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.

August consultation #2
Keratoconus with normal CCT that is first presenting at this age is usually mild and nonprogressive. Multifocal intraocular lenses (IOLs) in keratoconus are contraindicated because they further reduce contrast sensitivity, as would extended depth-of-focus (EDOF) IOLs even though they have greater tolerance for refractive error. This patient would most likely benefit from monovision, thus reducing his spectacle dependence at work. However, spectacles are still required for reading and driving at night. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 30, 2019 Category: Opthalmology Authors: Soon-Phaik Chee Tags: Consultation Section: Cataract Source Type: research

August consultation #3
This case of a 62-year-old man, who presents with nuclear cataracts, irregular astigmatism, a history of tamsulosin use, and a strong desire for spectacle independence, raises a number of issues we encounter in daily practice. A few red flags in his history tell us that he might have a difficult personality with unrealistic expectations: he is a poor historian, he is difficult to examine, and he refuses the physician's recommendation of a contact lens trial for monovision. By his own admission, he is “phobic” regarding his eyes. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 30, 2019 Category: Opthalmology Authors: Richard Schulze Tags: Consultation Section: Cataract Source Type: research

August consultation #4
This is a case of a 62-year-old man with decreased vision because of cataracts. He has myopia and astigmatism, and he refers to being very “phobic” regarding his eyes. Performing an eye examination and tests were difficult perhaps because of low cooperation by the patient. The RAM vision was 20/20 in both eyes, and the CCT was 628 μm and 613 μm in the right eye and left eye, respectively. Topographic analysis shows inferior corne al steepening, and there is incongruity regarding axis and amount of astigmatism between different studies done with different technologies. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 30, 2019 Category: Opthalmology Authors: Arturo Chayet Tags: Consultation Section: Cataract Source Type: research

August consultation #5
The challenges in this case are (1) interpretation of the erratic biometric data and (2) refractive planning to maximize spectacle independence. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 30, 2019 Category: Opthalmology Authors: Tal Raviv Tags: Consultation Section: Cataract Source Type: research

August consultation #6
This case requires expertise in both ophthalmology and psychology. The patient is motivated to be spectacle free. Good distance vision is desirable for many individuals, but the patient also has an occupational need for good intermediate vision. Furthermore, the patient has myopia and is probably used to reasonably good UNVA. This patient shows bilateral inferior corneal steepening without apparent thinning. This irregular astigmatism will result in vertical coma that will influence his postoperative visual outcome. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 30, 2019 Category: Opthalmology Authors: Yuri McKee, Warren Hill Tags: Consultation Section: Cataract Source Type: research

August consultation #7
As with all surgical patients, counseling is critical to match preoperative expectations with postoperative outcomes so patients will perceive a “successful” result. Careful discussion to understand a patient's desires is of paramount importance. During the discussion, we would tell this patient that we cannot guarantee a specific result and we cannot promise 100% spectacle independence. We would emphasize that we will do our best to und erstand his desires and optimize his outcome given his specific pathology. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 30, 2019 Category: Opthalmology Authors: Tarika Thareja, Deepinder K. Dhaliwal Tags: Consultation Section: Cataract Source Type: research

August consultation #8
In cases of irregular corneal astigmatism, we begin with a thorough slitlamp evaluation. Given the absence of possible causes (eg, dry-eye disease, anterior EBMD, Salzmann nodules) and the presence of bilateral inferior steepening on topography, we are concerned for corneal ectasia. Before discussing surgery, we would obtain corneal tomography to measure posterior curvature and to evaluate for thinning. Specifically, we would evaluate the tomography for features reported to have particular utility for the diagnosis of early keratoconus, including index height decentration and the index of vertical asymmetry. (Source: Journ...
Source: Journal of Cataract and Refractive Surgery - June 30, 2019 Category: Opthalmology Authors: C. Ellis Wisely, Nicole Fuerst, Terry Kim Tags: Consultation Section: Cataract Source Type: research

Editor's comment
Conventional wisdom dictates that presbyopic IOLs, diffractive in particular, should not be considered for patients with corneal or macular pathology because those conditions are likely to be associated with image quality degradation and poor subjective vision performance. Moreover, toric IOLs are best avoided when astigmatism measurements are inconsistent in magnitude and axis across several technologies. Those caveats are applicable to the case at hand, and the respondents were careful to point out those facts in considering the best IOL option(s). (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 30, 2019 Category: Opthalmology Authors: Samuel Masket Tags: Consultation Section: Cataract Source Type: research

