We present an overview of currently available toric intraocular lenses (IOLs) and multifocal toric IOLs. Relevant patient selection criteria, IOL calculation issues, and surgical techniques for IOL implantation are discussed. Clinical outcomes including uncorrected visual acuity, residual refractive astigmatism, and spectacle independency, which have been reported for both toric IOLs and multifocal toric IOLs, are reviewed. The incidence of misalignment, the most important complication of toric IOLs, is determined. Finally, future developments in the field of toric IOLs are discussed.

Toric intraocular lenses: Historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications

Incidence and outcome of cervical artery dissection: A population-based study

Toric intraocular lenses (IOLs) are the procedure of choice to correct corneal astigmatism of 1 D or more in cases undergoing cataract surgery. Comprehensive literature search was performed in MEDLINE using "toric intraocular lenses," "astigmatism," and "cataract surgery" as keywords. The outcomes after toric IOL implantation are influenced by numerous factors, right from the preoperative case selection and investigations to accurate intraoperative alignment and postoperative care. Enhanced accuracy of keratometry estimation may be achieved by taking multiple measurements and employing at least two separate devices based on different principles. The importance of posterior corneal curvature is increasingly being recognized in various studies, and newer investigative modalities that account for both the anterior and posterior corneal power are becoming the standard of care. An ideal IOL power calculation formula should take into account the surgically induced astigmatism, the posterior corneal curvature as well as the effective lens position. Conventional manual marking has given way to image-guided systems and intraoperative aberrometry, which provide a mark-less IOL alignment and also aid in planning the incisions, capsulorhexis size, and optimal IOL centration. Postoperative toric IOL misalignment is the major factor responsible for suboptimal visual outcomes after toric IOL implantation. Realignment of the toric IOL is needed in 0.65%-3.3% cases, with more than 10° of rotation from the target axis. Newer toric IOLs have enhanced rotational stability and provide precise visual outcomes with minimal higher order aberrations.

Optimizing outcomes with toric intraocular lenses

Purpose To evaluate the visual and refractive outcomes after toric intraocular lens (IOL) implantation in patients with high amounts of corneal astigmatism. Setting University Eye Clinic, Maastricht, The Netherlands; Oftalvist Centro Integral Ocular and Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Design Cohort study. Methods This study comprised eyes with cataract and more than 2.25 diopters (D) of corneal astigmatism who had toric Acrysof SN60T6, SN60T7, SN60T8, or SN60T9 IOL implantation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, visual potential index (ratio of postoperative UDVA to postoperative CDVA), residual refractive cylinder, IOL misalignment, and surgically induced astigmatism (SIA) were evaluated. Results The mean follow-up in this study of 67 eyes (45 patients) was 6.3 months. Postoperatively, the mean UDVA was 0.61 ± 0.26 (SD) and the mean CDVA, 0.81 ± 0.21. The UDVA of 20/40 was better in 83% of eyes and 20/30 or better in 50% of eyes. The mean visual potential index was 0.78. The residual refractive cylinder was less than 0.75 D in 62% of eyes and less than 1.00 D in 81% of eyes. The mean IOL misalignment was 3.2 ± 2.8 degrees. The mean SIA was −0.40 ± 0.60 D with a superior incision and −0.19 ± 0.78 D with a temporal incision ( P =.034). Conclusion Implantation of the toric IOL during cataract surgery was effective and safe in correcting high amounts of corneal astigmatism. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Cataract surgery with toric intraocular lens implantation in patients with high corneal astigmatism

Orbital compartment syndrome (OCS) is a potentially blinding condition characterized by a rapid increase in intra-orbital pressure. OCS is most commonly seen in the context of intra-orbital hemorrhage secondary to either trauma or surgery. A review of the literature indicates that better visual outcomes are achieved when interventions occur within the first 2 hrs. There are reports of visual recovery after a delay in management and consideration should be given to intervention even when presentation is delayed. Reported interventions include: lateral canthotomy with cantholysis, bony orbital decompression and treatment of the underlying cause.

