before we do that we wanted to take you on a journey through the highs and lows of the past twelve months by reflecting on some of the most significant events to shape your industry this year.

At the ESCRS congress in September, Peter Barry presented the full ESCRS endophthalmitis study results and controversially stated that, not only is the incidence of endophthalmitis higher than reported in the literature, but the risk of infection is further increased by clear corneal incisions and the use of silicon IOLs.

Zyoptix Aspheric, Bausch & Lomb's recent addition to its refractive armamentarium, has been found to induce significantly less amounts of spherical aberrations compared with conventional LASIK treatment, according to Dr Wing Kwong Chan, senior consultant and head of refractive surgery services at Singapore National Eye Center (SNEC). This technology could be most beneficial to patients with high order myopia or large pupils, and for professionals requiring best-possible night vision.