High intraocular pressure in eyes with late in-the-bag intraocular lens dislocation
The frequency of late in-the-bag intraocular lens (IOL) dislocation has increased over the past decades. Important predisposing factors are pseudoexfoliation syndrome (PXF), myopia, previous vitreoretinal surgery, and trauma,1 –3 and there is also an association with glaucoma.1–4 Furthermore, some studies report high intraocular pressure (IOP) in eyes with IOL dislocation despite no known glaucoma.1–5 Accordingly, it has been speculated whether the dislocation can cause an IOP increase. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Olav Kristianslund, Marius Dalby, Liv Drolsum Tags: Correspondence Source Type: research

Operative microscope slit beam to ascertain the alignment of toric intraocular lens intraoperatively
Today, cataract surgery goes beyond just removing the cataractous lens and placing an intraocular lens (IOL). With evolving technology and techniques, refractive cataract surgery is becoming increasingly common. One such surgical intervention is phacoemulsification followed by toric IOL implantation.1 Toric IOLs have the ability to neutralize corneal astigmatism to a greater extent provided they are placed in the desired position. However, keeping the IOL in the intended axis can be challenging. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Amar Pujari, Jayanand Urkude, Rashmi Singh, Ritika Mukhija, Mohamed Ibrahime Asif, Namrata Sharma Tags: Correspondence Source Type: research

Reply
Sullivan-Mackenna et  al. criticize the retrospective design of our study and reject the notion that performing a randomized trial in this instance would be unethical. We performed a retrospective analysis because we did not realize the significant benefits of Omidria until we were using it in every case. After more th an 100 cases in which Omidria was used, we reviewed our data to verify our impression that the drug was indeed providing a benefit. Observing for ourselves the consistent mydriatic-sustaining benefit as well as the substantial pain control of Omidria together with our review of the data from the con trolled...
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Keith A. Walter Tags: Letter Source Type: research

Reduction in surgical time and iris manipulation using continuous intracameral irrigation of phenylephrine and ketorolac to prevent miosis in FLACS
In their study of the effect of replacing intracameral irrigation of phenylephrine with intracameral irrigation of ketorolac and phenylephrine during femtosecond laser –assisted cataract surgery (FLACS), Walter et al.1 retrospectively assessed the rate of phacoemulsification surgery requiring pupil expansion devices. They also reported the time recorded for surgery after introducing phenylephrine 1.0%–ketorolac 0.3% (Omidria) into their routine cataract surge ry technique. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Daniel Sullivan-Mackenna, Harry Roberts, David O'Brart Tags: Letter Source Type: research

Reply
Although more studies are needed to establish the specific role of estrogen in corneal pathophysiology, we agree with Natarajan and Ravindran  about the possible association between hormonal variations and corneal alterations, whether topographic or biomechanical.1 We have to clarify, however, that the treatment provided to the patient in our case report consisted of a tibolone therapy for endometriosis rather than for infertility, as st ated by the letter's authors. Tibolone is a selective estrogen receptor modulator that rapidly converts to substances with estrogenic effect, such as 3α- and 3β-hydroxy-tibolone. (Sourc...
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Emilio A. Torres-Netto, J. Bradley Randleman, Nikki L. Hafezi, Farhad Hafezi Tags: Letter Source Type: research

Progression of keratoconus resulting from hormone replacement therapy
Torres-Netto et  al. recently reported a case of keratoconus progression caused by treatment for infertility.1 We had a similar unusual case of progression of stable keratoconus when a female patient was started on hormone replacement therapy for menopausal symptoms. Oral hormone replacement therapy is a mode of t reatment for menopausal symptoms and usually has a combination of estrogen and progesterone supplements.2 The serum level of estrogen in a woman on hormone replacement therapy increases and affects the corneal thickness and stiffness, which can become more pronounced in an already weakened keratocon ic cornea. (...
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Radhika Natarajan, Ramya Ravindran Tags: Letter Source Type: research

Glaucoma surgical problem revisited
One of the most common comorbidities encountered by anterior segment surgeons is the patient with both cataract and glaucoma. Surgical management options for combined cataract and glaucoma surgery have expanded considerably in recent years. Accordingly, I felt it would be instructive to revisit a case from several years ago.1 The identical clinical situation is presented to the same panel of consultants to determine whether practice patterns have changed from the time this case was initially presented. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - June 29, 2019 Category: Opthalmology Authors: Thomas W. Samuelson Tags: Consultation Section: Glaucoma Source Type: research