/pdf/orbital-compartment-syndrome-an-update-with-review-of-the-6i1i4ifzxw.pdf

Orbital Compartment Syndrome: An Update With Review Of The Literature

Background: Toric intraocular lenses (IOLs) are advocated as an effective treatment for both regular corneal-based astigmatism and cataract in both non-penetrating keratoplasty and penetrating keratoplasty (PK) patients. The aim of this analysis is to compare postoperative outcomes for both PK and non-PK patients to determine whether or not the past PK is relevant when calculating the appropriate IOL and predicting the postoperative results.Methods:A retrospective analysis was performed on 14 non-PK and eight PK patients who underwent cataract surgery and astigmatism correction with a Rayner toric IOL. Preoperatively, best spectacle-corrected visual acuity, biometry and refractive data were recorded. Postoperative analysis at 1 month looked at best-uncorrected visual acuity (BUVA), refractive data and IOL axis. Statistical analysis was undertaken to test for differences in outcomes between the PK and non-PK groups.Results: Preoperatively, a significant difference was seen between cylinder and astigmatism and not between sphere, axial length or anterior chamber depth. Analysis of preoperative best spectacle-corrected visual acuity, IOL error predictability, IOL rotational stability and refractive outcomes revealed no difference between PK and non-PK groups, but a significant difference was seen postoperatively with PK patients having worse BUVA.Conclusion: Toric IOLs are an effective means for treating both regular corneal-based astigmatism and cataract in both PK and non-PK patient groups. Analysis of results revealed similar trends for both groups in all areas except postoperative BUVA. Further studies are planned to better understand why PK patient's BUVA did not fit the trend of the other results.

Comparison of grafted and non-grafted patients with corneal astigmatism undergoing cataract extraction with a toric intraocular lens implant.

We report the case of a 76-year-old man who developed a late-onset Descemet's membrane detachment (DMD) 5 months after uncomplicated cataract surgery. Despite two air tamponade procedures that initially appeared successful, the DMD continued to return. After careful examination it was found that a surgical entry wound may have been scarred open (fish-mouthing), which continually promoted Descemet's membrane to detach. Excision of the abnormal scar led to an almost complete resolution of the DMD. To our knowledge, this is the first report of a pathological (fish-mouthing) entry wound causing a persistent, late DMD. We discuss the reasons why the management of late DMDs requires careful consideration.

Late-onset persistent Descemet's membrane detachment following uncomplicated clear corneal incision cataract surgery.

The medial canthus represents one of the most challenging regions of the face to reconstruct due to the anatomical structures present, the concavity of the area, and the differences in skin texture. We present a case series of 11 patients whose defects were reconstructed with a single V-Y island pedicle flap running along the nasofacial sulcus. Our single-stage flap which modified and simplified a previously described technique achieves similar cosmetic and postoperative outcomes along with a high level of patient satisfaction in an area which can be reconstructed in a variety of ways, often with suboptimal results.

Reconstruction of extensive medial canthal defects using a single V-Y, island pedicle flap.

1. Maekawa S, Shiga Y, Kawasaki R, Nakazawa T. Usefulness of novel laser speckle flowgraphy-derived variables of the large vessel area in the optic nerve head in normal tension glaucoma. Clin Experiment Ophthalmol 2014; 42: 887–9. 2. Aizawa N, Kunikata H, Yokoyama Y, Nakazawa T. Correlation between optic disc microcirculation in glaucoma measured with laser speckle flowgraphy and fluorescein angiography, and the correlation with mean deviation. Clin Experiment Ophthalmol 2014; 42: 293–4. 3. Kawasaki R, Wang JJ, Rochtchina E, Lee AJ, Wong TY, Mitchell P. Retinal vessel caliber is associated with the 10-year incidence of glaucoma: the Blue Mountains Eye Study. Ophthalmology 2013; 120: 84–90.

Bilateral subretinal abscesses: the first case of disseminated Nocardia beijingensis in Australia.

Chronic pain conditions are some of the most challenging problems upper-extremity surgeons face and often require a multimodal approach including neuromodulation. Peripheral nerve stimulation (PNS) is one of these modalities, delivering electrical stimulation to peripheral axons to modulate the spinal cord and block out nociceptive signals from the extremity. This blockade leads to long-lasting effects in both the peripheral and central nervous systems. Not only does PNS decrease peripheral pain signals but it also decreases the peripheral inflammatory response and assists with central nervous system plasticity for long-term pain control. Although PNS was initially developed in the 1960s, it has been underrepresented in the literature largely due to the advent of spinal cord stimulation and the lack of Food and Drug Administration-approved hardware for PNS. However, for upper-extremity pain, PNS provides notable benefits over spinal cord stimulation devices, as PNS allows for safer, more specific, and often more effective pain control. As clinicians attempt to limit narcotic use, therapies such as PNS have been revisited and are gaining popularity. We present a narrative review of PNS; discuss its mechanism of action, indications, and surgical technique; and provide a summary of the available literature for the upper-extremity surgeon. Peripheral nerve stimulation offers a solution for chronic, debilitating pain recalcitrant to other treatment modalities. 

http://www.jhsgo.org/article/S2589514122000019/pdf

Upper-Extremity Peripheral Nerve Stimulators

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