Cataract & Refractive

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.

A better informed patient is a goal that all healthcare professionals strive for. Better informed patients are able to make better choices about their healthcare and give informed consent for a procedure.

Ophthalmologists have been seeking to achieve the same quality and surgical success for high ametropia as has already been achieved for moderate ametropias. The analysis of refractive outcomes of procedures such as the Ferrara Ring implantation to correct early keratoconus, thermokeratoplasty to correct hypermetropia and corneal transplantation frequently reveals the presence of a residual ametropia that results in low or moderate visual acuity. It is our belief that the Artisan phakic intraocular lens (IOL) (Advanced Medical Optics) could go some way to adressing this issue. Hence, after mastering the surgical procedures involved for the implantation of the phakic IOL and its indication as an option for refractive surgery, we looked to assess the benefits of secondary lens implantation in the correction of residual ametropia and the impact it has on patient quality of life.

Refractive surgery dates back to the 19th century, when L.J. Lans demonstrated the effect of applying heat to the cornea to treat astigmatism. Once considered only by the courageous, refractive surgery has now become an everyday alternative form of visual correction, made possible by improvements in our understanding of corneal anatomy and physiology and the development of remarkable new tools.

Safety, with respect to loss of best spectacle-corrected visual acuity, records better results for phakic IOL implantation than for LASIK with higher corrections

Combined surgical management of coexisting cataract and glaucoma has recently gained popularity because of the several advantages that it presents. These advantages include, decreased risk, easier management of early and long-term postoperative intraocular pressure (IOP) and performing just one surgical procedure to manage both problems.

The development of presbyopia in hyperopic people aged between 45 and 65 is a serious refractive problem that, until recently, has had no practical solution. Individuals in this category are not usually considered to be "patients" but, nevertheless, face real problems with their everyday near and distance sight. We call this problem "hyperopic presbyopia".

80% of Tecnis patients and 85% of ReSTOR patients were very happy with all aspects of their vision, with the majority of patients in both groups deciding not to return to glasses, even for intermediate vision

The May 2005 acquisition of VISX saw AMO inherit a large installed base of refractive surgery technologies, which not only complemented its refractive IOL portfolio, but also transformed AMO into the world's leading refractive surgical company.

December 2005 witnessed the launch of Carl Zeiss Meditec's latest model for customized refractive surgery; the CRS-Master 2.1. Equipped with a new wave of design enhancements, topography-guided therapy has now been added as a new functionality mode to the system.

Wavefront analysis of the human eye is based on an optical theory that was first developed in astronomy more than 100 years ago, with roots that date back almost 400 years. Astronomers used the technology to reduce higher order aberrations (HOAs) induced by the earth's atmosphere. Recognising the potential of this analysis in ocular refractive surgery, manufacturers have recently introduced wavefront technology into several major laser systems in order to improve treatment outcomes and address HOAs within the visual system.

Early surgical intervention and adequate orthoptic therapy are important when dealing with children who have undergone cataract surgery. A pseudophakic implant represents an effective solution for the management of aphakic children; a multifocal IOL can provide additional correction, without hindering quality of vision. Here, Klaus Weber, MD provides a brief overview of the incidence, causes and management of childhood cataract, and recommends potential avenues of treatment for the visual rehabilitation of paediatric patients with aphakia.

Here, we take a closer look at Schwind's latest unveiling, the ESIRIS excimer laser with the ORK-CAM (ORK-Custom Ablation Manager) software with aspherical aberration-free profiles.

Ophthalmologists who perform refractive procedures today, often to the dismay of patients as well as the treating physicians, achieve less than optimal satisfactory results postoperatively in 5% to 25% of their patients. Residual refractive errors, overcorrection, as well as pre-existing irregular astigmatisms induced by small optical zones and/or decentred ablations are difficult to correct with standard treatments because of their irregular nature.

