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December consultation #6
IOL calculations in eyes that have undergone prior corneal refractive surgery can pose several challenges to the refractive surgeon. Particularly in cases of prior myopic laser vision correction, as seen in this patient, hyperopic refractive surprises can arise after cataract surgery due to underestimations of the final IOL power. Alterations in the keratometric index (ratio between the anterior and posterior corneal surfaces), inaccurate extrapolation of central corneal curvature values from steeper paracentral corneal points by modern-day keratometers and topographers, and erroneous predictions of the effective lens posi...
Source: Journal of Cataract and Refractive Surgery - November 30, 2019 Category: Opthalmology Authors: Nandini Venkateswaran, Terry Kim Tags: Consultation Section: Refractive Source Type: research

Editors' comment
IOL exchange or a piggyback IOL placement would be the first modality that comes to a surgeon ’s mind when handling a case as described. But this option is faced with the challenge that the patient may experience a refractive surprise again. Thus, we performed a pinhole pupilloplasty (PPP) to solve the refractive surprise rather than exchanging the IOL or placing a piggyback IOL (Video 1, available at https://jcrsjournal.org). The pinhole effect bars the peripheral rays arising due to corneal aberrations. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 30, 2019 Category: Opthalmology Authors: Marcony R. Santiago, Priya Narang, Amar Agarwal Tags: Consultation Section: Refractive Source Type: research

Gratitude
As 2019 comes to an end, we simply want to say “thank you” to the many special people who make this venture of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons possible. Please browse our annual acknowledgement of reviewers in the back pages of this issue (pg. 1851) and join us in thanking them for their unselfish commitment to peer review. It is impossible to overstate the importance of the work they do to ensure both the quality and the relevance of work you see in print and online at JCRS. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 30, 2019 Category: Opthalmology Authors: William J. Dupps Tags: From the editor Source Type: research

Editorial Board
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 30, 2019 Category: Opthalmology Source Type: research

Masthead
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 30, 2019 Category: Opthalmology Source Type: research

Table of Contents
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 30, 2019 Category: Opthalmology Source Type: research

Visual Acuity Chart
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 30, 2019 Category: Opthalmology Source Type: research

Can we efficiently use structured rating scales to objectively assess global technical skill in cataract surgery?
The American Board of Ophthalmology has recently created the Ophthalmology Milestone Project to standardize assessment and documentation of trainees' competence.1 However, it does not include objective measures and standardized and scalable tools to assess technical skill or competency. Several structured rating scales have been developed to assess technical skill in cataract surgery.2 These scales can track surgeons' learning curves for both task-specific and global technical skills, identify deficiencies, and enable consistent feedback. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - October 31, 2019 Category: Opthalmology Authors: Kapil Mishra, Sidra Zafar, S. Swaroop Vedula, Shameema Sikder Tags: Correspondence Source Type: research

Highly myopic vitrectomized eye develops delayed subluxation of 3-piece PMMA intraocular lens after complicated cataract surgery
A 50-year-old male patient had suffered a tennis ball contusion in his right eye in his youth. At the age of 29 years, he developed retinal detachment, which was successfully repaired by vitrectomy and gas tamponade. At the age of 35, the patient underwent laser in situ keratomileusis (LASIK) in both eyes. Three years Later, the right eye underwent cataract surgery with a 3-piece poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - October 31, 2019 Category: Opthalmology Authors: Rupert Menapace Tags: Consultation section: Cataract Source Type: research

November consultation #2
This case represents a relative emergency because rubbing of the nasal haptic in the iridocorneal angle could lead to a severe endothelial loss. Preoperative workup should include an endothelial cell count (ECC) with specular microscopy, and the patient should be asked about the model and the power of the IOL placed in his right eye. If these data are not available, a pseudophakic biometry should be performed, taking into account the previous refractive corneal surgery. Considering the fact that the patient has a PMMA IOL, it can be supposed that this IOL was placed in the ciliary sulcus as a consequence of a temporal post...
Source: Journal of Cataract and Refractive Surgery - October 31, 2019 Category: Opthalmology Authors: Pascal Rozot Tags: Consultation section: Cataract Source Type: research

November consultation #3
Figures 1 and 2 show a temporally dislocated 3-piece PMMA IOL and an incomplete capsule after a complicated phacoemulsification in a post-vitrectomy cataract eye with a PCR and a sulcus lens implantation with a malpositioned nasal haptic in front of the iris in a post-LASIK eye. It seems likely that horizontal subluxation of the IOL is the cause of the recent monocular diplopia and reduction in visual acuity. However, for the near future, I do not expect that the IOL would luxate entirely because of the pseudofixation by the prepupillary haptic. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - October 31, 2019 Category: Opthalmology Authors: Maurits V. Joosse Tags: Consultation section: Cataract Source Type: research

November consultation #4
Late IOL dislocation is becoming a more frequently occurring event after previously uncomplicated cataract surgery. Pseudoexfoliation, status post-vitrectomy, myopia, trauma, and uveitis are the most common causes, and these are at cumulative risk. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - October 31, 2019 Category: Opthalmology Authors: Gabor B. Scharioth Tags: Consultation section: Cataract Source Type: research

November consultation #5
This patient clearly has visual impairment attributable to (1) a significantly dislocated IOL, and (2) iris pigment defects probably because of mechanical contact between the poorly secured and anteriorly dislocated IOL. The goal is to reposition or exchange the IOL with a placement such that there is no contact with uveal tissue. This patient is young; therefore, any repair should be undertaken with the idea that it will be durable for 30 to 40 years. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - October 31, 2019 Category: Opthalmology Authors: Kenneth J. Rosenthal Tags: Consultation section: Cataract Source Type: research

November consultation #6
This 50-year-old male patient with a history of trauma, previous surgery, and LASIK has a subluxated 3-piece PMMA IOL in a highly myopic eye.1 (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - October 31, 2019 Category: Opthalmology Authors: Lars-Olof Hattenbach Tags: Consultation section: Cataract Source Type: research

November consultation #7
I think in this unfortunate case of trauma in an eye with a thin sclera and past refractive surgery, I would keep it simple and suture the existing IOL to the iris. The past vitrectomy is reassuring because it means we are less likely to encounter vitreous and have subsequent retinal re-detachment. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - October 31, 2019 Category: Opthalmology Authors: Thomas A. Oetting Tags: Consultation section: Cataract Source Type: research