Journal of Cataract and Refractive Surgery This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

September consultation #2
Toric ICL is a safe and effective alternative for astigmatism correction with a good rotational stability1; however, it is well known that its diameter calculation could be problematic and could lead to vault-related complications, more importantly, in keratoconus cases. This occurs because sulcus-to-sulcus (STS) and white-to-white (WTW) measurements do not always have a predictable and reliable correlation and different devices have important WTW measurement variability.2 (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Andrea C órdoba, Alejandro Navas Tags: Consultation section: Refractive Source Type: research

September consultation #3
The implantation of an ICL for myopia and myopic astigmatism in eyes with keratoconus has a great potential to end with an unpredictable outcome because of cone, irregular astigmatism, and instable refraction. Changing refraction and progression of the disease because of the biomechanically instable cornea causes fluctuation in vision. In the presented case, a hypervault of the implanted ICL also caused pigment dispersion and an imprecise refractive outcome. Because the patient reports blurry vision with diplopia in the left eye, a surgical correction is warranted. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Thomas Kohnen Tags: Consultation section: Refractive Source Type: research

September consultation #4
The blurry vision and diplopia are most likely attributable to corneal irregularities secondary to the keratoconus. Although the toric ICL might improve the regular astigmatic component, assuming it will stay in the correct axis, it does nothing to improve higher-order aberrations (HOAs). (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Donald R. Sanders Tags: Consultation section: Refractive Source Type: research

September consultation #5
First, I recommend implanting Ferrara-type ICRS and then explanting the toric ICL (two-step procedure). The implant of a spherical or toric IOL in cases of keratoconus should be considered for those cases where the morphology of the cornea has been previously corrected and stabilized by Ferrara-type ICRS.1 (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Jos é F. Alfonso Tags: Consultation section: Refractive Source Type: research

September consultation #6
We would first rule out underlying pathology such as retinal or macular diseases, strabismus, or a cortical lesion causing diplopia. Once those etiologies are excluded, we would assume this case to be monocular diplopia in the left eye. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Majid Moshirfar, Madeline B. Heiland, Mahsaw N. Motlagh Tags: Consultation section: Refractive Source Type: research

September consultation #7
The ICL is obviously rotating. The most important information, the anatomy behind the iris, regarding ICL (haptic and footplate) positioning and ICL sizing, is needed. Very high frequency digital ultrasound scanning of the posterior chamber and delineation of the anatomical markers is now essential. Otherwise, the clinician continues to go in blindly each time, risking endothelial cell loss and cataract formation in a young patient. Rotating is possible, but publications have shown that the largest sulcus diameter can be either in the vertical or the horizontal axis. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: H. Burkhard Dick, Dan Z. Reinstein Tags: Consultation section: Refractive Source Type: research

September consultation #8
I believe that the blurry vision accompanied with diplopia was caused by residual astigmatism after the toric ICL implantation. The residual astigmatism is estimated to result from the misalignment and insufficient degree of astigmatic correction (astigmatic correction of toric ICL up to 6.0 D). Simultaneously, the ICL was repositioned three times because of rotation. If a lens is too small, rotation becomes a concern in toric ICLs. However, it is difficult to imagine that the cause of rotation was the size of an ICL that was too small because the lens vault was 748 μm in the present case. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Kimiya Shimizu Tags: Consultation section: Refractive Source Type: research

September consultation #9
At my practice, we previously showed that toric ICL implantation was effective in terms of safety, efficacy, predictability, and stability for the correction of refractive errors for mild and stable keratoconus,1,2 and that the disease did not progress, even in the late postoperative period.3 Accordingly, considering that this patient ’s left eye had 7.25 D of astigmatism, this eye was not a good indication for toric ICL implantation alone. Moreover, even if postoperative rotation did not occur, some residual astigmatism would still have remained after surgery. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Kazutaka Kamiya Tags: Consultation section: Refractive Source Type: research

September consultation #10
This 39-year-old patient has central keratoconus with more involvement in the left eye. Stability is relative in patients with keratoconus, and it is unclear whether her current complaints have been present since the initial ICL surgery 2 years prior or whether this represents progression of her corneal disease. Despite her current 20/30 UDVA, this patient is reporting blurry vision with diplopia. A rough estimate is that 1.0 D of ICL add power will correct about 0.7 D of refractive astigmatism at the corneal plane. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: John A. Vukich Tags: Consultation section: Refractive Source Type: research

Editors' Comment
Because the ICL was previously repositioned already three times, an additional repositioning was considered as not useful. An ultrasound biomicroscopy is planned to rule out any anatomical anomaly or (multiple) cysts in the iridociliary sulcus. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Rudy M.M.A. Nuijts, Isabelle E.Y. Saelens Tags: Consultation section: Refractive Source Type: research

Reply
The authors agree on the importance of paying attention to every surgical step during needle-guided retropupillary fixation of iris-claw IOLs without underestimating even the simplest maneuvers. The iris is delicate and fluffy tissue and is not easy to manage. When traumatized by surgical maneuvers, the iris frays easily and releases pigment. Stretching it could result in an irregular pupil (corectopia). A long straight needle must be placed in the anterior chamber using a bimanual technique. A 30-gauge needle should be used as a guide to reduce the risk for damaging the anterior chamber structures (eg, corneal endothelium...
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Rino Frisina Tags: Letters Source Type: research

Long-term follow-up of needle-assisted retropupillary fixation of iris-claw intraocular lens
In a recent issue, Frisina et  al.1 decribed iris-claw intraocular lens (IOL) fixation using a needle-guided retropupillary method. We have been using the same surgical technique for the past 3 years,A the only difference being the absence of the 30-gauge needle to engage the long straight needle. It has become our preferred pr ocedure for the correction of aphakia in eyes without capsule support because it is much easier to enclavate the iris-claw IOL to the posterior surface of the iris, when possible, compared with currently available scleral fixation techniques. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Luca Biraghi, Maurizio Sborgia, Paolo Arpa Tags: Letters Source Type: research

Alternative management of capsulorhexis phimosis using vitrector trimming
A recent Consultation Section1 outlined several approaches for managing capsulorhexis phimosis, including neodymium:YAG (Nd:YAG) laser anterior capsulotomy, radiofrequency capsulotomy needle use, microscissors dissection, femtosecond laser use, and high-frequency diathermy cutting. Vitrector trimming of the fibrotic anterior capsule is another useful technique to surgically manage capsule contraction syndrome. First reported by Wilson et  al.2 in 1994 and later described by Yeh et al. in 2002,3 vitrector trimming offers an additional management option for cases similar to that presented in the Consultation Section1 (So...
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Ian Patterson, Kavitha Sivaraman, Michael Snyder Tags: Letters Source Type: research

Reducing the risk of endophthalmitis
“A good doctor cures the disease, but a great doctor cures the cause.”—Amit Kalantri, Wealth of Words (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Authors: Nick Mamalis Tags: From the editor Source Type: research

Editorial Board
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - August 28, 2019 Category: Opthalmology Source Type: research