It ensures faster rehabilitation of patients operated on using 22 gauge compared with conventional 2.8 mm coaxial phaco, probably because of the reduction in postoperative trauma during emulsification of the crystalline lens in a closed system with narrow incisions

The mixing and matching of refractive and diffractive multifocal intraocular lenses (MIOLs) to enhance vision in cataract patients is not a new concept. In fact, the theory was first pioneered and realised in 2000 by Uzeyir G?nenc, MD of Dokuz Eyl?l University, Izmir, Turkey, who went on to present his first set of results at the 2003 congress of the ASCRS. So why is it that, back then, nobody really paid attention to this technique? The answer is simple; the idea at that time seemed quite bizarre and was something that many surgeons would never consider performing in their own practice. Three years on and armed with five-year data, the global ophthalmic community is now starting to pay attention.

Keratoconus progression was halted in all 20 eyes treated at eight months postoperatively. In 75% of eyes we recorded a regression in pathology and an improvement in visual acuity was seen in 80% of eyes

Marred by reports of vision loss due to contamination, amongst other complications, trypan blue has received its fair share of bad press over recent years, with many unapproved versions of the formulation making its way into cataract surgeons' practices.

As a result of our excellent postoperative patient data in a variety of applications, we will continue to use the femtosecond laser technology in our practice. It supports our procedures with great precision and safety, it is easy to use and enables us to set new standards in our surgeries

As described by Huang et al. more than a decade ago, optical coherence tomography (OCT) is a non-contact, non-destructive imaging modality that acquires depth-resolved two- and three-dimensional images of biological tissue.

PCO secondary cataract, no matter how you label it, it exists and it is the most common complication of cataract removal or extraction.

The popularity of phakic IOLs in both cataract and refractive surgery has soared in recent years with lens manufacturers all joining the race to develop better lenses with improved outcomes and fewer complications. Although phakic IOLs are considered the ideal tools for the correction of high ametropias, because of their excellent accuracy and predictability, stability of refraction from day one and independence of tissue healing, they have, unfortunately, been marred by reports of certain complications throughout their development history. These complications include corneal decompensation, chronic inflammation, iris atrophy (pupil distortion), cataract and glaucoma. Here, Ant?nio Marinho, MD, PhD discusses the influence of phakic IOLs on cataract and glaucoma development.

Globally, LASIK is a very popular refractive procedure, which provides excellent visual acuity and quality of vision in low to moderate myopia and hyperopia.1 In the mid-nineties, however, LASIK was performed even in extreme myopic errors (up to 23D) or in corneas that were too thin with or without Forme Fruste Keratoconus (FFKC).

Ophthalmology is a branch of medicine that we, as ophthalmologists, regard as an elite branch of medicine and others, such as general surgeons and physicians, often consider as a minor and sometimes easy discipline. As a result of this misdirected preconception, a general practitioner, consultant or physician may not feel it necessary to fully inform us of a patient's health record because they do not consider that ophthalmic medications could, potentially, carry with them serious, sometimes life threatening side effects, if used inappropriately.

DSAEK will soon replace conventional PK surgery for the treatment of endothelial decompensation

Didier Ducournau talks about the development and growth of the EVRS and on his personal vision for vitreoretinal surgeons.

Postoperative endophthalmitis is a rare but potentially devastating intraocular infection, which could lead to severe and permanent visual impairment or even the loss of an eye.1-3 With the average life expectancy on the increase, the prevalence of cataract in the older population and therefore the cataract surgical rate has increased in recent decades.1,3 Many have voiced their concerns that this rise in the number of surgical procedures could bring with it a rise in incidence of endophthalmitis, hence, evaluation of postoperative infection incidence is extremely important in every clinical setting.

CE marked in April of 2006, the KS-3Ai has become the first preloaded aspheric silicone IOL to be approved in Europe for use in cataract surgery. Although the product has yet to gain approval in the US market, it is already available in Japan and will shortly be entering clinics in Europe.

Wound distortion by manipulation of two rigid cannulas during bimanual phaco through tight corneal incisions has been shown to be significant.