Cataract & Refractive

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.

Research, development, innovation and the quest for excellence go hand in hand with the evolution of the ophthalmology industry. With the new wave of phakic IOLs entering the market, each with its own unique offering and capabilities, it's hard to know which lenses will suit you and your patient best. Furthermore, does the introduction of these new refractive correctors threaten the position of the lasers that we have all come to grow to love? It seems that the laser refractive surgery industry is still going from strength to strength.

IOL implantation in older, cataract patients often fails to enhance vision to a level that is greater than that of the average non-cataractous lens of a similar age.

Surgeons should not feel ashamed if they only manage to see a few patients, devotion to the patient and then to your practice is of paramount importance. Then, and only then, will you be doing your job well.

Results of a study evaluating post-cataract surgery endophthalmitis at a regional tertiary referral centre in England show no evidence of an increase in incidence over a recent period of almost eight years, reported Omar M. Durrani, FRCS.

The corneal endothelium is able to function adequately, even after losing a large number of endothelial cells.

The techniques and materials employed for cataract surgery have improved significantly over recent years, resulting in enhanced functional surgical outcomes, smaller incision sizes and reduced incidences of astigmatism and endophthalmitis. Consequently, cataract surgery has become the most frequently performed surgery in Germany, with around 600,000 conducted each year.

May 2005 saw the birth of the term Microphakonit, when Agarwal removed cataracts using a 0.7 mm phaco needle tip with a 0.7 mm irrigating chopper, through the smallest incision ever documented.

New technologies, advances in phacoemulsification and better instruments have improved outcomes and reduced complications in cataract surgery. However, a similar advance has not been achieved in the same manner with intraocular lens (IOL) development.

Since we have been using the femtosecond laser, we have not had to fit a single therapeutic contact lens

Refractive surgery has radically changed the nature of clinical practice, with its success spawning the proliferation of commercial clinics owned and directed by non-medical personnel

Accommodative lenses on the whole are showing significant promise and have certain advantages over multifocal IOLs because they do not have different refractive zones, contrast or glare problems

Anterior chamber angle-supported phakic intraocular lenses have now become a viable alternative for the correction of moderate and high refractive errors with excellent levels of efficacy, predictability and safety.